Systemic Diseases-Dr. Hasan

Question 1

What are the most common autoimmune diseases found in women?

Answer 1

• Rheumatoid Arthritis
• Sjogrens Syndrome

Question 2

Systemic Sclerosis

Answer 2

• aka scleroderma
• dense collagen deposited in tissue
• more common in females
• Skin findings range from:
  
  • Raynaud phenomenon to mask-like and “mouse” facies
• Oral manifestations
  
  • changes to the lips and mouth
    
    • pursed lips
    • limited opening of mouth
  • Xerostomia-common
  • Smooth tongue and palatal rugae
• PAN-mandibular resorption
• Tx:
  
  • limit further progression
  • irreversible
  • range of motion exercises

Question 3

SLE

Answer 3

• Systemic Lupus erythrematous
• direct involvement of oral cavity by lupus
• 2 types of lesions
  
  • Not active disease
    
    • more frequent
    • due to reaction to drug
    • red, white, or both
    • painless
  • Active Disease
    
    • red ulcers surrounded by a white halo and white radiating lines
    • may or may not be painful
    • location
      
      • inside of cheek
      • hard palate
      • lower lip
• only way to determine if the lesion is from active disease is by biopsy

Question 4

Mucous Membraine Pemphigoid (MMP)

Answer 4

• group of immune-mediated chronic blistering conditions
• targets:
  
  • oral mucosa
  • genitals
  • conjunctival mucous membranes
  • skin mucous membranes
• Gingiva=most affected area
  
  • 94%
  • cause desquamative gingivitis
• Diagnosis based on clinical and histological samples
  
  • histo-shows detachment of epithelium from CT

Question 5

Behcet syndrome

Answer 5

• Neurological and vascular involvement
• have 2 of 3 factors:—Diagnosis
  
  • oral ulcers
  • genital ulcers
  • eye inflammation
• Positive Pathergy test
• affects people in their 30s
  
  • no evidence of gender
• Greatest Incidence
  
  • Mediterranean & asian
• Marked Prevalence-Turkey

Question 6

Amyloidosis

Answer 6

• 2 types:
  
  • organ limited
    
    • oral soft tissues rarely affects
  • systemic
    
    • macroglossia
• Tongue lesions
  
  • nodular or diffuse enlargment w/subsequent ulcerations or hemorrhages
• Biopsy to confirm diagnosis
• Tx:
  
  • steroids or immunosuppressants

Question 7

Anemia

Answer 7

• oral manifestations
  
  • Iron Deficiency anemia
    
    • atrophy and pallor of mucosa
    • atrophic glossitis
  • pernicious anemia
    
    • Magenta Tongue
      
      • erythema and atrophy of the tongue
• Common symptoms of both:
  
  • Burning of the:
    
    • lips, tongue, and buccal mucosa
  • angular cheilitis
• Overgrowth of Candida albicans

Question 8

Leukemia

Answer 8

• oral manifestations:
  
  • Gingival enlargement
  • petechiae,
  • mucosal bleeding
  • ulcers
    
    • mucosal ulcers
  • Hemorrhages
    
    • hard & soft palate
    • platlet count<20k/uL

Question 9

Thrombocytopenia

Answer 9

• low platelet count in patients without underlying heamtologic malignancy
• hemorrhages can range from
  
  • petechiae
  • hemorrhagic bullae
  • hematomas
• Bleeding occurs with minor trauma or spontaneously
  
  • depends on platelet counts

Question 10

Lichen Planus/Lichenoid Drug Reaction

Answer 10

• common autoimmune T-cell-mediated disease
  
  • 1-2% of population
• unknown etiology
• affects mucous membranes, skins, and nails
• Clinical types:
  
  • reticular
  • papular
  • plaque-like
  • erosive
  • atrophic
  • bullous
• common intraoral sites:
  
  • Buccal mucosa
  • tongue
  • gingiva
• oral mucosal lesions present alone or w/skin lesions
  
  • skin lesions- violaceous flat-topped papules on ankle, wrist, and genitalia
    
    • NOT ON FACE

Question 11

Multiple Myeloma

Answer 11

• occurs in oral cavity in later stages
  
  • mandible
• Facial asymmetry
• jaw or mucosal swelling
• Leads to numbness, bone pain, and tooth mobility
• Macroglossia-rare

Question 12

GERD

Answer 12

• aka heartburn
• relax lower esophageal sphincter
• common signs and symptoms:
  
  • burning sensation in your chest
  • chest pain
  • difficulty swallowing
  • regurgitaiton of food or sour liquid
  • Sensation of lump in your throat

Question 13

Laryngopharyngeal Reflux

Answer 13

• aka silent reflux
• stomach acid causes throat discomfort
  
  • behind the breast bone in the middle of the trunk
• Signs and symptoms:
  
  • heartburn-sometimes
  • damage throat and vocal cords
  • feels like something i stuck in the throat
  • Hoarse
  • Frequent throat clearing
  • Coughing
  • Bitter taste at back of throat
  • Difficulty swallowing
  • Sensation of post nasal drip
  • difficulty breathing

Question 14

Effect of reflux on teeth

Answer 14

• eroded enamel
  
  • smooth, shiny, and hard
  • if thin can show yellow color of dentin-sensitivity
  • not replaceable

Question 15

Crohn’s Disease

Answer 15

• inflammatory GI disorder
• oral lesions:
  
  • prevalence: 20-50%
  • primary sign before GI in 5-10%
• Aphthous ulcers
  
  • most common
• oral manifestation
  
  • Mucosal tags
  • cobble stoning
  • mucogingivitis
  • labial and facial swelling
  • linear ulcerations
  • RAS like ulcertions
  • angular cheilitis

Question 16

Ulcerative Colitis

Answer 16

• Inflammatory Bowel Disorder
• long-lasting inflammation and ulcers in digestive tract
  
  • affects innermost lining of large intestine (colon) and rectum
• 10x risk of colon cancer
• oral manifestations
  
  • Pyostomatitis vegetans
• symptoms:
  
  • Diarrhea-blood or pus
  • abdominal pain & cramping
  • rectal pain
  • Rectal bleeding
  • Urgency to defecate
  • Inability to defecate despite urgency
  • Weight loss
  • Fatigue & Fever
  • in children=Failure to grow

Question 17

Gardner Syndrome

Answer 17

• Genetic defect chromosome 5
  
  • autosomal dominant (or sporadic mutation)
• Characterized by:
  
  • intestinal polyposis w/very high risk of malignant transformation into colonic adenocarcinoma
• Head and neck manifestations-most being in childhood/adolescence
  
  • multiple enostosis of the jaws
  • supernumerary and/or unerupted teeth
  • increased risk of odontomas
  • osteomas of the jaw and paranasal sinuses
  • Epidermoid cysts of the skin

Question 18

What antibiotics are more likely to cause pseudomembranous colitis

Answer 18

• Fluoroquinolones
  
  • ciprofloxacin
  • levofloxacin
• Penicillins
  
  • amoxillin
  • ampicillin
• Clindamycin
• Cephalosporin’s
  
  • cefixime

Question 19

Pseudomembranous colitis: signs and symptoms

Answer 19

• Diarrhea
  
  • watery or bloody
• abdomina cramps, pain, or tenderness
• Fever
• Pus or mucus in stool
• Nausea
• Dehydration

Can begin 1-2 days after taking an antibiotic or several weeks after you finish antibiotic

Question 20

Dental Considerations for Down Syndrome Patients

Answer 20

• Retention of primary teeth could enter third decade
• increased risk of perio
  
  • premature loss of teeth
• Diminutive or hypo-plastic teeth
• increased wear of teeth due to grinding
• acid erosion due to GERD

Question 21

Sutism Spectrum Disorder

Answer 21

• common issues:
  
  • behavior problems
  • poor oral hygiene
  • early loss of teeth
• Need patience and consistency in out patient setting
• Might need to treat in OR

Question 22

Hyperthyroidism

Answer 22

• accelerated eruption of teeth in children
• Maxillary or mandibular osteoporosis
• high index of caries and perio
• burning sensation of tongue
• Incidence of:
  
  • Sjogren’s Syndrome
  • Systemic Lupus erythematosus

Question 23

Hypothyrodism

Answer 23

• Juvenile pts-dysgeusia is common
• foul or metallic taste
• Lips are puffy, thickened, and protruding
• Adults w/myxodema
  
  • macroglossia and enlarged lips due to depositon of water and protein
• Non-pitting Facial Swelling
• Underdeveloped mandible
• Perio

Question 24

Hyperparathyroidism: oral manifestations

Answer 24

• Brown tumor
• loss of bone density
• Soft tissue calcification
• Dental abnormalities
  
  • defects
  • alterations in dental eruption

Question 25

Hyperparathyroidism

Answer 25

• Maloclussion due to drifting
  
  • definite spacing-first sign of disease
• Pseudocystic lesion
  
  • radiolucent lesion at apex of tooth
  • misdiagnosed as periapical cyst or granuloma
• Radiographs
  
  • generalized rarification of the jaws
  • Decribed as-loss of medullary trabecular pattern
    
    • Jaw appears finely radiopaque
      
      • described as clear “Ground glass” appearance

Question 26

Diabetes Mellitus

Answer 26

• Metabolic disorder
  
  • Chronic hyperglycemia
• Oral manifestations:
  
  • Dry mouth
  • tooth decay
  • perio and gingivitis
  • oral candidiasis
  • burning mouth syndrome
  • taste disorders
  • rhinocerebral zygomycosis (mucormycosis)
  • aspergillosis
  • oral lichen planus
  • geographic tongue and fissured tongue
  • delayed wound healing
  • increased incidence of infection
  • salivary dysfunction
  • altered taste
  • impaired tooth eruption
  • benign parotid hypertrophy

Question 27

Addison’s disease

Answer 27

• aka primary adrenal insufficiency
• oral manifestations
  
  • pale brown or deep chocolate pigmentation of oral mucosa
    
    • angle of mouth, gingiva, tongue and lips
    • first evidence of disease

Question 28

Cushing’s Syndrome

Answer 28

• Children
  
  • Growth and developement
    
    • retarded skeletal and dental age
  • Reduced bone density
  • Loss of lamina dura