W3 Oral Manifestations of Systemic Disease

Question 1

List some of the system diseases + conditions that can present as an oral manifestation

Answer 1

• haematological disease
• gastrointestinal disease
• autoimmune conditions
• metabolic disease
• drug side effects
• neoplastic conditions
• infective conditions

Question 2

What 3 areas can oral manifestations of systemic disease appear?

Answer 2

1. teeth
2. oral mucosa
3. salivary glands

Question 3

What is oral ulceration?

Answer 3

discontinuity in the oral mucosa

Question 4

What causes a malignant oral ulcer?

Answer 4

oral squamous cell carcinoma

Question 5

What infections can cause solitary infective ulcers?

Answer 5

• tuberculosis (primary/secondary infection)

- tertiary syphillis

Question 6

What is a gumma?

Answer 6

A form of granuloma that is a soft, non-cancerous growth resulting from the tertiary stage of syphillis (pre-malignant lesion)

Question 7

What is the most common cause of multiple ulcers?

Answer 7

Recurrent Aphthous Ulceration (RAU)

Question 8

What are the 3 types of RAU?

Answer 8

• major
• minor
• herpetiform

Question 9

What possibly causes RAU and what must be excluded?

Answer 9

• possibly stress

- haematinic deficiency and GI disease must be excluded

Question 10

What multisystem condition can present as multiple ulcers?

Answer 10

Behcets

Question 11

What is Behcet’s disease?

Answer 11

Hereditary systemic vasculitis

Question 12

What are symptoms of Behcet’s disease?

Answer 12

• multiple ulcers similar to RAU
• genital ulceration
• uveitis
• erythema nodosum

Question 13

What are 6 oral signs of aneamia?

Answer 13

1. mucosal pallor
2. angular cheilitis
3. glossitis (inflammation of the tongue)
4. predisposition to candida
5. oral ulceration
6. disturbed taste

Question 14

What is an infective cause of multiple ulcers?

Answer 14

Primary herpetiform gingivo-stomatitis

Question 15

Name 3 types of mucocutaneous disorders.

Answer 15

1. Lichen planus
2. Vesiculobullous disease - pemphigus and pemphigoid
3. Lupus erythematosus

Question 16

What is Lichen Planus and how does it present orally?

Answer 16

• An inflammatory disorder that affects skin, hair, nails and mucous membranes.
• presents as lacy white patches in the mouth bilaterally
• asymptomatic and can be potentially malignant

Question 17

What is stomatitis?

Answer 17

Inflammation of the mouth

Question 18

What is halitosis?

Answer 18

Bad breath

Question 19

What is gingivitis?

Answer 19

Inflammation of the gums

Question 20

What is lupus erythematosus and what are the two types?

Answer 20

• Lupus erythematosus is a chronic autoimmune disease in which body attacks healthy tissue
• Discoid (skin is affected) and systemic (skin + organs affected)

Question 21

What are the oral manifestations of lupus erythematosus and what is a discoid lesion?

Answer 21

• ulcerations
• white patches
• red + white patches
• similar to Lichen Planus
• discoid lesion is in shape of disc

Question 22

What is vesiculobellus disease?

Answer 22

A type of mucocutaneous disease characterised by vesicles and bullae. (blisters)

Question 23

How does pemphigus vulgaris present?

Answer 23

• most present with oral lesions approx. 1 year before skin lesions
• painful extensive oral ulcerations
• preceded by blisters
• associated with Nikolsky sign

Question 24

What is the Nikolsky sign?

Answer 24

Upper layers of skin on blister slip away from lower layers when rubbed

Question 25

How does pemphigoid present?

Answer 25

- usually as blisters - benign mucous membrane pemphigoid - painful oral ulceration - can affect mucous membranes of other organs e.g. eye

Question 26

What is the difference between pemphigus and pemphigoid?

Answer 26

Pemphigus bullae are intra-epithelial (epidermis) and pemphigoid bullae are sub-epithelial. (epidermis and dermis)

Question 27

How do GI diseases cause oral ulcerations?

Answer 27

Due to malabsorption and thus consequent haematinic deficiency.

Question 28

What GI diseases cause oral ulcerations?

Answer 28

- Crohn's - Ulcerative colitis - Peutz Jeghers - Gardener's Syndrome

Question 29

What are the features of oral ulcerations due to Crohn's disease?

Answer 29

- cobble-stoning of mucosa - linear ulcerations - localised mucogingivitis - tissue tags/polyps - swelling, commonly of lips (OFG) - pyostomatitis vegetans

Question 30

What is OFG and what GI disease is it associated with?

Answer 30

- Orofacial Granulomatosis | - Crohn's Disease

Question 31

What is pyostomatitis vegetans and what GI diseases is it associated with?

Answer 31

- swelling and reddening of the mouth mucosa with little yellow pustules - associated with IBD e.g. Crohn's, ulcerative colitis

Question 32

When can ulcers due to Crohn's disease present?

Answer 32

Can present before abdominal symptoms

Question 33

How does ulcerative colitis present orally?

Answer 33

- oral ulceration - pyostomatitis vegetans - angular stomatitis

Question 34

What significance do oral ulcers have in ulcerative colitis?

Answer 34

Can indicate severity of disease, exacerbation and remission.

Question 35

What do white patches in the mouth that wipe off tend to be caused by?

Answer 35

-pseudomembranous candidiasis (thrush)

Question 36

What is thrush also known us?

Answer 36

Pseudomembranous candidiasis

Question 37

What causes white patches in the mouth that don't wipe off?

Answer 37

- trauma - neoplasia - epithelial dysplasia - chronic mucocutaneous candidiasis

Question 38

What deficiencies should be considered with white patches?

Answer 38

- haematinic deficiency | - immunosuppression

Question 39

List some causes of different oral pigmentation.

Answer 39

- racial pigmentation - melanotic macules - smoking - malignancy - Addison's disease

Question 40

What is Addison's Disease?

Answer 40

Disease of the adrenal glands leading to reduced cortisol and aldosterone secretion

Question 41

What do ACTH and MSH stand for (hormones)?

Answer 41

- Adrenocorticotrophic hormone | - Melanocyte-stimulating hormones

Question 42

What is xerostoma?

Answer 42

Dry mouth

Question 43

What can cause xerostoma?

Answer 43

- drugs - Sjogren's Syndrome - radiation therapy

Question 44

What are the two most common symptoms of Sjogren's Syndrome?

Answer 44

- dry mouth | - dry eyes

Question 45

What sex does Sjogren's Syndrome most commonly affect?

Answer 45

Females

Question 46

What is Sjogren's Syndrome?

Answer 46

A disorder of immune system in which white blood cells attack tear and saliva glands (can be primary/secondary)

Question 47

When secondary, what other autoimmune disorders is Sjogren's Syndrome often associated with?

Answer 47

- rheumatoid arthritis | - lupus

Question 48

How does Sjogren's Syndrome present orally?

Answer 48

- enlarged salivary glands - dry mouth causes: - increased caries - depapillated tongue, fissured - red dry wrinkled mucosa - increased predisposition to candida

Question 49

What are caries?

Answer 49

dental cavities

Question 50

What does NCTSL mean?

Answer 50

- Non-carious tooth surface loss | - erosion

Question 51

What G.I. problems can cause erosion and how?

Answer 51

- GORD - bulimia - pH of stomach can be 1

Question 52

How does NCTSL present in GORD/bulimic patients?

Answer 52

Erosion on palatal surfaces of upper anterior teeth

Question 53

How can leukaemia present orally?

Answer 53

- gingival enlargement - mucosal bleeding - ulceration - boggy gingivae (overgrowth, discoloured somtimes) - petechiae - infiltration by malignant cells - infective presentation due to immunosuppression (herpes, candida, opportunistic infection)

Question 54

What are petechiae?

Answer 54

Tiny red, brown, purple spots that can develop on skin or mucosal surfaces e.g. mouth caused by breakages of capillaries

Question 55

How can lymphoma present orally?

Answer 55

- palpable lymph nodes - extra/intra-oral swelling - ulceration - tooth migration/mobility

Question 56

What causes oral presentations of HIV?

Answer 56

Immunosuppression

Question 57

What are some oral presentations of HIV?

Answer 57

- Kaposi's sarcoma - ulceration - HPV lesions - salivary gland swelling - increased risk of malignancy

Question 58

What is Kaposi's sarcoma and what virus is it associated with?

Answer 58

A type of cancer that causes masses to grow in under skin, in lymph nodes and other organs. Masses are usually purple. Associated with Herpesvirus-8.

Question 59

What are HPV lesions caused by?

Answer 59

Human papillomavirus

Question 60

What do HPV lesions look like?

Answer 60

Usually flat warts, can be cauliflower-like when genital.