Oral manifestations of systemic disease

Question 1

What is examined in the 8 steps when screening for oral cancer?

Answer 1

1. gingiva and mucosa
2. lip
3. buccal mucosa and posterior gingiva
4. vestibule, anterior gingiva, mucosa
5. hard palate
6. tonsillar area, soft palate
7. ventral surface of tongue and floor of mouth
8. lateral border of tongue

Question 2

What colour may the teeth be if they were affected by tetracycline during odontogenesis?

Answer 2

Yellow to brown or grey

Question 3

What may you see if a patient suffers with fluorosis?

Answer 3

Opaque white or brown patches

Rough pitting

Question 4

What would the teeth look like due to severe long term or childhood jaundice?

Answer 4

Yellow or greenish

Question 5

How would you recognise if a patient has congenital syphilis?

Answer 5

Dental hypoplasia - notched and peg-shaped permanent incisors

Molars may also be deformed (moon’s molars) - this is where crowns are widest at the base and narrowest at the cusps, no grooves and crown surface is smooth

Question 6

What may you notice that would indicate that untreated congenital syphilis in a patient?

Answer 6

Sabre shins (anterior bowing of tibia)

Stamping gait

Question 7

What may indicate that your patient suffered with severe childhood fevers?

Answer 7

Horizontal grooves or pits (particularly of incisors)

Question 8

Give examples of 2 countries where people may suffer from severe fluorosis du to very high fluoride?

Answer 8

Yemen

Sudan

Question 9

How does severe rickets affect teeth?

Answer 9

Grooving or pitting of enamel

Question 10

What may you see if a patient suffered from hypoparathyroidism?

Answer 10

Ectodermal defects (grooving/pitting of enamel)

Question 11

Why may mucosal tissues look pale (pallor)?

Answer 11

Anaemia

Question 12

What may be the cause of pigmentation on the oral mucosa?

Answer 12

Ethnicity (racial pigmentation)

Addison’s (adrenal insufficiency, body doesn’t produce enough of certain hormones e.g. cortisol, aldosterone)

Question 13

What would a blue tint suggest?

Answer 13

Cyanosis - when tissues are not getting enough oxygen

Question 14

What would a yellowish tint of oral mucosa suggest?

Answer 14

Jaundice

Question 15

What may blue/brown gingival margins indicate?

Answer 15

Heavy metals - lead, bismuth

Question 16

What may blue/brown patches in mouth indicate?

Answer 16

Melanoma
Amalgam tattoo
Silver sulphide - old silver point RCT

Question 17

What is purpura?

Answer 17

It is the haemorrhaging of small blood vessels, causing a discolouration of the mucosa or skin

Question 18

What may purpura of the gingiva or mucosa be a sign of? (Name disease examples)

Answer 18

• Acute leukaemia
• HIV/AIDS
• Steroid treatment (iatrogenic)
• Myelodysplasias (rare blood cancers lacking healthy blood cells e.g. low platelets)

Question 19

What may be an additional feature if you are seeing purpura in the gingiva or mucosa?

Answer 19

Excessive gingival bleeding

Question 20

What may you see (or not see) if your patient has a clotting disorder? What is an example of this?

Answer 20

Excessive gingival bleeding
Anticoagulant excess
Purpura NOT present

Haemophilia A most common cause (also haemophilia B and Von Willebrand’s)

Question 21

Name 3 examples of what illness/condition may cause acute gingivitis

Answer 21

Acute leukaemia
Immunodeficiencies
AIDs
Agranulocytosis (blood disorder where pt lacks neutrophils)
Uncontrolled diabetes
Vitamin Deficiencies (Scurvy- Vit C, Pellagra- Vit B3)

Question 22

What medications are often the main cause of gingival hyperplasia?

What disease should you also consider?

Answer 22

Nifedipine (treats hypertension)
Cyclosporin (immunosuppressant)
Phenytoin (anti-seizure)

Also consider leukaemia

Question 23

Name 3 systemic disease that may present a stomatitis in the mouth

Answer 23

Measles
Chickenpox
Syphilis
Herpes Zoster
Herpes simplex
Tuberculosis (painful, hiding ulcer)
Actinomycoses (following removal of wisdom teeth)
Crohn's disease
Granulomatosis

Question 24

What may be the cause behind aphthous stomatitis?

What is aphthous stomatitis?

Answer 24

Iron, vit B12 or folic acid deficiency

Recurrence of benign and non-contagious mouth ulcers

Question 25

What may white patches/keratosis be a sign of?

Answer 25

``` Lichen planus Lupus Immunosuppression Renal failure Tertiary syphilis ```

Question 26

What is glossitis?

Answer 26

It is where the tongue becomes swollen and inflamed

Question 27

What can be the cause of glossitis (2)?

Answer 27

1. Anaemia: most common identifiable cause, most frequently due to iron deficiency (iron stored in filliform papillae) 2. Vitamin deficiencies: riboflavin deficiency and pellagra (rare), malabsorption syndrome

Question 28

What 4 effects could arise from HIV/AIDS or any immunosuppression?

Answer 28

Cervical lymphadenopathy Candidosis Kaposi's sarcoma (cancer that forms in lining of blood and lymph vessels) Hairy leucoplakia (triggered by EBV - causes white patches on tongue)

Question 29

Give 3 examples of less common effects from HIV/AIDS or immunosuppression

Answer 29

``` Angular chelitis Herpes simplex Herpes zoster Rapdily progressive perio Lymphoma ```

Question 30

Oral cancer frequently has NO symptoms - but give 5 examples of symptoms when they do occur

Answer 30

- sore lump of ulcer that does not heal after 2 weeks - lump in neck - painless, but hard and growing - white or red patch - Unusual bleeding, pain or numbness in mouth - Oral pain that does not go away or feeling that something is caught in throat - Difficulty or pain with chewing or swallowing (dysphagia) - Tongue mobility/stiffness problems - Difficulty with jaw opening - Jaw swelling - may present as poor denture fit - Rapid tooth loosening - (too fast for perio?) - Bad breath - Sensory and motor loss of the face (5&7 involved) - Abnormal taste in mouth -

Question 31

Give 3 examples of diseases which may present as changes in the jaws

Answer 31

Paget's disease Widespread metastases Hyperparathyroidism (this in turn causes hypercalcaemia)

Question 32

What makes up the Gardner triad?

Answer 32

1. SOFT TISSUE TUMOURS& ABNORMALITIES - e.g. lipomas, cysts 2. HARD TISSUE ABNORMALITIES - e.g. osteomas, odontomas 3. MULTIPLE INTESTINAL POLYPOSIS - high potential for malignant degeneration

Question 33

What illness is the most common cause for enlargement of cervical lymph nodes? What are other possible illnesses that cause this?

Answer 33

Oral sepsis ``` Glandular fever Hodgkin's disease Lymphoma (NH) Lymphocytic leukaemia HIV/AIDS ```

Question 34

What 4 conditions/illnesses may you notice by looking at your patient's hands?

Answer 34

Rheumatoid arthritis (xerostomia, Sjogren's syndrome) Clubbing (liver or heart disease) CNS - Parkinson's (tremor) Liver disease (liver palms, tremor