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PATIENT EXAMINATION BDS2 REFRESH > Oral Manifestations Of Systemic Disease > Flashcards

Oral Manifestations Of Systemic Disease Flashcards

1
Q

What are the two ways of making a diagnosis?

A

What we see and hear

Medical history and examination

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2
Q

Extra oral examination

A
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3
Q

Extra oral examination inside mouth

A
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4
Q

How do teeth indicate systemic disease ? Abnormal colour

A

Tetracycline = yellow to brown or grey
Fluorosis = opaque white or brown patches
Severe / childhood jaundice = yellow or green
Porphyria = (rare hereditary disease of haemoglobin metabolism) purplish red
Dentinogenesis Imperfecta / Osteogenesis Imperfecta = purplish or brownish but INCREASED TRANSLUCENCY

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5
Q

What can cause Dental Hypoplasia?
(Underdevelopment)
(5)

A
  • Congenital syphilis
  • Severe childhood fevers
  • Severe fluorosis
  • Severe rickets
  • Hypoparathyroidism
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6
Q

Congenital syphilis - dental hypoplasia?

A

– Notched and peg-shaped permanent incisors
– Molars may also be deformed (Moon’s molars)

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7
Q

Severe childhood fevers - dental hypoplasia?

A

– Horizontal grooves or pits
– particularly of the incisors

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8
Q

Severe fluorosis - dental hypoplasia?

A

– Rough pitting, white / brown
– opacities (very high fluoride areas
– eg Yemen / Sudan etc)

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9
Q

Severe rickets - dental hypoplasia?

A

– Grooving or pitting of the enamel

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10
Q

Hypoparathyroidism - dental hypoplasia?

A

– Ectodermal defects
– (grooving / pitting of enamel)

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11
Q

What causes abnormal loss of tooth surfaces?

A

1) Erosion - Extrinsic acids – (diet)?
Intrinsic acid – (gastric)?
– risk of oesophageal metaplasia and malignant conversion
– Typical in reflux disease
– heartburn
– Bulimia nervosa… (look for calloses on dorsum of digits)

2) Attrition - bruxism / TMJD / general emotional wellbeing?

3) Abrasion - components of diet / other device intra orally eg mouthpiece of wind instrument etc?

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12
Q

Look at reflective qs from PowerPoint 1

A
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13
Q

How does colour of mucous membranes indicate systemic disease?
Anaemia

A

Anaemia = pallor of mucus membrane + red beefy sore tongue

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14
Q

How does colour of mucous membranes indicate systemic disease?
Pigmentation

A

Ethnicity
Addisons disease

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15
Q

How does colour of mucous membranes indicate systemic disease?
Blue due to cyanosis

A

Cardiovascular disease
Respiratory disease

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16
Q

How does colour of mucous membranes indicate systemic disease?
Yellow tint due to jaundice?

A

haemolytic

obstructive hepatic

infectious

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17
Q

How does colour of mucous membranes indicate systemic disease?
White due to keratosis

A

trauma

mucosal disease

candida

cancer

18
Q

How does colour of mucous membranes indicate systemic disease?
Blue / brown gingival margins

A

Heavy metal poisoning - lead and bismuth

19
Q

How does colour of mucous membranes indicate systemic disease?
Blue / Brown patch

A

– melanoma
– Amalgam tatoo
– Silver sulphide – old silver point RCT

20
Q

How does gingival / mucosal bleeding indicate systemic disease?

A

PURPURA (bleeding under skin)
- HIV/AIDS + acute leukaemias
- iatrogenic - steroids
- Myelodysplasias
- excessive gingival bleeding

DISORDERS OF CLOTTING
- anticoagulant excess
- purpura not present
- HAEMOPHILIA A is the most important cause
- von willebrand disease
- excessive gingival bleeding

EXCESSIVE GINGIVAL BLEEDING

21
Q

Main causes of acute gingivitis

A

– Acute leukaemia,
– immunodeficiencies,
– AIDS
– Agranulocytosis
– Uncontrolled diabetes

  • vitamin deficiencies - vit C - scurvy, vit B3 - pellagra
22
Q

What causes gingival hyperplasia?

A

– Nifedipine
– Cyclosporin
– Phenytoin

Consider leukaemia

23
Q

Link between stomatitis - ulceration and systemic disease
What might cause the ulcers?

A

Apthous Ulceration because of :
- Recurrent aphthous stomatitis
- low levels of iron, folate and B12 (haematological associations)
- diet
- GI malabsorption / metabolic issues

Beçhet’s Disease
More than three episodes of oral ulcers per year

Reactive arthritis

Drug therapies
• Cardiovascular – Beta-blockers, niocorandil
• Oral hypoglycaemics (DM2)
• Chemotherapy cytotoxics
• Sulphonamides
• Barbiturates,
• Gold
• Urea

24
Q

Examples of systemic infections that affect mucous membranes - cause stomatitis

Stomatitis (inflammation of mucous membrane in the mouth)

A

Measles
Chicken pox
Syphilis
Herpes zoster
Herpes simplex
Tuberculosis - hiding painful ulcer
Actinomycoses – Occasionally following removal of wisdom teeth,
– fistula forms, yellow sulphur granules

25
Q

Look at reflective qs from 2 + ANSWERS

A
26
Q

GI Tract conditions that affect the mucous membranes

A

• Crohn’s Disease
• Coeliac Disease
• Ulcerative Colitis

27
Q

Orofacial Granulomatoses

A

Google def - condition where patients have persistent swelling of lips, face and other areas in the mouth

Melkersson - Rosenthal syndrome – neurological -> labial & peri-oral swellings – facial (VII) nerve paralysis & plicated (folded) tongue

Meischer’s syndrome – lip swelling only

Foodstuffs hypersensitivity (type IV) – eg cinnamon/cinnamaldehydes / benzoates (ie allergy - not from lecture just for understanding )

Crohn’s disease

Sarcoidosis

28
Q

What is Coeliac disease ?

Oral manifestations?

A

• Genetic inherited sensitivity to Gliadin component of wheat gluten….
Small bowel villous atrophy & malabsorption of many vitamins, minerals & micro-nutrients

  • Oral Ulceration
  • Angular cheilitis
  • Burning mouth
  • Glossitis
29
Q

What is Ulcerative Colitis?
Oral manifestations?

A

• Mural inflammation in Colon wall primarily - Shallow non-granulomatous mural ulceration – unlike Crohn’s tends not to fistulate

  • Haemorrhagic lesion
  • Pyoderma gangrenosum
  • Apthous like ulcer
  • Pyostomatitis vegetans - (small patches across the mucosa)
30
Q

Diseases affecting skin and mucous membranes:

A

– Pemphigus
– Mucous membrane pemphigoid
– Epidermolysis bullosa
– Erythema multiforme
– Lichen planus (more common)
– Linear IgA disease
– Dermatitis Herpetiformis

31
Q

Lupus - 2 types?

Oral manifestations?

A

DLE + SLE

DLE- affects skin and mucosa

SLE - Systemic Lupus Erythematosis - Rheumatological condition, ANA positive
– Chronic inflammation flattens cheeks (butterfly rash over malar regiuons)
– developing wolf-like facial (lupine(-> Lupus) features
– Plus reticular pattern oral keratosis v similar to Lichen planus pattern clinically

32
Q

What is keratosis?

What causes keratosis ?

A

White patches (in mouth)

Lichen planus
Lupus
Immunosuppressive
Candidosis
Renal failure
Tertiary syphilis

33
Q

What is glossitis?

What causes glossitis?

A

Inflammation of the tongue

• Anaemia
– Most common identifiable cause
– Most frequently due to iron deficiency (iron is stored in the filliform papillae) diet, malabsorbtion

• Vitamin deficiencies - Riboflavin deficiency (B12) and pellagra (B3)
- Malabsorption syndromes Eg coeliac

34
Q

What can cause an enlarged tongue?

A

• Hypertropy / Hyperplasia from use eg filling extracted tooth sites to maintain chewing
• Acromegaly
• Amyloidosis
• Neurofibromatosis
• Haemangioma & hamartomas
• Lymphangiomas
• Neoplasia

35
Q

What is amyloidosis

A

• Protein deposition in soft tissues – often tongue & renal involvement
• Often a monoclonal protein Ig Light / Heavy chain (Multiple myeloma?) Beta pleated sheet protein deposition

36
Q

Primary sjodrens syndrome + Secondary sjodrens syndrome

What do you need to watch out for?

What are the consequences of dry mucosa?

What drugs can cause dry mouth?

A

Primary - de novo occurrence (first time / no other conditions?? Unsure but googled)
Secondary - if preceded by another rheumatological condition eg rheumatoid arthritis, lupus

Dry oral, ocular and genital mucosa

Watch for lymphoma over time

Consequences of dry mucosa :
Infection
Caries
Toothwear
Candida overgrowth
Discomfort

Drugs = beta blockers, Antidepressant, chemotherapy

37
Q

Oral cancer symptoms

A

Often there are no symptoms but when there are :

• A sore, lump or ulcer on the lip or in the mouth that does not heal after 2 weeks
• A lump in the neck
• A white or red patch on the gums, tongue or lining of the mouth
• Unusual bleeding, pain or numbness in the mouth
• Oral pain that does not go away or a feeling that something is caught in the throat
• Difficulty or pain with chewing or swallowing
• Difficulty with jaw opening
• Jaw swelling - poor denture fit
• Tooth loosening – often rapid (too fast for perio?)
• Bad breath
• Sensory & / motor loss of the face (V &/ VII involved)
• Abnormal taste in the mouth
• Swallowing difficulty (dysphagia)
• Tongue mobility / stiffness problems

38
Q

How do changes in the jaw indicate systemic disease?

A

Areas of resorption or patchy resorption:

• Paget’s disease
• Widespread metastases
• Hyperparathyroidism

39
Q

How does cervical lymph nodes indicate systemic disease?

A

Oral sepsis is commonest cause of enlargement

May also be first sign of diseases of the reticuloendothelial system:
• Glandular fever
• Hodgkin’s disease
• Non-Hodgkin lymphoma
• Lymphocytic leukaemia
• AIDS

Metastatic disease (eg Oral squamous cell carcinoma)

40
Q

How can hands / arms indicate systemic disease?

A

• Rheumatoid arthritis - 2°Sjogren’s Syndrome

• Clubbing – chronic suppurative disease (often chest) , liver disease , cyanotic heart disease

• CNS – Parkinsonism

• Liver disease - liver palms & tremor , coagulopathies – drug handling

PATIENT EXAMINATION BDS2 REFRESH (7 decks)

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