Oral manifestations of systemic disease Flashcards
(43 cards)
Which lymph nodes should you always examine extra-orally?
Remember extra-oral examinations begins the moment the patient walks through the door.
- Submental
- Submandibular
- Cervical chain
- Supraclavicular
- Occipital
- Post auricular
- Pre auricular
slide 7 and 8
Which areas should you always examine intra-orally?
-Gingiva
-Mucosa
-Lips
-Vestibule
-Hard palate
-Floor of mouth
- Ventral and lateral border of the tongue
Why might teeth be abnormally coloured?
- Tetracycline used in odontogenesis might make them yellow, brown or grey
- Fluorosis (opaque white or brown patches)
- Severe long term/childhood jaundice (yellow or greenish)
- Porphyria, a rare hereditary disorder of Hb metabolism (purplish red colour)
- Dentinogenesis & osteogenesis imperfecta, hereditary conditions influencing mineralised tissues can manifest in mouth (purplish/brownish discolourations)
What is dental hypoplasia?
When enamel has not formed properly/correctly
When might dental hypoplasia occur and what would the classic manifestations of ongoing disease be?
In congenital syphilis
Once the child is born, the manifestations would include notched & peg-shaped permanent incisors & molars may also be deformed (Moon’s molars
What can cause enamel/dental hypoplasia?
- Severe childhood fevers
- Horizontal grooves or pits
-Especially in the incisors - Severe fluorosis
- Rough pitting, white/brown
- Opacities - Severe rickets
- Grooving or pitting of the enamel
- Due to low vitamin D so calcium absorption is affected - Hypoparathyroidism
- Ectodermal defects (grooving/pitting of enamel)
Which systemic conditions can abnormal loss of tooth surfaces reflect?
- Erosion (due to intrinsic or extrinsic acids)
- Attrition - bruxism
- Abrasion - components of diet
(Look at picture)
How might anaemia present orally in terms of discolouration?
Pallor, bleeding to palate of mucosa, red beefy sore tongue
What might unusual pigmentation on the oral mucous membrane, usually that of a brown melanin type pattern represent?
Either ethnicity or Addison’s disease
How might CVD & respiratory disease present orally?
Blue pigmentation due to cyanosis
How might jaundice present orally?
Yellow tint (have to take it seriously because it might be haemolytic, obstructive hepatic or viral, infectious hepatitis)
Why might the oral mucosa go white?
Keratosis (maybe because of trauma, mucosal disease, candida or cancer)
What can blue/brown tinges at the gingival margin indicate?
Heavy metal poisoning (lead/bismuth)
What might a blue/brown patch elsewhere on the oral mucosa represent?
Melanoma, amalgam tattoo or silver sulphide from degradation products of an old silver point RCT
What conditions might purpura or gingival/mucosal bleeding be indicative of?
Purpura:
-Acute leukaemias and HIV/AIDS
Iatrogenic – Steroids,
-May be subcutaneously and sub-mucosally
-Excessive gingival bleeding may be a feature
-Myelodysplasias – megakaryocytes fail in dysplastic marrows – low platelets
Disorders of clotting…
-Excessive gingival bleeding may be a feature
-Anticoagulant excess
-Purpura is not present
-(haemophilia A is the most important cause) - Don’t forget HaemophiliaB & von Willebrand’s Disease
What conditions might acute gingivitis reflect?
Acute leukaemia
immunodeficiencies
AIDS
Agranulocytosis
Uncontrolled diabetes
Scurvy (vitamin c deficiency)
Pellagra (Vit B3 deficiency, v rare)
What 3 main drug causes is gingival hyperplasia usually related to?
Nifedipine
Cyclosporin
Phenytoin
(always consider leukaemias)
What can stomatitis (ulcerations) be indicative of?
Apthous Ulceration:
-RAS – Major – Minor – Herpetiform
-Fe, Folate, B12- Diet, GI malabsorbtion / metabolic issues
Beçhet’s Disease:
>3 episodes ROU per annum (HLA B51 link)
Genital ulceration Eye lesions
+’ve Pathergy test Skin lesions
CNS involvement (Headache, brain fog etc)
Musculo-skeletal involvement
Reactive Arthritis (Reiter’s syndrome):
Urethritis Uveitis/Conjunctivitis Arthritis & Apthous Ulceration
What are some disorders with haematological associations that could present as stomatitis?
Haematinic deficiencies
Cyclic neutropenias
Leukaemias
Which drug therapies can result in mucosal breaches and therefore stomatitis/ulcerations?
Cardiovascular- beta blockers, nicorandil
Oral hypoglycaemics (DM2)
Chemotherapy cytotoxins
Sulphonamides
Barbiturates
Gold
Urea
What systemic infections can manifest in the oral mucosa & perioral tissues?
Measles (small white spots known as Koplick’s spots produced, not to be confused with fordyce granules which are completely normal)
Chicken pox (cutaneous rash)
Syphilis:
(primary: ulcer at innoculation site)
(secondary: snail track ulcer, widespread rash, generally feeling unwell)
(tertiary: gumma, can lead to nasal speech, Holmes Adie pupil, leucoplakia)
Herpes zoster
Herpes simplex
TB (painful, hiding ulcer)
Actinomycoses (following wisdom teeth removal, fistula forms, yellow sulphur granules)
Which GI tract conditions could present with stomatitis?
Oro-facial granulomatosis
Crohn’s disease
Coeliac disease
Ulcerative colitis
Which different conditions do oro-facial granulomatoses comprise?
Oro-facial granulomatoses : swelling and irritation in the mouth and face
Melkersson-Rosenthal syndrome - Labial & peri-oral swellings + facial nerve paralysis + pilcated tongue
Meischer’s syndrome - Lip swelling only
Foodstuffs hypersensitivity (type IV)
What is coeliac disease and how can it present?
- Allergy to gluten
- Oral ulceration
-Small bowel malabsorption of many vitamins, minerals and micro-nuitrients
-Angular cheilitis (sore cracked corners of the mouth)
-Burning of the mouth
-Glossitis (inflammation of the tongue)
