Oral Manifestations of Systemic Diseases

Question 1

What are the way that systemic diseases can manifest orally

Answer 1

• Can have dental effects
• Can have oral mucosal effects
• Drugs taken for disease can have oral effects

Question 2

How can systemic diseases have dental effects

Answer 2

• they can disrupt tooth structure formation and content

Question 3

What time period will result in dental defects in the primary teeth

Answer 3

pre/perinatal in the mother

Question 4

What time period will result in dental defects in the permanent teeth

Answer 4

perinatal/childhood disease

Question 5

What are congenital conditions/infections that can cause dental manifestations

Answer 5

congenital syphilis
other conditions part of the TORCH acronym
illness/metabolic disorders which dusrupt dental formation e.g cancer
Pigment from substances in the blood

Question 6

What is the TORCH acronym

Answer 6

represents congenital conditions that can be passed from mother to fetus

Question 7

What does TORCH stand for

Answer 7

• T = toxoplasmosis
• O = other e.g syphilis, VZV, HIV
• R = rubella
• C = cytomegalovirus
• H = herpes simplex

Question 8

What is the dental manifestation of congenital syphilis

Answer 8

• Hutchison’s incisors
• Mulberry molars

Question 9

What is ectodermal dysplasia

Answer 9

• congenital absence of ectodermal structure
• X-linked recessive

Question 10

What structures form from ectoderm

Answer 10

• skin
• mucous membrane of mouth
• brain, spinal cord
• tooth enamel

Question 11

What are the symptoms of ectodermal dysplasia

Answer 11

• dry skin
• partial/total absence of sweat and salivary glands
• teeth effected

Question 12

How does ectodermal dysplasia effect the teeth

Answer 12

• retarted eruption
• deformed
• conical crowns

Question 13

How may carriers of ectodermal dysplasia present

Answer 13

minimal hypodontia

Question 14

Which substances in the blood may cause staining of the teeth

Answer 14

• bilirubin
• tetracycline

Question 15

How does bilirubin stain the teeth

Answer 15

yellow/green change
usually linked to severe jaundice

Question 16

What is tetracycline

Answer 16

antibiotic
used to treat chalmydia, acne and helicobacter
contraindicated in <12

Question 17

How does tetracycline cause staining

Answer 17

• binds to calcium ions and becomes part of the tooths internal structure
• presents as a linear band

Question 18

What are the different conditions that can have oral mucosa effects

Answer 18

• giant cell granuloma
• Addison’s
• Immune deficiency
• skin immune disease
• haematinic deficiency

Question 19

What is a giant cell granuloma

Answer 19

can be peripheral or central
peripheral ones present as swellings varying in size, commonly ulcerated
histologically will show focal collections of multinucleate giant cels

Question 20

Why should you always take an xray of a giant cell epulis

Answer 20

• central giant cell granuloma may have perforated the cortex and presented as a peripheral lesion

Question 21

When a central giant cell granuloma is seen, why should we check parathyroid function

Answer 21

• could be as a result of excess parathyroid stimulation of osteoclasts
• reactive parathyroidism may be the cause due to renal failure, hypocalcaemia and parathyroid tumour
• increased PTH as a response to reduced serum calcium causes increased osteoclast activity to increase serum calcium

*known as browns tumour - histologically identical to CGCG but they have different clinical features

Question 22

What is Addison’s

Answer 22

• autoimmune condition impacting the adrenal glands
• results in reduced production of aldosterone and cortisol

Question 23

What are the mucosal effects of Addison’s

Answer 23

melanin pigmentation

Question 24

What are the immune deficiency/diseases that can result in mucosal changes

Answer 24

• OFG
• sjogren’s
• autoimmune disease
• infections

Question 25

What are the skin immune diseases that can cause mucosal changes

Answer 25

• lichen planus
• VB disease

Question 26

What are the effects of haematinic deficiency on the oral mucosa

Answer 26

oral ulceration
sore tongue

Question 27

What are the different connective tissue diseases that can impact the mouth

Answer 27

• systemic LE
• systemic sclerosis
• vasculitic diseases

Question 28

How does systemic LE present orally

Answer 28

• similar to lichen planus
• may see white striae on an erythematous background
• gingival lesions present similar to desquemative gingivitis

Question 29

What does sytemic sclerosis result in

Answer 29

• fibrosis
• dysregulated immune system
• microvascular angiopathy (disease of the BV)

Question 30

What are the oral manifestations of systemic sclerosis

Answer 30

• stiffness of lip and tongue
• trismus - limited mouth opening
• widened PDL

Question 31

What can vasculitic diseases be classified into

Answer 31

• large vessel disease
• medium vessel disease
• small vessel disease

Question 32

What is an example of a large vessel disease and what is its oral manifestation

Answer 32

Giant cell arteritis (temporal arteritis)
* pain over temple
* tongue pain

Question 33

What are 2 examples of medium vessel disease and their oral manifestations

Answer 33

Polyarteritis nodosa
* ulcers
Kawasaki disease
* cervical lymph node enlargement
* sore tongue
* cheilitis

Question 34

What is an example of a small vessel disease and what is its oral manifestations

Answer 34

Wegener’s granulomatosis
* vasculitic changes on the gingiva & palate
* can result in necrosis
* urgent referral to rheumatology
* can present with gingival swellings and ulcers

Question 35

What are acquired causes of immune deficiency

Answer 35

• diabetes
• drug therapy
• cancer therapy
• HIV

Question 36

What oral conditions should make you consider undiagnosed HIV when unexplained

Answer 36

• ulcers
• periodontal disease
• salivary gland swelling
• hairty leukoplakia

Question 37

How does periodontal disease present in an HIV px

Answer 37

• doesnt respond to plaque removal
• linear gingival erythema
• necrotizing ulcerative conditions

Question 38

What are causes of haematinic deficiency

Answer 38

• poor intake
• malabsorption
• blood loss
• increased demand

Question 39

What are the oral effects of drugs

Answer 39

• dry mouth
• oral ulceration
• lichenoid reaction
• angio-oedema
• osteonecrosis

Question 40

What drugs are implicated in lichenoid reactions

Answer 40

ace inhibitors
beta blockers

Question 41

What drugs are implicated in angio-oedema

Answer 41

ace inhibitors