Transcript of Oral manifestations of systemic diseases
- 1. Contents Systemic conditions associated with- -oral ulcers
-oral lesions -change in mucosal pigmentation -periodontal disease
- alteration of teeth Certain syndromes and dental manifestations
Conditions associated with delayed tooth eruption
- 2. Oral ulcers Systemic diseases manifesting o.ulcers are:
Microbial disease- Herpetic stomatitis Chicken pox Hand ,foot and
mouth disease Herpangina Infectious mononucleosis Hiv Anug Tb
syphilis Histoplasmosis Crytococcosis Blastomycosis
Paracoccidiodomycosis leishmaniasis
- 3. Kopliks spots
- 4. Contd.. Mucocutaneous disease Lichen planus Pemphigus
vulgaris Pemphigoid and variants Erythema multiforme Dermatitis
herpetiformis Linear IgA disease Epidermolysis bullosa c/c
ulcerative stomatitis Blood disorders Anemia Leukemia
Myelodysplastic syndrome Neutropenia Other white cell dyscrasias
Gammopathies Haematinic deficiencies
- 5. Vitamin deficiency disorders Vitamin B complex deficiency
Reddening of oral mucosa, tongue with or without ulceration,
swelling and burning Scurvy (vitamin C deficiency) Petechiae in
oral mucosa and swollen bleeding gums Pernicious anaemia, Iron
deficiency Pellagra Bald tongue (atrophic glossitis )
- 6. Contd Gastrointestinal disease Coeliac disease Crohns
disease Ulcerative colitis Rheumatic diseases Lupus erythematosus
Sweet syndrome Reiter syndrome Endocrine disorders Diabetes
Glucagonoma Vasculitides Behcets syndrome Wegeners granulomatosus
Periarteritis nodosa Giant cell arteritis Disorders of uncertain
pathogenesis Eosinophilic ulcer Hypereosinophilic syndrome
Necrotising sialometaplasia
- 7. Halitosis (oral malodour) Abnormal smell from breath
Diseases Malodourous breath Bronchiectasis , Lung abscess, Oral
sepsis (stomatitis, gingivitis) Smoking , Idiopathic Fishy odour
Hepatic failure Ammonical or urinary odour Uraemia or azotaemia
Fruity odour Diabetic ketoacidosis
- 8. . Oral lesions 1.Lichen planus- O/M : Erosive diffuse
erythema and painful ulceration with peripheral radiating striae
Reticular white lacy striae, especially on bilateral buccal
mucosa
- 9. Management In symptomatic patients, oral lesions may be
treated with a topicalcorticosteroid gel or rinse
- 10. Candidiasis (oral thrush) CONDITIONS ASSOCIATED WITH
INCREASED VULNERABILITY : Poor oral hygiene, xerostomia Recent
antibiotic treatment Dental appliance Early infancy Genetic immune
deficiency, aids Corticosteroid therapy Pancytopenia, anaemia,
malnutrition, malabsorbtion Diabetes , advanced systemic
disease
- 11. . 2.Lupus erythematosus O/M: oral discoid lesions,
honeycomb plaques, raised keratotic plaques, erythema , purpura,
petechiae, irregularly shaped ulcers, cheilitis .
- 12. Management Ora lesions resolve with immunosuppressive
therapy. For patients with limited skin/ oral disease,
corticosteroids or systemic antimalarial drugs are
appropriate.
- 13. . 3. Benign mucus membrane pemphigoid O/M : diffuse an
painful ulceration and scarring Intact blister formatoccasionally
may be intraorally (before rupture and ulceration)
- 14. . 4 . Pemphigus vulgaris O/M ; diffuse painful oral ulcers
, positive nikolsky sign oral lesions are the first manifestation
of disease and may precede the onset of skin lesions.
- 15. DD : Erosive lichen planus, benign mucus membrane
pemphigoid Management Oral lesions usually resolve with systemic
immunosuppressive therapy but maybe slower to resolve compared to
extraoral lesions.
- 16. . 5.Crohn disease O/M : diffuse mucosal swelling,
cobblestone mucosa, localised mucogingivitis, deep linear
ulceration, fibrous tissue tags, polyps or nodules, pyostomatitis
vegetans (snail track ulcers on an erythematous base)
- 17. Management Oral lesions resolve with systemic treatment of
underlying intestinal disease. however persistent ulcers may
require application of topical corticosteroids and persistent
swelling may respond to intralesional injection of triamcinolone
acetonide
- 18. . 6.Behcet syndrome O/M ; recurrent painful aphthous like
ulcers, usually numerous and especially involving the soft palate
and oropharynx Oral lesions are most common and may be the first
manifestation of the disease.
- 19. Change in mucosal pigmentation Addison disease O/M :diffuse
melanin pigmention, candidiasis (in patients with autoimmune
polyendocrinopathy- candidiasis- ectodermal dystrophy
syndrome)
- 20. Systemic factors causing periodontal disease Neutropenia
Immunodficiency state Downs syndrome Diabetes melitus Pregnancy
Oral contraceptives Drug induced-Dilantin sodium, phenytoin,
nifedipine Idiopathic hereditory familial fibrosis
- 21. Drug induced periodonitis
- 22. Periodontal bleeding and inflammation Diabetes melitus O/M:
gingivitis , periodontitis, candidiasis, generalized atrophy of the
tongue papillae,taste dysfunction, salivary dysfunction, burning
mouth syndrome, delayed wound healing
- 23. Treatment for periodonditis may improve glycemic control
Furthermore severe periodontal disease may be a strong predictor of
various diabetic complications including nephropathy, stroke,
transient ischemic attack, angina , MI and heart failure
- 24. . HIV associated periodontal disease O/M: linear gingival
erythema necrotising ulcerative gingivitis necrotising ulcerative
periodontitis
- 25. . Thrombocytopenia O/M: petechia , purpura, ecchymosis,
hemorhagic bullae, hematomas
- 26. . Leukemia O/M: mucosal bleeding, ulceration, petechiae
diffuse/localised gingival enlargement secondary
infections-candidiasis, hsv periodontal bone loss
- 27. Alteration in teeth in systemic disorders Morphological
change Teeth involved Disease/condition Enamel hypoplasia Primary
& permanent teeth Rickets , Osteomalacia, Malabsorption,
Coeliac disease, Hypoparathyroidism Enamel hypoplasia with
discoloration Tetracyclines given during pregnancy,infancy and
childhood upto 8years of age Enamel discolouration(mottling) Dental
fluorosis Loss of deciduos dentition Downs syndrome, Juvenile
hypophosphataemia
- 28. Dental erosion Gastroesophageal reflux disease O/M: water
brash, xerostomia, burning sensation, halitosis, palatal erythema,
d. erosion
- 29. . Bulimia and Anorexia O/M: d.erosion, xerostomia,
increased caries rate , sialadenosis
- 30. Syndromes associated with cleft lip and palate Most common
is Pierre Robin syndrome (micrognathia, cleft palate and
glossptosis, airway distress ) Other syndromes includes Goldenhar
syndrome, median cleft face syndrome, orofacial digital syndrome,
Perts syndrome , Nagar syndrome, Oto palato digital syndrome, Down
syndrome and Marfan syndrome
- 31. Sjogren syndrome Oral signs and symptoms -dry mouth
-cracker sign -burning -salivary swelling -caries -candidiasis
Ocular signs and symptoms -foreign body sensation -inability to
produce tear -light intolerance Other -fatigue, fever -kidney,
muscle, nerve, liver involvement -connective tissue disease
- 32. Management : Follow up regularly Salivry substitutes Eye
drops Cariescontrol Soft diet Control of secondary infections
- 33. Delayed Tooth Eruption Local conditions associated with
DTE
- 34. . Systemic conditions associates with DTE
- 35. . Genetic conditions associated with DTE