1. 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. 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. 3. Kopliks spots
4. 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. 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. 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. 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. 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. 9. Management In symptomatic patients, oral lesions may be treated with a topicalcorticosteroid gel or rinse
10. 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. 11. . 2.Lupus erythematosus O/M: oral discoid lesions, honeycomb plaques, raised keratotic plaques, erythema , purpura, petechiae, irregularly shaped ulcers, cheilitis .
12. 12. Management Ora lesions resolve with immunosuppressive therapy. For patients with limited skin/ oral disease, corticosteroids or systemic antimalarial drugs are appropriate.
13. 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. 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. 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. 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. 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. 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. 19. Change in mucosal pigmentation Addison disease O/M :diffuse melanin pigmention, candidiasis (in patients with autoimmune polyendocrinopathy- candidiasis- ectodermal dystrophy syndrome)
20. 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. 21. Drug induced periodonitis
22. 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. 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. 24. . HIV associated periodontal disease O/M: linear gingival erythema necrotising ulcerative gingivitis necrotising ulcerative periodontitis
25. 25. . Thrombocytopenia O/M: petechia , purpura, ecchymosis, hemorhagic bullae, hematomas
26. 26. . Leukemia O/M: mucosal bleeding, ulceration, petechiae diffuse/localised gingival enlargement secondary infections-candidiasis, hsv periodontal bone loss
27. 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. 28. Dental erosion Gastroesophageal reflux disease O/M: water brash, xerostomia, burning sensation, halitosis, palatal erythema, d. erosion
29. 29. . Bulimia and Anorexia O/M: d.erosion, xerostomia, increased caries rate , sialadenosis
30. 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. 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. 32. Management : Follow up regularly Salivry substitutes Eye drops Cariescontrol Soft diet Control of secondary infections
33. 33. Delayed Tooth Eruption Local conditions associated with DTE
34. 34. . Systemic conditions associates with DTE
35. 35. . Genetic conditions associated with DTE