Oral manifestations of systemic diseases

Done by Dr. Mohammed Sa’ad (B.D.S)

AL Imam Ali ( A.S ) General HospitalMaxillofacial Surgery Department

Introduction

• Careful examination of the oral cavity may reveal findings indicative of an underlying systemic condition, and allow for early diagnosis and treatment. Examination should include evaluation for mucosal changes, periodontal inflammation and bleeding, and general condition of the teeth.

GIT Diseases

• Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestions, the liver, gallbladder, and pancreas.

• Crohn's disease, also known as Crohn syndrome and regional enteritis, is a type of inflammatory bowel disease (IBD).

• Ulcerative colitis is a form of inflammatory bowel disease (IBD) that causes inflammation and ulcers in the colon.

• Gastroesophageal reflux is a chronic symptom of mucosal damage caused by stomach acid coming up from the stomach into the esophagus.

• Chronic liver disease in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis.

• Crohn disease– diffuse labial, gingival or mucosal swelling– „cobblestoning“ of buccal mucosa and

gingiva– aphtous ulcers– mucosal tags– angular cheilitis– oral granulomas

• Ulcerative colitis– oral signs are present in periods of

exacerbation of disease– aphtous ulceration or superficial

hemorrhagic ulcers– angular stomatitis– pyostomatitis vegetans, pyostomatitis

gangrenosum

cobblestoning of the gut mucosa

GIT diseases

pystomatitis vegetans

• Gastroesophageal reflux– reduction of the pH of the oral cavity below

5,5 – enamel damage– damage of the dentin – higher sensitivity (to

temperature..), caries

• Chronic liver diseases– jaundice– petechiae or gingival bleeding (hemostasis

disorder)

GIT diseases

Hematologic Diseases

• Hematologic diseases are disorders which primarily affect the blood

• Anemia is usually defined as a decrease in the amount of red blood cells (RBCs) or hemoglobin in the blood.

• Leukemia is a group of cancers that usually begins in the bone marrow and results in high numbers of abnormal white blood cells.

• Anemias

– folate and vit. B12 deficiency– iron deficiency

– glossitis• red colour• athrophic papilae• recurrent aphthae

– candidal infection– angular stomatitis– oral pain

Hematologic diseases

• Leukemia

– gingival hypertrophy– petechiae– mucosal ulcers– hemorrhage

Treatment of leukemia– reactivation of herpes simplex virus – oral mucosistis

Hematologic diseases

Summary of oral manifestations of gastrointestinal and hematologic diseases

Angular cheilitis• Iron-deficiency anemia

Hemorrhage• Pyostomatitis vegetans• Scurvy• Ulcerative colitis

Aphthous ulcers• Crohn's disease• Pernicious anemia• Ulcerative colitis

Intraoral burning• Iron-deficiency anemia• Pernicious anemia

Candidiasis• Crohn's disease (steriod therapy)• Iron-deficiency anemia• Pyostomatitis vegetans (steriod therapy)• Ulcerative colitis (steroid therapy

Summary of oral manifestations of gastrointestinal and hematologic diseases

Labial swelling• Crohn's disease

Erosion of enamel and dentin• Anorexia nervosa/bulimia• Gastroesophageal reflux

Gingivitis• Anorexia nervosa/bullimia• Crohn's disease• Scurvy

Glossitis• Crohn's disease• Iron-deficiency anemia• Pernicious anemia• Ulcerative colitis

Ulcerations and erosions• Crohn's disease• Iron-deficiency anemia• Pernicious anemia• Pyostomatitis vegetans• Ulcerative colitis

Connective tissue disease• connective tissue disease is any disease that has the

connective tissues of the body as a target of pathology.• Sjögren's syndrome is a chronic autoimmune disease

in which the body's white blood cells destroy the exocrine glands.

• Kawasaki disease is an autoimmune disease in which the medium-sized blood vessels throughout the body become inflamed.

• Scleroderma is a chronic systemic autoimmune disease characterised by hardening (sclero) of the skin (derma).

• Lupus erythematosus is a systemic autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue.

• Sjögren syndrome– autoimmune disease– men : women - 1 : 9, 50 years and older

Main signs– sicca syndrome– keratoconjuctivitis sicca – xerostomia

Oral signs– decrease in saliva

• xerostomia– dry, red, wrinkled mucosa

• difficulty in swalloving and eating• disturbance in taste and speech• increased dental caries• infections• atrophy of the papilae• candidiasis

Connective-tissue diseases

• Kawasaki disease– vasculitis of medium and large arteries

Oral signs– swelling of papilae on the surface of the

tongue (strawbery tongue)– intense erythema of the mucosal

surfaces– cracked, cherry red, swolen and

hemorrhagic lips

Connective-tissue diseases

• Scleroderma– diffuse sclerosis of the skin, GIT,

heart muscle, lungs, kidney

Oral signs– pursed lips – dificult to open the

mouth – esophafeal sclerosis

gastroesophageal reflux – damage of enamel

– pale, rigid mucosa– teleangiectasias– decreased mobility of tongue– salivary hypofunction

Connective-tissue diseases

Limited mouth opening and decreased tongue mobility

Gingival retraction

• Lupus erythematosus– autoimmune disease

Oral signs– ulcerations– oral lesions of lichen planus –

painfull– petechiae– damage of salivary glands -

xerostomia

Connective-tissue diseases

ulcer

lichen planus lesions

Pulmonary diseases

• Cystic fibrosis, also known as mucoviscidosis, is a genetic disorder that affects mostly the lungs but also the pancreas, liver, kidneys and intestine.

• Sarcoidosis, is a disease involving abnormal collections of inflammatory cells (granulomas) that can form as nodules in multiple organs.

• Cystic fibrosisOral signs– disorder of salivary

glands– swelling lips– gingivitis– dryness

Pulmonary diseases

• SarcoidosisOral signs– multiple, nodular, painles ulcerations of the

gingiva, bucal mucosa, labial mucosa and palate– tumorlike swelling of salivary glans– swelling of the tongue– xerostomia– facial nerve palsy

Pulmonary diseases

Cutaneous diseases

• Psoriasis is a long lasting disease characterized by patches of abnormal skin.

• Acanthosis is diffuse epidermal hyperplasia.

• PsoriasisOral signs– fissured tongue– small white papules– red and white plagues– bright red patches

• Acantosis nigricans– hyperpigmentation, papillomatosis

Oral signs– gingival hyperplasia– gingiva, tongue, lips - papilomas

Cutaneous diseases

Endocrine diseases• Diabetes mellitus, is a group of metabolic

diseases in which there are high blood sugar levels over a prolonged period.

• Thyroid disorders is the condition that occurs due to excessive or insufficient production of thyroid hormone by the thyroid gland.

• Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to cortisol.

• Addison’s disease is a rare, chronic endocrine system disorder in which the adrenal glands do not produce sufficient steroid hormones.

• Diabetes mellitusOral signs– xerostomia caused decreased

salivation and increased glucosa level in saliva

• gingivitis• oral infections• candidiasis

– higher incidence of caries– bilateral enlargement of parotid

glands– altered taste– burning mouth syndrome

Endocrine diseases

gingivitis

hyperplasia

bilateral parotid

gland enlargement

• HypoparathyroidismOral signs– candidiasis– upper lip twitching

• HyperparathyroidismOral signs– loss of the lamina dura surrounding the

roots of the teeth– decrease of trabecular density– osseous lesions „brown tumor“

Endocrine diseases

• Cushing´s syndromeOral signs– fatty tissue deposition – „moon face“– osteoporosis pathological fractures of

the mandible, maxilla or alveolar bone– delayed healing of fractures and also sof

tissue injuries

• Addison´s diseaseOral signs– „bronzing“ hyperpigmentation of the skin– oral mucosal melanosis – buccal mucosa,

tongue

Endocrine diseases

moon face

hyperpigmentation

Renal diseases

• Uremic stomatitis a rare form of stomatitis that occurs with renal failure.

• Uremic stomatitis– rare– in undiagnosed and untreated chronic renal

failure– irritation and chemical injury of mucosa by

ammonia or ammonium compoundsSigns– painful plagues and crusts – bucal mucosa, the

floor or dosrum of the tongue, floor of the mouth

– Type I• generalized or localized erythema• exudate• pain, burning, xerostomia, halitosis, gingival

bleeding, candidiosis– Type II

• ulceration• secondary infection• anemia

Renal diseases

Thanks A lot

Any Question ?

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