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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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