UNIVERSITY OF MOSULCOLLEGE OF DENTISTRY
Oral manifestation of systemic diseases:It may be defined as the clinical sign and symptoms that appear in the oral cavity in association to a specific disease these manefestation may be pathognomonic or not to that specific disease.
Cardiac abnomalities and diseases.It includes the following:
Congenital heart disease.
Ischemic heart disease
Congestive heart failure.
Oral petechia may be found in IE patient.Congenital heart disease.
In cyanotic CHD, bluish discoloration of the oral mucosa.
Hemorrhage in oral mucosa due to reduce platelets.
Increase the risk of oral infection due to low WBC.
No oral complications have been associated with hypertension itself. Patients with malignant
hypertension have been reported to occasionally develop facial palsy.
Patients with severe hypertension have been reported to bleed excessively after surgical procedures or trauma; however, excessive bleeding in patients with hypertension is not common and is controversial
Lichnoid drug reactiongingival hyperplasia
No lesions or oral complications are the direct result of coronary atherosclerotic heart disease.
Most manifestation is due to the drugs used treatment of this disease and it complications, however, may produce oral changes such as:
increased bleeding after trauma or surgical procedures (take warfarin or aspirin).
In rare cases, patients with coronary atherosclerotic heart disease with angina may have pain referred to the lower jaw or teeth. The pattern of onset of pain causedby physical activity and its disappearance with rest usually serves as a clue to its cardiac origin.
The only significant oral complications found in patients with arrhythmias are those that occur as adverse effects of the medications used to control arrhythmia.
Angioedema of lip, face, or tongue
Increased gag reflex;
Lupus like oral lesions
It include the following:
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
SNORING AND OBSTRUCTIVE SLEEP APNEA
Patients with COPD who are chronic smokers have an increased likelihood of develop in.
extrinsic tooth stains
black hairy tongue in a cigarette smoker
and oral cancer(SCC),leukoplakia and erythroplakia
theophylline has been associated with the development of Stevens-Johnson syndrome
black hairy tongue in a cigarettenicotine stomatitis
Stevens-Johnson syndrome.Nasal symptoms, allergic rhinitis, and mouth breathing are common with extrinsic asthma. Mouth breathers with asthma may have altered nasorespiratory function that can cause increased upper anterior and total anterior facial height, higher palatal vaults, greater overjets, and a higher prevalence of crossbites.
The medications taken by patients who have asthma may contribute to oral disease, as:decrease salivary flow
increased prevalence of gingivitis and caries
Oral candidiasis (acutepseudomembranous type)
erosion of enamel.
gingivitisOral candidiasis (acutepseudomembranous type)
TB manifests infrequently in the oral cavity. Oral lesions can occur at any age but are most frequently seen in men about 30 years of age and in children.
The classic mucosal lesion is a painful, deep, irregular ulcer on the dorsum of the tongue. The palate, lips, buccal mucosa, and gingiva also may be affected.
Mucosal lesions have been reported to be granular, nodular, or leukoplakia and sometimes painless.
Extension into the jaws can result in osteomyelitis. The cervical and submandibular lymph nodes may become infected with TB; this condition is called scrofula. The nodes become enlarged and painful and abscesses may form and drain.
Involvement of the salivary glands is rare.
scrofulaclassic mucosal lesion is a painful, deep, irregular ulcer on the dorsum of the tongue
Large tongue.Long soft palate.
Redundant pharyngeal tissue.
GASTROINTESTINAL DISEASEGASTROINTESTINAL DISEASE
It include the following:
Hemorrhage in palateangular or labial cheilitis
The use of systemic antibiotics for peptic ulcer disease may result in fungal overgrowth (candidiasis) in the oral cavity, as median rhomboid glossitis.
(1) diffuse labial, gingival, or mucosal swelling;(2) inflamatory hyperplasia with cobblestoning of the buccal mucosa and gingiva.
(3) indurated polypoid like lesion in the vestibule & retromolar pad area.
(4) aphthous ulcers
(5) mucosal tags
(6) angular cheilitis & glossitis.
(7) persistent deep linear ulceration with hyperplastic margin.
(8) persistent lymphadenopathy.
(9) perioral erythema &scaling of the skin & full width gingivitis.
Noncaseating granulomas are characteristic of orofacial Crohn disease.
Labial swelling in orofacial granulommaLabial swelling ,fissuring and angular chelitis in orofacial granulomma
Oral ulceration in orofacial granulomatosisCobblestone appearance in orofacial granulomatosis
Mucosal tags in orofacial granulomatosisGingival proliferative lesion in orofacial granulomatosis
Gingival lesion in orofacial granulomatosisGingival swelling and cobblestonning appearance of the oral mucosa of 2 children with orofacaial granulomatosis
Melkerson Rosenthal Syndrome consist of :Facial paralysis.
Plicated mucosal swelling.
It is closely related to crohn disease.
Melkerson Rosenthal SyndromFacial oedema involoving the lip
Plication and swelling of the midline palatal mucosa
Ulcerative colitis:it is restricted to the colon and is limited to the mucosa and submucosa
aphthous ulcerations or
superficial hemorrhagic ulcers(chroin oral ulcer) may be seen in the oral cavity
Pyostomatitis vegetans which is deep fissures, pustules and papillary projection.
Pyostomatitis vegetans in adult patient with crohn’s disease or ulcerative colitis. Ulcerative colitis
Gastroesophageal reflexErosion of the enamel exposes the underlying dentin.
Associated with candidiasis
Gastro intestinal disease
Pallor of oral mucosaXerostomia
Pigmentation of oral mucosa
Petechiae and ecchymosis of oral mucosa and bleeding tendency.
Enamel hypoplasiaOsteodystrophy (radiolucent jaw lesions)
Ammonia breath odor.
Loss of lamina dura.
Hemodialysis reverses many of the severe oral manifestations associated with ESRD:
Uremic odor, taste change & dry mouth
tongue and mucosal pain are symptoms that persist in many of these patients.
secretion occur among patients undergoing hemodialysis more frequently than among healthy patients.
higher plaque and calculus indices, and lower levels of salivary
Sexually transmitted diseaseThis include the diseases:
HUMAN PAPILLOMAVIRUS INFECTION
Oral manefestation ranges from slight erythema of the oropharynx to severe ulceration with a pseudomembranous coating oropharynx, patients describe that they have a sore throat and the mucosa becomes fiery red, with tiny pustules and an itching and burning sensation
tonsils become involved, they are invariably enlarged and inflamed with or without a yellowish exudate. The patient may be
asymptomatic or incapacitated, with limited oral function (eating, drinking, talking),
It results from auto inoculation of type 2 herpes into the oral cavity .
Mostly affect lip and tongue.
1ry syphilis cause chancre in lip and tongue(slightly raised ulcerated firm plaque usually round &indurated with raised rulled margins
2nd syphilis cause snail tract and mucus patches affect intraoral site.(small smooth erythematous area or superficial greysh to yellowish erosion or ulceration.
3ry syphilis cause:
gummatous lesion and may cause perforation of the palate.
syphilitic leukoplakia of the tongue.
Syphilitic glossitis which is shrinkage of the size of the tongue due to fibrosis.
Mucous pathes of the 2nd syphilisIt is caused by treponema pallidum.Congenital syphilis characterized byHutchinson’s incisiors (barrel shape and notch on the incisal edge)Neural deafness Interstaial keratosis.Molar hypopalstic(mulberry or moon molar).High palatal arch .Saddle nose.Mental handicapp is common.
Auto inoculatoin of HPV into the oral cavitySpecific genotype associated with development of carcinomaIt characterized by:Verruca vulgaris (common warts)Condyloma acuminatum(genital wart)papillomaFocal epithelial hyperplasia(heck’s disease)
Wart of the lipPapilloma of the oral mucosa
just inside the right commissure
It is caused by EBV.Fever,sore throat, tonsillar enlargement lymphoadenopathy.
Mouth ulced with faucial oedema and tonsillar exudate.
Generalized skin rash and petechiae of the palate especially at the junction of soft and hard palate and sometimes in lips.
Faucial oedema ,exudate and ulceration in infectious mononucleosisPalatal petechiae in infectious mononucleosis
AIDS and related conditionsDry Mouth
The most common side effect from HIV / AIDS medication is dry mouth. Saliva helps wash away bacteria and the acids that the bacteria produces along with sugars and foods, therefore, producing less saliva as a result of dry mouth can contribute to tooth decay, gingivitis and gum disease. (Treatment :saliva substitute or a fluoride rinse to help decrease the risk of tooth decay(.
AIDS and related conditionsCandidiasis (Erythmatous candidiasis, Pseudomembranous candidiasis.)
Herpes Simplex Lesions
necrotizing ulcerative periodontitis
necrotizing ulcerative gingivitis
oral hairy leukoplakia.
Linear gingival erythema