oral manifestation 1

UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY
ORAL MEDICINE

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:
Infective endocardities.
Congenital heart disease.
Hypertension..
Ischemic heart disease
Cardiac arrhythmias.
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 reaction

gingival 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:
dry mouth
taste changes
stomatitis
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.
petechiae,
gingival bleeding
Bitter
taste,
oral ulcerations

petechiae

Oral ulceration

Dry mouth

Hypersalivation
Metallic taste
Taste changes
lichenoid reactions
Gingival Hyperplasia
Taste aberration

Dry mouth
Angioedema of lip, face, or tongue
Taste changes
lichenoid reactions
burning mouth
Increased gag reflex;
drymouth
Lupus like oral lesions
lymphadenopathy
hypersalivation

It include the following:
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
ASTHMA
Tuberculosis
SNORING AND OBSTRUCTIVE SLEEP APNEA

Patients with COPD who are chronic smokers have an increased likelihood of develop in.
halitosis,
extrinsic tooth stains
nicotine stomatitis.
black hairy tongue in a cigarette smoker
periodontal disease
and oral cancer(SCC),leukoplakia and erythroplakia
theophylline has been associated with the development of Stevens-Johnson syndrome
.

black hairy tongue in a cigarette

nicotine stomatitis


SCC

erythroplakia

leukoplakia

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.

gingivitis

Oral 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.

scrofula

classic mucosal lesion is a painful, deep, irregular ulcer on the dorsum of the tongue

Large tongue.

Long soft palate.
Long uvula.
Redundant pharyngeal tissue.
Large tonsils.
Retrusive mandible.

GASTROINTESTINAL DISEASE

GASTROINTESTINAL DISEASE

It include the following:

Liver Disease
peptic ulcer
PSEUDOMEMBRANOUS COLITIS
Crohn disease
Ulcerative colitis
Gastroesophageal reflex

Hemorrhage in palate

angular or labial cheilitis
Atrophic tongue

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 granulomma

Labial swelling ,fissuring and angular chelitis in orofacial granulomma

Oral ulceration in orofacial granulomatosis

Cobblestone appearance in orofacial granulomatosis

Mucosal tags in orofacial granulomatosis

Gingival proliferative lesion in orofacial granulomatosis

Gingival lesion in orofacial granulomatosis

Gingival swelling and cobblestonning appearance of the oral mucosa of 2 children with orofacaial granulomatosis

Melkerson Rosenthal Syndrome consist of :

Facial paralysis.
Facial swelling.
Fissure tongue.
Plicated mucosal swelling.
It is closely related to crohn disease.

Melkerson Rosenthal Syndrom

Facial 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 reflex

Erosion of the enamel exposes the underlying dentin.
PSEUDOMEMBRANOUS COLITIS
Associated with candidiasis
Gastro intestinal disease

Pallor of oral mucosa

Xerostomia
Pigmentation of oral mucosa
Parotid infections
Dysgeusia
Candidiasis
Petechiae and ecchymosis of oral mucosa and bleeding tendency.
stomatitis

Enamel hypoplasia

Osteodystrophy (radiolucent jaw lesions)
Uremic stomatitis.
Metallic taste.
Ammonia breath odor.
Loss of lamina dura.
bone radiolucency.

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.
Petechiae, ecchymosis.
higher plaque and calculus indices, and lower levels of salivary

Sexually transmitted disease

This include the diseases:
GONORRHEA
SYPHILIS
GENITAL HERPES
INFECTIOUS MONONUCLEOSIS
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 syphilis

It 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 lip

Papilloma of the oral mucosa
just inside the right commissure
Gingival papilloma

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 mononucleosis

Palatal petechiae in infectious mononucleosis

AIDS and related conditions

Dry 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(.
Swollen Glands

AIDS and related conditions

Candidiasis (Erythmatous candidiasis, Pseudomembranous candidiasis.)
Herpes Simplex Lesions
necrotizing ulcerative periodontitis
necrotizing ulcerative gingivitis
oral hairy leukoplakia.
Kaposi sarcoma
Linear gingival erythema