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 hyperplasiaNo 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 caused by 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 ulcerationDry 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 stomatitisSCC
erythroplakia
leukoplakiaStevens-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 reflexHemorrhage in palate
angular or labial cheilitisAtrophic 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 granulomatosisMucosal tags in orofacial granulomatosis
Gingival proliferative lesion in orofacial granulomatosisGingival lesion in orofacial granulomatosis
Gingival swelling and cobblestonning appearance of the oral mucosa of 2 children with orofacaial granulomatosisMelkerson 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 lipPlication 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 INFECTIONOral 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 commissureGingival 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