(2) Oral Manifestatios of Systemic Disease
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Transcript of (2) Oral Manifestatios of Systemic Disease
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ORALMANIFESTATIOS OF
SYSTEMIC DISEASEDEPT. OF DERMATOLOGY
K.A.U.H
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Biology of the mouth
Oral epithelium:
- keratinised: masticatory mucosa (hard
palate, gingiva and post tongue)- non-keratinised: lining mucosa (buccal,
labial, alveolar, floor of the mouth, ventral
tongue and soft palate)- Specialised: dorsum of tongue. Taste.
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Biology - Immunity
Mechanical: movement of tissue, speech,
salivation (Xerostomia)
Saliva: enzymes, mucin GALT: B-cell and IgA
Cellular: Neutrophils and others WBC. If
abnormal: inf ulcers, periodontal diseaseand gingivitis
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*Dis. Affecting teeth
Loosening and early loss: locals: gingivitis.
systemic: DM, low immunity (HIV, Leuckopenia), disease
of CT. Discoloration:
Extrinsic causes: poor hygiene, smoking, drinks, stains..
Intrinsic: drugs (Tetracyclines), flurosis, porphyria,kernicterius.
Hypodontia and malformed teeth: Ectodermaldysplasia.
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*Dis. Affecting Periodontium1. Gingival Bleeding
- Locals: gingivitis, periodontitis, acute
necrotizing gingivitis (poor hygiene, HIV,
Neutropenia, leukemia)
- Systemic: Leukaemia, HIV, clotting disease,
drugs (anticoagulants), scurvy.
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Period.2. Swelling
Locals:
Chronic Gingivitis.
Hyperplastic (Mouth breathers).
Tumors and cysts.
Systemic:
Pregnancy.
Drugs (Phenytoin, ciclosporine, Nifidipine).
Sarcoidosis.
Leukemia.
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Period. Swelling/cont.
Systemic
Infiltartives: Amyloid, Mucopolysaccharides,
Mucolipidosis, Lipoid proteinosis..
Crohns dis
Wegners granulomatosis
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Dis. Period-3.Gingival redness
Gingival redness:
local: chronic gingivitis (commonest)
systemic: Desquamative gingivitis, HSV,Vascular abnormality (HHT, Haemangioma,
KS..), Bullous diseases; esp. Pemphigus, Allergic
response.
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PERIODO-4. WHITE PATCHES (Leukoplakia)
Locals:
Frictional, smokers, ca, burns..
systemic:
Candidiasis, L.P, Lupus, CRF, Hairy
Leukoplakia, white-sponge naevus, Syphilitic.
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Dis Of Period.-5.Pigmentation
This can be seen normally in dark people.
Local causes: Amalgam tattoo, melanocytic
macules Systemic causes: Addisons dis., K.S,
Melanoma and Drugs (Hydroxychloroquine,
minocycline).
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Pigment. Amalgam tattoo
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Cont. Ulcers
Drugs: Cytotoxics, NSAIDS, Alendronate.
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Dis Of period.7 - Blisters
Locals: Burn, Mucoceles
Underlying cause: Immunobullous
conditions usually present as desqumativegingivitis (Pemphigus, B.P, MMP), HSV.
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Desquamative Gingivitis
Persistent red glazed sometimes painful
labial gingiva (usually sparing margins)
Causes: MMP, LP>>,BP, DH, LAD,.. Treatment: difficult but: improved hygiene,
Topical Steroids or Tacrolimus. Severe:
Dapsone
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Dequ. Gingivitis
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Drug induced gingival swelling
Phenytoin, Ciclosporin, Nifedipine and
Diltiazem.
Increase with prolonged use and poor oralhygiene.
Mx: good oral hygiene, removal of plaque
prior to initiation of treatment, surgicalexcision.
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Gingival swelling-Phenytoin
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*Dis of oral mucosa-1.Pigmentation
Normal in dark people, Asians and Mediteranians.Bilateral and symmetrical.
Melanocytic macules are seen in 3% pop.
Other causes: Melanoma and Ks
Addisons disease and ectopic ACTH
Drugs (minocycline, antimalarials, occp..)
Malignant Acanthosis nigricans Rare causes (NF, Hemochromatosis,IP..)
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Mucosal2. Redness
Infections: HSV, Candidiasis.
Inflammatory: LP, MMP, Pemphigus,
Allergic. Vascular: Telangiectasia (HHT), KS, PWS.
Nutritional: Low B12, Folate, Iron (red
tongue). Drugs (mucositis).
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Mucosal redness
GT (geographical tongue).
MX: Look for signs of underlying dis. check
hematenics (B12, Folate , Iron).
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Redness- GT
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Mucosal3.Ulcers
Local causes: Trauma, orthodontic
applicances, Tumors
Recurrent Aphthous stomatitis Systemic causes:
Haematological, GI, Dermatological,
Infective, Vasculitis, Iatrogenic, ?,drugs
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RAS
Recurrent episodes of ulceration each
lasting 1-4 weeks.
Aetiology: ? But: search for cause Clinical patterns:
Minor 80% (
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RAS
Investigations: FBC,ESR,IRON,
B12,FOLATE,ANTIENDOMYSIAL ab.
Treatment:most cases-eventual remession
Topical anti Inflammatory agents
Systemic agents: Steroids, Colchicine,Dapsone. Thalidomide.
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RAS
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Mucosal-4. White patches (Leukoplakia)
Infective (Candida, Hairy Leukoplakia).
Inflammatory (LP.LE..).
Liver and Renal diseases. Genetics: Whitesponge Nevus.
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Leukoplakia
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Leukoplakia-LP
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Mucosal-5.Blisters/Erosions
Locals: Burn, Mucocele..
Underlyings: Pemphigus, BP, MMP,EB,EM,
Infections: HSV, Chickenpox, Coxackie..
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Behcets Syndrome
Major Criteria: Oral aphthae: 90-100%
Genital ulcers: 60-80%
Ocular (iridocyclitis, vasculitis..): 10-90%
CNS (Meningioencephalitis)
Skin (pustules, EN, Pathergy) 50-90%
Minors: proteinuria, thrombophlebitis,Aneurysms, Arthralgias.
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Behcets syndrome
Mx of oral ulceration:
Mild: Topical steroids , 5-Aminosalicylic acid,
others.
Severe: Colchicine, Ciclosporine, Azathioprine
Main Morbidity is related to Ocular Disease
so always involve an Ophthalmologist.
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Lichen Planus
Aetiology?
Cutaneous: itchy papules, violaceouscolour. Hair and nails may be involved.
Oral:
1. Bilateral white areas- Linear, Reticular,P/P
2. Erosive OLP: Dorsal and Lateral bordersof tongue, Buccal Mucosa.
3. Desquamative Gingivitis.
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LP-CONT
Mx:
MILD: Topical CS
Moderate: topical Tacrolimus +- Top Cs Severe: oral steroids, Ciclosporine,
hydroxychloroquine, Azathioprine, Acitretin.
EOLP: Risk of SCC.
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Pemphigus
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Oral involvement in Various dis-Endocrine
Addisons: mucosal hyper pigmentation.
Congenital hypothyroidism: macroglossia.
Acromegaly: macroglossia. DM: Period disease, Xerostomia,
candidiasis.
Pregnancy: Gingivitis, Epulis.
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GIT
Pernicious Anemia: ulcers, glossitis,
ang.stomatitis, red lesions
Coeliac : ulcers, glossitis, angular stomatitis P-J synd: melanosis
Crohns: ging. Hyperplasia, ulcers, golssitis,
cobblestoning of mucosa
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Hematologic
Hematinic def: Burnning, ulcers, glossitis,
angular stomatitis
Sickle cell :osteomyelitits of Jaw WBC : Ulcers, infections
Hemostsis def: bleeding
Leukemias: ging swelling, bleeding,infections and ulcers
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Renal
CRF: Xerostomia, Halitosis, Leukoplakia,
bleeding
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Drugs
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CTD
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others
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END