Friday, October 28, 2011

Oral manifestations of systemic diseases

GIT diseases
Crohn disease
diffuse labial, gingival or mucosal swelling
cobblestoning of buccal mucosa and gingiva
aphtous ulcers
mucosal tags
angular cheilitis
oral granulomas
Crohn disease
Ulcerative colitis
oral signs are present in periods of exacerbation of disease
aphtous ulceration or superficial hemorrhagic ulcers
angular stomatitis
pyostomatitis vegetans, pyostomatitis gangrenosum
pyostomatitis 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
enamel damage and
damage of the dentin
Chronic liver diseases
petechiae or gingival bleeding (hemostasis disorder)

Hematologic diseases
folate and vit. B12 deficiency or iron deficiency
red colour
atrophic papilae
recurrent aphthae
candidal infection
angular stomatitis
oral pain

gingival hypertrophy
mucosal ulcers
            Treatment of leukemia
reactivation of herpes simplex virus – oral mucosistis
gingival hypertrophy in leukemia
Summary of oral manifestations of gastrointestinal and hematologic diseases
Labial swelling
Crohn's disease

   Crohn's disease
   Iron-deficiency anemia
   Pernicious anemia
   Ulcerative colitis

Erosion of enamel and dentin
Anorexia nervosa/bulimia
        Gastroesophageal reflux
Ulcerations and erosions
   Crohn's disease
   Iron-deficiency anemia
   Pernicious anemia
   Pyostomatitis vegetans
   Ulcerative colitis

Anorexia nervosa/bullimia
Crohn's disease

Pyostomatitis vegetans
        Ulcerative colitis
Angular cheilitis
Iron-deficiency anemia

Aphthous ulcers
Crohn's disease
Pernicious anemia
Ulcerative colitis

Intraoral burning
   Iron-deficiency anemia
   Pernicious anemia

   Crohn's disease (steriod therapy)
   Iron-deficiency anemia
   Pyostomatitis vegetans (steriod therapy)
   Ulcerative colitis (steroid therapy

Connective-tissue diseases
Sjögren syndrome
autoimmune disease
men : women - 1 : 9
50 years and older
     Main signs
sicca syndrome
keratoconjuctivitis sicca
     Oral signs
decrease in saliva
dry, red, wrinkled mucosa
difficulty in swalloving and eating
disturbance in taste and speech
increased dental caries
atrophy of the papilae

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

diffuse sclerosis of the skin, GIT, heart muscle, lungs, kidney
    Oral signs
pursed lips – dificult to open the mouth
esophageal sclerosis ® gastroesophageal reflux – damage of enamel
pale, rigid mucosa
decreased mobility of tongue
salivary hypofunction

Lupus erythematosus
autoimmune disease
        Oral signs
similar tooral lesions of lichen planus – painful
damage of salivary glands - xerostomia

Pulmonary diseases
Cystic fibrosis
    Oral signs
disorder of salivary glands
swelling lips

    Oral signs
multiple, nodular, painles ulcerations of the gingiva, bucal mucosa, labial mucosa and palate
tumorlike swelling  of salivary glans
swelling of the tongue
                      facial nerve palsy
Cutaneous diseases
    Oral 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

Endocrine diseases
Diabetes mellitus
    Oral signs
xerostomia caused decreased salivation and increased glucosa level in saliva
oral infections
higher incidence of caries
bilateral enlargement of parotid glands
altered taste
burning mouth syndrome

    Oral signs
upper lip twitching

    Oral signs
loss of the lamina dura surrounding the roots of the teeth
decrease of trabecular density
osseous lesions „brown tumor“

Cushing´s syndrome
    Oral 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
moon face
Addison´s disease
Oral signs
„bronzing“ hyperpigmentation of the skin
oral mucosal melanosis – buccal mucosa, tongue
Renal diseases
Uremic stomatitis
in undiagnosed and untreated chronic renal failure
irritation and chemical injury of mucosa by ammonia or ammonium compounds
painful plagues and crusts – bucal mucosa, the floor or dosrum of the tongue, floor of the mouth
Type I
generalized or localized erythema
pain, burning, xerostomia, halitosis, gingival bleeding, candidiosis
Type II
secondary infection
painful plagues and crusts – bucal mucosa, the floor or dosrum of the tongue, floor of the mouth


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