Oral Manifestations of Systemic Disease II

• How might anaemia present orally in terms of discolouration?

  Pallor, bleeding to palate of mucosa, red beefy sore tongue
• What might unusual pigmentation on the oral mucous membrane, usually that of a brown melanin type pattern represent?

  Either ethnicity or Addison's disease
• How might CVD & respiratory disease present orally?

  Blue pigmentation due to cyanosis
• How might jaundice present orally?

  Yellow tint (have to take it seriously because it might be haemolytic, obstructive hepatic or viral, infectious hepatitis)
• Why might the oral mucosa go white?

  Keratosis (maybe because of trauma, mucosal disease, candida or cancer)
• What can blue/brown tinges at the gingival margin indicate?

  Heavy metal poisoning (lead/bismuth)
• What might a blue/brown patch elsewhere on the oral mucosa represent?


  Melanoma, amalgam tattoo or silver sulphide from degradation products of an old silver point RCT
• What conditions might purpura or gingival/mucosal bleeding be indicative of?

  
• What conditions might acute gingivitis reflect?

  Acute leukaemia

  immunodeficiencies

  AIDS

  Agranulocytosis

  Uncontrolled diabetes

  Scurvy (vitamin c deficiency)

  Pellagra (Vit B3 deficiency, v rare)
• What 3 main drug causes is gingival hyperplasia usually related to?

  Nifedipine

  Cyclosporin

  Phenytoin

  (always consider leukaemias)
• What can stomatitis (ulcerations) be indicative of?

  
• What are some disorders with haematological associations that could present as stomatitis?


  Haematinic deficiencies

  Cyclic neutropenias

  Leukaemias
• Which drug therapies can result in mucosal breaches and therefore stomatitis/ulcerations?

  Cardiovascular- beta blockers, nicorandil

  Oral hypoglycaemics (DM2)

  Chemotherapy cytotoxins

  Sulphonamides

  Barbiturates

  Gold

  Urea
• What systemic infections can manifest in the oral mucosa & perioral tissues?

  Measles (small white spots known as Koplick's spots produced, not to be confused with fordyce granules which are completely normal)

  
  

  Chicken pox (cutaneous rash)

  
  

  Syphilis:

  (primary: ulcer at innoculation site)

  (secondary: snail track ulcer, widespread rash, generally feeling unwell)

  (tertiary: gumma, can lead to nasal speech, Holmes Adie pupil, leucoplakia)

  
  

  Herpes zoster

  
  

  Herpes simplex

  
  

  TB (painful, hiding ulcer)

  
  

  Actinomycoses (following wisdom teeth removal, fistula forms, yellow sulphur granules)
• Which GI tract conditions could present with stomatitis?

  Oro-facial granulomatosis

  Crohn's disease

  Coeliac disease

  Ulcerative colitis

  
• Which different conditions do oro-facial granulomatoses comprise?

  Oro-facial granulomatoses : swelling and irritation in the mouth and face

  
  

  Melkersson-Rosenthal syndrome - Labial & peri-oral swellings + facial nerve paralysis + pilcated tongue

  
  

  Meischer's syndrome - Lip swelling only

  
  

  Foodstuffs hypersensitivity (type IV)

  
• What is coeliac disease and how can it present?

  - Allergy to gluten

  - Oral ulceration

  
  

  -Small bowel malabsorption of many vitamins, minerals and micro-nuitrients

  
  

  -Angular cheilitis (sore cracked corners of the mouth)

  
  

  -Burning of the mouth

  
  

  -Glossitis (inflammation of the tongue)

  
• What is ulcerative colitis and how can it present orally?

  Mural inflammation in colon wall primarily

  Features shallow non-granulomatous mural ulcerations & they don't tend to form fistulas (unlike Crohn's disease)

  Oral manifestations included

  
• Which diseases that affect the skin can also affect the oral mucous membrane?

  Pemphigus

  Mucous membrane pemphigoid

  Epidermolysis bullosa

  Erythema multiforme

  Lichen planus (most common)

  Linear IgA disease

  Dermatitis herpetiformis
• Which lupus conditions can manifest in and around the mouth?

  The 2 images are manifestations of discoid lupus, not systemic lupus

  
• What is keratosis?

  White patch changes on the oral mucosa, can be attributed to lichen planus, lupus, immunosuppression, candidosis, renal failure, tertiary syphilis

  
• What might cause glossitis (inflamed/sore tongue)

  -Anemia

  
  

  -Vitamin deficiency