Oral Manifestations of Systemic Disease III

• What is macroglossia & what can it be associated with?

  Enlarged tongue, can be associated with:

  
  

  Hypertrophy/hyperplasia from use e.g. filling extracted tooth sites to maintain chewing

  
  

  Acromegaly (late pituitary growth hormone excess)

  
  

  Amyloidosis

  
  

  Neurofibromatosis

  
  

  Haemangioma & Hamartomas

  
  

  Lymphangiomas

  
  

  Neoplasia

  
• What is important to note about the clinical presentation of macroglossia?

  That the tooth imprints on dorsum of tongue suggesting enlargement (white arrows) unlike lateral margin indentations (crenulations) suggesting a tongue thrusting habit

  
• What is amyloidosis?


  Protein deposition in soft tissues- often tongue & renal involvement
• How do you prove a diagnosis of amyloidosis?

  Positive staining to congo-red

  
  

  You can also expect birefringence on cross polarised light microscopy

  
• What diagnostic criteria would prove that dry mouth is Sjogren's syndrome?

  
• What else can cause dry mouth?

  Drugs: beta blockers, anti-depressants, etc

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  Obligate mouth breathers

  
  

  Anxiety states
• What is the Challacombe scale?

  Measures clinical oral dryness

  
• What variety of effects can viral immunodeficiency cause?

  Common:Cervical lymphadenopathy, candidosis, Kaposi's sarcoma, hairy leucoplakia

  Less common:angular cheilitis, herpes simplex/zoster, venereal warts, recurrent ulcers, rapidly progressive periodontitis, histoplasmal ulcers, cytomegalovirus, lymphoma, parotitis, etc.

  
• What could be some symptoms of oral cancer?

  
• What do we mean by changes in the jaw and what could this be attributed to?

  Areas of resorption or patchy resorption & sclerosis in the jaws, which may be due to skeletal diseases & associated with changes in the blood chemistry.

  
  

  Might be Paget's disease, widespread metastases, hyperparathyroidism, Gardner's syndrome

  
• What is Gardner's syndrome?

  GI polyps and associated findings of SOD:-Sebaceous cysts-Osteomas-Desmoid tumors

  polyps have higher malignancy potential
• What is the most common cause of cervical lymph node enlargement?

  Oral sepsis

  
• Why else might the cervical lymph node be enlarged?

  It may be the first sign of diseases of the reticuloendothelial system:

  
  

  Glandular fever

  Hodgkin's disease

  Non-Hodgkin lymphoma

  Lymphocytic leukaemia

  AIDS & its prodromes

  Or metastatic disease (e.g. oral squamous cell carcinoma)

  
• What manifestations of the hands and arms can show signs of other conditions?

  
• Clubbing


  bulbous enlargement of distal phalanges of fingers and toes that occurs with chronic cyanotic heart and lung conditions