OP: chapter #9 - oral manifestations of systemic diseases (exam 4)

agranulocytosis

marked decrease in the number of granulocytes, particularly neutrophils

anemia

reduction of the # of red blood cells, quantity of hemoglobin or volume of packed RBC's to less than normal

ecchymosis

small, flat, hemorrhagic patch larger than a petechia on the skin or mucous membrane

ketoacidosis

accumulation of acid in the body resulting from the accumulation of ketone bodies

neutropenia

a decreased number of neutrophils

petechia

minute red spot on the skin or mucous membrane caused by escape of a small amount of blood

immunodeficiency

this can lead to opportunistic diseases such as infection and neoplasia

bone disease

this can affect the maxilla and mandible

systemic disease

this can cause dental and periodontal changes

systemic disease drugs

this can affect oral tissue

endocrine system

consists of a group of integrated glands and cells that secrete hormones

endocrine disorders

too much or too little hormone is produced

hyperpituitarism

excess hormone production by the anterior pituitary gland

hyperpituitarism

cause = pituitary adenoma that produces growth hormone

gigantism

results if hyperpituitarism occurs before the closure of long bones in adolescence

acromegaly

results when hypersecretion occurs during adult life with hyperpituitarism

gigantism; acromegaly

conditions caused by hyperpituitarism

gigantism

clinical features:

-excessive growth of skeleton

-8+ feet the tall

-weighs several hundred pounds

-suffer from headaches, chronic fatigue, muscle & joint pain

gigantism

tx:

-surgical removal or radiation of pituitary adenoma

acromegaly

clinical features:

-affects men & women in their 40s

-poor vision

-light sensitivity

-enlargement of hands and feet

-increase in rib size

acromegaly

facial changes:

-enlargement of maxilla and mandible may cause separation of teeth and malocclusion (open bite)

-enlarged forehead and an enlargement of nasal bones

-enlargement of maxillary sinus = deepening of voice

acromegaly

mucosal changes

-may have thickened lips and macroglossia

acromegaly

tx:

-pituitary gland surgery or radiation therapy

hyperthyroidism

thyrotoxicosis; graves disease

hyperthyroidism

excess production of thyroid hormone:

-increases patient's metabolism

-10x more common in women than in men in their 30s and 40s

-most common cause is graves disease

graves disease

an autoimmune disorder in which antibodies stimulate the thyroid cells

graves disease

clinical signs:

-thyroid gland enlarges

-too much thyroid hormone is produced

-increase in patient's metabolism

hyperthryoidism

clinical features:

-thyroid enlargement

-exophthalmos

-weight loss

-excessive sweating

-rosy complexion and erythema of palms

-fine hair and softened nails

-anxiety, weakness & restlessness

-cardiac problems due to increased stress on the cardiovascular system that leads to higher occurrence of stroke

hyperthyroidism

oral manifestations in children:

-premature exfoliation of deciduous teeth

-premature eruption of permanent teeth

hyperthyroidism

oral manifestations in adults:

-osteoporosis may affect alveolar bone

-caries and periodontal disease may appear and develop more rapidly in these patients

-burning tongue

hyperthryodisim

tx:

-surgery removal of thyroid

-medications to suppress thyroid activity

-administration of radioactive iodone

hypothyroidism

a decreased output of thyroid hormone

hypothyroidism

causes include:

-treatment for hyperthyroidism

-developmental disturbances

-autoimmune destruction of thyroid

-iodine deficiency of mother during pregnancy

-drugs

hypothyroidism

oral manifestations:

-cretinism

-myxedema

cretinism

oral manifestations:

-thickened lips

-enlarged tongue

-delayed eruption of teeth

myxedema

oral manifestations

-macroglossia (enlarged tongue)

-swelling of face and extremities

-fatigue

-weakness

-dry skin

-slow heart rate and lower body temperature

hyperparathyroidism

results from excessive secretion of parathyroid hormone from the parathyroid glands

parathyroid hormone

plays a role in calcium and phosphorus metabolism

hyperparathyroidism

clinical features:

-found in adults over 60 years

-more common in women

-mild cases may be asymptomatic or may have joint pain/stiffness

-lethargy and coma may occur

-kidney stones b/c of increased calcium secretions

-affects skeletal system and gastrointestinal system

hyperparathyroidism

oral manifestations:

-bone changes = loosening of teeth

-well defined unilocular or multilocular radiolucencies

-ground glass appearance, loss of lamina dura

hyperparathyroidism

treatment:

-correcting the cause of increased hormone production (tumors, renal disease, kidney failure, vitamin D deficiency)

diabetes mellitus

a chronic and incurable disorder of carbohydrate metabolism characterized by abnormally high blood glucose levels

hyperglycemia

high blood glucose levels

diabetes mellitus

results from:

-lack of insulin

-defective insulin that does not work to lower blood glucose levels

-increased insulin resistance caused by obesity

ketoacidosis

features:

-breakdown of fatty tissue leads to production of ketone acid

-ketone acids lowers the blood pH

-acute condition can lead to coma and death

-increased susceptibility to infection due to delayed WBC activity

diabetes mellitus

complications:

-damage to blood vessels

-organ systems (eyes, kidney, nerves)

-atherosclerosis of large & medium size blood vessels

macrovascular disease

complications:

-thrombi can cause gangrene and amputation

-myocardial infarction/heart attack = most common cause of death

-stroke or cerebrovascular accident

diabetes mellitus

tx:

-control of blood glucose alone is NOT sufficient

-control blood sugar, diet & exercise

-control cholesterol

-control blood pressure

-role of dentists and dental hygienists = education

type 1 diabetes

insulin dependent diabetes mellitus

type 1 diabetes

thought to be an autoimmune disease

type 1 diabetes

insulin-producing cells of the pancreas are destroyed

type 1 diabetes

3% of all diabetic patients have this type & can occur at any age with the peak age = 20

type 1 diabetes

abrupt onset & includes 3 P's:

-polydipsia = excessive thirst

-polyuria = excessive urination

-polyphagia = excessive appetite

type 1 diabetes

patients require insulin their entire lives

type 1 diabetes

the current approach to management of these patients involves:

-multiple insulin injections

-proper diet & exercise

-frequent determination of blood glucose levels

hypoglycemia

low blood sugar

severe hypoglycemia

insulin shock

brittle diabetes

uncontrolled blood glucose levels

type 2 diabetes

non-insulin dependent diabetes mellitus

type 2 diabetes

-characterized by insulin resistance

-97% of all diabetic patients have this type of diabetes

-gradual onset

-usually occurs 35-40 years of age or older as metabolism slows

type 2 diabetes

characterized by:

-weight gain = social, cultural, ethnical

gestational diabetes

features:

-occurs during pregnancy

-disappears after pregnancy

-increased birth weight of child

-mother & child have a higher risk of developing type 2 diabetes later in life

type 2 diabetes

clinical features:

-vascular system adversely affected

-decreased resistance to infection

-skin infections

-urinary tract infections

-tuberculosis

acanthosis nigricans

-clinical feature of type 2 diabetes

-pigmented, velvety plaques in the folds and creases of the body

type 2 diabetes

oral complications:

-oral candidiasis

-mucormycosis

-bilateral asymptomatic parotid gland enlargement

-xerostomia

-periodontal disease

-heightened response to plaque

-slow wound healing

-increased susceptibility to infection

diabetes mellitus

periodontal disease:

-significant complication

-aggravates the control

-significant predictive clinical marker

-if disease is uncontrolled, so is periodontal disease

addison disease

insufficient production of adrenal steroids

addison disease

causes:

-malignant tumor

-tuberculosis

-deep fungal infections

-hiv infection

-autoimmune disease

-unknown

addison disease

to compensate, the pituitary gland increases production of adrenocorticotropic hormone

addison disease

clinical features

-stimulation of melanocytes

-bronzing of the skin

-melanotic macules on oral mucosa

addison disease

tx:

-corticosteroid replacement therapy

primary adrenal cortical insufficiency

other name for addison disease:

hypercorticolosim

other name for cushing syndrome

cushing syndrome

caused by sustained increase in glucocorticoid levels

cushing syndrome

usually from prescribed corticosteroid therapy for autoimmune disease or organ transplantation

cushing syndrome

pituitary adenoma is the cause

cushing syndrome

features:

-weight gain

-buffalo hump

-moon facies

-poor healing

blood disorders

the complete blood count examines red blood cells, white blood cells and platelets

anemia

a reduction in the oxygen-carrying capacity of blood

anemia

most often related to a decrease in the number of circulating RBCs

anemia

-nutrition: iron, folic acid & vitamin b12

-suppression of bone marrow stem cells

anemia

oral manifestations:

-same for ALL types

-pallow of skin and oral mucosa

-angular cheilitis

-erythema & atrophy of oral mucosa

-loss of filiform & fungiform papillae on the dorsum of the tongue

iron deficiency anemia

an insufficient amount of iron is supplied to bone marrow for red blood cell development

iron deficiency anemia

most common anemia in the US

iron deficiency anemia

possible causes:

-deficient iron intake

-blood loss from heavy menstrual bleeding or chronic GI bleeding

-poor iron absorption

-increased requirement for iron in situations such as pregnancy or infancy

iron deficiency anemia

features:

-often asymptomatic

-patients may experience:

*weakness

*fatigue/low energy

*shortness of breath

*cardiac palpitations

iron deficiency anemia

tx:

-dietary supplements

pernicious anemia

vitamin b12 deficiency caused by a deficiency in intrinsic factor

pernicious anemia

probably an autoimmune disorder in most situations

vitamin b12; folic acid

essential nutrient needed for DNA synthesis

pernicious anemia

oral manifestations:

-angular cheilitis

-mucosal pallor

-painful, atrophic & erythematous mucosa

-mucosal ulceration

-loss of papillae on the dorsum of the tongue

-burning and painful tongue

folic acid and vitamin b12 deficiency anemia

oral manifestations:

-indistinguishable from those of pernicious anemia

sickle cell anemia

an inherited blood disorder

sickle cell anemia

characteristics:

-predominantly in black, Mediterranean or asian origin

-occurs before age 30 and after 6 months

-more common in women

sickle cell anemia

-red blood cells develop a sickle shape when there is decreased oxygen

-can be triggered by exercise, exertion, administration of a general anesthetic, pregnancy or even sleeop

sickle cell anemia

clinical features:

-joint PAIN

-weakness

-shortness of breath

-fatigue and nausea

-delayed growth in children

-sickle cell crisis

-acute chest syndrome

-abnormalities in kidney function, eyes, cardiovascular system & CNS

-heart enlargement and cardiac failure

sickle cell anemia

-there is a loss of trabeculation and large, irregular marrow spaces appear

-changes in skull trabeculae radiate outward

-"hair on end" appearance

sickle cell anemia

diagnosis:

-sickle shaped or crescent shaped cells may be seen on a blood smear

-number of red blood cells is low

-hemoglobin content is low

sickle cell anemia

tx:

-largely supportive

-administration of oxygen

-removal of abnormal RBC and blood transfusion with normal RBC

-unpredictable prognosis

pancytopenia

severe depression of bone marrow activity causes a decrease in all circulating blood cells