Oral Manifestations of Systemic Diseases

what is traumatic ulcerative granuloma w stromal eosinophilia (tugse)

deep chronic ulceration due to damaged muscle- from repetitive trauma

what is the common age group w traumatic ulcerative granuloma w stromal eosinophilia (tugse)

usually adults

common location of traumatic ulcerative granuloma w stromal eosinophilia (tugse)

tongue > buccal and lip

tx for traumatic ulcerative granuloma w stromal eosinophilia (tugse)

incisional biopsy and remove cause of trauma

how long would you wait to biopsy an ulcer, why would you do this

MUST DO A BIOPSY on ulcers that are present for more than 2 weeks; can look clinically similar to squamous cell carcinoma

what are the 5 non-endocrine systemic diseases we go through

• jaundice

• amyloidosis

• crohn disease

• hypophosphatasia

• Vit D resistant rickets

what are the 5 endocrine systemic diseases we go through

• pituitary (gigantism/ acromegaly/ dwarfism)

• thyroid (hypo/hyperthyroidism)

• parathyroid (hyperparathyroidism)

• pancreas (T1/2DM)

• adrenal (addisons, cushings synd/disease)

jaundice is also known as

icterus

what is jaundice

excess bilirubin in the bloodstream accumulates in yellowish discoloration of the skin and mucosa

what is the bilirubin level in someone w jaundice

exceeds 2 mg/dl

what are the 5 common causes of jaundice

physiologic or pathologic:

• hemolytic anemia/sickle cell anemia

• liver disease

• bile duct obstruction

• cancer

• gilbert syndrome (glucuronosyltransferase)

are there oral manifestations w jaundice

no- just the yellow skin color usually

what are you suspicious of

jaundice

what is amyloidosis

group of conditions characterized by the deposition of an extracellular, proteinaceous substance termed amyloid

most of the time amyloidosis is systemic, why is this concerning

can lead to death most of the time within a few years due to cardiac or renal failure

there are 5 classifications of amyloidosis but we only need to know 2! what are they

• organ limited

• primary and myeloma associated amyloidosis

features of organ limited amyloidosis (2)

• limited to one organ

• infrequent oral features

what age group and gender type is more affected by primary and myeloma associated amyloidosis

older males

in primary and myeloma associated amyloidosis, 15-20% are due to…

multiple myeloma

extra-oral locations affected by primary and myeloma associated amyloidosis

extra-oral: eyelid, neck, lips

intra-oral manifestations of primary and myeloma associated amyloidosis

thick lips (rock-solid), macroglossia

how can skin appears in primary and myeloma associated amyloidosis

smooth-surfaced, firm, waxy papules and plaques

what is Chrohn’s disease

inflammatory and immunologically mediated condition of unknown cause

common age affected by Crohn’s disease

teenagers

location affected by Crohn’s disease

anywhere along the GI tract

common symptoms of Crohn’s disease

abdominal cramping, diarrhea, pain, nausea, and fever; weight loss and malnutrition may develop

in Crohn’s disease, oral lesions are significant bc they precede…

the GI lesions 30% of the time

what are some oral manifestations of Crohn’s disease

• diffuse, nodular swelling

• cobblestone appearance of oral mucosa

• linear ulcerations of the buccal vestibule

tx for oral lesions in Crohn’s disease

sulfa drug/prednisone; oral lesions will clear w tx of GI disease

what is hypophosphatasia

rare metabolic disease where there is a decrease in alkaline phosphatase enzyme

mode of inheritance in hypophosphatasia

AD

oral manifestations pf hypophosphatasia

• lack of cementum

• premature loss of teeth: esp lower incisors

• bone abnormalities

what is vitamin d-resistant rickets also known as

hereditary hypophosphatemia

what is the mode of inheritance of vitamin d-resistant rickets/ hereditary hypophosphatemia

X-linked

does vitamin d-resistant rickets/ hereditary hypophosphatemia affected M or F more

M

common age affected by vitamin d-resistant rickets/ hereditary hypophosphatemia

early age: infancy/childhood

what is vitamin d-resistant rickets/ hereditary hypophosphatemia

• low serum phosphate (no problem w the enzyme)

• low calcium

• normal vitamin D

oral manifestations of vitamin d-resistant rickets/ hereditary hypophosphatemia

• large pulp horns extending to DEJ

• multiple non-vital teeth

• absence of caries or trauma

what is the most common cause of anemia

iron deficiency

clinical (non-oral) manifestations of iron deficiency anemia

fatigue, tired, lightheaded, lack of energy

oral manifestations of iron deficiency anemia

angular cheilitis, atrophic tongue, glossitis, burning sensation maybe due to candidiasis

what is plummer-vinson syndrome also known as

paterson-kelly syndrome

what is plummer vinson syndrome/paterson-kelly syndrome

rare condition in women of scandinavian or north european background

clinical (non-oral) manifestations of plummer vinson syndrome/paterson-kelly syndrome

• iron deficiency anemia

• dysphagia

• koilonychia

oral manifestations of plummer vinson syndrome/paterson-kelly syndrome

• atrophic glossitis

• esophageal webs

• premalignant and associated w oral and esophageal SCC

etiology of gigantism

inc in growth hormone from pituitary gland before closure of the epiphyseal plates

is gigantism pre or post puberty

pre-pubertal

is acromegaly pre or post puberty

post-pubertal

oral manifestations of gigantism

• enlarged mandible + prognathism

• generalized macrodontia

etiology of acromegaly

inc in growth hormone from pituitary gland after closure of epiphyseal plate

what is dwarfism

dec secretion of growth hormone from the pituitary gland

oral manifestations of dwarfism

• maxilla/mandible smaller

• midface underdeveloped

• microdontia

• malocclusion

• delayed eruption and prolonged retention of teeth

• development of roots is delayed

• failure of development of 3rd molars

what gland plays a primary role in regulation of cellular metabolism

thyroid gland

what is hyperthyroidism

hyperfunction of thyroid gland, mass in the anterior midline of the neck

what are the most common causes of hyperthyroidism

Grave’s disease, toxic multinodular goiter

clinical manifestations of hyperthyroidism

• weight loss

• tachycardia

• excessive perspiration

• tremor

• warm smooth skin

• exophthalmos

• glossopyrosis (burning of the tongue)

• thyroid storm

what is thyroid storm

complication in dental tx due to other manifestations being heightened at the clinic (like tachycardia)

what are the two types of hypothyroidism

• cretinism (congenital hypothyroidism)- kids

• myxedema (acquired hypothyroidism)- adults

what are common manifestations of hypothyroidism

enlarged tongue, cold intolerance, thinning of hair

funx of parathyroid gland

regulation of Ca levels via phosphate diuresis and intestinal reabsorption of Ca

intraoral manifestations of hyperparathyroidism

• sometimes radiolucent lesions in the jaws, often multiple

• loss of normal trabecular bone pattern

• ground glass or frosted glass appearance

• loss of lamina dura around the teeth

what is addison’s disease also know as

hypoadrenocorticism- insufficient production of corticosteroid

a pt w addison’s disease can go through what is called Addison crisis, what is this

when there are low levels of corticosteroids in your body, these patients, especially under stressful situation, can go into kind of a hypovolemic shock bc they don't have the hormones to help them cope with the stress

addison’s disease is mostly systemic, but sometimes you can see one intraoral manifestation

a brown pigmentation that can can be on the lips intra orally and on the skin; more of that bronze color

addison’s disease most common age group affected

adults

cushing disease vs cushing syndrome

disease: endogenous cause, overproduction of cortisol caused by pituitary tumor, adrenal tumor, or unknown

syndrome: exogenous cause, taking medicines containing glucocorticosteroids

what are some common clinical manifestations that can be used to describe cushing’s syndrome

moon face, buffalo hump, purple striae

what is T1 diabetes

complete lack of insulin; young age onset

what is T2 diabetes

inadequate insulin production or resistant of target tissue

is T1 or T2 diabetes more common

T2

clinical manifestations of T1 D

polyuria, polydipsia, polyphagia, ketoacidosis

intra-oral manifestations of T2 D

• periodontal disease

• delayed healing

• infection

• oral candidiasis (30%)

• xerostomia (30%)

what is the normal blood glucose range

70-120 mg/dL