PD

Oral Manifestations of Systemic Diseases

Endocrine DisordersIntegrated glands and cells secrete hormones. Dysfunction may result from:

  • Overproduction (hyperfunction)

  • Underproduction (hypofunction)

Hyperpituitarism

Definition: Excess hormone production by the pituitary gland.Cause: Often due to a benign tumor (pituitary adenoma).Growth Hormone Effects:

  • During Development: Hypersecretion during growth can lead to gigantism, resulting in individuals exceeding 8 feet tall.

  • In Adults: Leads to acromegaly, characterized by excess growth hormone production after the closure of growth plates.

Clinical Features of Hyperpituitarism:

  • Excessive skeletal growth

  • Headaches stemming from increased intracranial pressure

  • Chronic fatigue impacting daily activities

  • Muscle pain due to abnormal hormone levels

  • Poor vision caused by optic nerve compression

Facial Changes: Enlarged maxilla and mandible may cause malocclusion, deepened voice, and macroglossia (enlarged tongue).

Treatment: Measurement of growth hormone; often treated by surgery to remove the tumor from the pituitary gland or medication to control hormone levels.

Hyperthyroidism (Thyrotoxicosis)

Definition: Excess production of thyroid hormone, more common in women than in men.Causes: Hyperplasia, tumors, pituitary disease, and metastatic tumors from other primary sources.Most Common Cause: Graves' Disease, an autoimmune disorder leading to overstimulation of the thyroid gland.

Clinical Features:

  • Symptoms include goiter (enlarged thyroid), rosy complexion, excessive sweating, fine hair, and exophthalmos (protruding eyes).

  • Oral Manifestations in Children: Can cause premature loss of baby teeth and early eruption of permanent teeth; may lead to osteoporosis in adults due to excessively high metabolic activity.

Treatment: Medications to suppress thyroid activity, radioactive iodine therapy, and sometimes surgery to remove part of the thyroid gland.

Hypothyroidism

Definition: Decreased thyroid hormone output resulting in slowed metabolic processes.Types:

  • Cretinism: Infants with untreated congenital deficiency leading to stunted growth and developmental issues.

  • Myxedema: Swelling of skin and soft tissues in older children/adults, associated with severe deficiency.Causes: Autoimmune diseases (like Hashimoto's thyroiditis), iodine deficiency, certain medications, and pituitary disease affecting hormone production.

Oral Changes:

  • In infants: Thickened lips, enlarged tongue, and delayed eruption of teeth can hinder nutritional intake.

  • In adults: Enlarged tongue, dry oral mucosa, and other oral symptoms possible such as periodontitis.

Hyperparathyroidism

Definition: Excess secretion of parathormone affecting calcium and phosphorus metabolism, leading to elevated calcium levels in blood.Causes: Hyperplasia, tumors (adenomas), or due to kidney failure; more prevalent in middle-aged women.

Clinical Features: Symptoms range from mild cases being asymptomatic to severe lethargy, fatigue, kidney stones, and even coma in critical cases.

Oral Manifestations Include: Changes in the bone density, radiographically presenting as radiolucencies (dark areas) in the jawbones; can lead to pathologic fractures.

Diabetes Mellitus

Definition: Chronic disorder affecting carbohydrate (glucose) metabolism, leading to hyperglycemia due to inadequate insulin production or utilization.

  • Types of Diabetes:

    • Type 1: Insulin-dependent, with onset at any age but predominantly in younger populations, characterized by polyuria, polydipsia, and polyphagia.

    • Type 2: Non-insulin dependent, developing progressively, commonly associated with obesity, sedentary lifestyle, and increased insulin resistance.

Oral Complications: Fungal infections (like Candida), xerostomia (dry mouth), increased incidence of dental caries, periodontal disease, and delayed healing of tissues after injury or surgery.

Addison Disease

Definition: Primary adrenal cortical insufficiency characterized by insufficient production of adrenal steroids.Oral manifestations: Brown pigmentation of the skin and oral mucosa occurs due to increased melanocyte-stimulating hormone levels; this may also affect the gums.Treatment: Steroid replacement therapy to manage symptoms and prevent adrenal crises.

Blood Disorders

AnemiaDefinition: Decrease in the number of red blood cells or hemoglobin, leading to reduced oxygen delivery. Common forms include iron deficiency anemia and pernicious anemia (vitamin B12 deficiency).Oral manifestations: Pallor of the mucosa, atrophy of tongue papillae leading to a smooth or smooth red tongue, and angular cheilitis.

Sickle Cell AnemiaDefinition: Inherited disorder characterized by abnormal hemoglobin that leads to sickle-shaped red blood cells, obstructing blood flow, and causing pain episodes.Clinical Features: Common symptoms include fatigue, joint pain, weakness, and episodes of pain crises. Oral manifestations feature loss of trabeculation on radiographic imaging of the jawbones.

Celiac SprueDefinition: A chronic disorder leading to sensitivity to gluten, which damages the intestinal lining and affects nutrient absorption.Oral Manifestations: Can cause a painful tongue, mucosal ulceration, and delayed eruption of teeth.Treatment: Strict adherence to a gluten-free diet to manage symptoms and promote healing.

HemophiliaTypes:

  • Type A: Caused by Factor VIII deficiency.

  • Type B: Caused by Factor IX deficiency.Oral manifestations: Significant risk of spontaneous gingival bleeding, especially after surgical procedures or injuries.

Immunodeficiency Disorders

Divided into primary (due to genetic defects) and secondary (acquired from other illnesses or conditions such as HIV/AIDS).

Conclusion

Understanding systemic diseases and their oral manifestations is crucial for diagnosis and management in dental practice. Suitable treatment plans must be integrated based on the systemic condition of the patient.