Oral manifestations of systemic diseases

GIT diseases

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Crohn disease

– diffuse labial, gingival or mucosal swelling – „cobblestoning“ of buccal mucosa and gingiva – aphtous ulcers – mucosal tags – angular cheilitis – oral granulomas •

Ulcerative colitis

– oral signs are present in periods of exacerbation of disease – aphtous ulceration or superficial hemorrhagic ulcers – angular stomatitis – pyostomatitis vegetans, pyostomatitis gangrenosum cobblestoning of the gut mucosa pystomatitis vegetans

GIT diseases

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Gastroesophageal reflux

– reduction of the pH of the oral cavity below 5,5 – enamel damage – damage of the dentin – higher sensitivity (to temperature..), caries •

Chronic liver diseases

– jaundice – petechiae or gingival bleeding (hemostasis disorder)

Hematologic diseases

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Anemias

– folate and vit. B12 deficiency – iron deficiency – glossitis • red colour • athrophic papilae • recurrent aphthae – candidal infection – angular stomatitis – oral pain

Hematologic diseases

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Leukemia

– gingival hypertrophy – petechiae – mucosal ulcers – hemorrhage Treatment of leukemia – reactivation of herpes simplex virus – oral mucosistis

Summary of oral manifestations of gastrointestinal and hematologic diseases

Angular cheilitis • Iron-deficiency anemia Intraoral burning • Iron-deficiency anemia • Pernicious anemia Hemorrhage • Pyostomatitis vegetans • Scurvy • Ulcerative colitis Aphthous ulcers • Crohn's disease • Pernicious anemia • Ulcerative colitis Candidiasis • Crohn's disease (steriod therapy) • Iron-deficiency anemia • Pyostomatitis vegetans (steriod therapy) • Ulcerative colitis (steroid therapy

Summary of oral manifestations of gastrointestinal and hematologic diseases

Labial swelling • Crohn's disease Erosion of enamel and dentin • Anorexia nervosa/bulimia • Gastroesophageal reflux Gingivitis • Anorexia nervosa/bullimia • Crohn's disease • Scurvy Glossitis • Crohn's disease • Iron-deficiency anemia • Pernicious anemia • Ulcerative colitis Ulcerations and erosions • Crohn's disease • Iron-deficiency anemia • Pernicious anemia • Pyostomatitis vegetans • Ulcerative colitis

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Connective-tissue diseases

Sj ögren syndrome

– autoimmune disease – men : women - 1 : 9, 50 years and older Main signs – sicca syndrome – keratoconjuctivitis sicca – xerostomia Oral signs – decrease in saliva • xerostomia – dry, red, wrinkled mucosa • difficulty in swalloving and eating • disturbance in taste and speech • increased dental caries • infections • atrophy of the papilae • candidiasis

Connective-tissue diseases

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Kawasaki disease

– vasculitis of medium and large arteries Oral signs – swelling of papilae on the surface of the tongue (strawbery tongue) – intense erythema of the mucosal surfaces – cracked, cherry red, swolen and hemorrhagic lips

Connective-tissue diseases

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Scleroderma

– diffuse sclerosis of the skin, GIT, heart muscle, lungs, kidney Oral signs – pursed lips – dificult to open the mouth – esophafeal sclerosis  gastroesophageal reflux – damage of enamel – pale, rigid mucosa – teleangiectasias – decreased mobility of tongue – salivary hypofunction

Limited mouth opening and decreased tongue mobility Gingival retraction

Connective-tissue diseases

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Lupus erythematosus

– autoimmune disease Oral signs – ulcerations – oral lesions of lichen planus – painfull – petechiae – damage of salivary glands xerostomia ulcer lichen planus lesions

Pulmonary diseases

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Cystic fibrosis

Oral signs – disorder of salivary glands – swelling lips – gingivitis – dryness

Pulmonary diseases

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Sarcoidosis

Oral signs – multiple, nodular, painles ulcerations of the gingiva, bucal mucosa, labial mucosa and palate – tumorlike swelling of salivary glans – swelling of the tongue – xerostomia – facial nerve palsy

Cutaneous diseases

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Psoriasis

Oral signs – fissured tongue – small white papules – red and white plagues – bright red patches •

Acantosis nigricans

– hyperpigmentation, papillomatosis Oral signs – gingival hyperplasia – gingiva, tongue, lips - papilomas

Endocrine diseases

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Diabetes mellitus

Oral signs – xerostomia caused decreased salivation and increased glucosa level in saliva • gingivitis • oral infections • candidiasis – higher incidence of caries – bilateral enlargement of parotid glands – altered taste – burning mouth syndrome bilateral parotid gland enlargement gingivitis hyperplasia

Endocrine diseases

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Hypoparathyroidism

Oral signs – candidiasis – upper lip twitching •

Hyperparathyroidism

Oral signs – loss of the lamina dura surrounding the roots of the teeth – decrease of trabecular density – osseous lesions „brown tumor“

Endocrine diseases

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Cushing ´s syndrome

Oral signs – fatty tissue deposition – „moon face“ – osteoporosis  pathological fractures of the mandible, maxilla or alveolar bone – delayed healing of fractures and also sof tissue injuries •

Addison ´s disease

Oral signs – „bronzing“ hyperpigmentation of the skin – oral mucosal melanosis – buccal mucosa, tongue hyperpigmentation moon face

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Renal diseases

Uremic stomatitis

– rare – in undiagnosed and untreated chronic renal failure – irritation and chemical injury of mucosa by ammonia or ammonium compounds Signs – painful plagues and crusts – bucal mucosa, the floor or dosrum of the tongue, floor of the mouth – Type I • generalized or localized erythema • exudate • pain, burning, xerostomia, halitosis, gingival bleeding, candidiosis – Type II • ulceration • secondary infection • anemia