The relation between oral cavity and the systemic diseases. How oral cavity acts as a diagnostic tool and aids in the treatment.

1. Oral Cavity Is Mirror
Image Of Body
By: Navreet Bajwa
Pavleen Sahni
(Sri Guru Ram Das Institute Of Dental Sciences And Research)

2. The Mouth
 Lovers kiss with it, babies coo with it,
fighters curl it in rage, winners lift it up in
victory and a dental surgeon looks into it.
 It is an easily accessible window to the
body.
 The health status of our oral cavity can
give us strong indication of health of our
bodies.
 It acts as an early warning system.

3. It's A Two Way Street
Systemic diseases
have oral
manifestations.
Oral diseases can
affect treatment
for systemic
disease.
Treatment for
systemic disease
can affect oral
health.
Oral disease can
increase risk for
systemic disease.
Oral health affects
quality of life.

4. Blood Dyscriasis

5. Anaemia
• Atrophic glossitis.
• Mild ulcerations can be seen.
• Mucosal pallor and dryness
• Smooth, red painful burning tongue
• Candidiasis
• Angular chelitis

6. Thalassemia
• Prominent premaxilla and
irregularly arranged maxillary
teeth.
• Mucosal pallor
• Inner and outer plates become
elongated producing bristals like
crew cut or hair on end
appearance.

7. Erythroblastosis Foetalis
•Erythroblastosis fetalis may be
manifested in the teeth by
deposition of blood pigment in the
enamel and dentin of developing
teeth giving them a green brown or
blue colour.

8. Leukaemia
• Mucosal bleeding
• Ulceration
• Petechiae
• Diffuse or localized gingival enlargement.
The gingiva may feel boggy and appear
hemorrhagic with or without concurrent
ulceration.

9. Gastrointestinal Disorders

10. Crohn’s Disease
• Diffuse swelling of one or both lips.
• Angular cheilitis
• Painful linear ulcerations in the buccal
vestibule
• Mucosal tags

11. Ulcerative Colitis
• Aphtous ulceration or
superficial hemorrhagic ulcers
• Angular stomatitis
• Pyostomatitis vegetans,
Pyostomatitis gangrenosum

12. Gastro-Esophageal Reflux Disease (GERD)
•Erosion of tooth structure
•Prone to fracture as underlying dentine is
exposed
•Newly exposed dentine= smooth and shiny
•Older= stained
•Pulpal exposure
•Sensitivity to thermal stimuli
•Erosion common on palatal surfaces of
maxillary dentition and occlusal surfaces of
mandibular posterior teeth

13. Endocrinal Disorders

14. Diabetes Mellitus
•Xerostomia
•Gingivitis
•Periodontitist
•Gingival enlargement
•Increased prevalence of dental caries
•Salivary gland enlargement
•Burning Mouth Syndrome
•Increased risk of oral infections

15. Addison’s Disease
•Oral mucosal melanosis precedes the
skin pigmentation.
• The diffuse or patchy brown macular
pigmentation most commonly occurs
on the buccal mucosa, but can also
occur on the floor of the mouth,
ventral tongue, and other areas of the
oral mucosa

16. Dermatological Disorders

17. Lichen Planus
•Wickham’s striae.
• Radiating white striae to
vesiculobullous, atrophic, or erosive
form.
•These appear weeks before the skin
lesions.

18. Erythema Multiforme
•Acute self limiting dermatitis
characterized by iris or target lesion.
•Hyperemic macules
•Papules or vesicles, which may
become eroded or ulcerated and bleed
freely.
•Swollen and ulcerated lips.

19. Psoriasis
• Angular cheilitis.
•Fissured tongue and benign migratory
glossitis.
•Lesions involve the lips, buccal mucosa,
palate, gingiva and floor of the mouth and
appear as gray or yellowish-white plaques.
•As silvery white, scaly lesions with an
erythematous base.

20. Lupus Erythematosus
•White spots or radiating white
striae.
• Superficial, painful ulceration may
occur with crusting or bleeding.
• There is severe fissuring and
atrophy of lingual papilla.
•Butterfly rash is preceded by these.

21. Nutritional Deficiency

22. Scurvy
•Inflammation of the interdental and
marginal gingiva followed by bleeding,
ulceration, foul breaths due to
fusospirochetal stomatitis.
•Hemorrhages into and swelling of the
periodontal membranes occur,
followed by loss of bone and loosening
of the teeth, which eventually exfoliate.

23. Vitamin D Deficiency
•Developmental anomalies of dentin
and enamel
•Delayed eruption
•Malalignment of the teeth in the jaws.

24. Vitamin K Deficiency
•Gingival bleeding most common
•Prothrombin levels below 35% result
in bleeding after tooth brushing
•When below 20% result in
spontaneous gingival hemorrhages.

25. Vitamin B-Complex Deficiency
•Initially glossitis involving the tip
and/or the lateral margins of the
tongue, followed later by complete
atrophy of all papillae
•The tongue has a magenta color
•Pallor, involving oral mucosa
•Cheilitis, maceration and fissuring at
the angles of the mouth.

26. Osteoporosis
•Bone loss in the jaw and around
teeth.
•Tooth loss
•Loose or ill-fitting dentures
•Gum disease

27. Viral Infections

28. Human Papilloma Virus
•Often seen in HIV infected patients.
•Multiple intra-oral warts.
•CD4 cell count lower than 500
cells/mm³ in cases of extensive disease.

29. Herpes Simplex Virus
•Painful, persistent, progressive, clean-based
ulcers.
•Sometimes HSV can also present with
atypical deep ulcers, verrucous or
vegetative erosions, or folliculitis.
•Extensive lesion seen when CD4 cell
count is below 50cells/mm³.

30. Varicella Zoster Virus
•Usually, VZV is the cause of varicella
or chicken pox, in children, and the
cause of herpes zoster or shingles, in
elderly people.
• Chronic verrucous or vegetative
nodules can develop on the original
sites of varicella lesions
•Dermatomal vesiculo-pustular
lesions, preceded by localized itching,
tenderness, or burning pain, are the
hallmark.

31. Measels
•Oral lesions Frequently occur 2-3 days
before cutaneous lesion .
•Koplik’s spot -irregularly shaped flex
which appear blue , white specks
surrounded by bright red margin in
the buccal mucosa and the inside of
the lips.
•Redness , petecheiae and small round
ulcerations may also appear.

32. Fungal Infections

33. Candidiasis
• Well-demarcated, erythematous,
moist patches with satellite pustules.
•More common in oral cavity than on
skin.

34. Deep Fungal Infections
•Penicilliosis, histoplasmosis, and
cryptococcosis.
•Many other manifestations of these
three diseases, including plaques,
nodules, ulcers, abscesses, or cellulitis.
•Oral lesions of histoplasmosis can be
found as oral nodules or ulcers

35. Bacterial Infections

36. Tuberculosis
•Tongue lip , palate , tonsils are most
frequently affected .
•Typical lesion is vegetating , usually
painless& irregular.
•Submandibular & cervical lymph
nodes are frequently infected (
Scrofula).

37. Scarlet Fever
•Mucosa of the palate may appear
congested, throat often fiery red.
•Tonsils & faucial pillars are usually
swollen , sometime covered with a
grayish exudates.
•Coated “white strawberry” tongue.
•By day 4 or 5, the white coating
disappears, revealing the
representative “raspberry tongue”.

38. Conclusion

39.  The oral signs and symptoms empower an oral physician with the ability to predict the systemic
status of the patients examined thus enabling identification of the underlying undiagnosed
disease.
 The diagnosis of oral manifestations of blood systemic diseases is vital in dentist's perspective. The
knowledge on the systemic diseases is important in day to day clinical practice.
 Often oral manifestations are the first sign or the most significant sign of systemic disease. Dental
surgeons must acquire familiarity with systemic conditions that can affect the oral cavity, so that
appropriate referral can be made. Physicians need to be aware of significance of oral complaints,
their relationship to local causes, and potentially to systemic diseases.
 It has thus been rightly stated: “Mouth is the mirror of the human body”

40. Bibliography
Crispian Scully and Roderick A Cawson, Medical problems in dentistry, 5 th edition, New Delhi,
Churchill Livingstone, 2005
Greenberg MS, Glick M, Ship JA. Burket’s Oral Medicine, Eleventh edition. Hamilton: BC Decker Inc.
2008
Neville, Damm, Allen, Bouquot. Oral and Maxillofacial Pathology. 2 nd edition. New Delhi: Elsevier,
2002
Shafer’s Textbook of Oral Pathology. 4thed. Oral aspects of metabolic disease. In: WB.Saunders, 1993