done by dr. Mohammed Saad ( BDS ) @ Al Imam Ali ( A.S ) General Hospital Baghdad, Iraq 2015 MOH

1. Oral manifestations of
systemic diseases
Done by
Dr. Mohammed Sa’ad (B.D.S)
AL Imam Ali ( A.S ) General Hospital
Maxillofacial Surgery Department

2. Introduction
• Careful examination of the oral cavity may
reveal findings indicative of an underlying
systemic condition, and allow for early diagnosis
and treatment. Examination should include
evaluation for mucosal changes, periodontal
inflammation and bleeding, and general
condition of the teeth.

3. GIT Diseases
• Gastrointestinal diseases refer to diseases involving
the gastrointestinal tract, namely the esophagus,
stomach, small intestine, large intestine and rectum,
and the accessory organs of digestions, the liver,
gallbladder, and pancreas.

4. • Crohn's disease, also known as Crohn
syndrome and regional enteritis, is a type of
inflammatory bowel disease (IBD).
• Ulcerative colitis is a form of inflammatory
bowel disease (IBD) that causes inflammation
and ulcers in the colon.
• Gastroesophageal reflux is a chronic symptom
of mucosal damage caused by stomach acid
coming up from the stomach into the
esophagus.
• Chronic liver disease in the clinical context is a
disease process of the liver that involves a
process of progressive destruction and
regeneration of the liver parenchyma leading to
fibrosis and cirrhosis.

5. • 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
GIT diseases
pystomatitis vegetans

6. • 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)
GIT diseases

7. Hematologic Diseases
• Hematologic diseases are disorders which
primarily affect the blood
• Anemia is usually defined as a decrease
in the amount of red blood cells (RBCs) or
hemoglobin in the blood.
• Leukemia is a group of cancers that
usually begins in the bone marrow and
results in high numbers of abnormal white
blood cells.

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

9. • Leukemia
– gingival hypertrophy
– petechiae
– mucosal ulcers
– hemorrhage
Treatment of leukemia
– reactivation of herpes simplex virus – oral mucosistis
Hematologic diseases

10. Summary of oral manifestations of
gastrointestinal and hematologic diseases
Angular cheilitis
• Iron-deficiency anemia
Hemorrhage
• Pyostomatitis vegetans
• Scurvy
• Ulcerative colitis
Aphthous ulcers
• Crohn's disease
• Pernicious anemia
• Ulcerative colitis
Intraoral burning
• Iron-deficiency anemia
• Pernicious anemia
Candidiasis
• Crohn's disease (steriod therapy)
• Iron-deficiency anemia
• Pyostomatitis vegetans (steriod
therapy)
• Ulcerative colitis (steroid therapy

11. 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

12. Connective tissue disease
• connective tissue disease is any disease that has the
connective tissues of the body as a target of pathology.
• Sjögren's syndrome is a chronic autoimmune disease
in which the body's white blood cells destroy the
exocrine glands.
• Kawasaki disease is an autoimmune disease in which
the medium-sized blood vessels throughout the body
become inflamed.
• Scleroderma is a chronic systemic autoimmune disease
characterised by hardening (sclero) of the skin (derma).
• Lupus erythematosus is a systemic autoimmune
disease in which the body’s immune system mistakenly
attacks healthy tissue.

13. • Sjögren 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

14. • 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

15. • 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
Connective-tissue diseases
Limited mouth opening and decreased
tongue mobility
Gingival retraction

16. • Lupus erythematosus
– autoimmune disease
Oral signs
– ulcerations
– oral lesions of lichen planus –
painfull
– petechiae
– damage of salivary glands -
xerostomia
Connective-tissue diseases
ulcer
lichen planus lesions

17. Pulmonary diseases
• Cystic fibrosis, also known as mucoviscidosis,
is a genetic disorder that affects mostly the
lungs but also the pancreas, liver, kidneys and
intestine.
• Sarcoidosis, is a disease involving abnormal
collections of inflammatory cells (granulomas)
that can form as nodules in multiple organs.

18. • Cystic fibrosis
Oral signs
– disorder of salivary
glands
– swelling lips
– gingivitis
– dryness
Pulmonary diseases

19. • 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
Pulmonary diseases

20. Cutaneous diseases
• Psoriasis is a long lasting disease
characterized by patches of abnormal
skin.
• Acanthosis is diffuse epidermal
hyperplasia.

21. • 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
Cutaneous diseases

22. Endocrine diseases
• Diabetes mellitus, is a group of metabolic
diseases in which there are high blood sugar
levels over a prolonged period.
• Thyroid disorders is the condition that occurs
due to excessive or insufficient production of
thyroid hormone by the thyroid gland.
• Cushing's syndrome is a collection of signs
and symptoms due to prolonged exposure to
cortisol.
• Addison’s disease is a rare, chronic endocrine
system disorder in which the adrenal glands do
not produce sufficient steroid hormones.

23. • 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
Endocrine diseases
gingivitis
hyperplasia
bilateral parotid
gland enlargement

24. • 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

25. • 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
Endocrine diseases
moon face
hyperpigmentation

26. Renal diseases
• Uremic stomatitis a rare form of
stomatitis that occurs with renal failure.

27. • 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
Renal diseases

28. Thanks A lot
Any Question ?

29. REFERENCES
1. U.S. Department of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville, Md.: U.S. Department of
Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.
2. Janket SJ, Baird AE, Chuang SK, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2003;95(5):559-569.
3. Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG.
2006;113(2):135-143.
4. Demmer RT, Jacobs DR Jr, Desvarieux M. Periodontal disease and incident type 2 diabetes: results from the First National Health and
Nutrition Examination Survey and its epidemiologic follow-up study. Diabetes Care. 2008;31(7):1373-1379.
5. Moazzez AH, Alvi A. Head and neck manifestations of AIDS in adults. Am Fam Physician. 1998;57(8):1813-1822.
6. Gonsalves WC, Chi AC, Neville BW. Common oral lesions: Part I. Superficial mucosal lesions. Am Fam Physician. 2007;75(4):501-507. 7.
Neville BW, Damm DD, Allen CM, Bouquot JE. Pernicious anemia. In: Oral and Maxillofacial Pathology. 3rd ed. St. Louis, Mo.: Saunders
Elsevier; 2009:829-831.
8. Schiّdt M. Oral manifestations of lupus erythematosus. Int J Oral Surg. 1984;13(2):101-147.
9. Nico MM, Vilela MA, Rivitti EA, Lourenço SV. Oral lesions in lupus erythematosus: correlation with cutaneous lesions. Eur J Dermatol.
2008;18(4):376-381.
10. Callen JP. Oral manifestations of collagen vascular disease. Semin Cutan Med Surg. 1997;16(4):323-327.
11. Jessop S, Whitelaw DA, Delamere FM. Drugs for discoid lupus erythematosus. Cochrane Database Syst Rev. 2009;(4):CD002954.
12. Sirois DA, Fatahzadeh M, Roth R, Ettlin D. Diagnostic patterns and delays in pemphigus vulgaris: experience with 99 patients. Arch
Dermatol. 2000;136(12):1569-1570.
13. Hyams JS. Extraintestinal manifestations of inflammatory bowel disease in children. J Pediatr Gastroenterol Nutr. 1994;19(1):7-21.
14. Pittock S, Drumm B, Fleming P, et al. The oral cavity in Crohn’s disease. J Pediatr. 2001;138(5):767-771.
15. Coenen C, Bِrsch G, Müller KM, Fabry H. Oral inflammatory changes as an initial manifestation of Crohn’s disease antedating abdominal
diagnosis. Report of a case. Dis Colon Rectum. 1988;31(7):548-552.
16. Talbot T, Jewell L, Schloss E, Yakimets W, Thomson AB. Cheilitis antedating Crohn’s disease: case report and literature update of oral
lesions. J Clin Gastroenterol. 1984;6(4):349-354.
17. Plauth M, Jenss H, Meyle J. Oral manifestations of Crohn’s disease. An analysis of 79 cases. J Clin Gastroenterol. 1991;13(1):29-37. 18.
Field EA, Tyldesley WR. Oral Crohn’s disease revisited—a 10-year-review. Br J Oral Maxillofac Surg. 1989;27(2):114-123.
19. Strakosch CR, Gordon RD. Early diagnosis of Addison’s disease; pigmentation as sole symptom. Aust N Z J Med. 1978;8(2):189-190. 20.
Mealey BL. Periodontal disease and diabetes. A two-way street [published correction appears in J Am Dent Assoc. 2008;139(3):252]. J Am
Dent Assoc. 2006;137(suppl):26S-31S.
21. Moore PA, Weyant RJ, Mongelluzzo MB, et al. Type 1 diabetes mellitus and oral health: assessment of periodontal disease. J Periodontol.
1999;70(4):409-417.
22. Taylor GW, Burt BA, Becker MP, et al. Non-insulin dependent diabetes mellitus and alveolar bone loss progression over 2 years. J
Periodontol. 1998;69(1):76-83.