medical ppt

1. Wednesday,
April 12, 2023
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Oral manifestations of systemic diseases
PROFESSOR DR. HIWA OMER AHMED
GENERAL AND BARIATRIC SURGERY

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April 12, 2023
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Systemic diseases with oral findings include
1. Autoimmune
2. Hematological
3. Endocrine
4. Neoplastic processes.
5. Infectious
6. Eating problems

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April 12, 2023
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Autoimmune disease
 may manifest as
1. oral ulcerations.
2. changes in the salivary and parotid glands.
3. changes in the tongue.

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April 12, 2023
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Systemic lupus erythematosus
(SLE)
Presents with oral
findings in 8%-45%
manifesting as typically
ulcerated, atrophic, and
erythematous; they
usually demonstrate a
central zone with
radiating, fine, white
striae.

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April 12, 2023
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Systemic sclerosis (scleroderma)
 The lips appear pursed,
 opening of the mouth may be
limited.
 Xerostomia is common;
 the tongue appears smooth
 the palatal rugae.
 On panoramic radiographs,
mandibular resorption may be
noted

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April 12, 2023
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April 12, 2023
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Sjögren syndrome
Findings related to decreased saliva, such as
increased risk of dental caries
1. Infections
2. Dysphagia.
3. Saliva is often thick or absent, and the oral
mucosa may be dry, red, wrinkled.
4. The tongue may be atrophic or fissured with deep
grooves and malodorous due to food trapping

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April 12, 2023
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April 12, 2023
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Systemic amyloidosis
1. Macroglossia due to
amyloid deposition in the
tongue
2. Tongue lesions present as
nodular or diffuse
enlargement
3. Subsequent ulcerations
or hemorrhages.

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April 12, 2023
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Miscellaneous
 Painful oral ulcerations are common among all of these conditions,
which may be difficult to distinguish from one another
 Pemphigus vulgaris
 Wegener granulomatosis
 Crohn disease
 Behçet syndrome
 Sarcoidosis
 Lichen planus.
Ulcerations associated with pemphigus vulgaris

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April 12, 2023
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Crohn disease
 diffuse swelling
 localized mucogingivitis
 cobblestoned mucosa
 Nodules
 Tissue tags
 Polyps,
 Pyostomatitis vegetans can
also occur in association with
Crohn disease
. Pyostomatitis vegetans

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April 12, 2023
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Hematologic illnesses
 Gingival bleeding
 Tongue changes such as glossitis
 Mucosal pallor and atrophy are common in anemia
 hemorrhages and gingival bleeding are often
associated with hematopoietic neoplasms or
coagulopathies.

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April 12, 2023
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Anemia
 Iron-deficiency anemia often
presents as atrophy and pallor
of the mucosa and atrophic
glossitis
 Patients with pernicious
anemia may present with
erythema of the tongue and
atrophy. (magenta tongue)

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April 12, 2023
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Leukemia
1. Gingival enlargement
2. Petechiae, mucosal bleeding
3. Hemorrhages
on both the hard and soft palates
4. Mucosal ulcers may also be present
5. Bony infiltration by malignant cells
can lead to ulcerations of the palate
and destruction of the nasal cavity
and paranasal sinuses

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April 12, 2023
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Thrombocytopenia
 Hemorrhages
can range from
petechiae to
hemorrhagic
bullae and
hematomas

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April 12, 2023
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Multiple myeloma
 Oral cavity involvement occurs in the
later stages of multiple myeloma and
often involves the mandible.
 Facial asymmetry and jaw
 Mucosal swelling can occur
 Bony destruction can lead to
pathologic fractures
 Rarely, deposition of amyloid that
leads to macroglossia can occur.

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April 12, 2023
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Endocrine
illness
 are variable and depend on the underlying condition.

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April 12, 2023
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Diabetes mellitus
1. Oral manifestations of both
types of DM include
periodontitis as well as
gingivitis.
2. Nontender enlargement of
the parotid glands.
3. Fungal infections (both C
albicans and mucormycosis),
4. Dysgeusia
5. Burning or dry mouth
Periodontitis

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April 12, 2023
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Thyroid disease
 Hypothyroidism:
 Glycosaminoglycan deposition in the lips
and tongue leads to associated swelling.
 In children, tooth eruption may be
affected.

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April 12, 2023
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Parathyroid disease
 The Chvostek sign, twitching of the upper lip after facial nerve
stimulation at the zygomatic process.
 Pitting and enamel
hypoplasia.
 Macroglossia
 Dysgeusia.
 Delayed eruption
 Poor periodontal health
 Altered tooth morphology and delayed wound healing

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April 12, 2023
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Adrenal disease
 Hypercortisolism
1. “moon” facies
2. Bone loss also occurs and may
be noted on radiographs of the
mandible.
 Hypoadrenocorticism (Addison
disease)
Hyperpigmentation of the oral
mucosa

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April 12, 2023
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Neoplastic changes
 Include metastatic lesions to the bony and soft
tissues of the oral cavity.
 In the pediatric population, oral changes can be
related to rare cancers, such as Langerhans
cell histiocytosis,

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April 12, 2023
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Oral Kaposi sarcoma
 Occurs in up to 25%
of HIV cases and may
be the initial sign of
infection.
 Oral findings include
nonpigmented,
violet, or brown-red
plaques or tumors of
the tongue, palate,
and gingiva.

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April 12, 2023
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Metastatic disease
 Metastatic tumors constitute
approximately 1% of oral
malignant neoplasms.
Tumors can occur on both the
hard and soft palates, but
most often affect the jaws
 Lung cancer metastasizes
most often to the oral soft
tissues, whereas breast
cancer metastasizes to the
jaw

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April 12, 2023
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Infectious etiologies
 Kawasaki disease.
 Red, dry, cracked
lips and an
extremely red,
swollen tongue
(often called
strawberry
tongue)

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April 12, 2023
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Chronic diseases
 Gastroesophageal
reflux disease Dental
erosions, water brash,
and xerostomia can all
occur in patients with
gastroesophageal reflux
disease.
 Burning sensations,
palatal erythema, and
halitosis may also be
present.

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April 12, 2023
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Eating disorders
 Oral manifestations of eating disorders include
xerostomia, dental erosions, sialadenosis, and
dental caries.