features

1. Dr.Roohia

2. HEMATOLOGIC DISEASES
 Iron-Deficiency Anemia:
 Oral manifestations may
include angular cheilitis,
atrophic glossitis, mucosal
pallor, and generalized
atrophy of the oral
mucosa.
 The glossitis may include
flattening of the papillae
on the dorsum of the
tongue and is often
accompanied with a
tenderness or a burning
sensation.

3.  This process may result in
a smooth, erythematous
tongue mimicking benign
migratory glossitis, also
known as “geographic
tongue” or erythema
migrans;
 lesions on the tongue that
are red and white,
nonindurated, atrophic,
but with a slightly elevated,
white rim, and the site
keeps changing over a
period of time.

4.  Plummer-Vinson syndrome or Paterson-Kelly
syndrome is another type of irondeficiency anemia
that presents with glossitis, and is generally seen in
women of Scandinavian and Northern European
origin

5.  Pernicious Anemia:
 The oral manifestations
include burning of the
tongue, lips, and buccal
mucosa as well as other
mucosal sites
 Focal or diffuse erythema
of the tongue and mucosal
atrophy is noted,
depending on the duration
and severity of the
condition. An interesting
term, “magenta tongue”

6.  Multifocal patchy
erythematous zones on
the tongue dorsum and
lateral border in a
patient with pernicious
anemia
 which is considered a
low-risk area for
development of
squamous cell carcinoma

7.  Leukemia:
 Oral complications of
leukemia include petechial
hemorrhages of posterior
hard palate and soft palate,
and spontaneous gingival
bleeding.
 The gingival bleeding is
precipitated when the
platelet count falls
between 10,000 and
20,000/mm3

8.  Areas of tissue destruction,
necrosis, ulceration of the palate
significant finding
 Diffuse oral candidiasis is often a
complication
 The leukemic cells may also
produce a diffuse, boggy,
nontender
 swelling with or without
ulceration, which appears as a
gingival enlargement or even a
tumor-like growth containing a
collection of leukemic cells
called granulocytic sarcoma or
extramedullary myeloid tumor
An ulcerated gingival enlargement
consistent with a leukemic “granulocytic
sarcoma” noted on the left posterior buccal
maxillary mucosa

9.  Langerhans Cell Histiocytosis (Histiocytosis X):
 Langerhans cell histiocytosis (LCH) is characterized by
abnormal monoclonal proliferation of antigen-presenting
Langerhans cells
 Oral manifestations of LCH include irregular ulcerations of
the hard palate, which may be the primary manifestation of
the disease.
 Gingival inflammation and ulcerated nodules, difficulty in
chewing, and foul-smelling breath also occur. Large
ulcerations with exposed bone, ecchymoses, gingivitis, and
periodontitis followed by tooth loss are the hallmark of this
condition.

10.  Radiographically, the teeth
often appear to be “floating in
air” and in some cases may
present with a large
radiolucent region exhibiting
significant bone loss.
 Oral swellings or ulcerations
resulting from
 mandibular or maxillary bone
involvement may be
common, and ulceration may
develop on the gingiva,
palate, and floor of the
mouth

11. Multiple Myeloma:
Multiple myeloma usually involves the oral cavity in the later stages of the disease.
An interesting finding is amyloid deposits in the tongue leading to macroglossia, which in some
cases prompts a biopsy ultimately leading to the final diagnosis.
Patient with multiple myeloma, with significant facial asymmetry of the left side and
buccal mucosal swelling intraorally extending from the left canine to the posterior molar
region.

12. AUTOIMMUNE CONDITIONS
 Sjo¨ gren Syndrome:
 The oral manifestations in
SS are generally related to
the low salivary volume
and comprise dysphagia,
dysgeusia, difficulty in
eating and speaking, as
well as an increased rate of
dental caries and
susceptibility to infection
 xerostomia include dry,
red, and wrinkled mucosa.

13.  The tongue may appear “bald” or even “cobblestone-
like” due to atrophy of the papilla.
 Cracks, fissures of the tongue, redness, and cheilitis
are additional findings
 This increase in dental caries is especially noted
around the cervical region of the teeth.23

14.  Kawasaki Disease:
 Kawasaki disease, also known
as mucocutaneous lymph
node syndrome
 (1) edema of extremity,
erythema;
 (2) polymorphous exanthem;
 (3) bilateral conjunctival
injection;
 (4) erythema and strawberry
tongue; and
 (5)acute cervical
lymphadenopathy

15.  The most striking oral
finding includes swelling
of papillae on the surface
of the tongue
(strawberry tongue) and
intense erythema of the
mucosal surfaces. The
lips may be cracked, red,
swollen, and often
hemorrhagic and crusted

16.  Scleroderma (Progressive
Systemic Sclerosis; Hide-
Bound Disease):
 Deposition of
extraordinary amounts of
dense collagen in the
tissues of the body.
 When exposed to cold
temperatures these
patients show what is
termed Raynaud
phenomenon in their
terminal phalanges.
Patient with scleroderma exposed to cold
temperature exhibiting Raynaud
phenomenon,
with cyanotic fingers and palm

17.  The lips appear pursed due to
constriction of the mouth, thus
making it difficult to open the
mouth and resulting in what is
termed microstomia, causing
limited opening of mouth in
about 70% of these patients
 A “purse-string” appearance
caused by creases and folds of
skin radiating from the mouth
may be noted.
 Xerostomia is a consistent
finding, and some of these
patients have concurrent
secondary SS

18.  The tongue can lose
mobility and generally
has a smooth appearance
 The collagen deposits
invariablyresult in
smoothening of the
palatal rugae.
 Diffuse widening of the
periodontal ligament
space is noted in the
entire dentition

19.  Systemic Lupus
Erythematosus: