This document discusses various oral manifestations of gastrointestinal disorders, including:
1. Gastroesophageal reflux disease, which can cause tooth erosion from stomach acid contact. Enamel is lost in a smooth, shiny pattern.
2. Crohn's disease and ulcerative colitis, which can cause oral ulcers and lesions related to nutritional deficiencies from inflammation and malabsorption.
3. Orofacial granulomatosis, characterized by non-caseating granulomatous inflammation affecting the lips and oral tissues, causing swelling. Corticosteroids are a first-line treatment but relapses are common.
Abrasion ( Regressive Alterations of Teeth)
Reference books:-
Shafer’s Textbook:- https://amzn.to/3eNCqRx
Purkait textbook:- https://amzn.to/30AfTCq
What is Abrasion?
Causes of abrasion
Treatment of abrasion
Clinical features of Abrasion
Definition of Abrasion:- Abrasion is the pathological wearing of dental tissues or dental restorations by friction with foreign substances independent of occlusion.
Etiology and pathogenesis of Abrasion
#abrasion
#educational
#education
#oralpathology
#regressivealterationofteeth
Abrasion ( Regressive Alterations of Teeth)
Reference books:-
Shafer’s Textbook:- https://amzn.to/3eNCqRx
Purkait textbook:- https://amzn.to/30AfTCq
What is Abrasion?
Causes of abrasion
Treatment of abrasion
Clinical features of Abrasion
Definition of Abrasion:- Abrasion is the pathological wearing of dental tissues or dental restorations by friction with foreign substances independent of occlusion.
Etiology and pathogenesis of Abrasion
#abrasion
#educational
#education
#oralpathology
#regressivealterationofteeth
Dentin dysplasia (DD) is a rare hereditary disturbance is inherited as an autosomal dominant trait.
unknown etiology that affects approximately 1 :100,000.
In 1972, Witkop classified it into type I and type II which affect both dentitions.DD Type I
Radicular dentin dysplasia
Characterized by:-
1.Both dentitions are affected.
2.Normal appearing crowns
3.No or only rudimentary root development (rootless teeth)
4.Incomplete or total obliteration of the pulp chamber.
5.Teeth may exhibit extreme mobility and exfoliate prematurely.DD type II
coronal dentin dysplasia
Characterized by:-
1.partial pulpal obliteration.
2.Thistle-tube-or flame-shaped coronal pulp chambers
3. Thread-like root canals
4. Usually the absence of periapical radiolucencies.
5. In this type of anomaly, teeth roots are of normal shape and contour.The enamel and the immediately subjacent dentin appear normal.
Deeper layers of dentin show an atypical tubular pattern with an amorphous, atubular area, and irregular organization.
Normal dentinal tubule formation appears to have been blocked so that new dentine forms around obstacles and takes on the characteristic appearances described as “lava flowing around boulders”The radiograph revealed features of dentine dysplasia type I with normal appearance of crown but no root development Autosomal Dominant Disorder:
Manifested in heterozygous states
At least one parent of index case is usually affected
Both males and females are affected.
Clinical feature can be modified by variation in penetrance and expressivity. Some individual inherit the mutant gene but are phenotpically normal. This is reffered to as “incomplete penetrance”.
In many condition the age of onset is delayed.
Inheritance Pattern:
Typical pattern is a heterozygous affected parent with a homozygous unaffected parent.
Every child has one chance in two of having the disease
Both sexes are affected equally..Autosomal Recessive Disorder
Largest category of Mendelian disorder
Usually does not affect the parent of the affected individual, but sibling may show the disease.
Complete penetrance is common.
Onset is frequently early in life.
Usually affect enzymatic proteins.
Pattern Of Inheritance:
Typical pattern is two heterozygous unaffected (carrier) parent.
The triat does not usually affect the parent, but siblings may show the disease
Siblings have one chance in four of being affected
Both sexes affected equally.
AIDS is defined as a condition indicative of a defect in cell-mediated immunity occurring in a person with no known cause for immunodeficiency other than the presence of HIV.
CDC defined AIDS as
“The occurrence of one or more group of life-threatening opportunistic infections, malignancies, neurologic diseases and other specific illness in patients with HIV infection or with CD4 counts less than 200/cu mm”
For undergraduate dental students this presentation gives you the wide idea about the oral ulceration & it's causes. There causes also described though it's very easy for the reader to understand & planned how to approach the studying of ulcerations regarding the mouth. Here vesicular bullous lesions also described.
Dentin dysplasia (DD) is a rare hereditary disturbance is inherited as an autosomal dominant trait.
unknown etiology that affects approximately 1 :100,000.
In 1972, Witkop classified it into type I and type II which affect both dentitions.DD Type I
Radicular dentin dysplasia
Characterized by:-
1.Both dentitions are affected.
2.Normal appearing crowns
3.No or only rudimentary root development (rootless teeth)
4.Incomplete or total obliteration of the pulp chamber.
5.Teeth may exhibit extreme mobility and exfoliate prematurely.DD type II
coronal dentin dysplasia
Characterized by:-
1.partial pulpal obliteration.
2.Thistle-tube-or flame-shaped coronal pulp chambers
3. Thread-like root canals
4. Usually the absence of periapical radiolucencies.
5. In this type of anomaly, teeth roots are of normal shape and contour.The enamel and the immediately subjacent dentin appear normal.
Deeper layers of dentin show an atypical tubular pattern with an amorphous, atubular area, and irregular organization.
Normal dentinal tubule formation appears to have been blocked so that new dentine forms around obstacles and takes on the characteristic appearances described as “lava flowing around boulders”The radiograph revealed features of dentine dysplasia type I with normal appearance of crown but no root development Autosomal Dominant Disorder:
Manifested in heterozygous states
At least one parent of index case is usually affected
Both males and females are affected.
Clinical feature can be modified by variation in penetrance and expressivity. Some individual inherit the mutant gene but are phenotpically normal. This is reffered to as “incomplete penetrance”.
In many condition the age of onset is delayed.
Inheritance Pattern:
Typical pattern is a heterozygous affected parent with a homozygous unaffected parent.
Every child has one chance in two of having the disease
Both sexes are affected equally..Autosomal Recessive Disorder
Largest category of Mendelian disorder
Usually does not affect the parent of the affected individual, but sibling may show the disease.
Complete penetrance is common.
Onset is frequently early in life.
Usually affect enzymatic proteins.
Pattern Of Inheritance:
Typical pattern is two heterozygous unaffected (carrier) parent.
The triat does not usually affect the parent, but siblings may show the disease
Siblings have one chance in four of being affected
Both sexes affected equally.
AIDS is defined as a condition indicative of a defect in cell-mediated immunity occurring in a person with no known cause for immunodeficiency other than the presence of HIV.
CDC defined AIDS as
“The occurrence of one or more group of life-threatening opportunistic infections, malignancies, neurologic diseases and other specific illness in patients with HIV infection or with CD4 counts less than 200/cu mm”
For undergraduate dental students this presentation gives you the wide idea about the oral ulceration & it's causes. There causes also described though it's very easy for the reader to understand & planned how to approach the studying of ulcerations regarding the mouth. Here vesicular bullous lesions also described.
Many systemic diseases are reflected in the oral mucosa, maxilla, and mandible.
Mucosal changes may include ulceration or mucosal bleeding.
Immunodeficiency can lead to opportunistic diseases such as infection and neoplasia.
Bone disease can affect the maxilla and mandible.
Systemic disease can cause dental and periodontal changes.
Drugs prescribed for a systemic disease can affect oral tissue.
for undergraduate dental students this presentation includes essential & common disorders which related to the tongue very briefly. Though this may be very helpfull to you to as a start for further readings & studying.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
2. Thilanka Umesh Sugathadasa Page 1
Oral Manifestations of Gastrointestinal Disorders
1. Gastro- esophageal reflux disease
2. Crohn’s disease
3. Ulcerative colitis
4. Oro facial granulomatosis
5. Gardner’s syndrome
6. Peutz- jeghers syndrome
7. Malabsorption conditions affecting hematopoiesis
8. Metastatic disease to the jaws
9. Jaundice
Condition Features Clinical/Dental features Diagnosis & Mx
Oesophagea
l
disease(Refl
ux
oesophagitis
- Gastro-
Oesophagea
l reflux
disease-
GORD)
Backflow of acid from
stomach in to
oesophagus.
One of the most
common type of
dyspepsia.
Considered to be due
to hiatal
(diaphragmatic)
hernias.
GORD is predisposed
by
- GI disease like high
acidity in stomach
content & impaired
gastric mobility.
- Extra-GI conditions
such as obesity, large
meals, smoking,
alcohol
Can be caused by
increased acid
production & defect in
the sphincters
Symptoms
- Heart burns
- Burning sensation behind
the sternum
- Most commonly felt after
the meals
- Acid taste
Signs
- Tooth erosion
- Stricture(Acid in
oesophagus-Irritation--
Fibrosis-Strictures--Fe
absorption)
Dental aspect
- Dental erosion typically in
palatal aspect of upper
anterior teeth & premolars.
- Clinically, enamel is lost
over broad areas of the
teeth that are exposed to
the gastric contents.
- In bulimics, it is commonly
seen & is most severe on the
maxillary anterior
teeth.(Bulimia- self induced
vomiting can see changes in
the palatal mucosa also).
-Eroded enamel is smooth,
shiny & hard. If it become
thin enough, yellowish
DD
- Candidal
oesophagitis(seen in
immunocompromised pts
or Aplastic anemic pts. )
- Chemical burns from
acids/ NSAIDS
General Mx
- Reducing weight
- Raising head at least 4
inches at night.
- Taking frequent meals
with antacids.(Aluminium
hydroxide)
- H2 blockers
- Proton pump inhibitors
(more effective)
3. Thilanka Umesh Sugathadasa Page 2
colour of dentin becomes
visible & teeth may become
sensitive to temperature
changes.
- Once enamel has eroded, it
is not replaceable
physiologically though the
patient may need dental
restorative Rx.
- Because enamel erosion is
directly proportional to the
contact time with gastric
acid, can get some idea of
frequency & duration of
reflux problem by assessing
amount of enamel loss.
Crohn’s
disease
See oral Ulceration
part
Inflammatory
condition of unknown
cause.
With UC named as
Inflammatory Bowel
disease.
Inflammation extends
up to lining of the
affected organs.
Differences between
UC & CD presents in
Oral ulceration note.
CD appears to be
heterogeneous group
of disorders probably
caused by commensal
bacteria in people
with genetically
determined
dysregulation of
mucosal T
lymphocytes.
Inflammation
mediated by TNF
Sub mucosal chronic
inflammation with
many mononuclear,
Clinical features
- Common in ileoceacal
region, but can affects any
part of GI tract.
- Ulceration, fissuring &
Fibrosis os walls.
- Manifestations are depend
on severity & affected site.
- Complication include
weight loss, GI obstruction,
Internal/ External fistula,
Perianal fissures, Abcesses,
Arthralgia, Renal damage
Dental features
- Ulcers
- Facial/ labial swelling
- Mucosal tags
- Cobblestone proliferation
of mucosa(Irregular swelling
with fibrosis in between)
- Angular cheilitis
- May be caused by CD itself
or by nutritional deficiencies
Some patients may have
asymptomatic intestinal
disease or some may
develop it later.
Dental Mx may be
complicated by
Malabsorption &
Steroids/immunocompra
mise therapy.
NSAIDs should be
avoided.(Can induce
gastric ulceration)
Antibiotics that could
aggravate diarrhea
should be avoided(Co-
amoxiclave &
Clindamycine)
4. Thilanka Umesh Sugathadasa Page 3
interleukin producing
cells.
Non caseating
granuloma form in sub
mucosa & lymph
nodes
Melkerson Rosenthal
Syndrome & Cheilitis
granulomatosa are
incomplete manifestations of
CD.
OFG
Group of diseases
characterized by
noncaseating type
granulomatous
inflammation affecting
soft tissues of Oral &
maxillofacial region.
- Melkersson-
Rosenthal syndrome
- Cheilitis
granulomatosa
(Swelling restricted to
the lips,)
Precise cause is
unknown but can be
infections, genetic
predisposition, Allergy
Recently researchers
have identified a
monoclonal
lymphocytic expansion
& suggested it could
be secondary to
chronic antigenic
stimulation.
Cytokine which
produce by the
lymphocytic clone
could be responsible
for the formation of
granulomas.
However,
immunologic
origin(cell- mediated
hypersensitivity
reaction) is favoured
because of presence
of activated helper T
lymphocytes
expressing IL-2
receptors.
Clinical features
- Non-tender recurrent
labial swelling that
eventually becomes
persistent.
- Swelling may affect one or
both lips, causing lip
hypertrophy (macrocheilia)
- Swelling is initially soft but
becomes firmer with time
due to fibrosis.
- Recurrent facial swelling,
may affects chin, cheeks,
periorbital region & eyelids.
- Rarely may not be
associated with lip
hypertrophy.
- Intraoral involvement may
take the form of
hypertrophy, erythema or
nonspecific erosions
involving the gingiva, oral
mucosa or tongue.
Diagnostic dilemma may be
further complicated by
systemic diseases such as
crohn’s disease, sarcoidosis,
DD of persistent lip swelling
- Angioedema(Idiopathic/
hereditary)
- Sarcoidosis
- Crohn’s disease
- OFG
- Specific infections(TB/
leprosy & deep fungal
infection)
- Amyloidosis
- Tumors(Tissue or minor
salivary gland tumor)
Diagnosis is mainly by
exclusion
Rx is difficult due to
absence of etiologic
factors.
Rx objectives are to
improve pts clinical
appearance & comfort
Spontaneous remission
possible.
Eliminate the
odontogenic infections
1st
line Rx
- Local or systemic
corticosteroids.
- intralesional
triamcinolone 10mg/ml
(Recently higher
concentrations -
40mg/ml) due to
injection volume become
less.
systemic steroids
therapy is limited now
due to complications &
recurrent nature.
- With steroids results
are immediate
- Relapses are common
Complications
- Skin atrophy
- Hypopigmentation
Other
- Thalydomide
- Methotrxate
- Metronidazole
5. Thilanka Umesh Sugathadasa Page 4
Ulcerative
Colitis
Inflammatory bowel
disease.
Affecting part or
whole large intestine,
frequently lower
colon & rectum.
Cause inflammation
& ulcers in superficial
layers of large
intestine mucosa
followed by pseudo
polyp formation.
Diarrhea with mucus +blood
+pus
Pain, fever, anorexia
Extra abdominal signs are
minimal
Commonest complication is
Iron deficiency anaemia.
Skin lesions present like
Erythema nodosum.
Carcinoma
Dental aspect
Oral manifestations are
rare.
Chronic ulceration can be
occur. (Polystomatitis
gangrenosum)
Polystomatitis vegetans
(Multiple intraepithelial
micro abscesses)
Lesions related to anaemia
Antibiotics & NSAIDS
should be avoided.
Gardner’s
syndrome
Autosomal dominant
condition
Genetic defect on the
chromosome 5
Characterized by the
intestinal polyposis
with a very high risk
of malignant
transformation into
colonic
adenocarcinoma.
Head & Neck manifestations
- Multiple enostoses (bone growth within the bony cavity)
of the jaws
- Supernumerary & or unerupted teeth
- Increased risk of odontomas(Compound)
- Osteomas of the jaws & paranasal sinuses.
- Epidermoid cyst in the skin of Head & Neck.
Peutz-
jeghers
syndrome
Associate with
harmatomatous
polyposis, mostly of
small intestine
Autosomal dominant.
Intraorally, lesions are
usually flat, painless, brown
pigmented patches of
buccal mucosa, tongue or
labial mucosa.
No Rx required to
pigmented lesion unless
there are cosmetic or
social reason.
Malabsorpti
on
condition
affecting
hematopoie
sis
GI diseases related to
protein- caloric
malnutrition or
micronutrient
Malabsorption may
have an effect(Iron)
Atrophic tongue
Ulcer with bright red border
Burning
sensation(glossopyrosis)
Angular cheilitis
Candidal infection
Antifungal
Remove the cause.
6. Thilanka Umesh Sugathadasa Page 5
Metastatic
disease to
the jaws
Malignant neoplasms of liver & GI tract occasionally metastasize to oral region
commonly posterior mandible, through hematogenous route.
Vertebral plexes of veins considered as primary mechanisms whereby these tumors
bypass the right heart- lung capillary bed.
Asymptomatic
Pain
Paresthesia
Loosening of teeth
Radiographs shows irregular, poorly circumscribed & often multifocal radiolucencies
Less commonly metastases may involve the maxilla or oral soft tissues
Jaundice
Excess bilirubin in blood results in accumulation of bilirubin in tissues, including oral
mucosa(Yellow)
Lingual frenum & soft palate are higherly affected(which contain elastin)
Careful with persons who eats large amount of Vit A
Yellowish to greenish pigmentation can be seen in the teeth of children with
hyperbilirubinemia during calcification