This document discusses various systemic conditions that can manifest orally and affect oral health. It covers conditions associated with oral ulcers, lesions, pigmentation changes, periodontal disease and tooth alterations. Specific conditions discussed in detail include lichen planus, lupus erythematosus, pemphigoid, pemphigus vulgaris, Crohn's disease, Behcet's syndrome and Sjogren's syndrome. It also covers syndromes associated with cleft lip/palate and factors that can cause delayed tooth eruption.

2. Contents
 Systemic conditions associated with-
-oral ulcers
-oral lesions
-change in mucosal pigmentation
-periodontal disease
- alteration of teeth
 Certain syndromes and dental manifestations
 Conditions associated with delayed tooth eruption

3. Oral ulcers
 Systemic diseases
manifesting o.ulcers are:
 Microbial disease-
Herpetic stomatitis
Chicken pox
Hand ,foot and mouth
disease
Herpangina
Infectious mononucleosis
Hiv
Anug
Tb
syphilis
Histoplasmosis
Crytococcosis
Blastomycosis
Paracoccidiodomycosis
leishmaniasis

4. Kopliks spots

10. Contd..
Mucocutaneous disease
Lichen planus
Pemphigus vulgaris
Pemphigoid and
variants
Erythema multiforme
Dermatitis
herpetiformis
Linear IgA disease
Epidermolysis bullosa
c/c ulcerative stomatitis
Blood disorders
Anemia
Leukemia
Myelodysplastic
syndrome
Neutropenia
Other white cell
dyscrasias
Gammopathies
Haematinic deficiencies

11. Vitamin deficiency disorders
Vitamin B complex
deficiency Reddening of oral mucosa,
tongue with or without
ulceration, swelling and
burning
Scurvy (vitamin C
deficiency)
Petechiae in oral mucosa and
swollen bleeding gums
Pernicious anaemia,
Iron deficiency
Pellagra
Bald tongue (atrophic
glossitis )

13. Contd…
 Gastrointestinal disease
 Coeliac disease
 Crohns disease
 Ulcerative colitis
 Rheumatic diseases
 Lupus erythematosus
 Sweet syndrome
 Reiter syndrome
 Endocrine disorders
 Diabetes
 Glucagonoma
 Vasculitides
 Behcets syndrome
 Wegeners granulomatosus
 Periarteritis nodosa
 Giant cell arteritis
 Disorders of uncertain
pathogenesis
 Eosinophilic ulcer
 Hypereosinophilic syndrome
 Necrotising sialometaplasia

14. Halitosis (oral malodour)
Abnormal smell from
breath
Diseases
Malodourous breath Bronchiectasis , Lung
abscess, Oral sepsis
(stomatitis, gingivitis)
Smoking , Idiopathic
Fishy odour Hepatic failure
Ammonical or urinary odour Uraemia or azotaemia
Fruity odour Diabetic ketoacidosis

15. .
Oral lesions
1.Lichen planus-
O/M : Erosive – diffuse erythema and painful ulceration
with peripheral radiating striae
Reticular – white lacy striae, especially on
bilateral buccal mucosa

16.  Management
In symptomatic patients, oral lesions may be treated
with a topicalcorticosteroid gel or rinse

17. Candidiasis (oral thrush)
 CONDITIONS ASSOCIATED WITH INCREASED
VULNERABILITY :
Poor oral hygiene, xerostomia
Recent antibiotic treatment
Dental appliance
Early infancy
Genetic immune deficiency, aids
Corticosteroid therapy
Pancytopenia, anaemia, malnutrition, malabsorbtion
Diabetes , advanced systemic disease

21. .
2.Lupus erythematosus
O/M: oral discoid lesions, honeycomb plaques, raised
keratotic plaques, erythema , purpura, petechiae,
irregularly shaped ulcers, cheilitis .

22.  Management
Ora lesions resolve with immunosuppressive therapy.
For patients with limited skin/ oral disease,
corticosteroids or systemic antimalarial drugs are
appropriate.

23. .
3. Benign mucus membrane pemphigoid
O/M : diffuse an painful ulceration and scarring
Intact blister formatoccasionally may be intraorally
(before rupture and ulceration)

24. .
4 . Pemphigus vulgaris
O/M ; diffuse painful oral ulcers , positive nikolsky sign
oral lesions are the first manifestation of disease and
may precede the onset of skin lesions.

25.  DD : Erosive lichen planus, benign mucus membrane
pemphigoid
 Management
Oral lesions usually resolve with systemic
immunosuppressive therapy but maybe slower to
resolve compared to extraoral lesions.

26. .
5.Crohn disease
O/M : diffuse mucosal swelling, cobblestone mucosa,
localised mucogingivitis, deep linear ulceration,
fibrous tissue tags, polyps or nodules, pyostomatitis
vegetans (snail track ulcers on an erythematous base)

27.  Management
Oral lesions resolve with systemic treatment of
underlying intestinal disease.
however persistent ulcers may require application of
topical corticosteroids and persistent swelling may
respond to intralesional injection of triamcinolone
acetonide

28. .
6.Behcet syndrome
O/M ; recurrent painful aphthous like ulcers, usually
numerous and especially involving the soft palate and
oropharynx
Oral lesions are most common and may be the first
manifestation of the disease.

31. Change in mucosal pigmentation
 Addison disease
O/M :diffuse melanin pigmention, candidiasis (in
patients with autoimmune polyendocrinopathy-
candidiasis- ectodermal dystrophy syndrome)

32. Systemic factors causing
periodontal disease
Neutropenia
Immunodficiency state
Downs syndrome
Diabetes melitus
Pregnancy
Oral contraceptives
Drug induced-Dilantin sodium, phenytoin, nifedipine
Idiopathic hereditory familial fibrosis

33. Drug induced periodonitis

34. Periodontal bleeding and inflammation
 Diabetes melitus
O/M: gingivitis , periodontitis, candidiasis, generalized
atrophy of the tongue papillae,taste dysfunction,
salivary dysfunction, burning mouth syndrome,
delayed wound healing

35.  Treatment for periodonditis may improve glycemic
control
 Furthermore severe periodontal disease may be a
strong predictor of various diabetic complications
including nephropathy, stroke, transient ischemic
attack, angina , MI and heart failure

36. .
 HIV – associated periodontal disease
O/M: linear gingival erythema
necrotising ulcerative gingivitis
necrotising ulcerative periodontitis

38. .
 Thrombocytopenia
O/M: petechia , purpura, ecchymosis, hemorhagic
bullae, hematomas

39. .
 Leukemia
O/M: mucosal bleeding, ulceration, petechiae
diffuse/localised gingival enlargement
secondary infections-candidiasis, hsv
periodontal bone loss

40. Alteration in teeth in systemic
disorders
Morphological change Teeth involved Disease/condition
Enamel hypoplasia Primary & permanent
teeth
Rickets , Osteomalacia,
Malabsorption,
Coeliac disease,
Hypoparathyroidism
Enamel hypoplasia with
discoloration
” Tetracyclines given
during pregnancy,infancy
and childhood upto
8years of age
Enamel
discolouration(mottling)
” Dental fluorosis
Loss of deciduos
dentition
Downs syndrome,
Juvenile
hypophosphataemia

41. Dental erosion
 Gastroesophageal reflux disease
O/M: water brash, xerostomia, burning sensation,
halitosis, palatal erythema, d. erosion

42. .
 Bulimia and Anorexia
O/M: d.erosion, xerostomia, increased caries rate ,
sialadenosis

44. Syndromes associated with cleft lip
and palate
 Most common is Pierre Robin syndrome
(micrognathia, cleft palate and glossptosis, airway
distress )
 Other syndromes includes Goldenhar syndrome,
median cleft face syndrome, orofacial digital
syndrome, Perts syndrome , Nagar syndrome, Oto
palato digital syndrome, Down syndrome and Marfan
syndrome

48. Sjogren syndrome
 Oral signs and
symptoms
 -dry mouth
 -cracker sign
 -burning
 -salivary swelling
 -caries
 -candidiasis
 Ocular signs and
symptoms
 -foreign body sensation
 -inability to produce tear
 -light intolerance
 Other
 -fatigue, fever
 -kidney, muscle, nerve,
liver involvement
 -connective tissue disease

50.  Management :
 Follow up regularly
 Salivry substitutes
 Eye drops
 Cariescontrol
 Soft diet
 Control of secondary infections

51. Delayed Tooth Eruption
 Local conditions associated with DTE

52. .
 Systemic conditions associates with DTE

53. . Genetic conditions associated with DTE