ORAL MANIFESTATIONS OF SYSTEMIC MEDICAL DISORDER

1. ORAL MANIFESTATIONS OF
SYSTEMIC MEDICAL
DISORDER
MODERATER/GUIDE:
DR. KAVITA BENDWAL
MAM
ASSOCIATE PROFESSOR
RDGMC UJJAIN
PRESENTER:
DR. AGRASHI AGRAWAL
(JR1)

2. ORAL CAVITY

3. CLASSIFICATION
•SYSTEMIC INFECTIOUS DISEASE
•CONNECTIVE TISSUE DISEASE
•GASTROINTESTINAL DISEASE
•HEMATOLOGICAL DISEASE
•ENDOCRINE DISEASE
•NUTRITIONAL DEFICIENCY
•DRUG REACTION/ RADIOTHERAPY
•DERMATOLOGICAL DISEASE

4. SYSTEMIC INFECTIOUS DISEASES
•Viral
•Bacterial
•Fungal
•Protozoal

5. VIRAL DISEASES
1. Primary herpatic gingivostomatitis
2. Recurrent herpes labialis
3. Recurrent intraoral herpes simplex
4. Chickenpox
5. Herpes zoster
6. Infectious mononucleosis
7. Herpengina
8. Hand foot and mouth disease
9. Primary HIV infection

6. HERPES ZOSTER
Usual location: Cheek, tongue, gingiva, or palate

7. PRIMARY HERPATIC
GINGIVOSTOMATITIS
Usual location: lip and oral mucosa

8. RECURRENT HERPES LABIALIS
Usual location: Mucocutaneous junction of lip, perioral skin

9. RECURRENT INTRAORAL HERPES
SIMPLEX
Usual location: Palate and gingiva

10. CHICKENPOX
Usual location: Gingiva and oral mucosa

11. INFECTIOUS MONONUCLEOSIS
Usual location: Oral mucosa

12. HIV INFECTION
Usual location: Gingiva, palate, and pharynx

13. HIV ORAL MANIFESTATIONS

15. BACTERIAL DISEASES
1. Acute necrotizing ulcerative gingivitis (“trench mouth”)
2. Prenatal (congenital) syphilis
3. Primary syphilis (chancre)
4. Secondary syphilis
5. Tertiary syphilis
6. Gonorrhea
7. Tuberculosis

16. ACUTE NECROTIZING ULCERATIVE
GINGIVITIS (“TRENCH MOUTH”)
Usual Location:
Gingiva

17. SYPHILIS

18. Primary syphilis (chancre)
Lesion appearing where organism enters body; may occur on lips,
tongue, or tonsillar area
Secondary syphilis
Oral mucosa frequently involved with mucous patches, which occur
primarily on palate and also at commissures of mouth
Tertiary syphilis
Palate and tongue

19. GONORRHEA
Usual Location:
Lesions may occur in mouth at
site of inoculation or secondarily
by hematogenous spread from a
primary focus

20. TUBERCULOSIS
Usual Location:
Tongue, tonsillar area, soft
palate

21. FUNGAL DISEASES
1. Cervicofacial actinomycosis
2. Histoplasmosis
3. Candidiasis

22. CERVICOFACIAL ACTINOMYCOSIS

23. CERVICOFACIAL ACTINOMYCOSIS
Usual Location:
Swellings in region of face, neck, and floor of mouth
Infection may be associated with extraction, jaw fracture, or eruption
of molar tooth; in acute form, resembles acute pyogenic abscess, but
contains yellow “sulfur granules” (gram-positive mycelia and their
hyphae)

24. HISTOPLASMOSIS

25. HISTOPLASMOSIS
Ususal Location:
Any area of the mouth, particularly tongue, gingiva, or palate
Nodular, verrucous, or granulomatous lesions; ulcers are indurated
and painful; usual source hematogenous or pulmonary, but may be
primary

26. CANDIADIASIS

27. CANDIADIASIS
Usual location: Any area in mouth
Clinical feature:
Pseudomembranous type (“thrush”): creamy white curdlike patches
that reveal a raw, bleeding surface when scraped; found in sick
infants, debilitated elderly patients receiving high-dose
glucocorticoids or broad-spectrum antibiotics, and patients with AIDS
Erythematous type: flat, red, sometimes sore areas in same groups of
patients Course same as for pseudomembranous type
Candidal leukoplakia: nonremovable white thickening of epithelium
due to Candida
Angular cheilitis: sore fissures at corner of mouth

29. CONNECTIVE TISSUE DISORDERS
Systemic lupus erythematosus
Discoid lupus erythematosus
Sjogrens syndrome
Scleroderma
Sarcoidosis
Wegner’s Granulomatosis
Behecet’s Syndrome
Amyloidosis
Kawasaki Disease
Cowden Disease

30. SYSTEMIC LUPUS
ERYTHROMATOSUS

31. DISCOID LUPUS ERYTHEMATOSUS

32. SJOGRENS SYNDROME

33. SJOGRENS SYNDROME

34. SCLERODERMA

35. AMYLOIDOSIS

36. SARCOIDOSIS

37. BEHECET’S SYNDROME

38. WEGNER’S GRANULOMATOSIS

39. KAWASAKI DISEASE

40. COWDEN DISEASE

41. DERMATOLOGIC DISEASES
Mucous membrane pemphigoid
Stevens-Johnson syndrome
Pemphigus vulgaris
Lichen planus

43. MUCOUS MEMBRANE PEMPHIGOID
Usual Location:
Typically produces marked
gingival erythema and ulceration;
other areas of oral cavity,
esophagus, and vagina may be
affected

44. STEVENS-JOHNSON SYNDROME

45. PEMPHIGUS VULGARIS
Usual Location:
Oral mucosa and skin; sites of mechanical trauma (soft/hard palate,
frenulum, lips, buccal mucosa)

46. LICHEN PLANUS

47. LICHEN PLANUS
Usual Location:
Oral mucosa and skin
White striae in mouth; purplish
nodules on skin at sites of
friction; occasionally causes oral
mucosal ulcers and erosive
gingivitis

48. HEMAOLOGICAL DISORDERS
•Iron deficiency anemia
•Pernicious anemia
•Plummer vinson syndrome
•Leukaemia

49. IRON DEFICIENCY ANEMIA

50. PLUMMER VINSON SYNDROME

51. PLUMMER VINSON SYNDROME

52. LEUKAEMIA (USUALLY MONOCYTIC)
Usual Location:
Gingiva

53. GASTROINTESTINAL DISEASES
Inflammatory bowel diseases
 Crohn’s disease
 Ulcerative colitis
Gastroesophageal reflux disease
Celiac disease
Chronic liver disease
Malabsorption syndrome

54. CROHNS DISEASE

55. CELIAC DISEASE

56. CHRONIC LIVER DISEASE

57. PEUTZ JEGHER’S SYNDROME

59. DIABETES MELLITUS

60. ADDISON’S DISEASE
Usual Location:
Any area of mouth, but mostly
buccal mucosa
Blotches or spots of bluish-black
to dark-brown pigmentation
occurring early in disease,
accompanied by diffuse
pigmentation of skin; other
symptoms of adrenal
insufficiency

61. NUTRITIONAL DEFICIENCIES
•Vitamin B2 deficiency
•Vitamin B3 deficiency
•Vitamin C deficiency
•Vitamin B12 Deficiency

62. VITAMIN B2 DEFICIENCY

63. VITAMIN B3 (NIACIN) DEFICIENCY

66. VITAMIN C DEFICIENCY

67. VITAMIN 12 DEFICIENCY
(PERNICIOUS ANEMIA)

68. PERNICIOUS ANEMIA
Atrophic glossitis in a patient
with pernicious anemia. Mucosal
atrophy appears as smooth, bald
areas devoid of lingual papillae
on the dorsal tongue.