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    ORALMANIFESTATIOS OF

    SYSTEMIC DISEASEDEPT. OF DERMATOLOGY

    K.A.U.H

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    Biology of the mouth

    Oral epithelium:

    - keratinised: masticatory mucosa (hard

    palate, gingiva and post tongue)- non-keratinised: lining mucosa (buccal,

    labial, alveolar, floor of the mouth, ventral

    tongue and soft palate)- Specialised: dorsum of tongue. Taste.

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    Biology - Immunity

    Mechanical: movement of tissue, speech,

    salivation (Xerostomia)

    Saliva: enzymes, mucin GALT: B-cell and IgA

    Cellular: Neutrophils and others WBC. If

    abnormal: inf ulcers, periodontal diseaseand gingivitis

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    *Dis. Affecting teeth

    Loosening and early loss: locals: gingivitis.

    systemic: DM, low immunity (HIV, Leuckopenia), disease

    of CT. Discoloration:

    Extrinsic causes: poor hygiene, smoking, drinks, stains..

    Intrinsic: drugs (Tetracyclines), flurosis, porphyria,kernicterius.

    Hypodontia and malformed teeth: Ectodermaldysplasia.

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    *Dis. Affecting Periodontium1. Gingival Bleeding

    - Locals: gingivitis, periodontitis, acute

    necrotizing gingivitis (poor hygiene, HIV,

    Neutropenia, leukemia)

    - Systemic: Leukaemia, HIV, clotting disease,

    drugs (anticoagulants), scurvy.

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    Period.2. Swelling

    Locals:

    Chronic Gingivitis.

    Hyperplastic (Mouth breathers).

    Tumors and cysts.

    Systemic:

    Pregnancy.

    Drugs (Phenytoin, ciclosporine, Nifidipine).

    Sarcoidosis.

    Leukemia.

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    Period. Swelling/cont.

    Systemic

    Infiltartives: Amyloid, Mucopolysaccharides,

    Mucolipidosis, Lipoid proteinosis..

    Crohns dis

    Wegners granulomatosis

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    Dis. Period-3.Gingival redness

    Gingival redness:

    local: chronic gingivitis (commonest)

    systemic: Desquamative gingivitis, HSV,Vascular abnormality (HHT, Haemangioma,

    KS..), Bullous diseases; esp. Pemphigus, Allergic

    response.

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    PERIODO-4. WHITE PATCHES (Leukoplakia)

    Locals:

    Frictional, smokers, ca, burns..

    systemic:

    Candidiasis, L.P, Lupus, CRF, Hairy

    Leukoplakia, white-sponge naevus, Syphilitic.

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    Dis Of Period.-5.Pigmentation

    This can be seen normally in dark people.

    Local causes: Amalgam tattoo, melanocytic

    macules Systemic causes: Addisons dis., K.S,

    Melanoma and Drugs (Hydroxychloroquine,

    minocycline).

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    Pigment. Amalgam tattoo

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    Cont. Ulcers

    Drugs: Cytotoxics, NSAIDS, Alendronate.

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    Dis Of period.7 - Blisters

    Locals: Burn, Mucoceles

    Underlying cause: Immunobullous

    conditions usually present as desqumativegingivitis (Pemphigus, B.P, MMP), HSV.

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    Desquamative Gingivitis

    Persistent red glazed sometimes painful

    labial gingiva (usually sparing margins)

    Causes: MMP, LP>>,BP, DH, LAD,.. Treatment: difficult but: improved hygiene,

    Topical Steroids or Tacrolimus. Severe:

    Dapsone

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    Dequ. Gingivitis

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    Drug induced gingival swelling

    Phenytoin, Ciclosporin, Nifedipine and

    Diltiazem.

    Increase with prolonged use and poor oralhygiene.

    Mx: good oral hygiene, removal of plaque

    prior to initiation of treatment, surgicalexcision.

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    Gingival swelling-Phenytoin

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    *Dis of oral mucosa-1.Pigmentation

    Normal in dark people, Asians and Mediteranians.Bilateral and symmetrical.

    Melanocytic macules are seen in 3% pop.

    Other causes: Melanoma and Ks

    Addisons disease and ectopic ACTH

    Drugs (minocycline, antimalarials, occp..)

    Malignant Acanthosis nigricans Rare causes (NF, Hemochromatosis,IP..)

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    Mucosal2. Redness

    Infections: HSV, Candidiasis.

    Inflammatory: LP, MMP, Pemphigus,

    Allergic. Vascular: Telangiectasia (HHT), KS, PWS.

    Nutritional: Low B12, Folate, Iron (red

    tongue). Drugs (mucositis).

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    Mucosal redness

    GT (geographical tongue).

    MX: Look for signs of underlying dis. check

    hematenics (B12, Folate , Iron).

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    Redness- GT

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    Mucosal3.Ulcers

    Local causes: Trauma, orthodontic

    applicances, Tumors

    Recurrent Aphthous stomatitis Systemic causes:

    Haematological, GI, Dermatological,

    Infective, Vasculitis, Iatrogenic, ?,drugs

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    RAS

    Recurrent episodes of ulceration each

    lasting 1-4 weeks.

    Aetiology: ? But: search for cause Clinical patterns:

    Minor 80% (

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    RAS

    Investigations: FBC,ESR,IRON,

    B12,FOLATE,ANTIENDOMYSIAL ab.

    Treatment:most cases-eventual remession

    Topical anti Inflammatory agents

    Systemic agents: Steroids, Colchicine,Dapsone. Thalidomide.

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    RAS

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    Mucosal-4. White patches (Leukoplakia)

    Infective (Candida, Hairy Leukoplakia).

    Inflammatory (LP.LE..).

    Liver and Renal diseases. Genetics: Whitesponge Nevus.

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    Leukoplakia

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    Leukoplakia-LP

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    Mucosal-5.Blisters/Erosions

    Locals: Burn, Mucocele..

    Underlyings: Pemphigus, BP, MMP,EB,EM,

    Infections: HSV, Chickenpox, Coxackie..

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    Behcets Syndrome

    Major Criteria: Oral aphthae: 90-100%

    Genital ulcers: 60-80%

    Ocular (iridocyclitis, vasculitis..): 10-90%

    CNS (Meningioencephalitis)

    Skin (pustules, EN, Pathergy) 50-90%

    Minors: proteinuria, thrombophlebitis,Aneurysms, Arthralgias.

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    Behcets syndrome

    Mx of oral ulceration:

    Mild: Topical steroids , 5-Aminosalicylic acid,

    others.

    Severe: Colchicine, Ciclosporine, Azathioprine

    Main Morbidity is related to Ocular Disease

    so always involve an Ophthalmologist.

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    Lichen Planus

    Aetiology?

    Cutaneous: itchy papules, violaceouscolour. Hair and nails may be involved.

    Oral:

    1. Bilateral white areas- Linear, Reticular,P/P

    2. Erosive OLP: Dorsal and Lateral bordersof tongue, Buccal Mucosa.

    3. Desquamative Gingivitis.

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    LP-CONT

    Mx:

    MILD: Topical CS

    Moderate: topical Tacrolimus +- Top Cs Severe: oral steroids, Ciclosporine,

    hydroxychloroquine, Azathioprine, Acitretin.

    EOLP: Risk of SCC.

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    Pemphigus

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    Oral involvement in Various dis-Endocrine

    Addisons: mucosal hyper pigmentation.

    Congenital hypothyroidism: macroglossia.

    Acromegaly: macroglossia. DM: Period disease, Xerostomia,

    candidiasis.

    Pregnancy: Gingivitis, Epulis.

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    GIT

    Pernicious Anemia: ulcers, glossitis,

    ang.stomatitis, red lesions

    Coeliac : ulcers, glossitis, angular stomatitis P-J synd: melanosis

    Crohns: ging. Hyperplasia, ulcers, golssitis,

    cobblestoning of mucosa

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    Hematologic

    Hematinic def: Burnning, ulcers, glossitis,

    angular stomatitis

    Sickle cell :osteomyelitits of Jaw WBC : Ulcers, infections

    Hemostsis def: bleeding

    Leukemias: ging swelling, bleeding,infections and ulcers

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    Renal

    CRF: Xerostomia, Halitosis, Leukoplakia,

    bleeding

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    Drugs

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    CTD

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    others

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    END


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