oral manifestations of connective tissue disease (ctd
Post on 14-Feb-2016
220 Views
Preview:
DESCRIPTION
TRANSCRIPT
Oral Manifestations of Connective Tissue Disease (CTD)Group B
Mohamad Aiman | Che Ku Farah Najwa | Fatin NabihahLim Shuang Ying | Chan Yunn Yee | Aifa Nadhirah
Contents• Introduction• Connective Tissue Diseases with Oral Manifestations
• Systemic Lupus Erythematous• Rheumatoid arthritis• Vasculitides (Bechet’s Disease, Kawasaki Disease)• Systemic Sclerosis• Sjorgen’s Syndrome• Mixed connective Tissue Disease
• References
Connective Tissue Diseases• Diseases that involved the body’s connective tissues as the
primary target of pathology.• They represent a spectrum of disorders, from single to
multiple organ systems due to systemic autoimmune dysfunction or dysregulation.
• Connective tissues include connective tissue proper, cartilage, bone tissues and blood.
Systemic Lupus Erythematous• Lupus : wolf (Greek) disease bites the tissue. • SLE is defined as an autoimmune disease characterized by
antibodies that may initiate immune complex reactions, resulting in multisystem disease.
• Susceptibility related to • immune system genes : HLA-DR3 and B8, HLA-DR2• complement C4 genes• polymorphism of T-cell receptor.
Clinical features• Onset :
• acute, resembling infection• vague symptoms may progress over the years.
• Arthralgia & myalgia• Skin, mouth, hair
• malar rash ( butterfly rash)• Photosensitivity rash ( rash on skin exposed to sunlight)• Oral ulcer• Alopecia ( hair loss)
• Anaemia• Pericardium inflamed, causing
• Pleurisy (pains in the side of chest)• Pericarditis (central chest pain)
• Myocarditis - leads to cardiac failure. Increase risk of infarction. Endocarditis can develop.• Kidney inflamed proteinuria & haematuria (assoc. w. hypertension)• Minor disturbance of mood and depressive or hysterical behaviour• Women w SLE can pass antibodies across placenta (fetal heart block)
Butterfly rash
Manifestations of SLESkin & Joints • Rash
• Arthritis & Polyarthralgia
Serous membranes • Pericarditis• Pleurisy
Cardiovascular • Endocarditis• Myocarditis• Raynaud's syndrome
Lungs • Pneumonitis
Kidney • Nephritis
Neurological • Cranial nerve palsy• Neuroses• Strokes
Eyes • Conjuctivitis• Retinal damage
Git • Hepatosplenomegaly, Pancreatitis• Sjogren's syndrome
Blood • Anaemia & purpura
Dental Aspect [SLE]• Oral mucosa lesion seen in 20% of patients• May resemble oral lichen planus lesions.
• 2 predominant types :• Oral ulcer
• Usually occur on palate and oropharynx• Characteristically painless
• Discoid lesion• Similar to those occurring in skin (whitish striae radiating from central
erythematous area –brush border)• Common affected site :buccal mucosa, gingiva, labial mucosa
• Surgery/ extraction may exacerbate the symptom• Bleeding tendency• Antimalarial drug used in SLE may cause oral mucosal melanin
pigmentation.
Chronic palatal lesion in SLE
Discoid lupus lesion on the lower lips
Hard palate ulcer in SLE
Discoid lupus lesion on buccal mucosa
Rheumatoid Arthritis• A multisystem disease, but join pain and damage are the most
prominent features.• It is immunologically mediated;
- An abnormal immunoglobulin is form in the join tissue and an auto-antibody to the abnormal immunoglobulin (Rheumatoid factor, RF) is produced in response. - Immune complex (antigen-antibody complex) formation may then lead to the activation of inflammation and lead to synovial damage.
• Women are affected 3:1 men• Onset are typically between age 30-40
Other Features and Complication
Orafacial Manifestations
1. Temperomandibular Joint (TMJ) Involvement
• Due to synovial inflammation and connective tissue degeneration
• Can cause bilateral; deep, dull, aching pain exacerbation during movement of TMJ.
• Including tenderness and swelling in the periauricular region, limitation of mandibular range of movement and clicking and tenderness of masticatory muscle.
• Limitation in mouth opening as the disease worsening, anterior open bite due to loss of condylar height and class II malocclusion with heavy posterior occlusal contact.
• Radiographic finding of TMJ: joint effusion, disc displacement and condylar abnormalities.
2. Periodontal Disease• Increase in pocket depths• Furcation involvement• Loss of alveolar bone and tooth loss• Limitation on oral hygiene due to arthritic involvement of hands
and limiting opening.
- This all happen due to the connection of inflammatory process in joint and oral tissue.
3. Xerostomia and Decrease In Salivary Flow
• Occurs in Rheumatoid Arthritis patient with Sjogren Syndrome.
• Leads to: difficulty in swallowing & speaking oral soreness & burning sensation difficulty in function with oral prosthesis increase risk for caries.
Open anterior bite in patient with Juvenile Rheumatoid Arthiritis
Furcation involvement in RA
Increase of pocket depths in RA
Vasculitis/Vasculitides• Vasculitis – a group of clinical syndromes characterized by
inflammation that predominately involves the blood vessels of unknown etiology.
• According to size of the vessels affected, it can be classified into:• Large vessel• Medium vessel (Kawasaki Disease)• Small vessel (Bechet’s Disease)
Behcet's Disease• An auto inflammatory disease resulting in damage to blood
vessels throughout the body.• Common in men, onset: middle 20-50 y/o• Most common symptoms:
• Oral ulcerations• Genital ulcerations• Inflammation of the internal portions of the eye (uveitis)
Oral Manifestations • Oral ulceration tends to be the earliest manifestation of
Behcet's Disease.• Can be major, minor or herpetiform ulcers. • Predominantly found on non-keratinized mucosa (tongue, lips,
buccal mucosa, gingiva)• Indistinguishable from common apthous ulcer (more
extensive, more painful, more frequent and evolve quickly from a pinpoint flat ulcer to a large sore)
• Lesions can be shallow or deep, and usually have a central, yellowish, necrotic base and a punched-out, clear margin.
• Appear singly or in crops, persists in 1-2 weeks, and subside without leaving scars.
Minor aphthous ulcer
Major aphthous ulcer Herpetiform ulcer
Kawasaki Disease• Aka mucocutaneous
lymph node syndrome.• Idiopathic multisystem
disease characterized by vasculitis of small and medium blood vessels.
• Unknown aetiology, occurs in children <5 years.
• Characteristics: • Conjunctivitis• Rash• Cervical
lymphadenopathy • Strawberry tongue • Changes in peripheral
extremities• High grade
fever≥5days
Oral Manifestations
• Erythema, dryness, fissuring, peeling, cracking and bleeding of lips
• “Strawberry tongue” it is indistinguishable from that associated with streptococcal scarlet fever with erythema
• Prominent fungiform papillae• Diffuse erythema of the oropharyngeal mucosa
Strawberry tongue
Cracking and bleeding lips
Erythema lips
Kawasaki disease
Systemic sclerosis (Scleroderma)
• ‘skleros’ = hard, ‘derma’= skin• Characterised by :
• sclerotic skin changes (subcutaneous and submucous fibrosis) that are often accompanied by multisystem disease.
• Progressive stiffening of skin.• Associated with antibodies.
• Female predominance (F:M = 4:1)• Onset : 30-50 years of age
Oral Manifestations
• Periodontal involvement• Widening periodontal ligament space (<10%)• No tooth mobility• Increaseing pocket depth• Gingivitis
• Tongue involvement• Due to involvement of oral submucosa• Become stiff/rigid• narrowed
• Temporomandibular Joint Dysfunction + Microstomia• Limit mouth opening (due to fibrosis)• Gross change in mandibular• Resorption of condyle, angle and body of mandible
• Xerostomia• 25 % cases• With/ without xeropthalmia
• Lips involvement• Constricted oral orifice (fish mouth)• Pursed with radiating furrows
• More decayed, filled or missing teeth
80% patients have manifestations at head and neck regions, 30% starts from here
Sjogren’s Syndrome• Etiology :
• Chronic inflammatory disease of unknown etiology characterized by lymphocytic infiltration and destruction of exocrine
• Destruction of exocrine gland can cause absence of physiologic secretions, dryness of mucus membranes and conjunctiva, keratoconjunctivitis sicca, xerostemia, and other manifestation.
• Sign/Symptoms :• Mucosal dryness• Eyes: Dry, burning, red eyes(photosensitivity)• Mouth: Dysphagia, enlarged salivary glands, cavities• Systemic: Raynaud’s phenomenon, lung infections, fibrosis, renal
disease, pancreatitis, thyroiditis, athralgias, myositis
• Treatment :• No specific cure• Treat dry eyes with ophthalmic drop PRN• Emergent referral for patient with cornea ulceration• Dry mouth: Pilocarpine; maintain excellent oral hygiene to avoid
cavities• Treat athralgias with hydroxychloroquine• May need steroids for systemic symptoms
• Oral manifestations of Sjogren’s Syndrome:• Mouth: Dysphagia, enlarged salivary glands, cavities• Decreased salivary flow• Xerostomia• Burning of tongue (glossodynia)
Mixed Connective Tissue Disease
• MCTD is an overlapping syndrome of SLE, SSc, RA and polymyositis.
• Presence of a distinctive antibody U1-ribonucleoprotein (RNP)
Clinical Manifestations
1. Swollen (edema) hands2. Raynaud’s phenomenon (particular series of discolorations of
the fingers and/or toes after exposure to changes in temperature)
3. Synovitis > joint pain (arthralgia)4. Myositis > muscle pain (myalgia)5. Acrosclerosis (special form of Scleroderma characterized by
skin thickening and stiffness affecting the extremities, head and face and is associated with Raynaud’s Phenomenon).
Oral Manifestations • Dry mouth • Oral mucasal ulceration• Focal sialadenitis (90%)
Painful swollen salivary glandRedness of the overlying skinDifficulty in opening the mouthFeverSwelling of the lymph nodes in the neck region
References• Cawson, Odell. Cawson’s Essentials of Oral Pathology and Oral
Medicine. 8th Edition. Elsevier.• Kumar, Clark. Kumar&Clark Clinical Medicine. 6th Edition.
Elsevier Saunders.• Scully, Cawson. Medical Problems in Dentistry. 5th Edition.
Elsevier.
top related