BY, NAZIA ALI

1. INTRODUCTION 2. GASTROINTESTINAL DISEASES 3. AUTOIMMUNE DISEASES 4. VIRAL INFECTIONS 5. HORMONAL DISORDERS 6. HAEMATOLOGICAL DISORDERS 7. NUTRITIONAL DISORDERS

Many systemic conditions have oral manifestations. Recognition of these clinical signs may facilitate early diagnosis or in some cases provide some understanding of the level of control of the disease. Systemic disorders may signal their presence by oral symptoms. Such as : Gums that have grown over the teeth may mean a patient has leukemia. A red or furry tongue may indicate scarlet fever. A tongue covered with brownish sores, typhoid fever. A pale, smooth glossy tongue, pernicious anemia. A fine black line that appears on the gums,chronic lead poisoning. Spongy gums signal chronic mercury poisoning.

A doctor can also find diagnostic clues to  Addison's disease  Diabetes mellitus  Vitamin B deficiency  Scurvy  Sjogren's syndrome (an autoimmune disorder )  Inflammatory bowel disease  Multiple sclerosis by examining the oral cavity.  Foul breath may indicate a lung abscess.  An extended tongue that bends to one side may indicate a stroke.

Thus the mouth is a valuable reflection of what's going on in our body.

GIT DISEASES
CROHN'S DISEASE Itis a form of inflammatory bowel disease (IBD). It usually affects the intestines, but may occur anywhere from the mouth to the end of the rectum (anus).

APHTOUS ULCERS

MUCOSAL TAGS

ULCERATIVE COLLITIS It is a type of inflammatory bowel disease (IBD) that affects the large intestine (colon) and rectum.

PYSTOMATITIS VEGETANS

AUTOIMMUNE DISORDERS

It is an autoimmune disorder that involves blistering and sores (erosions) of the skin and mucus membranes.

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It is also known as a canker sore, is a type of mouth ulcer which presents as a painful opensore inside the mouth or upper throat characterized by a break in the mucous membrane. MINOR APHTHOUS ULCER: Discrete, round or oval ulcers Occur on movable mucosa Up to 1 cm in diameter with a erythematous halo surrounding a yellowish-white fibrin yellowishsurface

MAJOR APHTHOUS ULCERS: Larger (>1 cm), deeper, and longer lasting than minor aphthous ulcers Very painful Occur in the posterior of the mouth more often than minor aphthous ulcers May require several weeks to heal

HERPETIFORM APHTHOUS ULCERS

Tiny (1 to 2 mm) Resemble herpes simplex ulcers Painful, generally occur in groups

It is a skin disorder due to an allergic reaction or infection.

ORAL MANIFESTATIONS:  Oral lesions are usually ulcers.  Frequently form on lateral borders of the tongue.  Crusted and bleeding lips are frequently seen.  Stevens-johnson syndrome is the most severe form of Erythema Multiformae

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It is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva.

ATROPHY OF THE PAPILLAE

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 It is a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive.  Infection with HIV occurs by the transfer of body fluids.  Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells.

They may be the first signs of infection. They are highly predictive markers of immune deterioration and disease progression. Are key elements in the staging and classification of patients.

The WORLD HEALTH ORGANIZATION divides the oral manifestation of HIV/AIDS into three categories:

Candidasis Erythematous Pseudomembranous Hairy leucoplakia Kaposis sarcoma Non hodgkins lymphoma Periodontal disease Linear Gingival Erythema Necrotizing Ulcerative Gingivitis Necrotizing Ulcerative Periodontitis

 Bact rial i cti s cobact ri avi cobact ri t berculosis 

elanotic

er i

entation

 Necroti ing ulcerative stomatitis

Bacterial Infections Actinomyces israeli Escherichia coli Klebsiella pneumoniae Cat-scratch disease Drug Reactions Epithelioid(bacillary) angiomatosis Fungal Infections other than Candidiasis Cryptococcus neoformans Geotrictum candidum Histoplasma capsulatam Aspergillus flavus Neurological Disturbances Facial palsy Trigeminal neuralgia

1 ACUTE HERPETIC GINGIVOSTOMATITIS : The acute infection is caused by HSV-1 & the disease usually occurs during childhood, between 3-5 yrs of age.

ORAL MANIFESTATIONS
Reddenning of the oral mucosa, followed by numerous small vesicles formation over the keratinised mucosa. E.g.- gingiva, palate, lips, etc The vesicles contain clear fluid & rupture to leave multiple small, shallow painful ulcers. These are followed by diffuse large whitish ulcers surrounded by a red ring of inflammation (halo).

COLD SORES / HERPES LABIALIS

ORAL MANIFESTATIONS:  Painful little blisters about the size of a dime that usually form on the lips.
 Cold sores are caused by herpes simplex virus type-one or HSV-1.

EPSTEIN-BARR VIRUS
The most common disease associated with Epstein-Barr virus (EBV) is infectious mononucleosis, also called mono or "kissing disease." Symptoms include fever, fatigue, enlarged glands and sore throat. The virus is in saliva and moves easily from person to person by the exchange of saliva. Epstein-Barr virus infection may also cause a mouth sore (lesion or patch) called hairy leukoplakia, which looks white. It usually shows up on the side of the tongue.

Epstein-Barr virus has also been associated with cancer of the upper part of the throat.

Modes of Transmission for Oral Human Papilloma Virus: HPV is transmitted by skin-to-skin contact, not via exchange of bodily fluids. Symptoms of Oral Human Papilloma Virus: Most often HPV warts appear on the lips, but they can also appear on the tongue, gums, throat and palate. Lesions are more likely to be experienced by people with compromised immune systems. Treatment for Oral Human Papilloma Virus: There is no known cure. Warts can be suppressed by chemicals, freezing, laser therapy and surgery. Unfortunately, effective antiviral drugs for HPV have not been developed yet.

SYPHILIS It is a sexually transmitted infection caused by the spirochete bacteria Treponema pallidum subspecies pallidum.

Solitary chancre on the ventral surface of the tongue.

Two chancres on the tongue.

Mucous patches on the palate and gingiva.

Condylomata lata on the palate.

ORAL MANIFESTATIONS PRIMARY SYPHILIS of the mouth manifests as a solitary ulcer usually of the lip or, more rarely, the tongue. The ulceration is usually deep, with a red, purple, or brown base and an irregular raised border. SECONDARY SYPHILIS Maculopapular lesions 1. Macular syphilides: Macular lesions arise on the hard palate and manifest as flat-to-slightly raised, firm, red lesions. 2. Papular syphilides: They manifest as red, raised, firm round nodules with a grey center that may ulcerate. 3. Mucous patches: These manifest as oval-to-crescenteric erosions or shallow ulcers of about 1 cm diameter, covered by a grey mucoid exudate and with an erythematous border.

TERTIARY SYPHILIS Clinical disease arises in about one third of patients with untreated secondary syphilis. The oral complications show gumma formation,syphilitic leukoplakia (and risk of oral squamous cell carcinoma) and neurosyphilis. GUMMA FORMATION Gummas tend to arise on the hard palate and tongue, A gumma manifests initially as 1 or more painless swelling. The swellings eventually develop into areas of ulceration, with areas of breakdown and healing. There may be eventual bone destruction, palatal perforation, and oronasal fistula formation.

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DIABETES MELLITUS
It is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).

ORAL MANIFESTATIONS OF DIABETES MELLITUS

1. PERIODONTAL DISEASE  Microangiopathy altering antigenic challenge  Altered cell mediated immune response & impaired neutrophil chemotaxis.  Increased Ca+ & glucose lead to plaque formation.  Increased collagen breakdown. 2. SALIVARY GLANDS  Xerostomia is common.  Tenderness, pain & burning sensation of tongue.

3. DENTAL CARIES Increased caries prevelance in adult with diabetes.(xerostomia, increased salivary glucose). 4. ORAL BURNING & TASTE DISTURBANCES The burning may be due to peripheral neuropathy, xerostomia or candidiasis.
Good glycemic control may alleviate the burning sensation. Some patients have mild impairment of sweet taste sensation. This may be due to disordered glucose receptors or xerostomia.

5. FUNGAL INFECTION An increased predisposition to manifestations of oral candidiasis, median rhomboid glossitis, denture stomatitis & angular chelitis. Mucormycosis is a systemic fungal infection, occur in patients with uncontrolled DM. Seen as palatal ulceration or necrosis intraorally.

6. LICHEN PLANUS & LICHENOID REACTION The prevelance of oral lichen planus is higher in diabetic patients. 7. FASTER ALVEOLAR BONE RESORPTION 8. DELAYED WOUND HEALING Due to microangiopathy & utilisation of proteins for energy, may retard the repair of tissue Increased prevelance of dry socket 9. TRAUMATIC ULCERS & IRRITATION FIBROMAS

Anaemia Leukemia Polycythaemia Purpura

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It is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood.

ORAL MANIFESTATIONS Pallor: Oral mucosal, conjunctiva of the lower eyelid, nail beds Sooth, burning tongue; glossitis Recurrent oral ulceration Stomatitis Angular chelitis Candidiasis Reduced resistance to infection, poor wound healing & sepsis post-operatively
ANGULAR CHELITIS

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It is a type of cancer of the blood or bone marrow characterized by an abnormal increase of white blood cells. ORAL MANIFESTATIONS:
 Gingival swelling and hemorrhage  Mucosal purpura  Mucosal pallor  Fungal and viral infections  Oral ulceration  Lymphadenopathy  Cytotoxic therapy can provoke oral ulceration and mucositis  Busalfan can produce brown pigmentation of the oral mucosa

Carbohydrate deficiency Protein deficiency Fat deficiency Vitamin deficiencies Vitamin A Vitamin B Vitamin C Vitamin D Vitamin E Vitamin K

ORAL MANIFESTATION OF CARBOHYDRATE DEFICIENCY: 1. Altered carbohydrate metabolism is contributing etiological factor for periodontal disease. 2. Shorting, broadening of the mandible. 3. Gingival hyperplasia. 4. Teeth causing typical spacing of teeth

ORAL MANIFESTATION OF PROTEIN DEFICIENCY: Adversely effect periodontium. Delayed eruption of teeth. Caries prone teeth. Degenerative change in gingiva and periodontal ligament. Reddening of tongue with loss of papilla

ORAL MANIFESTATION OF FAT DEFICIENCY: Sore mouth with or without ulcerative lesion, halitosis. Unpleasant taste, loose teeth precocious exfoliation and failure of healing of tooth socket. Loss of supporting alveolar bone.

ORAL MANIFESTATION OF VITAMIN A DEFICIENCY : Hyperkeratosis, hyperplasia of gingival tissue. Atrophy of salivary gland. Hypoplasia of teeth. Increase susceptibility of caries. Delay eruption of teeth. Alveolar bone is retarded in its rate of formation.

ORAL MANIFESTATION OF VITAMIN B DEFICIENCY: Burning sensation of tongue. Angular stomatitis, Glossitis Filiform papilla become atrophic. Lips become red and shiny. Ulcer in the mouth.

ORAL MANIFESTATION OF VITAMIN C DEFICIENCY: Interdental and marginal gingiva is bright red, become ulcerated and bleed. Poor tissue healing. Poor resistance to infection. Scorbutic gingivitis Typical fetid breath.

ORAL MANIFESTATION OF VITAMIN D DEFICIENCY: Higher caries index as compare to normal. Hypoplasia of enamel.

ORAL MANIFESTATION FO VITAMIN E DEFICIENCY: Loss of pigmentation. Chalky white teeth. Disarrangement of ameloblast.

REFERENCES
 Textbook Of Oral Pathology-Shafers  Textbook of Carranza  Textbook of Biochemistry-Satyanarayan