Oral manifestations of systemic disease
Oral manifestations of systematic disease are signs and
Syphilis infection can be associated with longitudinal furrows of the tongue.Mineral and vitamin deficiencies can cause the
Cardiovascular and haematological system
A heart attack is a blood vessel in the heart being constricted either by a blood clot or atherosclerosis formation. A heart attack can cause pain the chest; sometimes this pain can radiate up to the jaw. (Malik et al., 2013)[4]
Nicorandil is a medication that is prescribed for the treatment of angina. It can cause major aphthous-like ulcer formation (BNF, 2020).[6]
Iron, folate and vitamin B12 deficiencies – The most commonest cause of iron deficiencies is low ferritin; this can cause the tongue to appear beefy red and appear sore. It can also present in the mouth as angular chelitis, which is an infection caused by either staphylococcus or candidiasis, and can make the corners of the mouth appear red and crispy.
Sickle cell disease is a hereditary genetic condition that results in deformed red blood cells to be formed. Sickle patients can experience sickle crisis, these are painful events in which if in the jaw can mimic dental pain and facial swelling can also occur during a crisis. The dental pulp can be affected by sickling and there may be a delayed eruption and hypoplasia of the dentition. Sickle patients are also at an increased risk of developing infection.
Thalasseamias is a group of inherited genetic disorders that affect the haemoglobin synthesis; it can result in either a reduced or absent globin chain production. If beta thalassaemia major is left untreated or under transfused, there is expansion of ineffective bone marrow, this leads to bony deformities resulting in dental malocclusion. Beta thalassaemia major patients may also be on bisphosphonates and are therefore at risk of developing osteonecrosis of the jaw.
Thrombocytopenia is a deficiency of platelets in the blood. It can present as red blood blisters in the mouth.
Respiratory system
Patients with respiratory conditions like asthma and chronic obstructive pulmonary disease can be prescribed steroidal inhalers to help strengthen their lungs. They must ensure after use that they rinse their mouths, otherwise there is an increase of dental caries, xerostomia, candidiasis, ulceration and gingivitis/periodontitis (Godara et al., 2011).[7]
Renal system
There are a number of oral complications following renal transplantation. Ciclosporin is an immunosuppressant medication that is used to help prevent patients from rejecting the transplanted kidney (BNF, 2020). Due to the immunosuppression (suppressed immune system), these patients are more likely to have gingival hyperplasia, aphthous ulceration, herpes simplex virus, oral leucoplakia; which may transform into squamous cell carcinoma, candidiasis infection or Kaposi's sarcoma (BNF, 2020).[6]
Digestive system
There are many specific diseases of the
Dysphagia is defined as a difficulty in swallowing. Structurally it worsens when eating solids and neurologically it is worse with fluids. Dysphagia may present as a barrier to care in the dental setting as the patient may require high volume suction in order to maintain patient comfort and reduce the risk of aspiration of dental material/ fluids.
Gastroesophageal reflux can present as retrosternal pain, acid brash and a
Crohn's disease is a patchy disease which can affect any area of the GI tract from the oral cavity to the anus. The manifestations depend on the affected area. The oral manifestations present as orofacial granulomatosis, an inflammatory condition affecting the oral mucosa. It is non-caveating granulomas and has a "cobblestone" appearance. Orofacial granulomatosis can be isolated or a manifestation of Crohn's disease and can be treated with local or systemic corticosteroids. An aggravating factor is cinnamon, therefore a cinnamon-free diet is recommended.[8]
Eating disorders are a psychological problem which has an impact on the gastrointestinal tract. Two common eating disorders are anorexia nervosa and bulimia nervosa. Anorexia nervosa is a refusal to maintain a "normal" body weight with a fear of weight gain and distorted perception of body image. Bulimia nervosa is binge-eating followed by attempts to restrict weight gain and can include purging. Eating disorder oral manifestation is severe palatal erosion due to vomiting. There is occlusal erosion of the maxillary teeth causing the incised edges of the incisors to be thin and knife-edged. Occlusal surfaces have a flat to cupped-out appearance.[12] Extra-orally eating disorders may present with swollen parotid glands.
Other oral manifestations of GI disease is
Endocrine system
Diabetes Mellitus has two main types: Type 1, autoimmune destruction of beta-cells leading to reduced insulin production and Type 2, the body becomes increasingly resistant to the effects of insulin leading to the bodies inability to regulate plasma glucose levels resulting in a fall in insulin production. Diabetes has numerous implications on oral health. Patient with diabetes have increase extent and severity of periodontal disease, increased prevalence of dental caries due to xerostomia, can experience burning mouth syndrome and candidal infections as well as experiencing altered taste sensation, altered tooth eruption and hypertrophy of the parotid glands. Other oral health problems include chronic hyperglycaemia, infection, delayed wound healing and lichen planus/lichenoid reactions.[13]
The oral manifestations of Acromegaly predominate as spacing of the lower incisor teeth and widening of the mandible. Other complications include visual field defects, headaches, Diabetes, Sleep apnoea, Hypertension, Arthralgia and Arthritis and Carpal Tunnel Syndrome.[13] Arthralgia and Carpal Tunnel Syndrome both have an impact on a patients' ability to maintain good oral hygiene practice and therefore may predispose them to Dental caries and Periodontal Disease. It is imperative these patients are given Enhanced Prevention in order to reduce the risk of Dental Caries and Periodontal Disease.
Another
Skeletal system
Osteopgenesis imperfecta, also known as brittle bone disease, is caused by a gene mutation affecting the collagen genes, patients generally present with a large number of fractures from minor injuries. Teeth, if affected, are of the appearance of dentinogenesis imperfecta.
Osteoporosis is a very common disease associated with a decreased bone mineral density, it mainly affects post menopausal women whose oestrogen levels have dropped. It is managed with the used of bisphosphonates. Prior to placement on bisphosphonates, a dental check must be done to extract any hopeless teeth as extractions in patients who have prolonged used of bisphosphonates are at risk of MRONJ.[clarification needed] (SDCEP,2017)
Immune system
Nervous system
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Muscular system
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References
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