OROFACIAL MANIFESTATIONS OF SYSTEMIC DISEASES Dr. Mary Mwacharo

INTRODUCTION The oral cavity is the gateway to the body It is a mirror that reflects what is happening in the body Lesions occur in oral cavity and the maxillofacial complex caused by systemic diseases or conditions

Introduction cont’ Haematological disorders/diseases Gastrointestinal diseases Connective tissue disorders Nutritional disorders Endocrine disorders Drug induced conditions

JUSTIFICATION Orofacial signs and symptoms may be the 1st clinical presentation of a systemic disease Early diagnosis results in early intervention Manifestations must be recognised to avoid wrong treatment being administered Management must focus on correcting the disorder as well as the oral manifestations Prevent complications during dental procedures

Haematological disorders Aplastic anaemia: multiple haemorrages in oral cavity, oral ulcers, oral candida infection, subconjunctival haemorrage

Leukemias: monocytic, lymphocytic, myeloid

Haematological disorders cont Disorders of haemostasis: mixed group of disorders with abnormal tendency to haemorrage or thromboembolism Manifest as petechiae, prolonged post extraction bleeding, spontaneous gingival bleeding or after mild trauma, conjunctival haemorrage

Gastrointestinal diseases Oral cavity is the portal of entry to the GI tract Many conditions affecting the GIT manifest in the mouth Gastro-oesophageal reflux disease (GERD). Regurgitation of gastric contents reduces oral pH < 5.5 resulting in dissolved enamel Enamel erosion also occurs in anorexia/bulimia

Enamel Erosion

Connective tissue disorders Sjogren’s syndrome: autoimmune disorder, mainly affecting women above 50yrs: keratoconjunctivits, xerostomia, angular stomatitis

Connective tissue disorders Scleroderma: diffuse sclerosis of skin, GIT, heart muscle, lungs, kidneys. Oral signs: difficulty in opening mouth due to pursed lips, decreased tongue mobility, salivary hypofunction

Nutritional deficiencies Iron deficiency anaemia: pallor of mucosa/conjunctiva, atrophic glossitis, angular stomatitis

Nutritional deficiencies cont’ Vit C deficiency: petechiae and echymosis in mucosa, erosive bleeding gums, early tooth loss in children

Endocrine Diseases Diabetes mellitus: oral infections such as candidiasis, altered taste, gingivitis, xerostomia

Endocrine diseases Addison’s disease/adrenal insufficiency: hyperpigmentation of skin, oral mucosa tongue,

Drug induced conditions Gingival hyperplasia caused calcium channel blockers for hypertension

Drug induced ulcers may be triggered by systemic or locally delivered medicines NSAIDs, cytotoxics, nicorandil etc

Conclusion Wide array of disorders have manifestations in oral cavity Many manifestations are non specific for particular conditions Clinician must be alert to possibility of concurrent or latent disease Take detailed history of patient and thorough examination Refer patient for appropriate treatment where necessary