1. Oral manifestations of systemic diseases

2. Crohn disease –diffuse labial, gingival or mucosal swelling –„cobblestoning“ of buccal mucosa and gingiva –aphtous ulcers –mucosal tags –angular cheilitis –oral granulomas Ulcerative colitis –oral signs are present in periods of exacerbation of disease –aphtous ulceration or superficial hemorrhagic ulcers –angular stomatitis –pyostomatitis vegetans, pyostomatitis gangrenosum cobblestoning of the gut mucosa GIT diseases pystomatitis vegetans

3. Gastroesophageal reflux –reduction of the pH of the oral cavity below 5,5 – enamel damage –damage of the dentin – higher sensitivity (to temperature..), caries Chronic liver diseases –jaundice –petechiae or gingival bleeding (hemostasis disorder) GIT diseases

4. Anemias –folate and vit. B12 deficiency –iron deficiency –glossitis red colour athrophic papilae recurrent aphthae –candidal infection –angular stomatitis –oral pain Hematologic diseases

5. Leukemia –gingival hypertrophy –petechiae –mucosal ulcers –hemorrhage Treatment of leukemia –reactivation of herpes simplex virus – oral mucosistis Hematologic diseases

6. Summary of oral manifestations of gastrointestinal and hematologic diseases Angular cheilitis Iron-deficiency anemia Hemorrhage Pyostomatitis vegetans Scurvy Ulcerative colitis Aphthous ulcers Crohn's disease Pernicious anemia Ulcerative colitis Intraoral burning Iron-deficiency anemia Pernicious anemia Candidiasis Crohn's disease (steriod therapy) Iron-deficiency anemia Pyostomatitis vegetans (steriod therapy) Ulcerative colitis (steroid therapy

7. Summary of oral manifestations of gastrointestinal and hematologic diseases Labial swelling Crohn's disease Erosion of enamel and dentin Anorexia nervosa/bulimia Gastroesophageal reflux Gingivitis Anorexia nervosa/bullimia Crohn's disease Scurvy Glossitis Crohn's disease Iron-deficiency anemia Pernicious anemia Ulcerative colitis Ulcerations and erosions Crohn's disease Iron-deficiency anemia Pernicious anemia Pyostomatitis vegetans Ulcerative colitis

8. Sjögren syndrome –autoimmune disease –men : women - 1 : 9, 50 years and older Main signs –sicca syndrome –keratoconjuctivitis sicca –xerostomia Oral signs –decrease in saliva xerostomia –dry, red, wrinkled mucosa difficulty in swalloving and eating disturbance in taste and speech increased dental caries infections atrophy of the papilae candidiasis Connective-tissue diseases

9. Kawasaki disease –vasculitis of medium and large arteries Oral signs –swelling of papilae on the surface of the tongue (strawbery tongue) –intense erythema of the mucosal surfaces –cracked, cherry red, swolen and hemorrhagic lips Connective-tissue diseases

10. Scleroderma –diffuse sclerosis of the skin, GIT, heart muscle, lungs, kidney Oral signs –pursed lips – dificult to open the mouth –esophafeal sclerosis  gastroesophageal reflux – damage of enamel –pale, rigid mucosa –teleangiectasias –decreased mobility of tongue –salivary hypofunction Connective-tissue diseases Limited mouth opening and decreased tongue mobility Gingival retraction

11. Lupus erythematosus –autoimmune disease Oral signs –ulcerations –oral lesions of lichen planus – painfull –petechiae –damage of salivary glands - xerostomia Connective-tissue diseases ulcer lichen planus lesions

12. Cystic fibrosis Oral signs –disorder of salivary glands –swelling lips –gingivitis –dryness Pulmonary diseases

13. Sarcoidosis Oral signs –multiple, nodular, painles ulcerations of the gingiva, bucal mucosa, labial mucosa and palate –tumorlike swelling of salivary glans –swelling of the tongue –xerostomia –facial nerve palsy Pulmonary diseases

14. Psoriasis Oral signs –fissured tongue –small white papules –red and white plagues –bright red patches Acantosis nigricans –hyperpigmentation, papillomatosis Oral signs –gingival hyperplasia –gingiva, tongue, lips - papilomas Cutaneous diseases

15. Diabetes mellitus Oral signs –xerostomia caused decreased salivation and increased glucosa level in saliva gingivitis oral infections candidiasis –higher incidence of caries –bilateral enlargement of parotid glands –altered taste –burning mouth syndrome Endocrine diseases gingivitis hyperplasia bilateral parotid gland enlargement

16. Hypoparathyroidism Oral signs –candidiasis –upper lip twitching Hyperparathyroidism Oral signs –loss of the lamina dura surrounding the roots of the teeth –decrease of trabecular density –osseous lesions „brown tumor“ Endocrine diseases

17. Cushing´s syndrome Oral signs –fatty tissue deposition – „moon face“ –osteoporosis  pathological fractures of the mandible, maxilla or alveolar bone –delayed healing of fractures and also sof tissue injuries Addison´s disease Oral signs –„bronzing“ hyperpigmentation of the skin –oral mucosal melanosis – buccal mucosa, tongue Endocrine diseases moon face hyperpigmentation

18. Uremic stomatitis –rare –in undiagnosed and untreated chronic renal failure –irritation and chemical injury of mucosa by ammonia or ammonium compounds Signs –painful plagues and crusts – bucal mucosa, the floor or dosrum of the tongue, floor of the mouth –Type I generalized or localized erythema exudate pain, burning, xerostomia, halitosis, gingival bleeding, candidiosis –Type II ulceration secondary infection anemia Renal diseases