Podcast
Questions and Answers
A 25-year-old patient presents with recurrent oral ulcerations and a history of abdominal cramping, pain, and diarrhea since adolescence. Intraoral examination reveals diffuse nodular swelling of the buccal vestibule with a creamy white surface and a cobblestone mucosal appearance. Which systemic condition is MOST likely associated with these findings?
A 25-year-old patient presents with recurrent oral ulcerations and a history of abdominal cramping, pain, and diarrhea since adolescence. Intraoral examination reveals diffuse nodular swelling of the buccal vestibule with a creamy white surface and a cobblestone mucosal appearance. Which systemic condition is MOST likely associated with these findings?
- Pyostomatitis vegetans
- Crohn's disease (correct)
- Ulcerative colitis
- Celiac disease
A patient diagnosed with ulcerative colitis develops oral lesions characterized by linear, 'snail track' pustules filled with eosinophils. These pustules are observed on the buccal mucosa and soft palate. This oral presentation is MOST indicative of which specific condition?
A patient diagnosed with ulcerative colitis develops oral lesions characterized by linear, 'snail track' pustules filled with eosinophils. These pustules are observed on the buccal mucosa and soft palate. This oral presentation is MOST indicative of which specific condition?
- Bullous pemphigoid
- Pemphigus vulgaris
- Pyostomatitis vegetans (correct)
- Erythema multiforme
A pediatric patient exhibits aphthous-like ulcerations of the oral mucosa, enamel defects with pitting in primary and permanent dentition, and delayed tooth eruption. Serological testing reveals anti-endomysial and anti-tissue transglutaminase antibodies. Which underlying systemic condition is MOST consistent with this clinical presentation?
A pediatric patient exhibits aphthous-like ulcerations of the oral mucosa, enamel defects with pitting in primary and permanent dentition, and delayed tooth eruption. Serological testing reveals anti-endomysial and anti-tissue transglutaminase antibodies. Which underlying systemic condition is MOST consistent with this clinical presentation?
- Celiac (Sprue) disease (correct)
- Irritable Bowel Syndrome
- Crohn's disease
- Ulcerative colitis
An adult patient presents with a complaint of persistent oral dryness and bilateral parotid gland enlargement. Medical history reveals a diagnosis of type 2 diabetes mellitus. Intraoral examination shows no signs of candidiasis or deep fungal infections. Which specific diabetic-related condition is MOST likely responsible for these oral findings?
An adult patient presents with a complaint of persistent oral dryness and bilateral parotid gland enlargement. Medical history reveals a diagnosis of type 2 diabetes mellitus. Intraoral examination shows no signs of candidiasis or deep fungal infections. Which specific diabetic-related condition is MOST likely responsible for these oral findings?
A patient with poorly controlled type 1 diabetes mellitus presents with a destructive, deep fungal infection of the palate. Histopathological examination reveals broad, nonseptate hyphae. This presentation is MOST consistent with which opportunistic infection?
A patient with poorly controlled type 1 diabetes mellitus presents with a destructive, deep fungal infection of the palate. Histopathological examination reveals broad, nonseptate hyphae. This presentation is MOST consistent with which opportunistic infection?
A patient with a history of Hashimoto's thyroiditis presents with thickened lips, macroglossia with scalloping, and delayed tooth eruption. Serum analysis indicates low T4 and elevated TSH levels. These clinical and laboratory findings are MOST indicative of which endocrine disorder?
A patient with a history of Hashimoto's thyroiditis presents with thickened lips, macroglossia with scalloping, and delayed tooth eruption. Serum analysis indicates low T4 and elevated TSH levels. These clinical and laboratory findings are MOST indicative of which endocrine disorder?
A young female patient presents with nervousness, heart palpitations, and exophthalmos. Intraoral examination reveals early eruption of permanent teeth. Serum analysis is MOST likely to reveal which hormonal profile?
A young female patient presents with nervousness, heart palpitations, and exophthalmos. Intraoral examination reveals early eruption of permanent teeth. Serum analysis is MOST likely to reveal which hormonal profile?
A patient undergoing thyroidectomy inadvertently had parathyroid glands removed. Post-operatively, the patient exhibits muscle twitching and oral examination reveals pitting enamel hypoplasia and persistent oral candidiasis. Laboratory findings are MOST likely to include:
A patient undergoing thyroidectomy inadvertently had parathyroid glands removed. Post-operatively, the patient exhibits muscle twitching and oral examination reveals pitting enamel hypoplasia and persistent oral candidiasis. Laboratory findings are MOST likely to include:
A patient presents with generalized enamel hypoplasia, widened pulp chambers with 'dagger-shaped' pulp stones, and oligodontia. Laboratory investigations reveal low serum calcium and high PTH levels. These findings are MOST consistent with:
A patient presents with generalized enamel hypoplasia, widened pulp chambers with 'dagger-shaped' pulp stones, and oligodontia. Laboratory investigations reveal low serum calcium and high PTH levels. These findings are MOST consistent with:
A child presents with short stature and bowed lower limbs. Intraoral examination reveals enlarged pulp chambers and elongated pulp horns extending to the dentinoenamel junction in multiple teeth. Serum phosphate levels are low. Which condition is MOST likely?
A child presents with short stature and bowed lower limbs. Intraoral examination reveals enlarged pulp chambers and elongated pulp horns extending to the dentinoenamel junction in multiple teeth. Serum phosphate levels are low. Which condition is MOST likely?
A young child presents with premature exfoliation of primary teeth and skeletal abnormalities resembling rickets. Radiographic examination reveals a 'copper beaten skull' appearance. Serum alkaline phosphatase levels are significantly decreased. This presentation is MOST suggestive of:
A young child presents with premature exfoliation of primary teeth and skeletal abnormalities resembling rickets. Radiographic examination reveals a 'copper beaten skull' appearance. Serum alkaline phosphatase levels are significantly decreased. This presentation is MOST suggestive of:
An adult patient experiences renewed growth of hands, feet, and jaw, leading to mandibular prognathism and diastema formation. This clinical presentation is MOST indicative of:
An adult patient experiences renewed growth of hands, feet, and jaw, leading to mandibular prognathism and diastema formation. This clinical presentation is MOST indicative of:
A patient with Addison's disease exhibits diffuse hyperpigmentation of the oral mucosa and skin, fatigue, and weakness. This hyperpigmentation is a direct consequence of increased levels of:
A patient with Addison's disease exhibits diffuse hyperpigmentation of the oral mucosa and skin, fatigue, and weakness. This hyperpigmentation is a direct consequence of increased levels of:
A chronic alcoholic presents with glossitis, dermatitis, dementia, and diarrhea. This classic triad is MOST indicative of deficiency in which vitamin?
A chronic alcoholic presents with glossitis, dermatitis, dementia, and diarrhea. This classic triad is MOST indicative of deficiency in which vitamin?
A patient with pernicious anemia complains of a painful, burning tongue and numbness in extremities. Oral examination reveals atrophic glossitis. This condition is primarily due to malabsorption of:
A patient with pernicious anemia complains of a painful, burning tongue and numbness in extremities. Oral examination reveals atrophic glossitis. This condition is primarily due to malabsorption of:
A patient presents with spontaneous gingival bleeding and ecchymoses. Coagulation studies are likely to reveal a deficiency in which vitamin-dependent clotting factor synthesis?
A patient presents with spontaneous gingival bleeding and ecchymoses. Coagulation studies are likely to reveal a deficiency in which vitamin-dependent clotting factor synthesis?
An elderly patient presents with angular cheilitis, atrophic glossitis, and dysphagia. Hematological investigations reveal hypochromic, microcytic anemia. These findings are MOST suggestive of:
An elderly patient presents with angular cheilitis, atrophic glossitis, and dysphagia. Hematological investigations reveal hypochromic, microcytic anemia. These findings are MOST suggestive of:
A 45-year-old woman of Northern European descent presents with dysphagia and atrophic glossitis. Further investigation reveals iron deficiency anemia and esophageal webs. This constellation of findings is classically termed:
A 45-year-old woman of Northern European descent presents with dysphagia and atrophic glossitis. Further investigation reveals iron deficiency anemia and esophageal webs. This constellation of findings is classically termed:
A patient with multiple myeloma develops macroglossia with teeth indentations, carpal tunnel syndrome, and dry mouth. Biopsy of the tongue reveals extracellular deposition of beta-pleated sheets. These findings are MOST consistent with:
A patient with multiple myeloma develops macroglossia with teeth indentations, carpal tunnel syndrome, and dry mouth. Biopsy of the tongue reveals extracellular deposition of beta-pleated sheets. These findings are MOST consistent with:
A patient with chronic renal failure develops an abrupt onset of white plaque and crust on the buccal mucosa and tongue, accompanied by a bad taste and burning sensation. The odor of ammonia is detected on the patient's breath. This oral condition is BEST described as:
A patient with chronic renal failure develops an abrupt onset of white plaque and crust on the buccal mucosa and tongue, accompanied by a bad taste and burning sensation. The odor of ammonia is detected on the patient's breath. This oral condition is BEST described as:
A 25-year-old male patient presents with polyarthritis, conjunctivitis, and urethritis following a bacterial dysentery episode. Intraoral examination reveals painless, erosive lesions mimicking geographic tongue. This clinical triad and oral findings are MOST suggestive of:
A 25-year-old male patient presents with polyarthritis, conjunctivitis, and urethritis following a bacterial dysentery episode. Intraoral examination reveals painless, erosive lesions mimicking geographic tongue. This clinical triad and oral findings are MOST suggestive of:
A patient undergoing chemotherapy for cancer develops severe oral mucositis with uncontrolled pain, bleeding, and secondary infection. This condition is primarily a result of:
A patient undergoing chemotherapy for cancer develops severe oral mucositis with uncontrolled pain, bleeding, and secondary infection. This condition is primarily a result of:
In the context of inflammatory bowel diseases, deep linear granulomatous-appearing ulcerations in the buccal vestibule are MOST characteristic of:
In the context of inflammatory bowel diseases, deep linear granulomatous-appearing ulcerations in the buccal vestibule are MOST characteristic of:
Papillary mucosal projections with deep linear ulcers and fissures in the oral mucosa are MOST indicative of the oral manifestations associated with:
Papillary mucosal projections with deep linear ulcers and fissures in the oral mucosa are MOST indicative of the oral manifestations associated with:
Aphthous-like ulcerations and enamel pitting in primary and permanent teeth are oral findings MOST commonly associated with which systemic condition?
Aphthous-like ulcerations and enamel pitting in primary and permanent teeth are oral findings MOST commonly associated with which systemic condition?
Oral lichenoid reactions, clinically mimicking lichen planus, can be induced as an adverse effect of medications used in the management of which systemic disease?
Oral lichenoid reactions, clinically mimicking lichen planus, can be induced as an adverse effect of medications used in the management of which systemic disease?
Early eruption of teeth in children is an oral manifestation specifically linked to which endocrine disorder?
Early eruption of teeth in children is an oral manifestation specifically linked to which endocrine disorder?
Thickened lips, macroglossia with scalloping/crenation of the lateral tongue, and delayed tooth eruption are oral features commonly associated with:
Thickened lips, macroglossia with scalloping/crenation of the lateral tongue, and delayed tooth eruption are oral features commonly associated with:
Loss of lamina dura and 'ground glass' appearance in radiographs are early osseous changes in the jaws associated with:
Loss of lamina dura and 'ground glass' appearance in radiographs are early osseous changes in the jaws associated with:
Pitting enamel hypoplasia and failure of tooth eruption in young children, coupled with a positive Chvostek's sign, suggest which underlying endocrine condition?
Pitting enamel hypoplasia and failure of tooth eruption in young children, coupled with a positive Chvostek's sign, suggest which underlying endocrine condition?
Generalized enamel hypoplasia, widened pulp chambers with pulpal calcifications ('dagger-shaped' pulp stones), and blunted root apices are oral findings strongly indicative of:
Generalized enamel hypoplasia, widened pulp chambers with pulpal calcifications ('dagger-shaped' pulp stones), and blunted root apices are oral findings strongly indicative of:
Elongated pulp horns and multiple normal teeth with periapical pathology are oral findings most characteristic of:
Elongated pulp horns and multiple normal teeth with periapical pathology are oral findings most characteristic of:
Premature loss of primary teeth due to lack of cementum and 'copper beaten skull' appearance are associated with which condition?
Premature loss of primary teeth due to lack of cementum and 'copper beaten skull' appearance are associated with which condition?
Diastema, mandibular prognathism, and macroglossia are oral and maxillofacial manifestations of:
Diastema, mandibular prognathism, and macroglossia are oral and maxillofacial manifestations of:
Diffuse or patchy macular pigmentation of the oral mucosa is a distinctive oral sign in:
Diffuse or patchy macular pigmentation of the oral mucosa is a distinctive oral sign in:
Glossitis and stomatitis are oral manifestations associated with deficiency of which vitamin?
Glossitis and stomatitis are oral manifestations associated with deficiency of which vitamin?
Burning sensation of the tongue, lips, and buccal mucosa, along with atrophy of papillae and erythema, are oral symptoms suggestive of deficiency in:
Burning sensation of the tongue, lips, and buccal mucosa, along with atrophy of papillae and erythema, are oral symptoms suggestive of deficiency in:
Gingival bleeding is a primary oral manifestation of deficiency in which fat-soluble vitamin?
Gingival bleeding is a primary oral manifestation of deficiency in which fat-soluble vitamin?
Angular cheilitis, dysphagia, atrophic glossitis, and glossodynia are oral manifestations characteristic of:
Angular cheilitis, dysphagia, atrophic glossitis, and glossodynia are oral manifestations characteristic of:
Esophageal webs combined with glossitis and iron deficiency anemia are diagnostic features of:
Esophageal webs combined with glossitis and iron deficiency anemia are diagnostic features of:
Macroglossia and crenation (scalloping) of the tongue, bumpy skin deposits around the mouth, and xerostomia are oral findings associated with:
Macroglossia and crenation (scalloping) of the tongue, bumpy skin deposits around the mouth, and xerostomia are oral findings associated with:
A white plaque all over the mouth, accompanied by bad taste, burning sensation, and halitosis, in a patient with renal failure, is indicative of:
A white plaque all over the mouth, accompanied by bad taste, burning sensation, and halitosis, in a patient with renal failure, is indicative of:
Painless oral ulceration, erosion/erythema of mucosa, and erosion of tongue mimicking geographic tongue, in a patient with polyarthritis, conjunctivitis, and urethritis, are suggestive of:
Painless oral ulceration, erosion/erythema of mucosa, and erosion of tongue mimicking geographic tongue, in a patient with polyarthritis, conjunctivitis, and urethritis, are suggestive of:
Flashcards
Crohn Disease
Crohn Disease
Patchy inflammation throughout the GI tract, from mouth to anus, abdominal cramping, pain, bloating, diarrhea, and potential weight loss; may present with recurrent oral ulcerations and nodular swelling.
Ulcerative Colitis
Ulcerative Colitis
Continuous, uniform inflammation in the large bowel that may cause diarrhea, rectal bleeding, abdominal pain, weight loss, and fever; also predisposes patients to pseudomembranous colitis.
Pyostomatitis Vegetans
Pyostomatitis Vegetans
Recurrent oral ulcerations consisting of linear 'snail track' pustules; often present before GI symptoms.
Celiac (Sprue) Disease
Celiac (Sprue) Disease
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Hyperthyroidism (Graves' Disease)
Hyperthyroidism (Graves' Disease)
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Thyroid Storm (Thyrotoxicosis)
Thyroid Storm (Thyrotoxicosis)
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Diabetes Mellitus (DM)
Diabetes Mellitus (DM)
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Hypothyroidism
Hypothyroidism
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Hyperparathyroidism
Hyperparathyroidism
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Hypoparathyroidism
Hypoparathyroidism
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Pseudohypoparathyroidism
Pseudohypoparathyroidism
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Hereditary Hypophosphatemia
Hereditary Hypophosphatemia
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Hypophosphatasia
Hypophosphatasia
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Acromegaly
Acromegaly
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Gigantism
Gigantism
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Addison Disease
Addison Disease
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Pellagra
Pellagra
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Vit B12/Cobalamin Def.
Vit B12/Cobalamin Def.
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Plummer-Vinson Syndrome
Plummer-Vinson Syndrome
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Amyloidosis/MM
Amyloidosis/MM
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Uremic Stomatitis
Uremic Stomatitis
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Reactive Arthritis
Reactive Arthritis
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Study Notes
Crohn Disease (IBD) (Regional ileitis)
- Patchy inflammation appears throughout the small and large intestines and anus
- Affects distal small intestine and proximal colon
- Symptoms include abdominal cramping, pain, bloating, diarrhea, and nausea
- Weight loss and malnutrition occurs due to poor GI tract absorption
- 20% of cases onset abruptly
- Diagnosed in adolescents
- Etiology is unknown and multifactorial
- Oral manifestation: Recurrent oral ulceration (like RAS)
- Nodular swelling, with diffuse/nodular swelling of oral and perioral tissue (hyperplastic margin)
- Deep linear granulomatous-appearing ulceration in the buccal vestibule, has a less erythematous halo
- Cobblestone mucosal appearance (bumpy) may be present
- Polypoid tag-like lesions on vestibular and retromolar mucosa
- Orofacial granulomatosis occurs from the enlargement of lips due to granulomatous inflammation
- Transmural granulomatous inflammation affects the entire wall, sarcoid-like, non-caseating, and poorly formed granuloma throughout tissue layers
- Patients have a higher risk for lymphoma due to transmural inflammation with lymphoid aggregates
- Oral involvement can be a sign of GI disease control
- Antibiotics, immunosuppressants, anti-inflammatory drugs, and biologics ('mab'; anti-TNF, anti-integrins/IL) can treat it
- Severe cases use high-dose corticosteroids and chemotherapeutics for remission
- Nutritional supplements (Iron, Folate) also used
- Surgical removal of a portion or all of the intestine affects Quality of Life
Ulcerative Colitis (IBD)
- Displays continuous and uniform inflammation in LARGE bowel
- Starts proximally from the rectum/anus, without any skip lesions or granulomas
- Symptoms include diarrhea, rectal bleeding, abdominal pain, weight loss, and fever
- Has increased risk of colon cancer because of lymphoid infiltration
- Increases the risk of pseudomembranous colitis with C. difficile overgrowth from clindamycin prescription that causes death Oral manifestation: Recurrent oral ulcerations
- Papillary mucosal projections with deep linear ulcers and fissures
- Pyostomatitis vegetans has intraepithelial pustules of mucosa and is most seen in patients with UC
- Tx for mild to moderate cases: anti-inflammatory medication, Aminosalicylate (5-ASAa), corticosteroids (Prednisone), and Immunosuppressants (Azathioprine)
- Tx for severe cases: Ciclosporin; Biologics (Mabs): Humira (Adalimumab), remicade (infliximab); JAK inhibitors (Tofacitinib, Filgotinib)
Pyostomatitis Vegetans
- Most common in patients with ulcerative colitis
- In EARLY disease process, recurrent pyostomatitis vegetans may get severe if UC occurs at a young age
- The affected site includes buccal and labial mucosa, soft palate, and ventral tongue
- It is present before 30 years old (YOUNG)
- 25% cases appear without GI symptoms
- Recurrent oral ulceration occurs, which is often the first sign and concurrent with/prior to GI symptoms
- The oral mucosa will be erythematous, thickened with multiple cream/yellow-colored pustules, and superficial erosions (ulcers; pseudomembrane)
- Differentiated from fordyce granules (intact epithelium; sebaceous)
- Shows the linear 'snail track' oral pustules (filled with eosinophils)
- Tx: Use topical corticosteroids, or Topical Tacrolimus, or if GI symptoms are under control, the oral lesion will resolve
Celiac (Sprue) disease
- Chronic autoimmune disease (Diffuse enteritis) of the small intestine
- Improves upon withdrawal of gluten proteins
- Over 90% express HLA-B8 histocompatibility antigen
- Bimodal, meaning it affects children (majority) and the elderly
- Sx include diarrhea, gas, weight loss, fatigue, impaired nutrient absorption (non-specific GI symptoms)
- Can be asymptomatic for some
- 10-15% risk of GI lymphoma
- Diagnosis is by blood test (checking for anti-endomysial, anti-tissue transglutaminase/ antideamidated gliadin antibodies) or endoscopy (biopsy) Oral findings include: aphthous-like ulceration of mucosa, enamel defects and pitting in the primary and permanent teeth, and delayed tooth eruption
Diabetes Mellitus (DM)
- Hyperglycemia is caused by either decreased production of insulin or tissue resistance to insulin
- Appears more in type 1 DM
- Oral indicators include periodontal disease (more rapid progression), delayed healing (poor healing post OS/exo with excessive granulation tissue)
- Enlargement and erythema of attached gingiva
- Increased risk of infection, such as candidiasis and deep fungal infection
- Xerostomia
- Diabetic sialadenosis, may appear in either type 1 or 2 DM (NIDDM)
- Enlarged bilateral parotid
- Hyperplasia of salivary gland (e.g parotid gland); replaced by fibrosis, fat
- Mucormycosis (deep fungal infection) of uncontrolled disease (destructive and spreads quickly, proliferation of palate)
- Benign migratory glossitis/ erythema migrans/ geographic tongue (in type 1)
Hypothyroidism
- Decreased thyroid hormone levels
- Cretinism manifests in CHILDREN
- Myxedema is seen in ADULTS
- Diagnosed by measuring T4 (free thyroxine) in the serum
- Primary (abnormality in thyroid gland) is low T4, elevated TSH
- Secondary (pituitary gland doesn’t produce adeq amount of TSH) is Low T4, low/borderline TSH
- Cause: Hashimoto’s thyroiditis; Thyroid surgery
- Symptoms: Lethargy, dry skin, thinning hair, edema of face and extremities, huskiness of voice, weakness, fatigue, and weight gain
- Infants experience failure to thrive
- Oral manifestation: thickened lips, macroglossia (accumulation of glycosaminoglycans (GAGs scalloping/crenation of lateral tongue
- Children may have failure of tooth eruption and enamel pitting
- Thyroid hormone replacement is tx
- Good prognosis
- Children not treated: Permanent CNS damage
Hyperparathyroidism
- Excessive PTH productions
- The primary cause is 80-90% by parathyroid adenoma, 15% by hyperplasia, 2% by parathyroid carcinoma
- A secondary effect is from PTH continuously produced in response to chronic low serum calcium
- More common in females (2-4 times than males)
- Classic Triad includes Bones, Stone, Groans (& Moans)
- Bones show effects such as subperiosteal resorption of distal phalanges (early in disease), early loss of lamina dura around roots, glass appearance in x-ray (blurred trabecular density in bone structure)
- Brown tumors (uni/multilocular RL) (Pelvis, ribs, MD.) Seen with persistent disease and have histo of giant cell lesion.
- Osteitis fibrosa cystica will show Central degeneration and fibrosis of longstanding brown tumors
- Patients will have renal calculi caused by elevated serum calcium and duodenal ulcers
- Changes in mental status
- Tx is by surgical removal of a portion or all of parathyroid gland
Hypoparathyroidism
- A reduced amount of PTH
- PTH normally stimulates osteoclasts to resorb bone and in the kidney, thereby bringing serum calcium to normal
- Loss of PTH function results in a drop in serum calcium causes hypocalcemia
- The low PTH means low Ca2+, high phosphate, and normal renal function in lab tests
- Etiology: surgical removal of the thyroid gland or Autoimmune destruction
- Seen in DiGeorge syndrome (anomaly) and Endocrine-candidiasis syndrome
- The result is altered teeth with pitting enamel hypoplasia and failure of eruption
- Chvostek’s sign causes twitching of the upper lip when the facial nerve is tapped just below the zygomatic process
- Endocrine-candidiasis syndrome causes persistent oral candidiasis
- In adults, tingling of the fingers and toes
- Tx consists of an oral vitamin D precursor, dietary supplements of Calcium, and injections of Teriparatide
Hemodialysis associated Amyloidosis
- Iatrogenic and due to hemodialysis treatment
- Accumulation of normal protein (beta-2 microglobulin) in plasma
- C/F Nodular "waxy" depositions in skin which will deposit in bones and joints, tongue, and exhibit microglossis
Uremic stomatitis
- uncommon complication of acute or chronic kidney failure (elevated urea blood levels)
- characterized by an Abrupt onset of white plaque/crust
- Bad taste, burning
- Painful with Odor of ammonia/urine in pt’s mouth
- On buccal mucosa, tongue, and FOM Tx: Clear within a few days after renal dialysis, Mildly acidic mouth rinse to clear oral lesions (eg: diluted hydrogen peroxide), or Palliative tx for pain (topical anesthesia, ice chips)
Addison’s disease
- Is a disorder in which the adrenal glands don't produce enough hormones
- Hyperpigmentation will be seen in Primary diseases. Only when the adrenal gland is affected, not the secondary
- Caused by autoimmune destruction or other dysfunctions of the gland. Can also be caused by secondary dysfunction such as use of prednisone or lack of ACTH release. Diffuse/patchy
- Adrenal failure will activate the pituitary which will increase ACTH, which will then increase MSH(melanocyte stimulating hormones)
Oral Manifestations of Systemic Diseases: Quick Notes
- Crohns: cobblestoning, linear ulcers, RAS, polypoid tag-like lesions, orofacial granulomatosis
- Ulcerative colitis: RAS, Papillary mucosal projections with deep linear ulcers and fissures, pyostomatitis vegetans
- Celiac: Aphthous-like ulcers, enamel defects/pitting, delayed eruption
- DM: PD, delayed healing, increased risk of infections, candidiasis, xerostomia, diabetic sialadenosis, geographic tongue, mucormycosis. Tx can cause oral lichenoid reaction.
- Hyperthyroidism: early eruption of teeth
- Hypothyroidism: thickened lips, macroglossia, scalloping/crenation of tongue, failure of tooth eruption, enamel pitting
- Hyperparathyroidism: loss of lamina dura, ground glass appearance, brown tumor (must r/o Hyper PTH if u see a lesion that looks like CGCG)
- Hypoparathyroidism: + chvostek sign, pitting enamel hypoplasia, failure of eruption, endocrine-candidiasis syndrome will present with persistent oral candidiasis.
- Pseudohypoparathyroidism: Generalized enamel hypoplasia, Widened pulp chambers with pulpal calcification (‘Dagger' shaped pulp stones), Oligodontia (absence of >6 teeth), Delayed eruption, Blunting of root apices (vital teeth)
- Hereditary Hypophosphatemia: elongated pulp horns, multiple normal teeth with PA pathology, nonvital teeth with parulis
- Hypophosphatasia: Premature loss of primary teeth (due to loss of cementum), copper beaten skull.
- Gigantism: Diastema, mandibular prognathia, macroglossia
- Primary Addison's Disease: Diffuse/patchy macular pigmentation
- Pellagra (Vit B3 def.): Glossitis, stomatitis
- Vit B12/Cobalamin def.: Burning sensation of tongue, lips, buccal mucosa, atrophy of papilla, erythema
- Vitamin K def: Gingival bleeding
- IDA: Angular cheilitis, dysphagia, Atrophic glossitis, Glossodynia
- Plummer-Vinson Syndrome: Esophageal webs, glossitis
- Amyloidosis/MM: macroglossia and crenation (scalloping), bumpy skin deposits around mouth, waxy plaques on skin, xerostomia, mucosal petechiae.
- Uremic Stomatitis: white plaque all over mouth, bad taste, burning, halitosis
- Reactive arthritis (Reiter’s syndrome): Painless oral ulceration, erosion/erythema of mucosa, Erosion of tongue (mimic geographic tongue)
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