Oral manifestations of systemic diseases

1. Oral Manifestations of
Systemic Diseases
Arsalan Wahid Malik

2. Pulmonary Conditions
 Wegener granulomatosis
 Sarcoidosis

3. Wegener granulomatosis
 A necrotizing vasculitis of small-to-medium vessels
associated with necrotizing granulomas of the upper
and lower airways.
 In limited Wegener granulomatosis, the disease spares
the kidneys and only involves the respiratory tract.
 Early diagnosis of this disease is essential in order to
prevent the irreversible glomerular damage that can
lead to death.

4. Oral involvement in Wegener
granulomatosis
 Oral lesions include ulcerations and gingival
enlargement. The oral ulcerations, which occur on the
buccal mucosa or palate, are the most common but
least specific oral lesions.
 The characteristic gingival appearance of Wegener
granulomatosis is a pathognomonic finding termed
"strawberry gingivitis,"

5. Oral involvement in Wegener
granulomatosis
 Gingivae take on a characteristic
swollen, reddened, and granular
appearance. Initially, bright red-to-
purple friable diffuse papules
originate on the labial interdental
papillae.
 Involvement may include the lingual
and palatal mucosa. Tooth and
alveolar bone loss are common

6. Oral involvement in Wegener
granulomatosis
 Biopsy findings of the gingivae demonstrate
necrotizing inflammation of vessels with
accompanying granulomatous inflammation.
The pseudoepitheliomatous hyperplasia,
microabscess formation, and multinucleate
giant cells.
 Pathological findings of Wegener
granulomatosis combined with a positive result
from antineutrophil cytoplasmic antibody
(ANCA) testing are diagnostic for the disease.

7. Oral involvement in Wegener
granulomatosis

8. Sarcoidosis
 An idiopathic systemic disease characterized by bilateral hilar
lymphadenopathy and noncaseating granulomas in the
lungs. Ocular and cutaneous manifestations are common.
 It may involve nearly any organ system; organs involved
include the liver, heart, spleen, eyes, kidneys, and lymph
system. Pulmonary manifestations are the most common and
include dyspnea with exertion, nonproductive cough, chest
pain, wheezing and nasal congestion, and hemoptysis.

9. Sarcoidosis (Oral manifestations )
 May include multiple, nodular, painless ulcerations of the
gingiva, buccal mucosa, labial mucosae, and palate.
Biopsy results reveal noncaseating granulomas
surrounded by multinucleate giant cells along with
lymphocytic infiltrate.
 Heerfordt syndrome may arise if symptoms include
parotid gland swelling, xerostomia, uveitis, and facial
nerve palsy. Rarely, sarcoidosis may involve the tongue,
including swelling, enlargement, and ulcerations.

10. Sarcoidosis (Oral manifestations )

11. Sarcoidosis (Oral manifestations )
 Oral involvement in sarcoidosis usually manifests after
systemic symptoms develop. This form is commonly a
diagnosis of exclusion. Biopsy samples are used to
identify noncaseating granulomas, a nonspecific finding

12. Oral manifestations of Skin Diseases
 Psoriasis
 Acanthosis Nigricans
 Amyloidosis

13. Psoriasis
 It is a chronic inflammatory condition of the skin.
 Occurs in the second or third decade of life and shows no sexual
bias.
 The scalp, elbows, or knees are typically affected with
characteristic scaly, white, well-demarcated plaques.
 Psoriasis is characteristically a cutaneous condition, some clinicians
believe it may uncommonly manifest on the lips, tongue, palate,
buccal mucosa, and gingiva.

14. Psoriasis
 Psoriatic tongue involvement appears indistinguishable from
geographic tongue involvement. In addition, a higher frequency of
fissured tongue occurs in patients with psoriasis.
 Small, whitish papules that yield bleeding points upon scraping; red
and white plaques that follow skin lesions; and bright-red patches.
 Because oral psoriasis rarely manifests without cutaneous
involvement, definitive oral diagnosis is made with the finding of
corresponding cutaneous lesions and is confirmed with biopsy
results.

15. Psoriasis

16. Acanthosis Nigricans
 A cutaneous disorder of hyperpigmentation and papillomatosis that
may precede or coincide with a variety of benign, familial, or malignant
disorders.
 Patients who are affected usually present in childhood or adolescence
with hyperpigmented velvety papillated plaques in flexural areas, such
as the neck, axilla and fingers.
 Malignancy-associated AN (MAN) is hypothesized to be due to
overproduction of an epidermal growth factor promoter secreted by
the associated neoplasm.

17. Acanthosis Nigricans
 It involve the lips, tongue, and palate. Gingival hyperplasia may also
occur.
 Nonpigmented hypertrophy of the papillae along the dorsal surface
and lateral edge of the tongue yield a characteristic fissured and
shaggy texture.
 The buccal mucosa shows some papillae, but, more commonly,
velvety white plaques are present along with the uneven
appearance. Interdental gingiva may become so hyperplastic that it
interferes with eating as it covers the teeth.

18. Acanthosis Nigricans

19. Amyloidosis
 It is the deposition of amyloid proteins in body tissues leading to
tissue damage.
 It is classified as either primary or secondary. The former results from
multiple myeloma or an idiopathic disease, while the latter is a
sequela of a chronic or inflammatory disease process.
 The most common oral manifestation of amyloidosis is macroglossia,
which occurs in 20% of patients.

20. Amyloidosis
 The enlarged tongue demonstrates lateral ridging due to teeth
indentation. Although pain is not usually present, enlargement,
firmness, and loss of mobility are common.
 Grossly, the tongue may be firm and appear relatively normal or it
may have yellow nodules on the lateral surface. Interference with
taste has also been reported in some patients, and hyposalivation
may result from amyloid deposition in the salivary glands.
 Submandibular swelling occurs subsequent to tongue
enlargement and can lead to respiratory obstruction. Rarlely, oral
ulceration may present

21. Connective tissue disorders
 Sjogren Syndrome
 Kawasaki disease

22. Sjogren Syndrome
 It the second most common autoimmune disease, affecting as
many as 3% of women aged 50 years or older.
 The sex predilection is profound: approximately 90% of patients
are female.
 Sjögren syndrome is characterized by sicca syndrome,
keratoconjunctivitis sicca, and xerostomia.
 A secondary form is associated with rheumatoid arthritis.

23. Sjogren Syndrome
 Oral changes include difficulty in swallowing and eating,
disturbances in taste and speech, increased dental caries, and a
predisposition to infection, all due to a decrease in saliva.
 The mucosal changes typical of xerostomia include dry, red, and
wrinkled mucosa. The tongue may exhibit a cobblestonelike
appearance due to atrophy of the papillae.
 Candidiasis is common in persons with Sjögren syndrome.

24. Sjogren Syndrome

25. Kawasaki disease
 is a vasculitis that affects medium and large arteries with a
corresponding cutaneous lymph node syndrome.
 Children younger than 5 years are most commonly affected. Patients
present acutely with edema, erythema of the hands and feet, fever, oral
erythema, and rash. The associated temperature must exceed 38.5°C
(101.3°F) for 5 days to meet diagnostic criteria.

26. Kawasaki disease
 Oral findings include swelling of papillae on the surface of the tongue
(strawberry tongue) and intense erythema of the mucosal surfaces.
 Ulceration in the oral cavity is a common presenting sign in a majority of
patients. The labia are cracked, cherry red, swollen, and hemorrhagic. The
last of these may be due to the long-standing high-grade fevers.

27. Liver diseases (Oral manifestations)
 Gingival bleeding
 Lichen planus
 Dry mouth
 Sialadenitis
 Periodontal disease
 Oral candidiasis
 Dental caries