Oral conditions derived from systemic diseases

It is imperative for the dentists to do a proper assessment during the examination. Some systemic diseases reveal symptoms in the oral cavity precede the occurrence provide substantial data to make an early conclusive diagnosis to an otherwise undiscovered systemic disease.

1. Digestive tract disorder
  • Gastroesophageal reflux disease (GERD) - a continual passage of acid from the stomach to the esophagus, damaging the mucosal lining.

    Oral manifestations
    • Tooth erosion found on the occlusal surfaces of the lower posterior teeth and palatal surfaces of the upper teeth 
    • Have halitosis
    • Itching on oral mucosa 
    • Burning feeling on oral mucosa
    • Ulcers caused by acid exposure
    • Experience bad taste
    • Teeth hypersensitivity
  • Crohn disease - an inflammation of the digestive tract lining, often bowel tissue is affected. Clinical symptoms include:
    • Blood in the stool
    • Abdominal pain and cramping
    • Diarrhea
    • Ulcers
    • Loss of appetite
    • Weight loss
    • In severe case, patients may experience fatigue, fever, eye inflammation, mouth sores, inflammation of the liver or bile ducts

    Ulcerative colitis - an inflammation of the colon lining close to the rectum.  Clinical symptoms include diarrhea, abdominal pain, blood in the stool, and fever.

    Oral manifestations
    include recurrent aphthous ulcers.

  • Gardner syndrome (familial adenomatous polyposis) - an autosomal dominant disorder, characterized by the present of polyps in the colon. Gardner syndrome is symptomatic in early 20, if not treated; intestinal polyps will become malignant.

    Oral manifestation
    : during puberty, jaw osteomas that require no treatment along with odontomas, impacted teeth, and supernumerary teeth, develop precedes that of the intestinal polyps. Early diagnosis and treatment prevent the polyps from becoming malignant tumors.

  • Amyloidosis - the deposition of protein amyloid to various organs and tissues.  Clinical symptoms vary, depending on the affected organs or tissues.

    Oral manifestations
    include: macroglossia (can be diffuse or nodular enlargement of the tongue) that may demonstrate teeth indentation on the side of the tongue

  • Peutz-Jeghers syndrome - an autosomal dominant disorder, characterized by
    • Benign intestinal polyps (low potential for malignancy) found in a small intestine, 
    • Asymptomatic brown patches on an oral mucosa, around the lips, nose and eyes. 
    • Clinical symptoms include abdominal pain, blood in the stool, and obstruction of stool in the patients age group between 10-30 years.

    Oral manifestations
    : oral pigmentation is the first symptom to appear. No treatment for oral manifestation.
2. Hematologic disease
  • Pernicious anemia - atrophy of the gastric mucosa caused by autoimmune destruction of the parietal cell in the stomach, results in a failure in the absorption of vitamin B12 in the intestinal mucosa.  Clinical symptoms include generalized weakness, numbness and tingling of the extremities, and painful tongue.

       Oral manifestations: tongue with bald appearance due to atrophy of the lingual papillae, experience burning tongue, and aphthous ulcers. For treatment, take vitamin B-12.

  • Kaposi sarcoma - common vascular tumor seen in HIV- patients appears red to purple often pigmented, characterized by oral lesion in the palate, tongue, and buccal mucosa.

       Oral manifestations: a painful mass of swelling on the palate, tongue, and buccal mucosa that requires treatment, later this mass ulcerate and cause more discomfort.  The treatment of oral lesions involves surgical removal, injection of chemotherapeutic agents.

  • Behcet's syndrome - blood vessels inflammation disease, common in young people especially men in the age group of 20-30 years.  Clinical symptoms include ocular inflammation, oral and genital ulcers, and arthritis in a severe case.  Only symptomatic treatment is available.

       Oral manifestations: the first symptom of Behcet's syndrome is recurrent oral aphthous ulcers at gums, palate, tongue, buccal mucosa, and pharynx.

  • Leukemia - the malignancy of hematopoietic tissue results in increased abnormal white blood cells in bone marrow.  Clinical symptoms include weakness, pallor, fever, bone pain, petechiae or ecchymoses in the mucous membrane of skin and mucous membrane

       Oral manifestations: Monocytic leukemia is the type of leukemia that frequently causes ulcers on the oral mucosa, gingival bleeding, gingival enlargement, and gangrenous stomatitis.  In acute childhood leukemia, demonstration of bone lesions in the jaws, skull, and loss of lamina dura around the roots can be seen in x-ray
3. Vitamin deficiency
  • Vitamin B complex deficiency - a nutritional disorder associated with vitamin B complex group that consist of thiamine, nicotinic acid, riboflavin, B12, folic acid, pyridoxine, choline, biotin, and pantothenic acid.  Clinical symptoms include angular cheilosis, seborrheic dermatitis in the nasolabial fold, circumoral pallor, and vascularization of the cornea.

    Oral manifestations: mostly at the tongue, e.g., enlargement of fungiform papillae, edema, red and smooth with burning sensation

  • Vitamin C deficiency - antioxidant, necessary for proper synthesis of collagen.  Clinical symptoms: spontaneous bleeding of the skin and gingival mucosa results in purple skin or bruised skin.

       Oral manifestations: gingival bleeding, periodontal disease, and loose teeth due to bone loss.
4. Inflammatory disease

(Besnier-Boeck-Schaumann disease)
- an inflammatory illness commonly attacks young adult creating:
  • Granulomas in lungs results in wheezing, coughing, short of breath or some cases have no symptoms
  • Enlarge lymph nodes in chest, neck, armpits, or groin
  • Spleen enlargement
  • Skin lesion found in the back, neck, face, and scalp, arms
  • Enlargement of Parotid gland 
  • Arthritis
  • Anemia

    Systemic symptoms vary depending on the affected organs. Some of the symptoms include fever, night perspiration, malaise, weight loss, itching and painful rashes in the lower leg area, burning and itchy eye. 

The first clinical sign of the disease is through oral exhibitions that may include asymptomatic lesions, enlargement of the salivary glands.

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