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Oral manifestations of systematic disease are signs and
symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality show ...

symptoms
of disease occurring elsewhere in the body detected in the
oral cavity In animal anatomy Anatomy (Greek ''anatomē'', 'dissection') is the branch of concerned with the study of the structure of s and their parts. Anatomy is a branch of natural science which deals with the structural organization of living thin ...
and oral secretions.
High blood sugar Hyperglycemia is a condition in which an excessive amount of glucose Glucose is a simple with the . Glucose is the most abundant , a subcategory of s. Glucose is mainly made by and most during from water and carbon dioxide, using energy fr ...

High blood sugar
can be detected by sampling
saliva Saliva (commonly referred to as spit) is an extracellular fluid In cell biology Cell biology (also cellular biology or cytology) is a branch of biology Biology is the natural science that studies life and living organisms, including t ...
. Saliva sampling may be a
non-invasive A medical procedure is defined as ''non-invasive'' when no break in the skin is created and there is no contact with the mucosa, or skin break, or internal body cavity beyond a natural or artificial body orifice. For example, deep palpation and pe ...
way to detect changes in the
gut microbiome Gut microbiota are the microorganisms including bacteria, and archaea that live in the digestive tracts of vertebrates including humans, and of Insect_morphology#Digestive_system, insects. Alternative terms include gut flora (an outdated term tha ...
and changes in
systemic disease A systemic disease is one that affects a number of organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categor ...
. Another example is
tertiary syphilis Syphilis is a sexually transmitted infection Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal disease, are infections that are Transmission (medicine), spread ...
, where changes to
teeth A tooth (plural teeth) is a hard, calcified Calcification is the accumulation of calcium salts in a Tissue (biology), body tissue. It normally occurs in the formation of bone, but calcium can be deposited abnormally in soft tissue,Miller, J. ...

teeth
can occur. Syphilis infection can be associated with longitudinal furrows of the tongue. Mineral and vitamin deficiencies can cause the
tongue to appear beefy red and feel sore
tongue to appear beefy red and feel sore
. Those deficiencies are
iron Iron () is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: their composition, structure, properties, behav ...

iron
,
folate Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
, and
vitamin B12 Vitamin B12, also known as cobalamin, is a water-soluble vitamin A vitamin is an organic molecule , CH4; is among the simplest organic compounds. In chemistry, organic compounds are generally any chemical compounds that contain carbo ...

vitamin B12
. A hairy tongue may be an indication of
Epstein Barr virus The surname Epstein ( yi, עפּשטײן, Epshteyn) is one of the oldest Ashkenazi Jewish family names. It is probably derived from the German town of Eppstein, in Hesse; the place-name was probably derived from Gaulish language, Gaulish ''apa'' ("w ...
infection and is usually seen in those infected with
human immunodeficiency virus The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause AIDS, acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the ...
. Other systemic diseases that can cause the tongue to form
aphthous ulcers Aphthous stomatitis is a common condition characterized by the repeated formation of Benignity, benign and Contagious disease, non-contagious mouth ulcers (aphthae) in otherwise healthy individuals. The informal term canker sores is also used, ma ...

aphthous ulcers
are:
Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension, ...

Crohn's disease
and
ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology i ...

ulcerative colitis
, Behcet's Syndrome,
pemphigus vulgaris Pemphigus vulgaris is a rare chronic blistering skin disease and the most common form of pemphigus. Pemphigus was derived from the Greek word ''pemphix'', meaning blister. It is classified as a type II hypersensitivity reaction in which antibody, ...
,
herpes simplex Herpes simplex is a viral infection A viral disease (or viral infection) occurs when an organism's body is invaded by pathogen In biology Biology is the natural science that studies life and living organisms, including their anatomy ...
,
histoplasmosis Histoplasmosis is a fungal infection Mycosis is an infectious disease An infection is the invasion of an organism's body Tissue (biology), tissues by Pathogen, disease-causing agents, their multiplication, and the reaction of host (biology), ...

histoplasmosis
, and
reactive arthritis Reactive arthritis, formerly known as Reiter's syndrome, is a form of inflammatory Inflammatory may refer to: * Inflammation, a biological response to harmful stimuli * The word ''inflammatory'' is also used to refer literally to fire and flammabi ...
.


Cardiovascular and haematological system

A
heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

heart attack
is a blood vessel in the heart being constricted either by a blood clot or atherosclerosis formation. A heart attack can cause pain the chest; sometimes this pain can radiate up to the jaw. (Malik et al., 2013)
Calcium channel blocker Calcium channel blockers (CCB), calcium channel antagonists or calcium antagonists are a group of medications that disrupt the movement of calcium () through calcium channels. Calcium channel blockers are used as antihypertensive drugs, i.e., as ...
s are medications prescribed for the treatment of a number of heart conditions and primarily to treat
high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank ...

high blood pressure
. They can cause gingival hypertrophy (overgrowth), particularly
dihydropyridine Dihydropyridine (DHP) is a molecule based upon pyridine, and the parent of a class of molecules that have been semi-Degree of unsaturation, saturated with two substituents replacing one double bond. They are particularly well known in pharmacology ...

dihydropyridine
and
nifidipine
nifidipine
. Poor dental hygiene and inflamed gums are a risk factor. The overgrowth is not permanent, it is suggested that if the medication is stopped then the overgrowth can reduce[ however, this is a decision that would have to be made in conjunction with the patient’s dentist and cardiologist as the risk of stopping some medications outweigh any advantage gained (Livada and Shiloah, 2013) Nicorandil is a medication that is prescribed for the treatment of angina. It can cause major apthous-like ulcer formation (BNF, 2020). Iron,
folate Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
and
vitamin B12 Vitamin B12, also known as cobalamin, is a water-soluble vitamin A vitamin is an organic molecule , CH4; is among the simplest organic compounds. In chemistry, organic compounds are generally any chemical compounds that contain carbo ...

vitamin B12
deficiencies – The most commonest cause of iron deficiencies is low ferritin; this can cause the Glossitis, tongue to appear beefy red and appear sore. It can also present in the mouth as Angular cheilitis, angular chelitis, which is an infection caused by either staphylococcus or candidiasis, and can make the corners of the mouth appear red and crispy. Sickle cell disease is a hereditary genetic condition that results in deformed red blood cells to be formed. Sickle patients can suffer from sickle crisis, these are painful events in which if in the jaw can mimic dental pain and facial swelling can also occur during a crisis. The dental pulp can be affected by sickling and there may be a delayed eruption and hypoplasia of the dentition. Sickle patients are also at an increased risk of developing infection. Thalassemia, Thalasseamias is a group of inherited genetic disorders that affect the haemoglobin synthesis; it can result in either a reduced or absent globin chain production. If beta thalassaemia major is left untreated or under transfused, there is expansion of ineffective bone marrow, this leads to bony deformities resulting in dental malocclusion. Beta thalassaemia major patients may also be on bisphosphonates and are therefore at risk of developing osteonecrosis of the jaw.   Thrombocytopenia is a deficiency of platelets in the blood. It can present as red blood blisters in the mouth.


Respiratory system

Patients suffering from respiratory conditions like asthma and chronic obstructive pulmonary disease can be prescribed steroidal inhalers to help strengthen their lungs. They must ensure after use that they rinse their mouths, otherwise there is an increase of Tooth decay, dental caries, xerostomia, candidiasis, ulceration and gingivitis/Periodontal disease, periodontitis (Godara et al., 2011).


Renal system

There are a number of oral complications following Kidney transplantation, renal transplantation. Ciclosporin is an Immunosuppressive drug, immunosuppressant medication that is used to help prevent patients from rejecting the transplanted kidney (BNF, 2020). Due to the immunosuppression (suppressed immune system), these patients are more likely to suffer from Gingival enlargement, gingival hyperplasia, aphthous ulceration, herpes simplex virus, Leukoplakia, oral leucoplakia; which may transform into squamous cell carcinoma, candidiasis infection or Kaposi’s sarcoma (BNF, 2020).


Digestive system

There are many specific diseases of the gastrointestinal tract which have an impact on Oral health (outline), oral health. Systemic disease can affect the upper GI tract such as dysphagia, dysmotility, Gastroesophageal reflux disease, gastro-oesophageal reflux and peptic ulcer disease; or lower in the tract such as coeliac disease, Crohn's disease, Crohn’s disease,
ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology i ...

ulcerative colitis
and familial adenomatous polyposis. Dysphagia is defined as a difficulty in swallowing. Structurally it worsens when eating solids and neurologically it is worse with fluids. Structural problems may include malignancy, stricture and pharyngeal pouching which can lead to Bad breath, halitosis, Regurgitation (digestion), regurgitation of undigested food and high feeling of dysphagia. Neurological problems may be related to the patient having multiple sclerosis, motor neuron disease, or having suffered from a stroke. Dysphagia may present as a barrier to care in the dental setting as the patient may require high volume suction in order to maintain patient comfort and reduce the risk of aspiration of dental material/ fluids. Gastroesophageal reflux can present as retrosternal pain, acid brash and a hoarse voice. Risk factors for gastroesophageal reflux disease are obesity, diet, smoking and hiatal hernia. Complications of which being oesophagitis, Barrett's esophagus, Barrett's oesophagus, Strictures and ulcers. Common management of gastroesophageal reflux disease include lifestyle measures, Proton-pump inhibitor, proton pump inhibitors and rarely surgery. The is a clear relationship between gastroesophageal reflux disease and dental erosion and therefore can be detrimental to hard tissues i.e. Tooth, teeth and also soft tissues of the mouth. Crohn's disease is a patchy disease which can affect any area of the GI tract from the oral cavity to the anus. The manifestations depend on the affected area. The oral manifestations present as orofacial granulomatosis, an inflammatory condition affecting the oral mucosa. It is non-caveating granulomas and has a "cobblestone" appearance. Orofacial granulomatosis can be isolated or a manifestation of Crohn's disease and can be treated with local or systemic corticosteroids. An aggravating factor is cinnamon, therefore a cinnamon-free diet is recommended. Eating disorders are a psychological problem which has an impact on the gastrointestinal tract. Two common eating disorders are anorexia nervosa and bulimia nervosa. Anorexia nervosa is a refusal to maintain a "normal" body weight with a fear of weight gain and distorted perception of body image. Bulimia nervosa is binge-eating followed by attempts to restrict weight gain and can include purging. Eating disorder oral manifestation is severe palatal erosion due to vomiting. There is occlusal erosion of the maxillary teeth causing the incised edges of the incisors to be thin and knife-edged. Occlusal surfaces have a flat to cupped-out appearance. Extra-orally eating disorders may present with swollen parotid glands. Other oral manifestations of GI disease is angular stomatitis, commonly seen in Iron-deficiency anemia, iron-deficient anaemia and mouth ulcers in Crohn's disease.


Endocrine system

Diabetes, Diabetes Mellitus has two main types: Type 1, autoimmune destruction of beta-cells leading to reduced insulin production and Type 2, the body becomes increasingly resistant to the effects of insulin leading to the bodies inability to regulate plasma glucose levels resulting in a fall in insulin production. Diabetes has numerous implications on oral health. Patient with Diabetes have increase extent and severity of periodontal disease, increased prevalence of Tooth decay, dental caries due to xerostomia, can suffer from burning mouth syndrome and Candidiasis, candidal infections as well as experiencing altered taste sensation, altered tooth eruption and hypertrophy of the parotid glands. Other oral health problems include chronic hyperglycaemia, infection, delayed wound healing and lichen planus/Lichen planus, lichenoid reactions. The oral manifestations of Acromegaly predominate as spacing of the lower incisor teeth and widening of the mandible. Other complications include visual field defects, headaches, Diabetes, Sleep apnea, Sleep apnoea, Hypertension, Arthralgia and Arthritis and Carpal tunnel syndrome, Carpal Tunnel Syndrome. Arthralgia and Carpal Tunnel Syndrome both have an impact on a patients’ ability to maintain good oral hygiene practice and therefore may predispose them to Dental caries and Periodontal Disease. It is imperative these patients are given Enhanced Prevention in order to reduce the risk of Dental Caries and Periodontal Disease. Another Endocrine system, endocrine disorder that may present orally is Addison's disease, Addison’s Disease. Signs include Hyperpigmentation, skin hyperpigmentation, alabaster-coloured pale skin, low blood pressure, Postural Hypotension, postural hypotension. Skin pigmentation have increased deposition in the palmer skin creases, nails and gingiva. Management of Addison’s is with steroids. During dental treatment the patient may require an increased dose of steroids based on treatment need.


Skeletal system

Osteogenesis imperfecta, Osteopgenesis imperfecta, also known as brittle bone disease, is caused by a gene mutation affecting the collagen genes, patients generally present with a large number of fractures from minor injuries. Teeth, if affected, are of the appearance of dentinogenesis imperfecta. Osteoporosis is a very common disease associated with a decreased bone mineral density, it mainly affects post menopausal women whose Estrogen, oestrogen levels have dropped. It is managed with the used of bisphosphonates. Prior to placement on bisphosphonates, a dental check must be done to extract any hopeless teeth as extractions in patients who have prolonged used of bisphosphonates are at risk of MRONJ. (SDCEP,2017)


Immune system

HIV, Human immunodeficiency virus infects and destroys cells of the immune system, principally the CD4+ helper cells, CD4+ T-helper lymphocytes. As well as lymphocytes, CD4 receptors are also present on the surface of macrophages and monocytes, cells in the brain, skin, and probably many other sites. The normal CD4 count is 500-1500 per mm3, and patients with human immunodeficiency virus infection often have a CD4 count less than 500. Patients who are infected with human immunodeficiency virus positive have an increased risk of developing infections and tumours. The lower the CD4 count, the greater the likelihood and the severity of illness. A CD4 count less than 200 is a diagnosis of HIV/AIDS, Acquired Immunodeficiency Syndrome (AIDS). Oral manifestations of human immunodeficiency virus include candidiasis, oral hairy leukoplakia, oral ulcers, oral warts, oral lymphoma and Kaposi's sarcoma-associated herpesvirus, Kaposi's sarcoma. Other presentations include gingivitis and oral malignancies. Treatment and management of AIDS is based on Highly Active Anti-Retroviral Therapy, highly active anti-retroviral therapy, which significantly lowers the prevalence of oral lesions, particularly oral candidiasis and oral hairy leukoplakia.


Nervous system


Muscular system


References

{{Oral pathology Dental anatomy