Dentists-Are They the First Informers
Department of Orthodontics Manipal College of Dental Sciences, Manipal, India
Abstract
The mouth has been called a mirror of the body. Careful examination of the oral cavity may reveal findings indicative of an underlying systemic condition, and allow for early diagnosis and treatment. There are approximately 200 systemic disorders which are accompanied by oral symptoms and/or signs. In most of instances, the oral clues are the first and sometimes even the only evidence of a disturbed state. Identifying these oral findings may allow for early diagnosis and treatment. This article is intended as a general overview of those conditions that have oral manifestations but also involve other organ systems.
INTRODUCTION
Oral cavity is like a gateway of our body. Not only does it predispose the body to various commensals but an insight to the early lesions displayed here can give a substantial hint about the systemic involvement of various diseases.The oral cavity provides many diagnostic clues to systemic disease, and may be the first indication of a systemic condition. In fact, many diseases appear first in the mouth and are thus found while patients are in the dental chair. Some of these manifestations are disease specific and help raise a high degree of suspicion for the alert clinician.
As oral health is integral to general health, manifestations of various systemic diseases in the oral cavity can make mouth as a diagnostic indicator for general health. Dentists are at the best place to discover them first and can recommend for further medical assessment. Early recognition of these conditions and their management should become more important in the practice of dentistry and diagnosis of systemic diseases may be facilitated by awareness of the oral presentation of systemic diseases.
This article presents a brief description of oral signs and symptoms of some hematologic, metabolic, dermatologic, connective tissue and nutritional diseases.
Table: Shows the selected systemic conditions along with their oral manifestations.
|
Sr.No. |
SYSTEMIC CONDITION |
ORAL MANIFESTATION |
|
1. |
Anemia1-3 |
Mucosal pallor; atrophic glossitis; candidiasis (including angular cheilitis); mucosal burning, pain, or tenderness; erythema |
|
2. |
Leukemia4,5 |
Mucosal bleeding, ulceration, petechiae, and diffuse or localized gingival enlargement; secondary infections (e.g., candidiasis, herpes simplex virus infection, periodontal bone loss) |
|
3. |
Thrombocytopenia6,7 |
Petechiae, purpura, ecchymosis, hemorrhagic bullae, hematomas |
|
4. |
Crohn disease8-11 |
Diffuse mucosal swelling; cobblestone mucosa; localized mucogingivitis; deep linear ulceration; fibrous tissue tags, polyps, or nodules; pyostomatitisvegetans (“snail track” ulcers on an erythematous base) |
|
5. |
Gastroesophageal reflux disease12 |
Water brash, xerostomia, burning sensation, halitosis, palatal erythema, dental erosion |
|
6. |
Lichen planus13,14 |
Erosive: diffuse erythema and painful ulceration with peripheral radiating striae Reticular: white lacy striae, especially on bilateral buccal mucosa |
|
7. |
Lupus erythematous15,16 |
Oral discoid lesions, honeycomb plaques, raised keratotic plaques, erythema, purpura, petechiae, irregularly shaped ulcers, cheilitis |
|
8. |
Benign mucus membrane pemphigoid |
Diffuse and painful oral ulceration, scarring |
|
9. |
Pemphigus vulgaris17 |
Diffuse and painful oral ulceration, positive Nikolsky sign |
|
10. |
Bulimia and anorexia18-20 |
Dental erosion, xerostomia, increased caries rate, sialadenosis |
|
11. |
Behcet syndrome21,22 |
Recurrent, painful aphthous-like ulcers, usually numerous and especially involving the soft palate and oropharynx |
|
12. |
Addison disease23 |
Diffuse melanin pigmentation, candidiasis |
|
13. |
Diabetes mellitus24,25 |
Gingivitis, periodontitis, candidiasis, generalized atrophy of the tongue papillae, taste dysfunction, salivary dysfunction, burning mouth syndrome, delayed wound healing |
|
14. |
HIV(Human immunodeficiency virus) -associated periodontal disease26-28 |
Linear gingival erythema: linear band of erythema along the free gingival margin Necrotizing ulcerative gingivitis: ulceration and necrosis of gingival interdental papillae, gingival bleeding and pain, halitosis Necrotizing ulcerative periodontitis: gingival ulceration, necrosis, rapid loss of periodontal attachment, edema, pain, spontaneous hemorrhage |
|
15. |
Riboflavin (B2) deficiency29,30 |
Glossitis, atrophic filiform papillae, fungiform become Engorged, Paleness of lips, Angular cheilitis |
|
16. |
Naicin deficiency31 |
Fiery red and painful oral mucosa, Profuse salivation, Desquamation of the epithelium, Pain and ulcerations of the interdental papillae, Angular cheilitis |
|
17. |
Vitamin C deficiency32,33 |
Spontaneous hemorrhage ,Ulceration, Severe periodontal disease |
|
18. |
Grave's disease34 (Hyperthyroidism) |
Accelerated shedding of deciduous teeth and eruption of permanent teeth |
|
19. |
Acromegaly35,36 (Hyperpituitarism) |
Renewed growth of small bones, Hypertrophy of soft palate, Mandibular prognathism, apertognathia, Diastema, Macroglossia |
AIM
Aim of this article is to provide a guide to the dentist for recognizing the oral symptoms and/or signs of selected systemic conditions.
CONCLUSION
Early detection is the first step towards the overall goal of early treatment, which holds the promise of greater efficacy with lesser morbidity.It is believed that knowledge of the dentist about oral lesions, as well as its associations with systemic alterations, may be essential in the early identiï¬cation of conditions, which contribute in the diagnosis and installation of appropriate treatment, consequently favoring the prognosis.
It is an old saying which holds true in daily life i.e., prevention is always better than cure because it nips the trouble in the bud.Any negligence at the earlier stages of a disease leads to complications and deterioration. As there is a well-known link between oral health and general health; it is highly recommended thatthe basic knowledge of oral diseases must be made compulsory among all medical and dental professionals.
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Dr. Ritesh Singla, Dr. Nishu Singla. Dentists-Are They the First Informers. Guident. 2013 Feb;6(4). Available from: https://guident.in/articles/general/dentists-are-they-the-first-informers.html
