Manifestasi Oral Penyakit Sistemik

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Manifestasi Oral Penyakit Sistemik


  • Renal Disorders

    • Oral ulcers – Blood urea nitrogen increases > 150mg/dl, it gets secreted through saliva – ureamic crystals – burn mucosa becomes - Red
    • Uraemic stomatitis – Burning sensation
    • Urea secreted in saliva
    • Urease enzyme produced
    • by oral microflora
    • Liberates free ammonia
    • Damages oral mucosa


  • Gastrointestinal disease

    • Ulcerative colitis

      • Characterized by periods of exacerbation and remission
      • Generally, oral lesions coincide with exacerbations of the colonic disease
      • Aphthous ulcers or angular stomatitis occurs in as many as 5-10% of patients, although hemorrhagic ulcers can occur
      • Rarely, patients can develop pyostomatitis vegetans (PSV)


    • Crohn disease

      • idiopathic inflammatory disorder that can involve the entire GI tract with transmural inflammation and noncaseating granulomas
      • the peak incidence occurs in the second and third decades of life
      • smaller peak in the sixth and seventh decades
      • Genetics
      • Symptoms of Crohn disease include intermittent attacks of diarrhea, constipation, abdominal pain, and fever
      • malabsorption and subsequent malnutrition
      • Intraoral involvement occurs in up to 50% of patients
      • diffuse lip, gingival, or mucosal swelling, cobblestoning of the buccal mucosa and gingiva; mucosal tags; and fissures at the angles of the mouth, orofacial granulomas, significant pain, impaired speech, or difficulty eating secondary to gingival and mucosal swelling, ulcers, or fissures




    • Pyostomatitis vegetans

      • concurrently with either Crohn disease or UC
      • as pustules that result in a “snail track” appearance, erosions, and vegetations involving the labial mucosa of the upper and lower lips, buccal mucosa, and gingival mucosa
      • the tongue and floor of the mouth are generally spared, the filiform and fungiform lingual papillae may be atrophic
      • pain and burning may be severe or negligible
      • Histologic examination reveals intraepithelial and subepithelial eosinophilic miliary abscesses
    • Gastroesophageal reflux

      • GASTROESOPHAGEAL REFLUX DISEASE (GERD) is defined as recurrent regurgitation of acidic gastric contents (pH 1-2) that causes damage to the esophageal mucosa and structures
      • 18-28% in the United States within the oral cavity
      • etiology of GERD varies among individuals, but it may be due to slackening of the lower esophageal sphincter, increased intra-abdominal pressure, or delayed gastric emptying
      • heartburn, chronic cough, sore throat, globus (lump in the throat), dysphagia, and odynophagia
      • erosive esophagitis, Barrett esophagus, and esophageal adenocarcinoma
      • pH of the oral cavity may fall below 5.5 dental erosion
      • nonspecific burning oral sensation, mucosal erosions and ulcerations, halitosis, and both xerostomia and hypersalivation


    • Chronic liver disease

      • Major causes include chronic hepatitis C, chronic hepatitis B, alcoholic liver disease, and nonalcoholic fatty liver disease
      • Coagulopathiesb →petechiae on the mucous membranes or excessive gingival bleeding with minor trauma, often in the absence of inflammation, high risk for severe hemorrhage
      • Jaundice may also appear in the oral mucosa due to the yellow pigmentation that results from deposition of bilirubin into the submucosa
    • Hepatitis C

      • (HCV) infection have a 2.5- to 4.5-fold increased risk of developing lichen planus (LP)
  • Nutritional Disease

    • Vitamins and minerals are essential to maintain the epithelial surfaces of the human body
    • a reduced intake due to poor diet, fatty diets, alcohol or drug addiction, or psychiatric disease, such as anorexia nervosa or bulimia nervosa
  • Hematologic disorder

    • White blood cell disorders

      • Leukemia
      • Lymphoma
      • Cyclic neutropenia
      • Langerhans cell histiocytosis
      • Multiple myeloma
      • Mastocytosis


    • Platelet disorders

      • Thrombocytopenia
      • Red blood cell disorders
      • Anemias
      • Hemochromatosis
      • Thalassemias
      • Polycythemia vera


  • Connective tissue disorder

    • Sjogren syndrome

    • Kawasaki disease

      • Mucocutaneous lymph node syndrome, is a vasculitis that primarily affects medium and large vessels
      • Children <5 years and has replaced rheumatic fever as the primary cause of childhood heart disease in the United States
      • Diagnostic criteria include a fever lasting 5 days or more, as well as at least four of the five following findings:
        • (1) acute cervical adenopathy;
        • (2) peripheral extremity edema, erythema, or desquamation;
        • (3) bilateral painless conjunctival injection;
        • (4) polymorphous exanthem; and
        • (5) oral mucosae erythema or strawberry tongue.
      • Cardiac sequelae of the vasculitis include aneurysms and myocardial infarction.
      • Myocarditis commonly occurs within a week following fever resolution
      • Swelling of papillae on the surface of the tongue (strawberry tongue) and intense erythema of the mucosal surfaces. s Ulceration in the oral cavity is a common presenting sign. The labia may appear cracked, cherry-red, swollen, or hemorrhagic


    • Systemic lupus erythemathous

    • Scleroderma

      • rare autoimmune disease characterized by progressive fibrosis in numerous organ systems
      • 50-300 cases per 1 million persons, and women are at a 3- to 14-fold increased risk
      • CREST (calcinosis, Raynaud phenomenon, esophageal involvement, sclerodactyly, and telangiectasias) syndrome
      • microstomia, a phenomenon in which the opening to the oral cavity reduces in size secondary to perioral collagen deposition
      • Xerostomia occurs as a result of progressive fibrosis of the salivary glands, and it often mirrors the progression of microstomia
      • telangiectasias and atrophy of the oral mucosa


  • Pulmonary Conditions


      • necrotizing vasculitis of small- to medium-sized vessels associated with necrotizing granulomas of the upper and lower airways and necrotizing glomerulonephritis
      • 20 and 160 cases per million persons, and evidence suggests it is more common in Northern European countries
      • also affect the eyes, ears, heart, central nervous system, peripheral nervous system, pharynx, and sinuses
      • ulcerations buccal mucosa or palate and gingival enlargement
      • strawberry gingivitis → characteristic boggy, erythematous-to-violaceous appearance, are exquisitely friable, and may also develop granular papules on the labial interdental papillae
      • antineutrophil cytoplasmic antibody (ANCA) testing +


    • Sarcoidosis

      • idiopathic systemic disease characterized by bilateral hilar lymphadenopathy and noncaseating granulomas in the lungs
      • African Americans (35-80 cases per 100,000 population) than in European Americans (3-10 cases per 100,000 population)
      • Females
      • involve nearly any organ, including the liver, heart, spleen, kidneys, and lymph system
      • papules and nodules or painless nonspecific ulcerations of the gingiva, buccal mucosa, labial mucosae, and palate
      • 19% and 59% of patients may also experience salivary gland involvement → tumorlike swellings
      • Heertfordt syndrome, is the constellation of fever, parotid gland swelling, uveitis, and facial nerve palsy



    • Amyloidosis
      • deposition of amyloid protein in the body’s tissues leading to tissue damage
      • 9 cases per million patient years
      • macroglossia, which occurs in 12-40% of patients → lateral ridging secondary to teeth indentation
      • the tongue may be firm and appear relatively normal, or it may have nodules, fissures, or ulcerations, often on the lateral surface
      • Hyposalivation may result from amyloid deposition in the salivary glands
      • Submandibular adenopathy occurs subsequent to tongue enlargement, and both can lead to respiratory obstruction
      • Interference with taste
  • Cutaneous disease

    • Psoriasis
      • chronic papulosquamous inflammatory condition of the skin that affects approximately 2% of the US population → the second or third decade of life → both men and women
      • Pindborg and van der Waal identified three findings suggestive of oral psoriasis:
        • (1) small, white papules that yield bleeding points upon scraping;
        • (2) red and white plaques that follow skin lesions; and
        • (3) bright-red patches
      • parakeratosis and hyperplasia of the epidermis, elongation of rete ridges, a thinned stratum granulosum, Munro microabscesses of neutrophils superficially, and chronic inflammation of the epidermis and the dermis with polymorphonuclear leukocytes, lymphocytes, and histiocytes
      • a cutaneous disorder of hyperpigmentation and papillomatosis. AN is generally associated with fibroblast growth factor receptor mutations and genetic or acquired insulin resistance on genes related to diabetes and metabolic syndrome
      • Nonpigmented hypertrophy of the papillae along the tongue’s dorsal surface and lateral edge yield a characteristic shaggy, fissured texture
      • Gingival hyperplasia may be prominent, with interdental gingiva so hyperplastic as to cover teeth and interfere with eating
  • Neurologic Disease

      • oral manifestations of NF do not differentiate between NF1 and NF2
      • intraoral neurofibromas on the lips, palate, buccal mucosa, gingiva, and tongue
      • most lesions of the tongue are nodular, diffuse macroglossia and enlargement of the fungiform papillae
      • Hyperpigmentation and enlargement of the gingiva may also be seen in NF1
      • Osseous manifestations include lesions of the cranial and jawbones, while dental abnormalities such as impacted teeth, supernumerary teeth, overgrowth of the alveolar process, and a possible increase risk of caries
  • Endocrine Disease

    • Diabetes

      • metabolic diseases characterized by elevations in blood glucose. Blood glucose levels are generally regulated by the hormone insulin, which is produced by the islet beta cells of the pancreas
      • fissured tongue, benign migratory glossitis, coated tongue, irritation fibroma, traumatic ulcers, and recurrent aphthous ulcers
      • increased prevalence lichen planus, although this remains highly controversial
      • Premalignant conditions such as leukoplakia, erythroplakia, and actinic cheilitis
      • Salivary dysfunction, with or without signs of salivary gland enlargement, burning mouth syndrome, and taste disturbances are also common in diabetes, likely owing to secondary neuropathy
      • increased risk for oral fungal infections, specifically candidiasis
      • dental caries, periodontitis, and gingivitis are also more common in persons with diabetes


    • Multiple endocrine neoplasia

      • syndromes refer to distinct constellations of benign and malignant endocrine tumors with autosomal dominant inheritance
      • MEN type 1 (OMIM #131100), which occurs in 1 in 30,000 people, is characterized by pituitary, parathyroid, and pancreatic tumors
      • MEN type 2a (OMIM 171400) is associated with tumors of the thyroid, parathyroid, and adrenal medulla
      • MEN type 2b (OMIM #162300) is also associated with thyroid and adrenal medulla tumors, but is found in patients with marfanoid features
      • Only MEN type 2b has been associated with specific oral manifestations
      • Nodules on the lips, resulting in a “bumpy” lip appearance, are a common finding caused by mucosal and submucosal ganglioneuromatosis, a prognathic or retrognathic mandible
    • Thyroid disorders

    • Parathyroid disorders

    • Adrenal disorders

      • Hypocorticalism
      • Hypercortisolism
  • Drug-induced conditions

    • Aphthous stomatitis
    • Dry mouth
    • Lichen planus
    • Gingival overgrowth (hyperplasia)
    • Candidiasis (secondary to inhaled steroids)
  • HIV Disease

    • Candidiasis
    • Herpes simplex
    • Hairy leukoplakia
    • Kaposi sarcoma
    • Cytomegalovirus
    • Human papillomavirus
    • Aphthouslike ulcerations

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