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

  • GRANULOMATOSIS WITH POLYANGIITIS (GPA), WEGENER GRANULOMATOSIS

    • 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

    

• MULTISYSTEM CONDITIONS

  • 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
  • ACANTHOSIS NIGRICANS
    • 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

  • NEUROFIBROMATOSIS TYPES 1 AND 2
    • 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