Oral Pathology Final Oral Manifestations of Systemic Disease Flashcards

Terms Definitions
What is a Heterogenous group of inherited metabolic disorders characterized by a lack of One or More Enzymes for Glycosaminoglycan synthesis.
How are Heparin sulfate, Dermatan sulfate, Keratin sulfate, & Chondroitin sulfate related to Mucopolysaccharidoses?
One or more of these ma be deficient in mucopolysaccharidoses. These GAGs are needed to form the connective tissue of the body
What are common signs of Mucopolysaccharidoses?
Obliterated pulp chambers and root canals (kind of like teeth you would see in dentinogenesis imperfecta, this is common (50%) in sanfilippo syndrome
Gingival Hyperplasia
Pointed cusps on posterior teeth
Impacted teeth with large follicles
What vitamin deficiency might contribute to oral leukoplakia?
Vitamin A
What vitamin deficiency might present as Glossitis, Stomatitis, Angular cheilitis, Glossodynia, Glossopyrosis, and Atrophy of papilla?
Vitamin B deficiency
In vitamin B1 (thiamin)deficiency Beriberi occurs in alcoholics/malnourished, what symptoms of pain are unique to this condition?
Glossodynia - Pain in tongue
Glossopyrosis - Burning tongue
What is the underlying problem associated with Scurvy, a vitamin C (ascorbic acid) deficiency?
Vitamin C is necessary for the formation of Collagen, which would result in poor healing if there was a deficiency
What would a deficiency in vitamin D lead to?
Childhoo Rickets
Adult Osteomalacia
What is the most common reason why someone becomes vitamin K deficient?
Dicumarol or Coumadin
Which of the following would most commonly manifest itself as a brown pigmentation of the skin with perioral and oral melanotic macules?
a) addison's disease
b) hyperparathyroidism
c) cretinism
d) nevoid basal cell carcinoma syndrome
e) graves disease
Addison disease
If extraoral signs and symptoms accompany recurrent aphthous stomatits, a diagnosis of which of the following should be considered?
a) Diabetes mellitus
b) Addison disease
c) SLE
d) Erythema migrans
e) Behcet syndrome
Behcet syndrome
Deficiency states reported to produce glossitis include which of the following?
a) Plummer-Vinson syndrome
b) Vitamin B complex deficiencies
c) Iron deficiency anemia
d) All of the above
e) A & C
All of the above
All of the following soft tissue lesions would have a female gender predilection except?
a) Lichen planus
b) Cicatricial pemphigoid
c) Squamous cell carcinoma
d) Desquamative gingivitis
e) Salivary gland tumors
This 50 year old patient was told recently by her physician that her serum calcium level was quite high. All of her dental radiographs present with features similar to the one projected. The patient's history and x-rays would suggest that this patient may
Which of the following is the most likely diagnosis of the firmly adherent white lesion seen bilaterally in this 50 year old patient? The lesion does NOT disappear when stretched?
a) Leukoedema
b) Leukoplakia
c) White sponge nevus
d) Lichen planus
e) Hair
Lichen planus
Which of the following should be included in the differential diagnoses of this red lesion of the maxillary gingiva/alveolar ridge?
a) Peripheral giant cell granuloma
b) Mucocele
c) Pyogenic granuloma
d) All of the above
e) A & C only
A & C only
Which of the following is the most likely diagnosis of the solitary, reddish, ulcerated lesion observed in this projected photograph?
a) Traumatic fibroma
b) Pyogenic granuloma
c) Parulis
d) Papilloma
e) Pulp polyp
Pyogenic granuloma
Which of the following should be included in the differential diagnosis of the projected exophytic mass?
a) Peripheral ossifying fibroma
b) Peripheral giant cell granuloma
c) Pyogenic granuloma
d) All of the above
e) A & C
All of the above
The lesion observed on the dorsal surface of this tongue have a history of changing pattern. Which of the following is the most likely diagnosis?
a) Hairy tongue
b) Median rhomboid glossitis
c) Erythema multiforme
d) Geographic tongue
e) Fissured tongue
Geographic tongue
Lesions such as the ones seen at the corners of the mouth, in this elderly female patient have been associated with which of the following?
a) Deficiency of riboflavin
b) Loss of vertical dimension
c) Infection with Candida albicans
d) All of the above
All of the above
Which of the following factors may play a role in the pathogenesis of xerostomia?
a) Mouth breathing
b) Sjogren's syndrome
c) Local radiation therapy
d) All of the above
e) A & C only
All of the above
Which of the following are causes of xerostomia?
a) Sjogren syndrome
b) Antihistamines
c) Postradiation changes
d) All of the above
e) A & C only
All of the above
Deficiency states reported to produce glossitis include which of the following?
a) Plummer-Vinson syndrome
b) Vitamin B complex deficiencies
c) Iron deficiency anemia
d) All of the above
e) A & C
All of the above
If extraoral signs and symptoms accompany recurrent aphthous stomatitis, which of the following disease entities should be considered foremost in the differential diagnosis?
a) Addison disease
b) Behcet syndrome
c) Crohn disease
d) Darier disease
e) Epide
Behcet syndrome
For a diagnosis of Stevens-Johnson syndrome to be made which of the following should be affected in addition to oral and skin lesions?
a) Kidney and liver
b) Gastrointestinal
c) Either ocular or genital mucosa
d) Either kidney or lungs
e) Platelet and gra
Either ocular or genital mucosa
Which of the following must be considered when pigmented macules are found on the skin and oral mucosa?
a) Addison disease
b) Peutz-Jeghers syndrome
c) McCune Albright syndrome
d) All of the above
e) A & C only
All of the above
What are the 3 targets for PTH?
Kidney: Reabsorbs calcium from the urine
Bone: Mobilizes calcium from the bone
Gut: Augments the absorption of calcium from the diet
What is the symptoms and treatment for Hypoparathyroidism?
Hypocalcemia, Chvostek's sign (twitching of the upper lip by tapping facial nerve just below zygomatic process), enamel hypoplasia (if present during odontogenesis), oral candidiasis
Tx: Vitamin D & Calcium Supplements
What are tooth abnormalities associated with Pseudohypoparathyroidism?
Enamel hypoplasia
Wide Pulp Chambers
dagger shaped pulp chambers, oligodontia, delayed eruption & blunt apices
What type of Hyperparathyroidism is associated with Parathyroid adenoma (80-90%)
Primary Hyperparathyroidism
What is the most common type of hyperparathyroidism after 60 years old?
Primary hyperparathyroidism
What are the symptoms of Hyperparathyroidism?
Stones: nephrolithiasis and metastatic calcifications
Bones: subperiosteal resorption in phalanges, Loss of Lamina Dura Surrounding the Teeth
abdominal Groans: duodenal ulcers
psychic Moans: depression, lethargy, weakness, seizures, confusion & dementia
What systemic condition produces Benign Tumor-like Lesions of Bone Radiographically and Microscopically Indistinguishable from the Central Giant Cell Granuloma of the Jaws?
Hyperparathyroidism produces Brown tumors of bone (osteitis fibrosa cystica) which is indistinguishable from the Central Giant cell granuloma of the jaws
What demographic does a Brown tumor apply to?
Why are brown tumors brown?
They contain blood and Hemosiderin. They are not neoplasms.
What is Secondary hyperparathyroidism usually associated with?
End Stage Renal Disease (Lack of Metabolism of Vitamin D)
What is the normal range of calcium un the blood?
9-11 mg/dl
How are bones affected by Hyperparathyroidism?
Subperiosteal resorption in phalanges
Loss of lamina dura surrounding teeth**
Ground glass bone due to decreased density and blurring loss of trabeculae
Brown tumors of bone (these giant cells are osteoclasts. they are mobilized and form a mass within the bone and are reabsorbing the bone from the inside out.)
What is the major difference between primary & secondary hyperparathyroidism when it comes to phosphate and calcium?
Both are Hypercalcemia, Hypercalciuria, Hyperphosphaturia

Primary = Hypophosphatemia
Secondary = Hyperphosphatemia
What is the most common form of Hypercortisolism?
Cushing syndrome - a sustained level of exogenous glucocorticoids (moon face, buffalo hump)
Why do patients with Hypercortisolism, like cushing, make bad dental patients?
Anything you do will take longer to heal and may be prone to infection
Periodontitis incidence will increase
Put off tx until they are stable
What is caused by an insufficient production of adrenal corticosteroid hormone?
Addison's Disease
What are the causes of Primary type Addison's disease?
Autoimmune destruction (most common)
TB & deep fungal (AIDS)
What are symptoms of Addison's Disease?
Oral Freckling first followed by skin hyperpigmentation
GI problems
Salt craving
What are some dental related problems that diabetes mellitus patients experience?
Periodontitis (incidence & severity)
Oral candidiasis (traced to decreased immune surveillence)
Diabetic Sialeadenosis (salivary glands become enlarged)
Zygomycosis (fungal infection in the maxillary sinus)
Migratory Glossitis (geographic tongue)
Delayed wound healing
What should you suspect if you have:
Obliterated pulp chambers & root canals
Gingival hyperplasia
Pointed cusps on posterior teeth
Impacted teeth with large follicles
Corneal clouding
Joint stiffness
Mental retardation
Coarse fa
What leads to cretinism in infancy and myxedema in adults?
In Hypothyroidism, there is systemic deposition of glycosaminoglycan ground substance in their connective tissue. What will this lead to?
Non-pitting edema
What disease has the symptoms of:
Enlarged Tongue & Lips
Swollen Face
Delayed eruption of teeth
Non-pitting peripheral edema
Who is most affected by Grave's disease?
Hyperthyroidism is 5-10x more common in Women
Why is Hyperthyroidism important to dentistry?
Increased sensitivity to EPINEPHRINE, exagerating tachycardia & hypertension
Risk of Thyroid Storm (large release of thyroxine due to stress or infection) death in20-40%
What causes Gigantism?
Rare condition of increased growth hormone from PITUITARY ADENOMA
(associated with McCune-Albright syndrome - Cafe au lait spots, fibrous dysplasia of bone, precocious puberty)
What are some dental signs of pituitary Dwarfism?
delayed tooth eruption
Often missing 3rd molars
In Crohn's disease, oral lesions are reported in 30% of cases and can precede gut lesions. What do these lesions look like?
Diffuse or nodular oral/perioral swellings
Cobblestone appearance of mucosa
Mucosal ulcers and fissures or present as pyostomatitis vegetans
What is a rare manifestation of ulcerative colitis or Crohn's Disease?
Pyostomatitis vegetans
Yellowish, slightly elevated linear, serpentine pustules on an erythematous mucosa (snail tract ulcerations)
Most often on buccal, labial soft palatal mucosa and tongue
Oral pain and discomfort possible
What do the lesions of pyostomatitis vegetans (a rare manifestation of ulcerative colitis or crohn's disease) manifest as?
Yellowish, slightly elevated, linear, serpentine pustules on an erythematous mucosa (snail tract ulcerations)
Where do oral manifestations of pyostomatitis vegetans manifest?
Buccal, labial, soft-palatal mucosa, and tongue
What type of Iron-deficiency Anemia is considered premalignant due to high incidence of oral, hypopharyngeal and esophageal carcinomas?
Plummer-Vinson Syndrome (Paterson-Kelly syndrom, sideropenic dysphagia)
Fatigue, weakness & SOB
Chronic iron deficiency anemia, glossitis & dysphagia
Esophageal webs and koilonychias (spoon-shaped nails)
Scandinavian Women 30-50 years old
Glossopyrosis, Glossodynia, & Angular cheilitis
Patients on anticoagulation therapy need a recent _________ to measure their ability to clot prior to dental treatment if there is any chance that dental care can cause bleeding.
Prothrombin Time
What is a normal Prothrombin time?
10-13 seconds

INR =1-4
/ 60

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