Disorders of oral cavity

Disorders of the Lips

Actinic cheilitis
Premalignant condition due to chronic UVR exposure Affects lower lip, initially edematous & erythematous, later atrophic, white, scaly plaque, may obliterate vermillion border Ulceration or induration biopsy to rule out malignant transformation

Disorders of the Lips

Angular cheilitis (perleche)
Inflammatory reactionerythema and maceration at the angles of mouth, fissuring and crusting may be present Predisposing factorsadvanced age, ill-fitting dentures, thumb-sucking in children, oral Candidiasis, bacterial infections

Disorders of the Lips

Cheilitis glandularis
Inflammatory painless enlargement of lower lip, usually in elderly men Triggered by actinic damage, bacterial infection, tobacco exposure, chronic irritation

Chelitis glandularis apostematosa

Painful enlargement, eversion of lip with erosions and recurrent bacterial infections or malignant transformation

Disorders of the Lips

Exfoliative cheilitis (factitious cheilitis)
Chronic superficial inflammation of vermilion borders of the lips Characterized by persistent scaling Attributed to repeated lip sucking, chewing or other manipulation of lips

Granulomatous cheilitis (cheilitis granulomatosa)

Granulomatous inflammation, acute onset of asymmetric swelling of the upper lip or lower lip Erythema, scaling, fissuring and erosions may develop Prolonged and recurrent course with eventual fixed swelling May be associated with constitutional symptoms, regional lymph node enlargement

Granulomatous cheilitis
Melkersson-rosenthal syndrome- triad of lingua plicata ( fissured or furrowed tongue), facial paralysis and granulomatous cheilitis Other cranial nerves (olfactory, auditory, glossopharyngeal, hypoglossal) may be involved Biopsy- oedema, perivascular lymphocytic infiltrate, focal granulomas resembling sarcoidosis or Crohns disease

Disorders of Tongue
Glossodynia (burning mouth syndrome)- spontaneous burning, discomfort, pain, irritation, or rawness of the tongue, has no identifiable etiology most of the time Etiology Idiopathic, Infection, Allergic/contact hypersensitivity, Mechanical trauma Xerostomia, Geographic tongue/ Fissured tongue Vesiculobullous disease, temporomandibular dysfunction Referred pain from teeth or tonsils Drugs- Antibiotics, psychiatric medications, chemotherapy

Etiology of Glossodynia
Neurologic
Peripheral nerve damage Diabetic neuropathy Trigeminal neuralgia Acoustic neuroma

Systemic disorders
Anemia (iron deficiency, pernicious) Nutritional deficiency Gastroesophageal reflux disease Sjogren syndrome Hypothyroidism Acquired immunodeficiency syndrome

psychiatric
Depression Anxiety Cancerophobia Somatoform disorder OCD

Disorders of Tongue
Glossitis- presents as pain, irritation or burning, hypogeusia, or dysgeusia Atrophic glossitis Due to filiform de-papillation Mild patchy erythema to a completely smooth, atrophic, beefy-red surface Etiology - pernicious anemia, protein and other nutritional deficiencies, chemical irritants, drug reactions, amyloidosis, sarcoidosis, vesiculobullous diseases, oral candidiasis and systemic infections Moeller or Hunter glossitis of pernicious anemia affects the lateral aspects and tip of the tongue respectively

Disorders of Tongue
Median rhomboid glossitis - atrophic disorder of the tongue secondary to chronic candidiasis

Disorders of Tongue
Geographic tongue- benign inflammatory condition, due to Loss of filiform papillae Erythematous plaques with an annular or serpiginous well demarcated white border Etiology- psoriasis, Reiter syndrome, atopic dermatitis, diabetes mellitus, anemia, hormonal disturbances, Down syndrome, lithium therapy

Disorders of Tongue
Fissured tongue (furrowed tongue, scrotal tongue, grooved tongue) normal variant seen in 5-11% individuals Numerous small irregular fissures oriented laterally on the dorsal tongue Also seen in - MelkerssonRosenthal syndrome, psoriasis, Down syndrome, acromegaly, Sjogren syndrome

Disorders of Tongue
Herpetic geometric glossitis - rare cause of fissuring of tongue, presents with acute onset of pain and deep longitudinal grooves with smaller lateral fissures

Disorders of Tongue
Hairy tongue (white or black hairy tongue) - hypertrophy of filiform papillae resembling hair-like projections Associated with - heavy tobacco use, mouth breathing, antibiotic therapy, poor oral hygiene, general debilitation, radiation therapy, chronic use of bismuth containing antacids, lack of dietary roughage White, yellow green, brown, or black color is due to chromogenic bacteria or staining from exogenous sources

Disorders of Tongue
Orai hairy leukoplakiacaused by Epstein-Barr virus, presents as asymptomatic, corrugated, white plaques with accentuation of vertical folds along the lateral borders of tongue Predominantly seen in HIV infection, organ transplant recipients and patients on chemotherapy

Disorders of Tongue
Macroglossia- congenital or acquired process, tongue is disproportionately large relative to the patients jaw size Difficulty with mastication and speech and accidental tongue biting are common Differential- Down syndrome, hypothyroidism, BeckwithWiedemann syndrome, neurofibromatosis, infection by mycobacteria, filamentous bacteria or fungus, amyloidosis

Disorders of Salivary Glands

Xerostomia (dry mouth) - decreased saliva production Women are twice as affected as men Signs and symptoms - diminished or altered taste and smell, halitosis, heavy plaque accumulation, difficulty in wearing dentures, recurrent yeast infections, burning sensation, difficulty swallowing, dry or cracked lips, salivary calculi and increased thirst

Causes of xerostomia
Medications - Antidepressants, antihistamines, diuretics Medical conditions - Parkinson disease, diabetes, anemia, cysticfibrosis, rheumatoid arthritis granulomatous inflammation - tuberculosis, sarcoid, Sjgren syndrome, HIV, amyloid Dehydration - Fever, excessive sweating, vomiting, diarrhea, blood loss, burns, smoking, consumption of tea, coffee Radiation therapy of head and neck Surgical removal of the salivary glands Old Age

Disorders of Salivary Glands

Mucocele (mucous retention cysts)benign, painless, dome- shaped fluctuant papules, due to trauma or obstruction of minor salivary gland ducts Multiple mucoceles - graft vs host disease, lichen planus, cicatricial pemphigoid Ranula - large, bluish, translucent fluctuant mass in the floor of the mouth due to obstruction of the submandibular and or sublingual duct Diffuse parotid gland enlargement acute mononucleosis, HIV infection

Disorders of Gingiva & Periodontium

Gingivitis - erythema, edema, and blunting of the interdental papillae, without bone loss
Predisposing factors - poor oral hygiene, tobacco use, diabetes

Periodontitis -chronic infection of connective tissue, periodontal ligament and alveolar bone
Long-term penodontitis is associated with increased risk of diabetes, heart disease, stroke and preterm birth birth control pills, diabetes, steroids, Down syndrome, Langerhans cell histiocytosis, HIV predispose to periodontitis Juvenile periodontitis is associated with genetic defects in leukocyte chemotaxis

Papillon-Lefevre syndrome - severe and destructive periodontal disease, with exfoliation of the deciduous and permanent teeth

Disorders of Gingiva & Periodontium

Erosive gingivostomatitis (desquamative gingivitis)inflammation and erythema of the gingiva, nonspecific reaction pattern, may be due to viral infection, autoimmune, inflammatory and blistering disorders Lichen planus - painful or asymptomatic lacy white patches, plaques or papules, often with erosions and ulcerations Lichenoid mucositis - NSAIDS, antihypertensive medications, contact allergy, graft-versus-host disease

Disorders of Gingiva & Periodontium

Acute necrotizing ulcerative gingivitis (trench mouth, vincent disease) Punched- out ulcers of the interdental papillae, gingival hemorrhage, severe pain, foul odor Fever and lymphadenopathy are common Precipitating factors- poor oral hygiene, nutritional deficiency, alcohol and tobacco use, Immunosuppression Etiologic agents- Treponema, Selenomonas, Bacteroides, Prevotella and Borrelia vincentii

Aphthous ulceration
Acute, recurrent, painful ulcers on nonkeratinized mucosa Most common cause of oral ulcerations Effect up to 30 % of the population Ulcers with a gray or yellow pseudomembrane and erythematous margin Potential triggers - heredity, food and medication allergy, decreased mucosal barrier integrity, hematologic and immunologic disorders, emotional stress, and trauma

Aphthous ulceration
Minor aphthae (90 -95 %) Age of onset Ulcer size Number of ulcers Sites affected Childhood or adolescence 24 mm Up to about 6 Mainly vestibule, labial, buccal mucosa & floor of mouth Major aphthae (5-10%) Childhood or adolescence 10 mm or larger Up to about 6 Any site Herpetiform ulcers (1-5%) Young adult Initially tiny, but ulcers coalesce 10100 Any site but often on ventrum of tongue

Duration of each ulcer

Up to 10 days

Up to 1 month

Up to 1 month

Aphthous ulceration
Systemic Conditions Associated
Hematinic deficiency (up to 20%)- iron, folic acid or vitamin B12 deficiency Gastrointestinal malabsorption (3%) - Celiac disease, dermatitis herpetiformis, gluten-sensitive enteropathy, Crohn disease, pernicious anemia Systemic lupus erythematosus, reactive arthritis HIV Behcet disease PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) MAGIC (mouth and genital ulcers with inflamed cartilage)

Behcets disease
Major criteria
Oral Aphthae Genital Ulcers Ocular- Iridocyclitis, Retinal vasculitis,Optic atrophy

Minor criteria
Proteinuria and haematuria Thrombophlebitis Aneurysms Arthralgias

CNS lesionsMeningoencephalitis, cerebral infarction, psychosis, cranial nerve palsies, cerebellar and spinal cord lesions

Dermatological
Pustules Erythema nodosum Pathergy

Non-aphthous erosions & ulcers

Pemphigus vulgaris, paraneoplastic pemphigus, bullous pemphigoid, cicatricial pemphigoid, EB acquisita Epidermolysis bullosa simplex, junctional EB & dystrophic EB demonstrate the most severe Discoid and SLE- oral discoid lupus is characterized by sunburst erythematous plaques surrounded by white radiating striations Erythema multiforme and stevens-johnson syndrome/toxic epidermonecrolysis

Non-aphthous erosions & ulcers

Chronic ulcerative stomatitis - autoimmune mucosal erosive disorder Resemble erosive LP Direct immunofluorescence- IgG bound to nuclei of keratinocytes of basal and lower epithelial layers Responsive to Hydroxychloroquine

Iatrogenic mucositis
Complications of systemic chemotherapy and head and neck radiation, occurs due to direct tissue injury of the mucosal epithelium

Disorders of mucosal pigmentation

Localized
Amalgam, tattoo Ephelis / Naevus Malignant melanoma Kaposis sarcoma PeutzJegher syndrome LaugierHunziker syndrome Melanotic macules

Generalized
Racial Localized irritation, e.g. smoking Drugs, e.g. phenothiazines, antimalarials, minocycline, contraceptives, mephenytoin Addisons disease/ Nelsons syndrome Ectopic adrenocorticotrophic hormone (e.g. bronchogenic carcinoma) Albrights syndrome Haemochromatosis Neurofibromatosis, incontinentia pigmenti Malignant acanthosis nigricans

Disorders of Teeth
DISORDER
Bulimia Congenital cytomegalovirus Congenital erythropoietic porphyria Congenital syphilis Ectodermal dysplasia

FINDINGS
Erosion of enamel and loss of dentin Yellow dentin and hypoplastic pitted enamel Erythrodontia of canine teeth and molars and brown discoloration of incisors Hutchinson teeth, mulberry molars Hypodontia/anodontia/microdontia, peg-shaped teeth, supernumerary teeth, enamel defects Supernumerary teeth

Gardner syndrome

Goltz syndrome

Anodontia and enamel defects

Disorders of Teeth
Incontinentia pigmenti Lepromatous leprosy Primary biliary cirrhosis Sjogren syndrome Reflux Tetracycline staining Tuberous sclerosis Hypodontia, conical-shaped teeth Reddening of upper teeth (pink spots) due to infection of dentin Green pigment deposits Caries, increased plaque accumulation, poor oral hygiene Erosion of enamel due to repeated exposure to gastric acid Permanent gray discoloration Pitted enamel of the permanent teeth

Benign Tumors
Pyogenic granuloma (pregnancy tumor) - an exaggerated, reactive proliferation of granulation and vascular tissue triggered by minor trauma or medication, classically during pregnancy Pulp polyp- exaggerated reactive proliferation of the dental pulp (neurovascular bundle), results when gross caries destroys the enamel crown Verruciform xanthoma - minute white or yellow verrucous papules on the gingiva, alveolar mucosa, or hard palate. Foamy, lipid-laden macrophages in biopsy Mucosal lipomas - present as asymptomatic, soft, yellow nodules on the buccal or vestibular mucosa, tongue, floor of the mouth or lips of middle-aged adults

Benign Tumors
Traumatic neuroma - occur around mental foramen, alveolar ridge, lip or tongue Neurofibromas and schwannomas (neurilemmoma) on the tongue or buccal mucosa Sipple syndrome - multiple mucosal neuromas, associated with pheochromocytoma, parafollicular thyroid cysts secreting calcitonin, medullaiy thyroid carcinoma and opaque nerve fibers on the cornea Granular cell tumor (Abrikosov tumor) - reactive process of Schwann cell origin, appears on the dorsal tongue as single or multiple asymptomatic firm, illdefined papule

Pre-Malignant Lesions
Leukoplakia - chronic, white, verrucous plaque with histologic atypia
Severity linked to the duration and quantity of tobacco and alcohol use Occur anywhere in the oral cavity Lip, tongue, or floor of the mouth lesions are prone for progression to SCC

Erythroplakia - non-inflammatory erythematous plaque

Analagous to intra-oral erythroplasia of Queyrat or SCC in situ Biopsies - severe dysplasia and areas of frank invasion

Pre-Malignant Lesions
Submucous fibrosis
generalized white discoloration of oral mucosa with progressive fibrosis, painful mucosal atrophy and restrictive fibrotic bands individuals who chew betel quid, a concoction of tobacco, lime, areca nut and betel leaves Ultimately leads to trismus, dysphagia and severe xerostomia 5 - 10 % progress to SCC

Malignant Lesions
Squamous cell carcinoma - present as leukoplakia, erythroplakia, erythroleukoplakia, irregular endophytic masses with ulceration or exophytic nodules High-risk anatomic sites - ventrolateral tongue, floor of the mouth, and the vermillion border of the lip Verrucous carcinoma - locally aggressive SCC in older adults presents as a hyperkeratotic, verrucous, exophytic white mass on the vestibules or mandibular gingiva, floor of the mouth, palate, and lip. Risk factors - smokeless tobacco and infections with HPV( 16 and 18)

Malignant Lesions
Proliferative verrucous leukoplakia - rare progressive multifocal leukoplakia, with white, hyperkeratotic, verrucous plaques involve large areas of mucosa
Women are affected four times as men More than 90 % undergo malignant transformation Smoking is not associated, HPV may be etiologic factor

Melanoma - irregular pigmented macule, patch or papule on the hard palate or maxillary gingiva
in older than 50 years advanced lesions may ulcerate or bleed Breslow depth - most important prognostic factor

Malignant Lesions
Hodgkin, non-Hodgkin, cutaneous Tcell, and Burkitt lymphoma - non-specific, indurated, painless masses Burkitt lymphoma is associated with alveolar bone destruction Langerhans cell histiocytosis - ulcerative gingivitis, periodontitis, ulceration and bony destruction, may be initial or sole manifestation of disease multicentric reticulohistiocytosis - flesh-colored to reddish-brown nodules on oral or nasal mucosa, in addition to classic cutaneous lesions and associated arthropathy Kaposi sarcoma - single or multiple hemorrhagic patches or exophytic nodules, most often on gingiva or palate

Varicosities
Asymptomatic, blue, soft nodules on the lips and ventrolateral tongue Not associated with any known systemic disease Caliber-persistent labial artery - raised pulsatile tortuous, blue rubbery bleb appreciation of lateral pulsation is diagnostic Mucosal hemangiomas - benign vascular tumors of infancy, erythematous or bluish vascular nodules, sometimes with associated thromboses and phleboliths, spontaneous regression usual Petechiae, ecchymoses, hematomas, and spontaneous gingival hemorrhage in thrombocytopenia, coagulation, hemolytic anemia, von willebrand disease, anticoagulant therapy

Salivary Gland Tumors

Occur most commonly on the palate and on the retromolar pad distal to the third molar Erythematous papules or ulcerated papules and nodules

Medication-Related Oral Changes

Teeth Discoloration Tetracyclines, Chlorhexidine

Gingiva Swelling
Dry mouth Disturbed Taste

Phenytoin, Ciclosporin, Nifedipine, Diltiazem

Tricyclic antidepressants, Phenothiazines, Antihypertensives, Lithium Metronidazole, Penicillamine

Ulcers
Lichenoid lesions Mucosa Thrush

Cytotoxic drugs, Non-steroidal anti-inflammatory agents

Non-steroidal anti-inflammatory agents Broad-spectrum antimicrobials, Corticosteroids Cytotoxic drugs Minocydine, antimalarials, clofazimine, amiodarone, ketoconazole, and zidovudine

Hyper pigmentation

Physical and Chemical Trauma

Chronic biting and manipulation of lips in and buccal mucosa in nervous habit- ragged, irregular, white plaque at the site of trauma Frictional keratosis - thickened white plaque (sharp tooth or overextended denture) Irritation fibroma - sessile nodule at site of chronic mucosal irritation Smokers palate or nicotine stomatitis - thermal injury to the hard palate of pipe smokers Appears as a diffusely white palate studded with 2-5mm erythematous umbilicated papules

Physical and Chemical Trauma

Epulis fissuratum Develops beneath poorly fitting dentures, painless, elongated ridges of hypertrophic mucosa along the anterior labial alveolar ridge

Giant cell epulis

A reactive hyperplastic proliferation, appears as a deep red papule on the interdental papillae Many multinucleated giant cells are seen histologically in a vascular proliferation

Chemical burn
Aspirin burns
Mucosa in direct contact with aspirin becomes necrotic and painful, also with Medications containing phenol

Contact stomatitis
Intra-oral erythema, ulceration or a lichenoid mucositis Dental amalgams, Cinnamate, flavorings, food additives, spices, toothpaste, mouthwash, dental epoxy resins, cosmetic lip products

Oral Manifestations of Viral Infections

Herpes (HHV-l and HHV-2) Chickenpox (HHV-3) Lip edema with erythematous, grouped vesicles, erosions, intra-oral hemorrhagic ulcers. Tongue involvement in immunocompromised patients Oral ulcers on palate or buccal mucosa

Herpes zoster (HHV-3)

Infectious mononucleosis Epstein-Barr virus (HHV-4)

Painful, unilateral, aphthous-like ulcers in second and third trigeminal nerve branch
Exudative tonsillitis, uvular edema, palatal petechiae, and, uncommonly, necrotizing ulcerative gingivitis

Oral hairy leukoplakia Epstein-Barr virus (HHV-4)

Congenital Cytomegalovirus (HHV-5) Roseola infantum (HHV-6) (exanthem subitum)

White plaques with prominent vertical folds on lateral tongue> dorsal tongue > buccal mucosa and vestibule in immunocompromised individuals
Yellow dentin and hypoplastic puffed enamel of the teeth, Aphthous-like ulcers Erythematous macules on soff palate

Oral Manifestations of Viral Infections

Kaposi sarcoma HHV-8 Herpangina Group A coxsackievirus Hand-foot-and- mouth disease (Coxsackie A-l6) Acute lymphonodular pharyngitis (Gp A Cox) Measles (rubeola) Rubella (German measles) Acute sero-conversion of HIV Erythematous to violaceous macules on palate, gingiva, tongue. Evolve into painful, ulcerated nodules Acute onset, 1- to 2-mm erythematous macules on palate and uvula. Lesions vesiculate and ulcerate, leaving painful superficial erosions Many small, painful ulcers with surrounding erythema on the tongue, buccal mucosa, palate White or yellow papules with an erythematous base on uvula, tonsils, oropharynx Koplik spots - brightly erythematous macules with white centers on buccal mucosa adjacent to posterior teeth Forschheimer spotssmall erythematous macules on palate Erythema, ulcerations, and secondary candidiasis

Oral Manifestations of Viral Infections

Squamous papilloma (HPV) Verruca vulgaris (HPV) Condyloma acuminatum (HPV) Focal epithelial hyperplasia (Heck disease) (HPV) Kawasaki disease Solitary, exophytic, pedunculated, mucosa colored papule, occurs on the palate or tongue Solitary or clusters of verruciform papules on the Buccal mucosa, lips, or perioral skin Resemble verruca vulgaris but are larger. Oral Involvement of the labia, lingual frenum, soft palate, and gingiva Benign, soft, painless 1- to 4-mm papules on the labial, buccal, or lingual mucosae Beefy red oropharynx, strawberry tongue (inflammation and papillary enlargement), severe hemorrhagic cheilits

Oral Manifestations of bacterial Infections

Scarlet fever (Group B Streptococcus) Erythema of hard palate and a white-coated Tongue with erythematous, edematous, fungiform papillae. Later the tongue becomes beefy red (strawberry tongue) Thick, gray pseudomembrane with erythematous Halo on tonsils, pharynx, gingiva, tongue, buccal mucosa Painful, necrotic oral ulcers or diffuse stomatitis

Diphtheria (Corynebacterium Diphtheriae) Tularemia (Francisella Tularensis)

Lepromatous leprosy

Firm yellow-pink ulcerative nodules (lepromas) on the palate or tongue. Macroglossia due to tongue infiltration, Reddening of upper teeth (pink spots) due to infection of dental pulp Painful hemorrhagic ulcers or vegetative nodules, Severe scarring

Granuloma inguinale

Oral Manifestations of bacterial Infections

Primary syphilis Chancrepainless ulceration with indurated borders on the lip, tongue, buccal mucosa, or oropharynx with lymphadenopathy Mucous patchesoval plaques on the tongue with a white or gray pseudomembrane. Split papules, macerated, flat-topped papules at the oral commissures (condyloma lata). chronic oral ulcerations Interstitial glossitis with atrophy of filiform and fungiform papillae and fissuring of the tongue, Pre-malignant leukoplakia, gummas involve palate Hutchinson teeth in 50%peg shaped with crescentic notches along incisal edge of incisors. Mulberry or Moons molarsrounded or crenated occlusal cusps of first molars Secondary syphilis

Tertiary syphilis

Congenital syphilis

Oral Manifestations of fungal Infections

Primary oral Aspergillus aspergillosis Necrotic, violaceous ulcerations with black eschar on gingiva and palate Maxillary sinus Aspergilus Untreated maxillary infection can progress to aspergillosis necrotic palatal perforation with a yellow and black palatal ulcer and facial edema

Zygomycosis, Mucor and Rhizopus

black, necrotic palatal ulceration

Histoplasmosis Blastomycosis Cryptococcus Coccidioidomycosis Para coccidioidomycosis

Chronic verrucous or necrotic mucosal ulceration

Oral Manifestations of fungal Infections

Oral candidiasis Acute pseudomembranous, Acute atrophic, Chronic atrophic, Chronic hyperplastic, Median rhomboid glossitis Predisposing factors- dry mouth, antimicrobials, corticosteroids, leukaemia, HIV inf, tobacco smoking, denture wearing, endocrinopathy

Oral manifestations of Endocrine disorders

Pituitary dwarfism Congenital hypothyroidism Gigantism/acromegaly Hyperparathyroidism Addisons disease Microdontia, Retarded tooth eruption Macroglossia, Retarded tooth eruption Spaced teeth, Mandibular prognathism, Macroglossia, Megadontia Bone rarefaction, Brown tumours Mucosal hyperpigmentation

Diabetes mellitus Pregnancy

Periodontal disease, Xerostomia, Candidiasis, Sialosis, Lichen planus Gingivitis, Epulis

Oral manifestations of Liver diseases

Alcoholic cirrhosis Bleeding tendency, Sialosis Chronic active hepatitis Primary biliary cirrhosis Lichen planus Sjgrens syndrome, Lichen planus

Hepatitis C

Lichen planus, Sjogrens syndrome

Oral manifestations of Gastrointestinal diseases

Pernicious anaemia Any malabsorption Ulcers, Glossitis, Angular stomatitis, Erythema Ulcers, Glossitis, Angular stomatitis

Chronic regurgitation
Crohns disease

Tooth erosion, Halitosis

Mucosal tags, Gingival hyperplasia, Cobblestoning of mucosa, Ulcers, Glossitis, Angular stomatitis

Coeliac disease
Chronic pancreatitis Cystic fibrosis Gardners syndrome (familial colonic polyposis)

Ulcers, Glossitis, Angular stomatitis, Dental hypoplasia

Sialosis Salivary gland swelling Osteomas

Oral manifestations of Renal diseases

Chronic renal failure Post renal transplant Xerostomia, Halitosis/taste disturbance, Leukoplakia Dental hypoplasia, Bleeding tendency Infections( herpetic, candidal), Bleeding tendency, Gingival hyperplasia, Kaposis sarcoma Hairy leukoplakia Delayed tooth eruption, Dental hypoplasia, Enlarged pulp Dental hypoplasia

Renal rickets (vitamin D resistant) Nephrotic syndrome

Oral manifestations Haematological diseases

Deficiency of haematinics (iron, folic acid or vitamin B12) Sickle-cell anaemia Burning sensation, Ulcers, Glossitis, Angular stomatitis Jaw deformities, Osteomyelitis

Aplastic anaemia
Leukaemia/lymphoma

Ulcers, Bleeding tendency

Infections, Ulcers, Bleeding tendency, purpura, Gingival swelling

Multiple myeloma

Bone pain, Tooth mobility, Amyloidosis

Amyloid disease

Enlarged tongue, Purpura

References
Fitzpatrick,s dermatology in general medicine 7th edition Rooks text book of dermatology 7th edition