Transcript Cardiovascular disease Oral manifestations

Changes of oral mucous membrane
in some systemic diseases
(gastrointestinal, cardiovascular,
endocrine and nervous systems)
Lecturer: Matsko N.V.
Department of therapeutic Dentistry, TSMU
 The
oral cavity is a mirror that reflects
many of the human body's internal
secrets. Some of these manifestations are
disease specific and may accompanied
many systemic diseases. It is very
important to recognize them and provide
correct diagnosis.
Cardiovascular diseases
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The classical risk factors for
cardiovascular disease:
- hypertension,
- hyper-cholesteroleamia,
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- cigarette smoking
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Two biological mechanisms
that explain the relationship
between cardiovascular
disease and periodontal
disease:
 – Bacteria from periodontal
disease may enter the
circulation and contribute
directly to the atheromatous
or thrombotic processes.
 – Systemic factors alter the
immune inflammatory
process involved in both
periodontal and
cardiovascular diseases.
Cardiovascular disease
Oral manifestations
 Periodontal
disease
 Lichenoid stomatitis
 Xerostomia
 Gingival hyperplasia
 Hemorrhagic complication
Cardiovascular disease
Oral manifestations
Periodontal disease
Cardiovascular patients with active
periodontal disease are 1.5-2.7 more
likely to experience a fatal cardiovascular
event
-Increased inflammation
-Increased bacteremia risk
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Cardiovascular disease
Oral manifestations
 Lichenoid
stomatitis
 Various cardiovascular drugs may induce
lichenoid lesions – oral discomfort
 Diuretics
 B1-adrenergic blockers
 ACE- inhibitors (angiotensin-convertingenzyme inhibitors)
Cardiovascular disease
Oral manifestations
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Dry mouth
Numerous cardiovascular drugs may
reduce salivary function:
Diuretics
B1-adrenergic blockers
Centrally acting sympathetic agonists
Synergistic affect with other medications
Cardiovascular disease
Oral manifestations
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Gingival hyperplasia:
Calcium-channel blockers are commonly
prescribed
Gingival enlargement usually apparent
within 1-2 months of therapy
Tissue usually firm and painless
Overlying inflammation may occur
Cardiovascular disease
Oral manifestations
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Hemorrhagic
complication:
Antithrombotic/anticoagulant agents
increase the risk of
-petechia(<2mm)
-purpura(>2mm<1cm)
-ecchymosis(>1cm)
-hemorrhage
Gingival hyperplasia
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Figure 1a: Photograph of a
32-year-old male patient at the
time of presentation shows
remarkable gingival
hyperplasia. The gingival
tissue between teeth 11 and 12
resembled an epulis.
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Extraoral examination showed
excessive hairiness of the
face.
Desquamation was observed
on the patient's back .
Endocrine system
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Endocrine pathology include:
-thyrotoxicosis;
 -hypothyroidism;
 -Cushing syndrome;
 -Addison disease;
 -acromegaly;
 -hyperandrogenism;
 -hypopituitarism;
 -primary hyperparathyroidism;
 -hypoparathyroidism;
 -pseudohypoparathyroidism;
 -manifestations of diabetes mellitus.
Diabetes
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Type 1 diabetes is usually
diagnosed in childhood. Many
patients are diagnosed when
they are older than age 20. In
this disease, the body makes
little or no insulin. Daily
injections of insulin are
needed. The exact cause is
unknown. Genetics, viruses,
and autoimmune problems
may play a role.
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Type 2 diabetes is far more
common than type 1. It makes
up most of diabetes cases. It
usually occurs in adulthood,
but young people are
increasingly being diagnosed
with this disease. The
pancreas does not make
enough insulin to keep blood
glucose levels normal, often
because the body does not
respond well to insulin. Many
people with type 2 diabetes do
not know they have it, although
it is a serious condition. Type 2
diabetes is becoming more
common due to increasing
obesity and failure to exercise.
Risk factors for diabetes
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There are many risk factors for type 2 diabetes,
including:
-Age over 45 years
-A parent, brother, or sister with diabetes
-Gestational diabetes or delivering a baby weighing
more than 9 pounds
-Heart disease
-High blood cholesterol level
-Obesity
-Not getting enough exercise
-Polycystic ovary disease (in women)
-Previous impaired glucose tolerance
Diabetes mellitus presented with an
ulcerating rash
Symptoms of diabetes
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Patients with type 1 diabetes
usually develop symptoms
over a short period of time.
The condition is often
diagnosed in an emergency
setting
Symptoms of type 1 diabetes:
Fatigue
Increased thirst
Increased urination
Nausea
Vomiting
Weight loss in spite of
increased appetite
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Type 2 diabetes develops
slowly, some people with high
blood sugar experience no
symptoms at all.
Symptoms of type 2 diabetes:
Blurred vision
Fatigue
Increased appetite
Increased thirst
Increased urination
Oral lesions at diabetes
FIGURE 1. Lingual view of mandibular
incisors of a 60-year-old
female with poorly controlled type 2
diabetes. The HbA1c value at initial
examination was 13.9%. Multiple
periodontal abscesses (teeth 22, 23, 25,
26, and 27) with severe inflammation and
bone loss can be seen.
Complications of Diabetes
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Eye Disease
 2. Kidney Disease
 3. Cardiovascular Disease
 4. Neuropathy
 5. Foot Problems
 6. Susceptibility to Dental disease,
especially periodontal (gum) infections.
Main oral health problems
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People with diabetes are at
higher risk for oral health
problems, such as
gingivitis (an early stage of
gum disease),
periodontitis (serious gum
disease).
People with diabetes are at an
increased risk for serious gum
disease because they are
generally more susceptible to
bacterial infection
have a decreased ability to
fight bacteria that invade the
gums.
Gingivitis in a 19-year-old
women with uncontrolled
diabetes mellitus
Other oral problems associated to
diabetes include:
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thrush,
 an infection caused
by fungus that grows
in the mouth,
 dry mouth which can
cause soreness,
ulcers, infections and
cavities.
Inflamed, papulonodular
hyperplasia of the gingiva in a
diabetic patient
Oral Complications of Diabetes
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Periodontitis
Increased rate of dental caries
Xerostomia
Salivary dysfunction
Burning mouth and tongue
Candidiasis
Cheilosis
Glossodynia
Lichen Planus
Oral changes associated with
diabetes include cheilosis,
mucosal drying, burning mouth
and tongue, diminished
salivary flow, alterations in the
flora of the oral cavity and
increased rate of dental caries.
Periodontal changes include
enlarged gingiva, sessile or
pedunculated gingival polyps,
polypoid gingival proliferations,
abscess formation,
periodontitis, and loosened
teeth. Periodontal disease in
diabetics follows no consistent
or distinct pattern.
Salivary Dysfunction & Xerostomia
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Salivary Hypofunction/ Dry mouth
Dry mouth (xerostomia) occurs when the salivary glands
are not functioning properly resulting in decreased
saliva. Saliva not only aids in digestion, but is a
necessary factor in oral health because it also helps to
keep your mouth moist and prevent tooth decay.
Diabetic neuropathy can also affect the salivary glands.
Polyuria
Topical treatments:
fluoride containing mouthrinses
salivary substitutes
Periodontal Disease
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Increased prevalence
of PerioDisease
 Decreased healing in
poorly controlled DM
 Management of
periodontal disease
may help improve
glycemic control
Dental Caries
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Increased prevalence
of dental caries
 Salivary
hyperglycemia
Oral Candidiasis
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Opportunistic fungal
infection commonly
associated with
hyperglycemia.
 Salivary dysfunction
compromise immune
function.
 Salivary
hyperglycemia
provide substrate for
fungal growth
Burning Mouth Syndrome
Burning mouth syndrome is a condition with no determined cause and is
characterized by a chronic burning pain in your mouth. This burning sensation
can be severe, feeling much the same as scalding and can affect the overall
areas of your mouth such as your tongue, gums, lips, inside of your cheeks, and
the roof of your mouth. Although BMS has no known cause and finding
treatment may by difficult, most people can bring it under control by working with
an oral health specialist.
Oral manifestations of patients
with hyperthyroidism
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-accelerated dental eruption in children,
-maxillary or mandibular osteoporosis,
-enlargement of extraglandular thyroid tissue,
-increased susceptibility to caries and
periodontal disease,
-burning mouth syndrome,
-development of connective-tissue diseases
such as Sjergen’s syndrome or systemic lupus
erythematosus.
Oral manifestations of patients
with hypothyroidism
 -delayed
eruption,
 -enamel hypoplasia in both dentitions,
 -anterior open bite,
 -macroglossia,
 -micrognathia,
 -thick lips,
 -dysgeusia,
 -mouth breathing.
Oral manifestations of patients
with hyperparathyroidism
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1. Dental abnormalities:
-widened pulp chambers;
-development defects;
-alterations in dental
eruption
-weak teeth
-maloclussions
2. Brown tumor
3. Loss of bone density
4. Soft tissue
calcifications
Oral manifestations of patients
with hypoparathyroidism
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1. Dental abnormalities:
-enamel hypoplasia in horizontal lines;
-poorly calcified dentin;
-widened pulp chambers;
-dental pulp calcifications;
-shortened roots;
-hypodontia;
-delay or cessation of dental development.
2. Mandibular tori
3. Chronic candidiasis
4. Paresthesia of the tongue or lips
5. Alteration in facial muscles
Addison's disease
Addison's disease results from a chronic insufficiency of the
adrenal cortex.
The first signs of the disease may be:
- pigmentation of the skin and mucous membranes due to
excessive deposition of melanin in the connective tissue
and epithelial cells. Pigmentation of the skin appears in
the areas exposed to light (the face, the back surface of
the hands). As the disease progresses the skin become
light brown or bronze color.
-possible fatigue, gastrointestinal disturbances (nausea,
vomiting, diarrhea, abdominal pain), headache, memory
loss, weight loss.
Addison's disease
Availability small (one to several
square millimeters) grey-black
spots or stripes, dark brown or
grey-blue color without signs of
inflammation on the mucous
membrane of the:
•
mouth in the cheek area,
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tongue edges,
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palate,
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gums.
The spots can be oval or take the
form of strips or fine grit, above
the level of the mucous
membrane, they are not separated.
Addison's disease
The most common symptoms are
fatigue, lightheadedness upon standing
or while upright, muscle weakness,
fever, weight loss, difficulty in standing
up, anxiety, nausea, vomiting, diarrhea,
headache, sweating, changes in mood
and personality, joint and muscle pains.
Addison's disease is differentiated from:
-multiple melanotic macules,
-smoker’s melanosis,
-Peutz-Jeghers syndrome,
-heavy metal poisoning,
-postinflammatory hyperpigmentation,
-congenital pigmentation of the oral mucosa, which is observed in
some nations
Fig. the band-like grayish blue pigmentation of the maxillary and mandibular
anterior gingiva after using drugs that include antimalarial agents .
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Addison's disease
 Treatment:
-replace the missing or low levels of cortisol (hydrocortisone)
 Prognosis:
-Prognosis for patients appropriately treated with hydrocortisone
and aldosterone is excellent. These patients can expect to enjoy
a normal lifespan.
-Without treatment, or with substandard treatment, patients are
always at risk of developing Addisonian crisis.