Download DrBenacka-Stomatology.13.Dec.2010

PATHOPHYSIOLOGY
OF ORAL CAVITY
Roman Benacka, MD, PhD
Department of pathophysiology
LF UPJŠ
Content
Oral manifestations of systemic disease
Oral manifestations of drug reactions
Contact stomatitis (irritation & allergy)
Bacterial & viral oral infections as focuses
for systemic spreading
Nutritional defects - avitaminoses
Topic 1
Oral manifestation of
systemic diseases
Gastrointestinal diseases
Haematological disorders
Connective tissue disorders
Pulmonary disorders
AIDS & Immunodeficiencies
Cutaneous disorders
Endocrine disorders
Topic 1A
Gastrointestinal
diseases
Crohn disease
transmural inflammation, noncaseating granulomas, and fissures in bowels
manifests systemically as arthritis, clubbing of the fingers, sacroiliitis, and
erythaema nodosum
intraoral signs occur in 8-9% of cases and may precede intestinal
involvement:
diffuse labial, gingival, or mucosal swelling;
cobblestoning of the buccal mucosa;
apthous ulcers, mucosal tags and angular cheilitis
Ulcerative colitis
oral lesions coincide with exacerbations of the colonic disease occur in 510% of patients
aphthous ulcerations or superficial hemorrhagic ulcers, angular stomatitis
Gastroesophageal reflux disease (GERD)
regurgitation causes acidic environment (pH 1-2) in the oral cavity
dissolving and errosion of enamel differing from caries; Caries is not
increased
commonly seen on the palatal surfaces exposing underlying dentin,
Topic 1A
Gastrointestinal
diseases
Hepatopathia and bilirubin metabolism and secretion disorders
jaundice (yellow pigmentation) - deposition of bilirubin (25-30 mg/l) in
the submucosa - mucosa on the soft palate and in the sublingual region
Chronic liver disease
excessive gingival bleeding with minor surgery - liver synthesizes
clotting factors, vitamin K requires proper liver functioning to be
adequately absorbed
Hepatitis C
leading infectious cause of chronic liver disease worldwide
association between hepatitis C and erosive oral lichen planus
transmission from patient to dentist
Topic 1B
Haematological
disorders
Anaemias
oral mucosa exhibit pallor
decreased resistance to infection - glossitis, recurrent aphthae, candidal
infections, and angular stomatitis
glossitis, tongue is reddened, the papillae are atrophic (first sign of
folate or vitamin B-12 deficiency anaemia)
angular stomatitis caused by a candidal infection (iron deficiency
anaemia)
Langerhans histiocytosis (histiocytosis X)
abnormal histiocytic and eosinophilic proliferation - most common form is the
eosinophilic granuloma in young adults. may present as a localized
proliferation, or it may present with extensive systemic involvement.
Oral sy.:
a) ulcerations on the gingiva (destructive gingivitis), palate, and floor of
the mouth.
b) progressive alveolar bone loss with dental extrusion and
characteristic floating teeth
Topic 1C
Connective tissue
disorders
Sjögren syndrome
Def.: second most common autoimmune disease (90% are female; 3% of women
over 50 years) manifested by thick and mucinous, or absent secretes (saliva, tears)
-> sicca syndrome - keratoconjunctivitis sicca, xerostomia, etc.; lymphocytic
Oral sy.:
xerostomia (dry, red, and wrinkled mucosa)
tongue has a cobblestone like appearance (atrophy of the papillae),
difficulty in swallowing and eating, increased dental caries (sugar is not
washed away by saliva), predisposition to infection (common is candidiasis)
Kawasaki disease (mucocutaneous lymph node syndrome)
Def.: vasculitis in medium and large arteries with a corresponding cutaneous lymph
node syndrome; replaced rheumatic fever as the primary cause of childhood (< 5
years) heart disease
Symptoms: acute cervical adenopathy, oedema & erythema, desquamation of the
hands and feet, fever, polymorphous exanthema - rash; acute cervical adenopathy;
aneurysm and myocardial infarction, myocarditis
Oral sy.:
papillae swelling on the surface of the tongue (strawberry tongue)
intense erythema of the mucosal surfaces, labia are cracked, cherry red,
swollen, and hemorrhagic
Topic 1D
Pulmonary disorders
Wegener granulomatosis
Def.: necrotizing vasculitis of small-to-medium arteries and veins +
necrotizing granulomas of the upper and lower airways +/necrotizing glomerulonephritis. Oral and skin manifestations may
be correlated with disease progression, thereby serving a
prognostic purpose
Oral sy.: in 97% of patients
ulcerations on the buccal mucosa or palate
gingival hyperplasia - is a path gnomonic finding: swollen,
reddened, and granular appearance to the gingivae (termed
strawberry gums) start as bright red-to-purple friable diffuse
papules originate on the labial interdental papillae
tooth and alveolar bone loss are common
Topic 1D
Pulmonary disorders
Sarcoidosis
Def.: idiopathic systemic inflammatory disease involving nearly any organ system
(liver, heart, spleen, eyes, kidneys), pulmonary manifestations are the most
common, cutaneous (5-20% of patients). oral sy presents after systemic symptoms
Oral sy.: multiple painless ulcerations of the gingiva, buccal mucosa, labia, and
palate + salivary gland tumorlike swellings. Rarely, sarcoidosis involves the tongue swelling, enlargement, and ulcerations. Heerfordt syndrome - triade: parotid gland
swelling, xerostomia, uveitis, and facial nerve palsy.
Amyloidosis
Def.: deposition of proteins in body tissues leading to tissue damage. Amyloidosis is
classified as primary, stemming from multiple myeloma or an idiopathic disease, or
as secondary, stemming from a chronic or inflammatory disease process
Symptoms: affects the skin, heart, tongue, and GI tract, while the secondary form,
although more common, has no cutaneous manifestations.
Oral sy.: a) macroglossia (the most common; 20% of patients) with lateral ridging
due to teeth indentation; b) loss of taste, xerostomia may result from amyloid
deposition in the salivary glands Submandibular swelling occurs subsequent to
tongue enlargement and may lead to respiratory obstruction.
Topic 1E
AIDS and other
immunodeficiencies
Candidiasis
repeated oral candidiasis is the first sign in 90% of patients with HIV.
Most common is pseudomembranous type - white plaques on the soft and hard palates,
buccal mucosa (most commonly), and tongue that leave a reddened area when scraped.
Herpes simplex virus (HSV)
double-stranded DNA virus that has 2 serotypes: HSV-1 and HSV-2
Oral sy.: oro-labial vesicles (lips, tongue, gingiva, hard palate) that are rupturing, and
leaving a small, irregular, and painful crusted weeping ulceration or fissures on dorsal
part of tongue. May extend to esophagus. Stress, fever, and sunlight may precipitate
reactivation. Until disproved, all perineal and ulcerations should be considered HSV in
patients who are infected with HIV.
Epstein-Barr virus (EBV) - Hairy leukoplakia (HL)
adherent corrugated white plaques most commonly on the lateral portions of the tongue
(5% of patients)
Kaposi sarcoma (KS)
- the most common skin or oral malignancy (lymph node enlargement), in patients who
are HIV positive
Oral sy.: brown, bluish, purple, or red patches or papules on the hard palate, mucosa,
and gingiva that ulcerate, and bleed
Cytomegalovirus (CMV)
double-stranded DNA virus (60% of people being seropositive but asymptomatic)
symptomatic disease - organ or bone narrow transplantation or HIV infection : retinitis
(30% ; blindness). pneumonia (5%; lung failure)
Oral sy.: very rare – aphthous-like ulcerations on the lips, tongue, pharynx, or any
mucosal site
Candidiasis
Primary herpetic gingivostomatitis (HEV 1) affects mostly children or young adults.
Inside the oral cavity, herpes simplex
typically affects only keratinized
tissues, such as the gingiva or the hard
palate.
Intraoral herpes zoster closely
resembles recurrent human herpesvirus
1 (HHV-1) infection
Topic 1F
Cutaneous
manifestations
Psoriasis
Def.: chronic papulosquamous inflammatory condition of the skin affecting
2% of population (20-30y)
Oral sy.: oral psoriasis rarely manifests without cutaneous involvement:
manifest on the lips, tongue, palate, buccal mucosa, and gingiva. Psoriatic
tongue involvement appears indistinguishable from geographic tongue
Acanthosis nigricans
Def.: is a cutaneous disorder of hyperpigmentation and papillomatosis that
may precede or coincide with a variety of benign, familial, or malignant
disorders. Most cases of AN are rare benign congenital (AD) disorder.
Malignancy associated AN (MAN) presents commonly with
adenocarcinoma of the stomach.
Oral sy.: in 25-50% of MAN patients - cutaneous and oral papillomatosis,
gingival hyperplasia hypertrophy of the papillae along the dorsal surface
and lateral edge of the tongue.
Topic 1F
Endocrine diseases
Diabetes mellitus
may increase the prevalence, incidence, or severity of gingivitis
and periodontitis.
Oral sy.: the severity and prevalence of periodontitis are increased
in persons with diabetes and are worse in persons with poorly
controlled diabetes
Periodontitis may exacerbate diabetes by decreasing glycemic
control. This effect indicates a degree of synergism and a link
between the 2 diseases.
Addison disease
Oral sy.: black tinge of gingivae and teeth
Topic 2
ORAL MANIFESTATION OF
DRUGS
Oral manifestations
Finding
Drugs
Xerostomia
antidepressants and antipsychotics, antihypertensives,
antihistamines, anticholinergics, decongestants
Candidiasis
In correlation with dose and frequency of the steroids
Gingival
calcium channel blockers (nifedipine (38% of patients),
enlargement nimodipine, nitrendipine, oxidipine, verapamil), dihydropyridines
(hyperplasia) (bleomycin), cyclosporine ( up to 85% of patients), phenytoin (~
50% of patients), valproate (antiepileptic)
Swelling
penicillins, aspirin, ACE inhibitors
Ulceration
Antineoplastics (methotrexate, 5-fluorouracil, doxorubicin,
melphalan), barbiturates; phenazone derivatives; salicylates;
sulfonamides; tetracycline; direct contact with compounds
containing aspirin, hydrogen peroxide, or phenol
Candidiasis after prolonged
steroid therapy in reumatism
Minocycline - associated bluish
gray hue of the alveolar mucosa
pigmentation in a patient who had
used the drug for several months to
treat severe acne.
Gingival enlargement in a
man with a several-year
history of using calcium
channel blockers
Erythema multiforme: multiple
erosions on the lips and tongue.
Ulcers in buccal
mucosa due to
coxsackie virus infection
Oral manifestations
Finding
Drugs
Vesico ulcerative
mucositis
nonsteroidal anti-inflammatory drugs (indomethacin, gold
salts, naproxen), meprobamate, methyldopa,
phenylbutazone, propranolol, spironolactone, thiazides,
and tolbutamide
Pigmentation
amiodarone, antimalarials (chloroquine, hydrochloroquine,
hydroxychloroquine, quinacrine, quinidine), bisulfan,
clofazimine, cyclophosphamide, estrogen, ketoconazole,
minocycline, phenolphthalein, chlorpromazine
Pemphigoidlike
antibiotics (antimalarials, penicillins, sulfonamides),
barbiturates, and salicylates
Pemphiguslike
antirheumatics (penicillamine, ibuprofen, phenacetin),
cardiovascular drugs (furosemide, captopril, clonidine),
antibiotics (penicillins, sulfonamides), antimicrobials, thiolcontaining drugs, and sulfonamide derivatives
Topic 3
CONTACT WITH FOREIGN
MATERAILS
Contact Stomatitis
Def.: inflammatory reaction of the oral mucosa by contact with
irritants or allergens.
Pathophysiol.: oral mucosa is resistant to irritants and allergens
High vascularization that favors absorption and prevents
prolonged contact with allergens
Low density of Langerhans cells and T lymphocytes
Dilution of irritants and allergens by saliva that also
buffers alkaline compounds
Occurence: may occur at any age. Irritant reactions appear to be
more common than allergic reactions. Burning mouth syndrome
that almost exclusively affects women.
Contact Stomatitis - Causes
Ingredients of candies and chewing gums
cinnamon compounds, menthol, propolis (a strong sensitizer often used
in the oral cavity because of its antiseptic properties)
Local use of drugs
antibiotics, anesthetics, antiseptics, and steroids, desinfectives e.g.
chlorhexidine, quaternary ammonium compounds)
Rubber and latex
e.g. gloves, dams, orthodontic elastics, bite blocks
Foods (rarely)
Children with atopic dermatitis and a food allergy may develop lip
swelling and stomatitis after contact with fruits
Cosmetics
Ingredients (ricinoleic acid, colophony derivatives, sunscreens lipsticks,
lip balms)
Contact Stomatitis - Causes
Ingredients of dentifrices, mouthwashes, dental cleaners
Flavoring agents (e.g. cinnamon compounds, eugenol, menthol)
Ingredients of dental restorations
Amalgam fillings contain mercury compounds (45-60%) and often
gold, palladium, platinum. Metallic mercury - common sensitizer
Dental cement used for sealing pulp canals (eugenol, balsam of
Peru, colophony)
Acrylic fillings (polymerized acrylate is relatively free of allergens)
Ingredients of dental prosthesis
Metal prostheses - may release nickel (present in dental braces,
bridges, and crowns), especially poorly made/ corroded
Acrylate sensitization is a common occupational problem in
dentists and dental technicians.
Allergic contact reaction
due to nickel in a dental
brace.
Irritant contact stomatitis of
the tongue.
Leukoplakialike lesion in a
patient who is allergic to
mercury.
Contact urticaria of the lip
due to food allergy
Acute allergic stomatitis
involving the oral mucosa
and the lip due to
benzocaine.
Allergic contact stomatitis
on the gingiva in a patient
with a positive patch test
result to nickel, palladium,
and mercury.
Contact urticaria of the
tongue in a patient with
latex allergy.
Lichen planus–like lesion
adjacent to a dental
restoration.
Allergic contact dermatitis involving the
lips and the perioral area due to propolis
Manifestations of contact stomatitis
Erythema and swelling - may be localized or diffuse,
ingredients of mouthwashes and toothpastes, dental materials, and
chewing gum flavorings
Erosions/ulcerations - evolution of vesicles and blisters rarely seen in the
mouth. outlined, whitish, rough, macerated areas.
Ulcerations are usually covered by a yellow-white exudate and may
present with an erythematous halo.
Chemical burns are not frequent because the oral mucosa is resistant
to heat and acid or alkaline compounds.
Prolonged contact with aspirin or vitamin C tablets, or contact with
irritants used for dental care.
Allergic contact stomatitis from metal salts or acrylates rarely causes
mouth ulcerations.
Contact urticaria
Swelling of the lips, the tongue, the buccal mucosa, and the gingiva
develops suddenly with intense itching due to allergy to foods.
Severe cases may be associated with upper airway obstruction.
Chemical burns result in tissue
necrosis produced by a chemical agent
used by the practitioner or the patient
to relieve pain. The lesion takes the
aspect of a whitish plaque which can
be removed, leaving an erosive, painful
surface
The bitten mucosa - alteration of normal tissue
- whitish multiple erosions, abrasions and slight
sloughing of the most superficial layers of the
mucosa. It affects the buccal mucosa, lips and
tongue wherever they can be reached by the
patient´s bite.
Manifestations of contact stomatitis
Lichen planus–like lesions
May occur at the site of mucosal contact with amalgam
restorations - lesions are typically localized.
Sensitization to gold, palladium chloride, and copper sulfate
Leukoplakia-like lesions
Contact sensitization from nickel and other metals
commonly localized in the medial part of the cheek.
Burning mouth syndrome
Burning pain and dryness of mucosa improving during meals.
Although contact allergy (especially to mercury) has often been
implicated, the disorder most likely has a psychogenic basis.
Other Compliants
Paresthesia, numbness, bad taste, salivation, itching
White-colored findings
Lichen planus - chronic dermatosis which
may affect both skin and mucosa. Oral
intercrossing white lines that give the
appearance of a weave or net
(arboriform).In some patients the lesions
may disappear spontaneously
Leukoplakia - whitish lesion which does not
slough off when scraped, histologically
presents as a spot, keratosis of wartlike.
They are produced by continued chronic
irritation in people with some sort of
predisposition (smoking habits, the rough and
or sharp surfaces of teeth, and or broken or
ill-adapted partial and full dentures)
Topic 4
BACTERIAL MOUTH
INFECTIONS
Bacterial mouth infections
Oral cavity contains some of the most varied and vast flora in the
body which - adhere to the teeth, the gingival sulcus, the tongue,
and the buccal mucosa.
Number and proportion of flora changes with the age and systemic
changes (pregnancy, drug intake)
Alterations in the flow and composition of salivary fluid and in the
levels and activity of defense components (e.g., immunoglobulins,
cytokines) in the saliva.
Oral microbiota participate in various systemic diseases.
Foci of infection in the oral cavity arising from chronic periodontitis
(inflammation of the periodontal attachment of the teeth and the
alveolar bone) or chronic periapical abscesses (i.e., inflammation
and abscess of the tissue attached to the apex of the root).
Bacterial infections of the mouth.
A 72-year-old man with severe
periodontal disease
Bacterial infections caused severe alveolar
bone loss and periodontitis in X-ray scan
Odontogenic abscess
Inflammatory
swelling
Origin of
infection focus
Odontogenic abscess
Pathways of spreading
Periodontal disease
The relative risk of cardiovascular
disease is doubled in persons
with periodontal disease
Periodontal and cardiovascular
disease share many common risk
and socioeconomic factors,
particularly smoking, which is a
powerful risk factor for both
diseases.
The chronic inflammatory state
and microbial burden in persons
with periodontal disease may
predispose to cardiovascular
disease in ways proposed for
other infections, such as with
Chlamydia pneumoniae.
Bacterial endocarditis due to
oral foci of infection
Etiology: Streptococcus viridans; Staphylococci (> 80% of cases)
Dental manipulation 90% (brushing teeth, chewing gum, eating
-> transient bacteremia;
8-10% oral infections - Transient oral bacteremia after tooth
extractions lasting less than 15-30 minutes
Occurence:
In developed countries 1-5 cases per 100,000 population per
year; mortality rate up to 80%
Patients with congenital or acquired cardiovascular defects are
at risk for BE. Mortality rate of 10-80%.
Symptoms:
Septic emboli, congestive heart failure with infection-induced
valvular damage, splenomegaly, splenic abscesses.
Neurologic manifestations (delirium, headache, and meningeal
irritation) may be caused by mycotic aneurysms.
Cardiovascular diseases due to oral
foci of infection
Manifestations:
atherogenesis, thromboembolia
coronary heart disease
cardiomyopathy
Etiology:
Chronic periodontal infections Streptococcus sanguis oral Gpositive bacteria & G -negative
Porphyromonas gingivalis found
in dental plaque
Mechanisms:
bacterias enter the bloodstream,
invade and proliferate within
heart and coronary artery
endothelial cells (found in carotid
and coronary atheromas)
direct effect on atheroma
formation & induce platelet
aggregation, thrombus formation
Glomerulonephritis due to oral
foci of infections
Occurence:
Patients (2-12 years) with poor oral hygiene, twice as common
in males as in females
most common primary renal disease in developing countries
Etiology: Streptococcus mitis or Streptococcus mutans bacteremia
Pathology:
In the early phases - diffuse glomerular and endocapillary
proliferation + polymorphonuclear infiltration
In later phases - mesangial deposits
Manifestations:
acute nephritic syndrome - abrupt onset of gross haematuria
and proteinuria oliguria, oedema, hypertension (80% of cases )
10-21 days after the onset of bacteraemia.
Non-specific symptoms, such as malaise, weakness, and
nausea, are frequent. Dull lumbar pain is present in 5-10% of
patients
Topic 5
Deficiency or excess of vitamins
Deficiency or excess of minerals
Deficiency or excess of main
nutrients
Oral manifestation of
nutrient defects
Vitamin-related disorders
VITAMIN
DEFICIENCY OR EXCESS
Vitamin C
Deficiency: Scurvy - red swollen gingiva; gingival friability;
periodontal destruction; increased tooth mobility &
exfoliation; sore burning mouth; soft tissue ulceration;
increased risk of candidiasis; malformed teeth (inadequate
dentine).
Excess: return to normal levels of the vitamin cause deficiency
(rebound scurvy).
Vitamin D
Deficiency: Abnormal bone regeneration osteoporosis;
osteomalacia; incomplete mineralisation of teeth & alveolar
bone; rickets.
Excess: Pulp calcification; enamel hypoplasia.
Vitamin K
Deficiency: Increased risk of bleeding & candidiasis
Scurvy
Scurvy-red swollen
gingiva
Vitamin C deficiency
Vitamin B2,B3,B6 deficiency
Folic acid, B12 deficiency
Iron deficiency
periodontal destruction;
increased tooth mobility &
exfoliation; sore burning mouth;
soft tissue ulceration;
candidiasis; malformed teeth
(inadequate dentine).
Angular cheilosis
Vitamin-related disorders
Vitamin A
Deficiency: Inadequate cell differentiation-impaired healing &
tissue regeneration; desquamation of oral mucosa;
keratosis; increased risk of candidiasis; gingival hypertrophy
& inflammation; leukoplakia; decreased taste sensitivity;
xerostomia; disturbed or arrested enamel development;
irregular tubular dentine formation and increased caries risk.
Excess: Impairs cell differentiation & epithelialisation-impaired
healing (mimics deficiency).
Vitamin B2
(Riboflavin)
Deficiency: Angular cheilosis; atrophy of filliform papillae;
enlarged fungiform papillae; shiny red lips; magenta tongue;
sore tongue.
Vitamin B3
(Niacin)
Deficiency: Angular cheilosis; mucositis; stomatitis; oral pain;
ulceration; ulcerative gingivitis; denuded tongue; glossitis;
glossodynia; tip of tongue is red & swollen; dorsum is dry &
smooth.
Vitamin-related disorders
Folic acid
Deficiency: Angular cheilosis; mucositis; stomatitis; sore or
burning mouth; increased risk of candidiasis; inflamed
gingiva; glossitis oral pain; ulceration; ulcerative gingivitis;
denuded tongue; glossitis; glossodynia; tip or borders of
tongue red & swollen; slick bald pale; apthous ulcers.
Vitamin B6 Deficiency: Angular cheilosis; sore or burning mouth; glossitis;
(Pyridoxine)
glossodynia.
Deficiency: Angular cheilosis; mucositis; stomatitis; sore or
burning mouth; haemorrhage gingiva; halitosis; epithelial
dysplasia of oral mucosa; oral paresthesia; detachment of
Vitamin B12
periodontal fibres; loss or distortion of taste; glossitis oral
(Cyanocoba
pain; ulceration; ulcerative gingivitis; denuded tongue;
lamin)
glossitis; glossodynia; tongue is "beefy", red, smooth &
glossy; delayed wound healing; xerostomia; bone loss;
apthous ulcers.
Mineral disorders
MINERAL
DEFICIENCY OR EXCESS
Fluoride
Deficiency: Decreased resistance to caries.
Excess: Disturbed amelogenesis; mottled/stained enamel;
enamel hypoplasia (fluorosis)
Iron
Deficiency: Angular cheilosis; pallor of lips and oral
mucosa; sore, burning tongue; atrophy/denudation of
filliform papillae; increased risk of candidiasis; glossitis.
Calcium
Deficiency: Incomplete mineralisation of teeth; rickets;
osteomalacia; osteoporosis; excessive bone resorption &
bone fragility; increased tendency to haemorrhage;
increased tooth mobility & premature loss.
Copper
Deficiency: Decreased trabeculae of alveolar bone;
decreased tissue vascularity; increased tissue fragility.
Mineral disorders
Zinc
Deficiency: Loss or distortion of taste & smell acuity; loss of
tongue sensation; delayed wound healing; impaired
keratinisation of epithelial cells; epithelial thickening;
atrophic oral mucosa, increased susceptibility to
periodontal disease, candidiasis, xerostomia & caries if
deficient during tooth formation.
Magnesium
Deficiency: Alveolar bone fragility; gingival hypertrophy
Phosphorus
Deficiency: Incomplete mineralisation of teeth; increased
susceptibility to caries if deficient during tooth
formation; increased susceptibility to periodontal
disease due to effects on alveolar bone
Main nutrients
NUTRIENT
DEFICIENCY OR EXCESS
Carbohydrate Deficiency: Caries rate generally decreases when
carbohydrate intakes decreases.
Excess: Increased frequency of intake of all carbohydrates
(except fibre) is a causative risk factor for caries
Fats
Protein
Water
Deficiency: Angular cheilosis; pallor of lips and oral mucosa;
sore, burning tongue; atrophy/denudation of filliform
papillae; increased risk of candidiasis; glossitis
Excess: No direct effect but fats may coat teeth and protect
them againts cariogenic challange.
Deficiency: Defects in tooth composition, eruption pattern &
resistance to decay; increased susceptibitlity to soft tissue
infrection poor healing/tissue regeneration.
Deficiency: Dehydration and fragility of of epithelial tissue;
decreased muscle strength for chewing; xerostomia;
burning tongue.
Changes in the tongue
Thrombocytopenic Purpura
Definition Thrombocytopenic purpura is a hematological disorder
characterized by a decrease in platelets in the peripheral blood.
Etiology nonspecific viral infection, myelotoxic agents.
Clinical features red lesions in the form of petechiae, ecchymoses,
hematomas, usually located on the palate and buccal mucosa
(Spontaneous gingival bleeding is a constant early finding.
Purpuric skin rash, epistaxis, and bleeding from the gastrointestinal and
urinary tract
Laboratory tests Peripheral platelet count, bone-marrow aspiration,
bleeding and clotting times.
Differential diagnosis Aplastic anemia, leukemias, polycythemia vera,
agranulocytosis, macroglobulinemia, drug reactions.
Infectious Mononucleosis
Definition Infectious mononucleosis is an acute, self-limited infectious
disease that primarily affects children.
Etiology Epstein–Barr virus transmitted through saliva transfer.
Clinical features The oral manifestations are early and common - palatal
petechiae, uvular edema, tonsillar exudate, gingivitis,rarely ulcers
Generalized lymphadenopathy, hepatosplenomegaly, maculopapular skin
rash, and sore throat are common.
Prodromal symptoms such as anorexia, malaise, headache, fatigue, and
later fever occur before the clinical manifestations.
Laboratory tests Heterophile antibody tests, and other specific antibody
tests (Paul–Bunnell test, monospot test).
Idiopathic thrombocytopenic purpura:
Infectious mononucleosis:
petechiae on the palate.