Oral Manifestation of Systemic Diseases.pptx

Manifestasi Oral Penyakit Sistemik

Blok Penyakit SitemikDrg. Erna Sulistyani, M Kes

23/02/20151Oral Manifestation of Systemic Diseases

Oral Manifestation of Inflammatory Bowel Disease 23/02/20152Crohn diseaseCrohn disease is characterized on pathology by non-caseating granulomaOral manifestation : 4 categories Specific: occur only in association with the bowel disease and/or show characteristic histology of that condition. In children with Crohn disease, orofacial Crohn disease can be an important presentation preceding the bowel diagnosisNon-specific : occur more commonly in patient with the bowel disease than in the general population, but the pathology is not diagnostic for the bowel disease.

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23/02/20153Complications of malabsorption caused by the bowel inflammation resulting in deficiencies in vitamins and minerals. Side effects or complications of medications prescribed to treat the bowel disease.

The first three of these categories may be useful in directing the doctor to the bowel problem and making the specific diagnosis. The oral changes preceded the diagnosis of Crohn disease in 60%. There may be a male predominance.

23/02/201541. Orofacial Chrons disease ( spesific)A cobblestone appearance of the oral cheek mucosaLabial and buccal gum swellings with mucosal tagFissuring of the midline of the lipAphthous-like ulceration and angular cheilitisEnlargement of the attached gums which are diffuse, red and granularSevere periodontitis is seen in these individuals but there is usually a good response to normal periodontal therapy

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Orofacial Chrons disease

23/02/201562. Nonspecific changes in the mouth and surrounding facial skin associated with Crohn disease: Angular CheilitisAphthous Stomatitis has been reported to affect up to 20-30% of patients with Crohn diseaseRecurrent abscesses Redness and scaling around the lips Pyostomatitis Vegetans very rare in Crohn disease Dry mouthBad breath (halitosis) Recurrent vomiting and regurgitation can cause oral pain and the acid result in dental decay.

23/02/20157Ulcerative Colitis Mucosal changes have been reported in some patients with ulcerative colitis. Specific orofacial changes of ulcerative colitis: Pyostomatitis vegetans Nonspecific changes of the mouth and surrounding skin associated with ulcerative colitis: Minor and major aphthous stoamtitis reported in at least 10%, usually worse with flares of the bowel disease and improving with treatment of the bowel inflammation. However this is probably no more common than the general population. Glossitis (inflamed tongue) Cheilitis (inflamed lips) Bad breath (halitosis) In children with ulcerative colitis, only nonspecific changes were seen in one large study.

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b. pyostomatitis vegetans redness with multiple yellow or white pustules. The pustules (microabscesses) easily rupture, to form superficial ulcers (erosions) which have been likened to snail trails.

23/02/20159Orofacial signs of malabsorption caused by inflamatory bowel disease (Chron Disease and Ulcerative Colitis)Malabsorption may be due to the chronic diarrhoea, reduced food intake, overgrowth of bacteria in the bowel, bowel surgery, the disease itself, or the drugs used to treat the bowel disease. Folic acid deficiency red painful tongue (acute), becomes shiny and smooth (chronic) (glossitis), and cheilitis Iron deficiency atropic glositis, angular cheilitisZinc deficiency acrodermatitis redness, scally skin, oral candidosis, glossitis

23/02/201510Vitamin A deficiency white patches on oral mucosa due to keratinization of mucous membranes Vitamin B complex deficiency stomatitis-glossitis-angular cheilitis Riboflavin (vitamin B2, Crohn disease as absorbed from small bowel) cheilosis, angular cheilitis, glossitis Niacin (vitamin B3) deficiency

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Acrodermatitis enteropathica

23/02/201512Vitamin B12 deficiency : glossitis (beefy red tongue with flat red patches mainly on the sides and top of the tongue), angular cheilitis, mouth ulcers, oral candidiasis, diffuse erythematous mucositis, pale oral mucosa, soreness of the tongue or mouth, burning mouth, reduced taste sensitivity Vitamin C deficiency scurvy Vitamin K deficiency gum bleeding Orofacial changes due to medications used to treat inflammatory bowel disease Many different medications may be used to treat various aspects of inflammatory bowel diseases including antibiotics, biologic agents, immunosuppressants, anti-diarrhoeal agents and for pain.

Oral Manifestation of Liver Disease23/02/201513

Dental Management Of Liver disease23/02/201514

VASCULAR AND HEART DISEASE23/02/201515Manifestasi oral spesifik tidak ada. Kebanyakan oleh karena pengobatan ;Hipertensi :Manifestasi oral karena obat anti hipertensi meliputi : xerostomia, lichenoid reactions, burning mouth sensation, loss of taste sensation or gingival hyperplasia, sialadenosis.Dental management:selalu cek tekanan darah tiap kunjungan.Perawatan pada pagi hari dan singkatPertimbangan pemberian sedative spt diazepam malam harisebelumnya dan 1 sd 2 jam sebelum perawatan gigi

23/02/201516Anastesi: hati2 jgn smp masuk pembuluh darah, max 2 ampul selebihnya hy boleh anastesi tanpa vasoconstrictor.Hati-hati adanya orthostatic hipotensi krn obat. Ischemic Heart DiseaseOral manifestations : anticoagulant or antiplatelet treatment, bleeding may occur, manifesting as hematomas, petechiae or gingival bleeding.In dental practice a minimum safety period of 6 months after acute infark myocard has been established before any oral surgical procedure can be carried out.

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INR :international normalized ratio(INR)Vc : vasoconstrictor

23/02/201518ARRHYTHMIASOral manifestationsMany antiarrhythmic drugs have side effects such as gingival hyperplasia or xerostomia. Dental managementEvaluate the current condition of the patient and the type of arrhythmia involved, as well as the medication prescribed.If important arrhythmia develops during dental treatment,the procedure should be suspended, oxygen is to be provided,and the patient vital signs are to be assessed: body temperature (normal values: 35.5-37C), pulse (normal values: 60-100 bpm), respiratory frequency (normal values in adults: 14-20 cycles or respirations per minute), blood pressure (normal values: systolic blood pressure under 140 mmHg and diastolic blood pressure under 90 mmHg

23/02/201519Sublingual nitrites are to be administered in the event of chest pain. The patient should be placed in the Trendelenburg position, The dental team should be prepared for basic cardiopulmonary resuscitation and initiation of the emergency procedure for evacuation to a hospital center, if necessary.

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23/02/201521HEART FAILUREOral manifestationsDue to the drug treatmentsACEIs (captopril, enalapril) can produce lichenoid reactions, burning mouth sensation and a loss of taste sensation,Diuretics (furosemide) can produce xerostomia.Dental Consideration Consultation with the supervising physician is advised in order to know the current condition of the patient and the medication prescribed. Dental treatment is to be limited to patients who are in stable condition, since these individuals are at an important risk of developing serious arrhythmias and even sudden death secondary to cardiopulmonary arrest

23/02/201522PREVENTION OF ENDOCARDITISThe most widely accepted endocarditis prevention protocols are those of the American Heart Association (AHA) and the British Society of Antimicrobial Chemotherapy (BSAC).Antibiotic prophylaxis for dental procedures is only indicated in patients with heart disorders related to a very high risk of developing endocarditis :Prosthetic heart valves.Previous infectious endocarditis.

23/02/201523 Congenital heart disease, only in the following situations:Untreated cyanotic congenital heart disease, including shunts and ducts.Congenital heart defects fully repaired with material or prostheses placed through surgery or with catheters, during the first 6 months after the operation. Repaired congenital heart disease, though with residual defects associated to prosthetic materials Heart transplant patients who develop cardiacvalve disease.

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Oral Manifestation ofRespiratory disease23/02/201525TuberculosisOral lesions are seen in 0.05 to 5% of the patients with TB Primary forms generally are uncommon and occur in younger patients with frequently associated caseation of the draining lymph nodes. usually affects the gingiva and mucobuccal foldsSecondary lesions are more common and are seen mostly in older persons.morecommon reflecting oral inoculation with infected sputum or as a result of hematogenous spread and involves mainly the tongue and hard palate. [6]Clinical picture is variable, the typical lesion is an irregular, superficial, or deep, which tends to increase slowly in size.Lesion rarely found on the floor of the mouth, gingiva, palate, and lips.

23/02/201526Oral lesions typically consist of a stellate ulcer with undermined edges with minimal induration and a granulating floor. Nodules, fissures, tuberculomas, or granulomas can be found.. Skin, cervical lymph nodes, and salivary glands are also frequently involved.Lesions may be single or multiple, painful or painless. Clinical diagnosis can be difficult because TB can mimic a variety of other conditions, including malignancy, HIV, Cicatricial pemphigoid, syphilis, and deep mycotic infection such as histoplasmosis, Wegener granulomatosis, and sarcoidosis,

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Primary Oral Manifetation of TB Patient (female, smoker)Secondary TB Oral Ulcer in patient with TB and HIV (+)

23/02/201528Differential diagnosis :periodontal abscess, syphilitic ulcer, mycotic ulcer.Laboratory test : tuberculin skin test ( positive indicates previous exposure to the M. Tuberculosis) Mantoux reaction was scored as positive if the induration was 10 mm in diameter or 5 mm in BCG-vaccinated subjects, in patients who had contact with someone with infectious TB and in those who have a chest X ray with fibrotic changes consistent with pulmonary TB. Biopsy for histologic examination, Ziehl-Neelsen staining with demonstration of acid and alcohol fast bacilli, and culture should be obtained.

Dental considerations for the patient with renal disease23/02/201529Chronic renal disease (CRD)as a progressive and irreversible decline in renal function associated with a reduced glomerular filtration rate (GFR). The most frequent causes of CRD are diabetes mellitus, arterial hypertension and glomerulonephritis.The diminished function of the kidneys results in an increase in the levels of urea in the blood and also in the saliva, where it will turn into ammoniaManifestation: 90 % patient have oral manifestationUrea in saliva :Halitosis , uremic stomatitis (red mucosa or ulcer covered by thick exudate or pseudomembrane)Children low caries activityTaste disorder, metalic tasteSalivary gland enlarge, hiposalivation,

23/02/201530Neuropathy :Burning and tendernessDecrease Imunne system : Candidal infection, gingival inflamationHemostasis disturbances :Prolonged bleeding, gingival bleesing, petechie, echymosisAnemia : Pale mucosaUrea in saliva : Tooth erosionVit D deficiency compensatory with Hiperparatiroid hormon: enamel hypoplasia, demineralization of bone, loss of bony trabeculae, loss of lamina dura, abnormal bone repair after extraction.

23/02/201531Dental management :Dental treatment perform within 24 hours of dyalisis but consider the presense of heparin(half life 4-6 hr)Be ware of shunt :avoid the arm with shunt form blood pressure readingProtection from HIV /hepatitis because od dyalisis.Monitor blood pressure before at and after dental treatmentAnemia and hemorahgiaOsteodystrophy : pathologic or iatrogenic fracture during dental treatmentMedication : consult with Physician. Be aware of adverse or synergistic effects.

23/02/201532Infection : no establish guideline Nystatin mouth wash 500.0000 units/ml 4 times a day Culture for antibioyic sensitivityAntibiotic prophylaxisTransplant patient : immunosupressive drug : increase risk of infectionSteroid Therapy : anticipate hypoadrenal crisis

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