Oral symptoms of systemic diseases - what to suspect?

Examination of the oral cavity (mouth) may reveal findings pointing to an underlying systemic condition, and allow for early diagnosis and treatment.

Oral examination should include evaluation for:

- mucosal changes
- periodontal inflammation and bleeding
- condition of the teeth

Examples of lesions:

- Oral findings of anemia may include mucosal pallor, atrophic glossitis, and candidiasis.

- Oral ulceration may be found in patients with lupus erythematosus (SLE), pemphigus vulgaris, or Crohn disease. Oral manifestations of lupus erythematosus may include honeycomb plaques (silvery white, scarred plaques); raised keratotic plaques (verrucous lupus erythematosus); erythema, purpura, petechiae, and cheilitis.

Oral findings in patients with Crohn disease may include diffuse mucosal swelling, cobblestone mucosa, and localized mucogingivitis.

- Diffuse melanin pigmentation may be an early manifestation of Addison disease.

- Periodontal inflammation or bleeding should prompt investigation of conditions such as diabetes mellitus, human immunodeficiency virus (HIV) infection, thrombocytopenia, and leukemia.

- In patients with gastroesophageal reflux disease (GERD), bulimia, or anorexia, exposure of tooth enamel to acidic gastric contents may cause irreversible dental erosion. Severe erosion may require dental restoration. 

- In patients with pemphigus vulgaris, thrombocytopenia, or Crohn disease, oral changes may be the first sign of disease.

Oral manifestations of systemic disease. Chi AC, Neville BW, Krayer JW, Gonsalves WC. Am Fam Physician. 2010 Dec 1;82(11):1381-8.
Image source: Head and neck. Wikipedia, public domain.

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