Oral manifestations of disease

Blue Lesions Lesions that are blue in color are the result of either vascular ectasias and tumors or melanin pigment in the dermis. Venous lakes (ectasias) are compressible dark-blue lesions that are found commonly in the head and neck region. Venous malformations are also compressible blue papulonodules and plaques that can occur anywhere on the body, including the oral mucosa. When there are multiple rather than single congenital lesions, the patient may have the blue rubber bleb syndrome or Mafucci's syndrome.

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In the diffuse forms of hyperpigmentation, the darkening of the skin may be of equal intensity over the entire body or may be accentuated in sun-exposed areas. The causes of diffuse hyperpigmentation can be divided into four major groups—endocrine, metabolic, autoimmune, and drugs. The endocrinopathies that frequently have associated hyperpigmentation include Addison's disease, Nelson syndrome, and ectopic ACTH syndrome. In these diseases, the increased pigmentation is diffuse but is accentuated in the palmar creases, sites of friction, scars, and the oral mucosa.

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Aging and Oral Health While tooth loss and dental disease are not normal consequences of aging, a complex array of structural and functional changes occurs with age that can affect oral health. Subtle changes in tooth structure (e.g., diminished pulp space and volume, sclerosis of dentinal tubules, altered proportions of nerve and vascular pulp content) result in diminished or altered pain sensitivity, reduced reparative capacity, and increased tooth brittleness.

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Dental Care of Medically Complex Patients Routine dental care (e.g., extraction, scaling and cleaning, tooth restoration, and root canal) is remarkably safe. The most common concerns regarding care of dental patients with medical disease are fear of excessive bleeding for patients on anticoagulants, infection of the heart valves and prosthetic devices from hematogenous seeding of oral flora, and cardiovascular complications resulting from vasopressors used with local anesthetics during dental treatment. Experience confirms that the risks of any of these complications are very low.

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Migrainous neuralgia may be localized to the mouth. Episodes of pain and remission without identifiable cause and absence of relief with local anesthesia are important clues. Trigeminal neuralgia (tic douloureaux) may involve the entire branch or part of the mandibular or maxillary branches of the fifth cranial nerve and produce pain in one or a few teeth. Pain may occur spontaneously or may be triggered by touching the lip or gingiva, brushing the teeth, or chewing. Glossopharyngeal neuralgia produces similar acute neuropathic symptoms in the distribution of the ninth cranial nerve.

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Dermatologic Diseases See Tables 32-1, 32-2, and 32-3 and Chaps. 52, 53, 54, 55, and 56.

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Diseases of the Tongue See Table 32-4.

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Ulcers Ulceration is the most common oral mucosal lesion. Although there are many causes, the host and pattern of lesions, including the presence of systemic features, narrow the differential diagnosis (Table 32-1). Most acute ulcers are painful and self-limited. Recurrent aphthous ulcers and herpes simplex infection constitute the majority. Persistent and deep aphthous ulcers can be idiopathic or seen with HIV/AIDS. Aphthous lesions are often the presenting symptom in Behçet's syndrome (Chap. 320).

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Diseases of the Oral Mucosa Infection Most oral mucosal diseases involve microorganisms (Table 32-1). Table 32-1 Vesicular, Bullous, or Ulcerative Lesions of the Oral Mucosa Condition Usual Location Clinical Features Course Viral Diseases Primary acute Lip and oral Labial Heals that spontaneously in 10– days.

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Pigmented Lesions See Table 32-2.

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Periodontal Disease Periodontal disease accounts for more tooth loss than caries, particularly in the elderly. Like dental caries, chronic infection of the gingiva and anchoring structures of the tooth begins with formation of bacterial plaque. The process begins invisibly above the gum line and in the gingival sulcus. Plaque, including mineralized plaque (calculus), is preventable by appropriate dental hygiene, including periodic professional cleaning.

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Harrison's Internal Medicine Chapter 32. Oral Manifestations of Disease Oral Manifestations of Disease: Introduction As primary care physicians and consultants, internists are often asked to evaluate patients with disease of the oral soft tissues, teeth, and pharynx. Knowledge of the oral milieu and its unique structures is necessary to guide preventive services and recognize oral manifestations of local or systemic disease (Chap. e7).

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