Oral manifestations of systemic disease

Oral Findings in Hemodialyzed Patients Diagnosed with Diabetes Mellitus and/or Hypertension-A Systematic Review

Chronic kidney disease is classified as a civilization disease and is being diagnosed in an increasing number of patients. Hypertension and diabetes mellitus often coexist in hemodialyzed patients. The aim of the present study was to identify publications on the oral cavity status of multimorbid hemodialyzed adult patients additionally diagnosed with hypertension and/or diabetes mellitus, published between 2012 and 2022 to establish evidence of the impact of hypertension and diabetes mellitus on the oral status of hemodialyzed patients. Scopus and Web of Science databases were searched. Eight articles were included in the review. In total, 3 articles discussed oral hygiene in hemodialyzed patients, 4 discussed periodontal status, 3 discussed mucosa condition and saliva parameters, and 3 discussed the problem of Candidiasis infections. The conclusions were as follows: there is still a limited number of publications discussing the oral status of hemodialyzed patients diagnosed with hypertension; involved articles have proven that coexisting diseases can influence the oral cavity status of hemodialyzed patients and cause periodontal disorders, lower hygiene status, saliva parameters and make the risk of Candida infections higher.

Systemic Diseases with Oral Manifestations and Their Impact on Health-Related Quality of Life

Health-related quality of life is a multidimensional concept established to evaluate the physical, psychological, and social impacts of health conditions on individuals’ well-being. Various tools for measuring health-related quality of life can be categorized into two subsets: generic and disease–specific instruments. The oral cavity can be stricken by a broad range of local and systemic diseases and their systemic treatment modalities. The most common systemic illnesses associated with oral lesions are hematologic disorders, endocrinopathies, neurological disorders, gastrointestinal conditions, mucocutaneous and rheumatic diseases, and neoplastic processes. Their manifestations in the oral cavity are, in most cases, rather nonspecific but should not be overlooked. Oral health is one of the most important parts of overall health, thus it has been proposed that poor oral health may affect health–related quality of life. The presence of oral manifestations of systemic diseases has a negative impact on the daily functioning of patients, decreasing their overall well-being. This article will review the most common systemic diseases with oral manifestations and their impact on the health–related quality of life. Oral health researchers should put a stronger emphasis on the patient-reported quality of life as a primary outcome in future clinical trials. The significance of this area has still not been widely understood in the current dental literature even though it could help improve patients’ health-related quality of life.

Prevalence of oral mucosal lesions, dental caries, and periodontal disease among patients with systemic lupus erythematosus in a teaching hospital in Chennai, Tamil Nadu

Background

The presence of oral symptoms and signs in many systemic diseases is not uncommon knowledge. Investigations that explore the relationship between systemic diseases and their oral manifestations are of particular interest to dentists, as this enables them to be better clinicians with an acumen to recognize, treat, or refer patients with the systemic disease to general physicians. This study was undertaken to understand the oral manifestations of systemic lupus erythematosus (SLE) with an emphasis on oral mucosal lesions, dental caries, and periodontitis.

Methods

A single institutional cross-sectional survey was conducted from September 2017 to July 2018 on a sample of 500 SLE patients attending the Institute of Rheumatology, Rajiv Gandhi Government General Hospital, Chennai. The dentition status, periodontal status, and oral mucosal lesions were assessed by a single trained and calibrated examiner using the World Health Organization (WHO) proforma, 2013. Besides, disease activity in SLE patients was assessed by rheumatologists using the SLEDAI index with a cutoff score of more than 4 indicating the presence of active disease. Demographic characteristics including age, gender, occupation, monthly income, and education status were assessed using a questionnaire. Data were entered into an Excel Sheet and all statistical analyses were performed using SPSS for Windows version 20.0 (SPSS Inc., Chicago, IL, USA).

Results

In the present study, the prevalence of dental caries was found to be 87.6% in patients with SLE. The prevalence of severe periodontitis defined as the presence of at least one tooth with a 6 mm or deeper pocket was found to be 85% and the prevalence of oral mucosal lesions was found to be 86%. The prevalence percentage for dental caries, periodontal disease, and oral mucosal lesions were found to be higher than the rates reported for the general population in India. Patients with active SLE had a higher prevalence of dental caries, periodontitis, and oral mucosal lesions than patients with inactive SLE.

Conclusion

It can be concluded from the present study that SLE patients are more vulnerable to oral diseases than the general population. Furthermore, disease activity in SLE patients has a strong positive correlation with oral health status in SLE patients.

Oral pathology in inflammatory bowel disease

The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.

Integrated case scripts to enhance diagnostic competency

Background

The overwhelmingly high burden of disease and disorder especially in developing countries requires oral physicians to provide optimal dental treatment without complicating individuals’ general health. The opportunity for learners to extract the multiple aspects of a systemic condition and to relate them with the presenting complaint in order to devise an appropriate dental treatment plan is limited by time in chair- side teaching. To overcome the necessity of exposing students to real patients with varying degrees of underlying disease, those in medical and nursing education unanimously employ imaginary scenarios similar to real cases. However, such clinical scripts are seldom practiced in dental education, and the prospect of structured integration is almost never addressed.

Objectives

To evaluate the effectiveness of applying systematic and integrated case-based discussion in dental education in terms of enhancing five essential skills to novice Indian dental students.

Methods

A mixed- methods study was carried out with thirty graduating third-year students in 5 focus groups. The integrated case-based focused group training occurred in 6 weeks and lasted approximately 90 minutes per discussion. Ten case scripts of hypothetical situations were discussed and five integrated modules were organized as a part of this program. Revised Bloom’s taxonomy was adopted to achieve the expected level of competency.

Results

Students performance following integrated case-based discussions was improved and their acceptance to this practice is positive.

Conclusions

The present study supports the need for course specific, basic science integrated seminars with concurrent case scripts discussion to enhance students’ competencies.

Key words:Case scripts, Revised Bloom’s taxonomy, chair-side teaching, integrated teaching.

Prevalence of oral lesions in hospitalized patients with infectious diseases in northern Brazil

The aim of this study was to assess the prevalence of oral lesions in infectious-contagious diseases patients being treated in the University Hospital of the Federal University of Pará, northern Brazil. One hundred seven patients with infectious diseases were clinically investigated for oral lesions at the University Hospital of Pará, northern Brazil. From total sample, most patients were men (65.7%) with a mean age of 45.4 years. About prevalence of systemic diseases, tuberculosis was the most frequent illness, followed by AIDS, hepatitis types B and C, leishmaniasis, and meningitis. Analyzing oral manifestations, periodontal diseases and candidiasis were the most prevalent diseases in both genders, followed by recurrent aphthous ulcers, saburral tongue, simplex herpes, and squamous cell carcinoma. Of all 107 patients, only 10 males and 6 females did not present any oral manifestation. There was no statistical difference between genders with any systemic condition (P>0.05). The great prevalence of oral manifestations in hospitalized patients with systemic disorder emphasizes the need of integral dental care in this context, aiming at a multidisciplinary approach of patients. Therefore, presence of some oral conditions, such as candidiasis, should be an alert to different systemic conditions, once in assistance with physicians; dentists can influence the early diagnosis and treatment.

Scurvy in a 10-month-old boy

We report a 10-month-old boy with inflammatory and necrotic gingival lesions, fever, irritability, and pseudoparalysis of the legs. Laboratory examinations revealed moderate anemia and skeletal X-rays showed osteopenia, scorbutic rosary at the costochondral junctions, and "corner sign" on the proximal metaphyses of the femora. The boy had been fed only with diluted cow's milk. He had never taken solid food, vitamin C, or iron complement. Seventy-two hours after starting oral vitamin C supplementation, there was significant improvement in the patient's gingival lesions and general health. The clinical presentation and laboratory and imaging findings, together with the dramatic response to ascorbic acid intake, allowed us to confirm the diagnosis of infantile scurvy. Scurvy, a dietary disease due to the deficient intake of vitamin C, is uncommon in the pediatric population. In an infant who has never received vitamin C, the combination of gingival lesions, pseudoparalysis, and irritability strongly suggests a diagnosis of scurvy. The clinical picture, together with the laboratory data, radiological studies, and therapeutic response to vitamin C administration, confirmed the diagnosis.