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15th July 2023
Secondary Oral Disease
Oral manifestations secondary to systemic diseases are often tested in the MRCP examinations. Some of the more common oral manifestations that are tested are summarised below (table 1).
| Speciality | Condition | Oral manifestations |
|---|---|---|
| Dermatology | Stevens-Johnson syndrome | Painful haemorrhagic erosions with a grey membrane |
| Autoimmune bullous disorders | Pemphigus vulgaris – oral mucosal ulceration is common | |
| Lichen planus | Wickham striae – fine white lines in the oral mucosa | |
| Angioedema | Hereditary angioedema caused by C1 esterase inhibitor deficiency. ACE inhibitors are a common trigger | |
| Haematology | Amyloidosis | Infiltration in the mouth – most commonly resulting in macroglossia |
| Leukaemia | Gingival hypertrophy (particularly in AML and APML) | |
| Endocrine | Addison’s disease | Hyperpigmentation – buccal mucosa, vermillion border, gums |
| Diabetes Mellitus | Gingivitis, periodontal disease | |
| Gastroenterology | Inflammatory Bowel Disease | Aphthous ulcers
Pyoderma vegetans – rare, pustules on the oral mucosa (more commonly seen in UC) |
| Coeliac disease | Enamel defects, mouth ulcers, atrophic glossitis | |
| Peutz-Jeghers syndrome | Hyperpigmented macules on the oral mucosa and lips | |
| Osler-Weber-Rendu syndrome (Hereditary Haemorrhagic Telangiectasia) | Telangiectasia can be seen around the mouth and face | |
| GORD | Acid erosion of the teeth | |
| Nutritional deficiencies | Angular cheilitis can be seen with iron/B12 deficiency | |
| Infectious Diseases | Oral candidiasis | White patches on the oral mucosa which can be scraped off leaving a raw area underneath. Caused by candida species |
| Oral hairy leukoplakia | Painless white plaques (typically on the lateral aspects of the tongue) which cannot be scraped off. Caused by EBV. | |
| Herpes Simplex Virus (HSV) | Cold sores
Herpetic gingivostomatitis can be seen in children who have not been exposed to HSV/immunosuppressed adults |
|
| Measles | Koplik’s spots are pathognomonic of measles infection (may precede rash) | |
| HIV seroconversion | Aphthous ulcers | |
| Kaposi’s sarcoma (KS) | Oral KS can be seen in patients with advanced HIV. It is associated with Human Herpesvirus-8 (HHV-8) | |
| Rheumatology | Behçet’s disease | Aphthous ulcers (genital ulcers also seen) |
| Systemic Lupus Erythematosus (SLE) | Aphthous ulcers, honeycomb plaques, non-specific erythema | |
| Genetic | Marfan’s syndrome | High-arched palate
Autosomal dominant mutation of FBN1 gene coding for fibrillin |
| Neurofibromatosis type 1 | Oral neurofibromas
Autosomal dominant mutation of NF-1 gene |
|
| Down’s syndrome | Macroglossia, crowded teeth
Trisomy 21 |
|
| Other | Radiotherapy | Oral mucositis |
Table 1: Secondary oral manifestations of systemic conditions
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