Manifestation of Systemic Diseases in Oral Cavity revised.pptx

Systemic disease in oral cavity

1. MANIFESTATION OF SYSTEMIC DISEASES IN ORAL CAVITY OF CHILDREN (PART 1) ASIYA SIYAD, AARCHA BIJU, SHANID MOHAMMED

2. CONTENT Endocrine diseases - Thyroid gland - Diabetes Mellitus Rickets Digestive System diseases - Peptic ulcer & GERD - Crohn’s disease

3. Endocrine diseases-thyroid gland HYPOTHYROIDISM What is hypothyroidism? Hypothyroidism is a common endocrine disorder in which your child’s thyroid gland does not produce enough thyroid hormone.  Hypothyroidism may be either a congenital (cretinism) or an acquired disorder (juvenile myxoedema or Hashimoto’s thyroiditis)

4. CRETINISM MYXOEDEMA

5. Prevalence In India compared with coastal cities such as Mumbai, Goa, Chennai(9.5%), cities locates in land have a higher prevalence(11.7%). A larger proportion of females than males (66.4% vs. 33.6 %) were found to be affected by hypothyroidism.

6. Oral Manifestations Decreased vertical facial growth. L arge protruding tongue (macroglossia), Dysgeusia( taste disorder) Decreased cranial base length and flexure, maxillary protrusion, and open bite with typical immature facial patterns. Delayed eruption of teeth and increased spacing between both primary and permanent teeth. Developmental anomalies such as enamel hypoplasia have been reported. Dry mouth/Xerostomia seen in Hashimoto’s Thyroiditis.

7. Oral Manifestations

8. ENAMEL HYPOPLASIA WITH SPACING MACROGLOSSIA

9. HYPERTHYROIDISM What is hyperthyroidism? Hyperthyroidism happens when the thyroid gland makes too much thyroid hormone. The most common associations are Graves’ disease, toxic multinodular goitre , toxic adenoma and subacute thyroiditis.

10. GRAVE’S DISEASE TOXIC MULTINODULAR GOITRE SUBACUTE THYROIDITIS

11. Prevalence In an epidemiological study from Cochin, subclinical and overt hyperthyroidism were present in  1.6% and 1.3%  of subjects participating in a community survey. Thyrotoxicosis is more common in females and is most likely to appear between 12 and 14 years of age .

12. Oral Manifestations Increased susceptibility to caries Periodontal diseases Loss of taste Mandibular and maxillary osteoporosis Accelerated tooth eruption Early primary tooth exfoliation Increased vertical facial growth with anterior open bite and mild mandibular prognathism

13. DENTAL CARIES PERIODONTAL DISEASE

14. Management and Prevention Dental professionals are often the first to suspect a thyroid disorder and aid in early diagnosis. Some patients are recommended to use certain toothpaste and mouth rinse formulated for xerostomia. Xylitol products are also great for patients who have oral manifestations of thyroid diseases. The principal concern in children with thyroid disorders is the increased risks associated with general anesthesia. Oral infections should be treated aggressively in conjunction with the help of the child’s endocrinologist. Preventive treatment is preferable to operative procedures, where possible.

15. DIABETES MELLITUS What is DM? Diabetes mellitus is  a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high . Type 1 or insulin-dependent diabetes mellitus is the most common form of diabetes in children.

16. Prevalence In india there are estimated 77 million people above the age of 18 year are suffering from diabetes and nearly 25 million are prediabetics. Approximately 2 in 1000 children between the ages of 5 and 18 years have the disease

17. oral manifestations Periodontitis Gingivitis Dental caries Tooth loss Oral candidiasis Ulcers and irritation fibromas Impaired wound healing Xerostomia Sailosis (enlargement of salaivary glands Burning mouth Impairement of taste Elevated plaque

18. Oral candidiasis ulcers Irritation fibroma sailosis Periodontitis with plaque

19. Management and treatment Children with well-controlled diabetes can receive dental treatment in the usual way, except when a general anaesthetic is required. Post-surgical healing can be delayed, particularly in poorly controlled cases It is standard practice to start a dextrose and insulin infusion to avoid complications Prophylactic antibiotic therapy is recommended prior to surgical procedures

20. RICKETS What is Rickets? Deficiency of vitamin D produces rickets in growing children, characterized by a failure of calcification of cartilage and bone. Children with rickets show severe disturbances in teeth and jaws.

21. RICKETS

22. Prevalence The prevalence of rickets in India was found to be more prevalent in males with 70% than in females with 30%. Rickets prevalence was around 46% in the study which is higher compared to other studies. Most of the cases around 85% belonged to the age group of 0-5 years.

23. Oral Manifestations Open bite. High arched palate . V shaped maxillary arch. Retardation of teeth eruption. Malpositioning of the teeth. Gingival abscess. Severe enamel hypoplasia. Dental caries on defected teeth.

24. OPEN BITE WITH ABSCESS HIGH- ARCHED PALATE V-SHAPED MAXILLARY ARCH

25. Multiple cavities with enamel hypoplasia Severe enamel hypoplasia

26. Prevention Early diagnosis is vital for preventing extensive decay in primary teeth However, preventive treatments such as placement of posterior stainless steel crowns and composite resin on anterior teeth. Dental hygiene treatment and management of patienst are vital to prevent primary and permanent tooth loss.

27. Management and treatment As a management composite sealant restorations can be done. invasive dental treatments like pulpectomies and extractions are done Antibiotic therapy to reduce abscess and swelling

28. PEPTIC ULCER & GERD Peptic ulcers are open sores that can form in the lining of the stomach or the first part of the small intestine.  Gastroesophageal reflux disease (GERD) occurs when stomach acid enters the esophagus . Both GERD and ulcers can cause similar symptoms, like burning upper abdominal pain and nausea

29. Prevalence The  point prevalence of peptic ulcer was 4.72% and the lifetime prevalence was 11.22% . The prevalence of GERD in India ranges from  7.6% to 30% , being < 10% in most population studies.

30. Oral manifestations Dental erosion. Xerostomia. Halitosis (bad breath). Mucositis. RAS( Recurrent aphthous stomatitis) like ulcerations. Sour taste and burning mouth.  

31. Dental erosion Mucositis RAS like ulceration

32. Management and treatment Patients with GERD should be referred for dental consultations for the collaborative managements. Preventive measures may involve the stimulation or substitution of salivary secretion ,neutralizing the effect of endogenous and exogenous acids , reducing tooth sensitivity, providing dietary advice. Proton pump inhibitors are used as a treatment.

33. CROHN’S DISEASE What is crohn ’s disease? Crohn’s disease (CD) is described as a chronic inflammatory bowel disease, mainly affecting the lower gastrointestinal tract, with the ileocolonic region being the most affected.   It is incurable and has a disabling course due to the development of various complications.

34. Prevalence Crohn’s disease accounts for more than 5% of patients presenting with lower GI symptoms. CD affects men and women equally. Its age of onset has a bimodal distribution, with a peak between 20 and 40 years of age and a second peak between 50 and 60 years of age.

35. Oral manifestations Linear ulceration or fissuring of the buccal and labial mucosa Diffuse swelling of the lips Angular cheilitis Diffusely swollen erythematous gingivae

36. Linear ulceration or fissure Diffuse swelling of lips Angular chelitis Swollen gums

37. Management and treatment The treatment commonly will require a collaborative effort with dental providers and physicians. Oral manifestations of the disease are not typically problematic and may no need specific oral treatment, but for patients who exhibit recurrent aphthous ulcerations may be prescribed topical streroids . For children regular monitoring of caries and periodontal risk should be done to maintain optimal oral health.

38. REFERENCE Textbook - Handbook of Peadiatric Dentistry www.ncbi.nlm.nih.gov my.clevelandclinic.org www.mayoclinic.org www.dentalhealth.org