Systemic Disease & Oral Manifestations MCQ

The mouth is a window on the rest of the body. Blood, nutritional, hormonal, gastrointestinal, and immune disorders all leave oral signs, and the dentist is sometimes the first clinician to notice them. The organizing skill is simple: when an oral finding does not fit a local cause, think systemically and refer for the blood work or medical evaluation rather than treating the mouth in isolation.

Hematologic Disease

• Leukemia can present in the mouth with diffuse gingival enlargement (leukemic infiltration), spontaneous gingival bleeding, mucosal petechiae, and recurrent infections; these signs out of proportion to plaque should prompt a complete blood count and referral.
• Iron deficiency anemia causes an atrophic, smooth tongue and angular cheilitis; the Plummer-Vinson triad adds dysphagia and an esophageal web (with a raised risk of esophageal cancer).
• Vitamin B12 (and folate) deficiency, including pernicious anemia, classically gives a beefy-red, smooth, sore tongue (glossitis).
• Bleeding disorders (thrombocytopenia, hemophilia, liver disease) cause petechiae, ecchymoses, and prolonged bleeding; bleeding risk should be assessed (platelet count, coagulation) and coordinated with the physician before surgery.

Nutritional and Endocrine Disease

• Vitamin C deficiency (scurvy) produces swollen, spongy, bleeding gums; B-vitamin deficiencies produce glossitis and angular cheilitis, so the oral exam is a genuine window on nutrition.
• Diabetes is the endocrine condition that shapes dental care most: uncontrolled hyperglycemia worsens periodontitis, slows healing, and predisposes to candidiasis and infection, and the relationship is bidirectional because treating periodontitis can modestly improve glycemic control.
• Addison disease (adrenal insufficiency) causes diffuse brown (bronze) mucosal and skin pigmentation; acromegaly (growth hormone excess) enlarges the jaw with mandibular prognathism, tooth spacing, and macroglossia.
• Hyperparathyroidism erases the lamina dura on radiographs (and can cause a brown tumor), and congenital hypothyroidism can cause macroglossia and delayed eruption.

Gastrointestinal Disease

• Crohn disease can show oral cobblestone mucosa, linear or aphthous-like ulcers, and mucosal tags, sometimes before the gut disease is diagnosed.
• Gastroesophageal reflux and eating disorders (bulimia) cause dental erosion, classically on the palatal and lingual surfaces (perimylolysis) from repeated acid exposure.
• Celiac disease is associated with recurrent aphthous ulcers and developmental enamel defects.
• Peutz-Jeghers syndrome features perioral and labial melanotic macules together with intestinal polyposis, so the pigmentation is a clue to a systemic condition.

Immune, Dermatologic, and Syndromic Disease

• Systemic lupus erythematosus can cause oral ulcers and lichenoid lesions (with the classic malar facial rash); lichen planus, pemphigus, and pemphigoid are immune-mediated diseases with prominent oral involvement covered with the mucosal lesions.
• Behcet disease is defined in part by recurrent oral ulcers (its most common feature) together with genital ulcers and eye inflammation (uveitis).
• Amyloidosis can cause macroglossia, and several syndromes have telltale oral features that aid diagnosis.
• The unifying theme is that recurrent, severe, or adult-onset oral ulceration, or oral signs accompanied by systemic symptoms, should trigger evaluation for an underlying systemic disease.