Diseases of the immune system. The principles of immune diagnosis, immunotherapy, immunorehabilitation, immunization.

X linked agammaglobulinaemia  X linked hypogammaglobulinaemia  Immunoglobulin deficiency with increased IgM  Immunoglobulin heavy chain gene deletion  Kappa chain deficiency  Common variable immunodeficiency  IgA deficiency  Transient hypogammaglobulinaemia of infancy  Selective IgG subclass deficiency Causes for primary immunodeficiencies

 Severe combined immunodeficiency  Adenosine deaminase deficiency  Purine nucleoside deficiency  Major histocompatibility complex (MHC)ii deficiency  Reticular disgenesis Combined immunodeficiency

Hereditary Hemorrhagic Telangiectasia (Rendu- Osler-Weber Disease) - Autosomal dominant - tend to undergo repeated hemorrhage - Epistaxis may be an early sign - Pt. may suffer from anemia, but not usually life threatening.

 · Infections  HIV  Acute severe viral infections Drug induced  Immunosuppressive drugs  Cytotoxic drugs  Radiotherapy Secondary Immunodeficiency Conditions

Pseudomembranous Candidiasis

Esophageal Candidiasis

Hyperplastic Candidiasis

Periodontitis

Consider: Bacterial Viral Fungal Combination Silverman, Eversole, Truelove. Essentials of Oral Medicine. London, B.C. Decker, Idiopathic Necrotizing Stomatitis

Aphthous Ulcer

Erythemathous Candidiasis

Linear Gingival Erythema

Lymphoepithelial Cyst

Angular Candidiasis

HSV Labialis

Intra-oral Herpes

Silverman, Eversole, Truelove. Essentials of Oral Medicine. London, B.C. Decker, Minor Aphthous Ulcers

Coccidiomycosis

 Myeloma  Leukaemias  Hodgkin’s and non Hodgkin’s lymphomas Metabolic disorders Malnutrition Iron deficiency Diabetes mellitus Autoimmune diseases  SLE  ITP  Systemic scleroderma Myelo- or lymphoproliferative disordes

Black hairy tongue.

Geographic tongue.

Fissured tongue.

 Pernicious anemia is a condition in which the body does not absorb vitamin B 12.  People who have this condition show signs of anemia, weakness, pallor, and fatigue on exertion.  Other signs can include nausea, diarrhea, abdominal pain, and loss of appetite.  The oral manifestations of pernicious anemia include angular cheilitis (ulceration and redness at the corners of the lips), mucosal ulceration, loss of papillae on the tongue, and a burning and painful tongue. Pernicious Anemia

Iron deficiency. The tongue is devoid of filiform papillae. Angular cheilitis was also present in this patient.

Diseases of the Oral Soft Tissues

Leukoplakia.

Lichen planus.

Erythematous candidiasis.

Minor aphthous ulcer.

Cellulitis.

Leukemia.

 HIV-associated periodontis resembles acute necrotizing ulcerative gingivitis superimposed on rapidly progressive periodontitis.  Other symptoms include: Interproximal necrosis and cratering Marked swelling Intense erythema over the free and attached gingiva Intense pain Spontaneous bleeding and bad breath HIV-Associated Periodontitis

Atypical periodontal disease in a patient with HIV infection.

 Enlargement of the cervical (neck) nodes.  Lymphadenopathy is  frequently seen  in association with AIDS. HIV Cervical Lymphadenopathy

HIV lymphoma.

Hairy Leukoplakia

Kaposi's Sarcoma

Herpes Simplex

Human Papilloma Viruses

An immunologically mediated condition that presents in one of serval forms, and affects skin, CT and specific internal organs

 Salivary Hypofunction/ Dry mouth Dry mouth (xerostomia) occurs when the salivary glands are not functioning properly resulting in decreased saliva. Saliva not only aids in digestion, but is a necessary factor in oral health because it also helps to keep your mouth moist and prevent tooth decay. Diabetic neuropathy can also affect the salivary glands.  Polyuria  Topical treatments: 1.fluoride containing mouthrinses 2.salivary substitutes Salivary Dysfunction & Xerostomia

Oral Candidiasis  Opportunistic fungal infection commonly associated with hyperglycemia.  Salivary dysfunction compromise immune function.  Salivary hyperglycemia provide substrate for fungal growth

Burning Mouth Syndrome Burning mouth syndrome is a condition with no determined cause and is characterized by a chronic burning pain in your mouth. This burning sensation can be severe, feeling much the same as scalding and can affect the overall areas of your mouth such as your tongue, gums, lips, inside of your cheeks, and the roof of your mouth. Although BMS has no known cause and finding treatment may by difficult, most people can bring it under control by working with an oral health specialist.

 -delayed eruption,  -enamel hypoplasia in both dentitions,  -anterior open bite,  -macroglossia,  -micrognathia,  -thick lips,  -dysgeusia,  -mouth breathing. Oral manifestations of patients with hypothyroidism

Oral manifestations of patients with hyperparathyroidism  1. Dental abnormalities: -widened pulp chambers; -development defects; -alterations in dental eruption -weak teeth -maloclussions  2. Brown tumor  3. Loss of bone density  4. Soft tissue calcifications

 1. Dental abnormalities:  -enamel hypoplasia in horizontal lines;  -poorly calcified dentin;  -widened pulp chambers;  -dental pulp calcifications;  -shortened roots;  -hypodontia;  -delay or cessation of dental development.  2. Mandibular tori  3. Chronic candidiasis  4. Paresthesia of the tongue or lips  5. Alteration in facial muscles Oral manifestations of patients with hypoparathyroidism

Addison's disease Availability small (one to several square millimeters) grey-black spots or stripes, dark brown or grey-blue color without signs of inflammation on the mucous membrane of the: mouth in the cheek area, tongue edges, palate, gums. The spots can be oval or take the form of strips or fine grit, above the level of the mucous membrane, they are not separated.

Addison's disease The most common symptoms are fatigue, lightheadedness upon standing or while upright, muscle weakness, fever, weight loss, difficulty in standing up, anxiety, nausea, vomiting, diarrhea, headache, sweating, changes in mood and personality, joint and muscle pains.

Addison's disease is differentiated from: -multiple melanotic macules, -smoker’s melanosis, -Peutz-Jeghers syndrome, -heavy metal poisoning, -postinflammatory hyperpigmentation, -congenital pigmentation of the oral mucosa, which is observed in some nations Fig. the band-like grayish blue pigmentation of the maxillary and mandibular anterior gingiva after using drugs that include antimalarial agents. *