1. Systemic disorders and sydromes with H & N manifestation
Jan Laco, M.D., Ph.D.

2. Cardiovascular diseases
Infective endocarditis
source: bacteraemia after tooth brushing or extraction
< 15% IE
valve defects: congenital x rheumatic fever
prosthetic valves
colonisation of cardiac valves  vegetations  valve destruction
!!! ATB cover !!!

3. Cardiovascular diseases
Kawasaki disease
= mucocutaneous LN syndrome
Japan
Children
Mucositis
cervical lymphadenopathy
coronary arteritis  aneurysm  myocardial infarction

4. Cardiovascular diseases
antihypertensive drugs
nifedipine
 gingival hyperplasia

5. Respiratory tract diseases
Tuberculosis
rare complication of open lung TBC
painless ulcer on dorsum of tongue
cervical lymphadenopathy
Mi: caseating granulomas

6. Respiratory tract diseases
Sarcoidosis
chronic granulomatous disease of unknown origin
lungs, LN (hilar), salivary glands
oral: painless swelling – gingivae, lips
diagnosis: biopsy of labial glands
Mi: non-caseating granulomas + calcifications
Heerfordt´s syndrome: parotis with sarcoidosis + xerostomia + uveitis + fever

7. Lethal midline granuloma syndrome
clinically: destruction of central facial tissue + fatal outcome
Wegener´s granulomatosis
systemic necrotising vasculitis (ANCA+)
granulomas of upper and lower RT
glomerulonephritis
Angiocentric T cell lymphoma

8. Gastrointestinal diseases
Crohn´s disease
inflammatory disease of unknown origin
ileocaecal region - thickening and ulceration
oral: lips swelling
cobble stone thickening of buccal mucosa with painful small ulcers
Mi: small granulomas

9. Gastrointestinal diseases
Gardner´s syndrome (AD inheritance)
= multiple jaw osteomas + polyposis coli with malignant potential
dental defects, epidermal cysts
Peutz-Jeghers syndrome
pigmented macules around lips + intestinal polyposis (small bowel)

10. Nutritional deficiencies
vitamin A
squamous metaplasia  keratinisation (leukoplakias ?)
vitamin B2
angular stomatitis - painful red fissures at angles
vitamin B12 - pernicious anaemia
glossitis
vitamin C - scurvy
gingival swelling and bleeding
vitamin D - rickets

11. Endocrine disorders and pregnancy
Pituitary hyperfunction of growth hormone
gigantism
acromegaly
jaws (condylar growth) + hands + feet

12. Endocrine disorders and pregnancy
Adrenocortical diseases
Addison´s disease = cortical insufficiency
failure of cortisol and aldosteron secretion
early sign – oral pigmentations – gingivae, buccal mucosa, lips
Adrenal medulla
MEN IIb
= phaeochromocytoma + hyperparathyroidism + thyroid medullary carcinoma + oral mucosal neurofibromas

13. Endocrine disorders and pregnancy
Diabetes mellitus
relative or absolute deficiency of insulin
oral: candidosis
acceleration of periodontal diseases
dry mouth
oral lichenoid reactions (drugs)

14. Endocrine disorders and pregnancy
gingivitis
pregnancy epulis formation
recurrent aphthae

15. Haematological disorders - anaemias
iron deficiency (microcytic a.)
chronic menstrual blood loss
chronic bleeding from peptic ulcer
pernicious anaemia (macrocytic a.)
middle aged women
autoimmune chronic gastritis  vitamin B12 deficiency
+ neurological disease: degeneration of spinal cord

16. Haematological disorders - anaemias
mucosal and skin pallor + fatigue + breathlessness + tachycardia
atrophic glossitis (B 12) - first sign
atrophy of filiform papillae
angular stomatitis
candidosis

17. Haematological disorders - leukaemias
= neoplastic disorder of bone marrow
acute x chronic
lymphoblastic x myeloblastic
ALL - children
AML - adults
anaemia + infection + bleeding tendency
hepatosplenomegaly + lymphadenopathy
oral: gingival swelling + mucosal ulcerations + purpura

18. Haematological disorders - haemorrhagic diseases
bleeding after tooth extraction > 1 day
1. vascular disorder
2. platelet disorders
purpura, petechiae, ecchymoses
imm. follow trauma  spontaneous stop
3. clotting disorders
long severe bleeding after short delay

19. Haematological disorders - haemorrhagic diseases
Idiopathic thrombocytopenic purpura
antibodies x platelets  low number in blood
children, young women
von Willebrand´s disease (AD inheritance)
low level of vW factor (part of FVIII)
drugs associated
aspirin

20. Haematological disorders - haemorrhagic diseases
Haemophilia A (X inheritance)
most common
FVIII deficiency
childhood
bleeding into muscles or joints (haemarthros)
Acquired disorders
liver diseases
vitamin K deficiency
anticoagulant treatment - warfarin

21. Cervical lymphadenopathy - infections
Bacterial
teeth, tonsils, face
TBC
cat-scratch disease
Viral
herpetic stomatitis
infectious mononucleosis
HIV infection
Parasitic
toxoplasmosis

22. Cervical lymphadenopathy - neoplasms
Primary
Hodgkin´s lymphoma
non-Hodgkin lymphomas
Secondary
carcinomas
melanoma
leukaemias

23. Autoimmune diseases middle aged women antibodies in blood
rheumatoid arthritis
Sjögren´s syndrome
systemic lupus erythematosus
systemic sclerosis

24. Autoimmune diseases Systemic lupus erythematosus Systemic sclerosis
antinuclear factors
20% patients have oral symptoms
skin rash (butterfly) + arthritis + pleuritis + glomerulonephritis
oral: lichenoid lesions
Systemic sclerosis
subcutaneous and visceral fibrosis (GIT, lungs, …)
mask-like face + limited oral opening

25. AIDS retrovirus HIV 1 sexual + i.v. drugs + blood transmission
deterioration of cell immunity (CD 4 T cell)
opportunistic infections
75% patients have orofacial diseases
infections
tumors
cervical lymphadenopathy

26. AIDS – oral infections Fungal Viral Bacterial
trush or other forms of candidosis
70% patients
Viral
HSV stomatitis
EBV – hairy leukoplakia
Bacterial
gingivitis + periodontitis

27. AIDS – hairy leukoplakia
almost unique to AIDS !!!
EBV virus
lateral borders of tongue
soft white painless area with corrugated surface
Mi: hyperkeratosis + koilocytes
No premalignant lesion
indicator of low immune status  poor prognosis
may regress spontaneously

28. AIDS - tumors 50% patients Kaposi´s sarcoma – HSV 8
purplish bleeding area or nodule on palate
Mi: vascular tumor - minute proliferating blood vessels
Non-Hodgkin lymphomas
painless swelling of palate + gingiva
Mi: high grade B cell lymphomas