Oral Manifestations Of Systemic Diseases Research Articles

Assessment of oral manifestations of systemic health related knowledge of medical students pursuing internship programme at a tertiary health care centre

AimClinicians across the entire medical profession are responsible for detection, prevention and imparting importance of oral health to the patients. However, many studies conducted so far show lack of knowledge of medical students regarding dental conditions. The present observational study was undertaken to evaluate the knowledge of oral manifestations of systemic diseases amongst medical students undergoing Internship program at a tertiary centre. Materials & methodA self-structured Questionnaire comprising of 20 questions was used as a survey tool to assess the understanding of 100 medical students undergoing internship program. They were explained about the purpose of the study. The questionnaire consisted of an objective part Yes/No (7 questions) and subjective part designed on likert scale(13 questions). There were questions on their view on current curriculum for dentistry in medical undergraduate training and possible enhancement in teaching modalities. The subjective part had five options to choose from, Strongly agree, Agree, Neutral, Disagree And Strongly Disagree. Statistical analysisThe responses of objective questions was recorded and percentage calculated for both options. The total score was obtained for each participant based on their reponses to the subjective questions based on the Likert scale. Student t-test was applied to calculate means between male and female students. ResultsFor all objective questions, percentage was calculated for affirmative and negative responses. The responses were calculated on scale5-1 for the subjective questions. Reverse scoring was done for questions 10,11,12 i. e scale 1–5. The maximum achievable score in this category was 65 which was further divided into three category as Excellent score range 55–65, Good score range 45–54, Unsatisfactory score range 35–44. The number of students in excellent category were 11, Good 66, unsatisfactory 23. The average score obtained was 48.175. The mean scores for males was 48.0161 and for females it was 48.142. The scores were slightly better for females but the difference was statistically insignificant as (p-value = 0.455056). ConclusionThe present study showed good level of Knowledge on oral manifestations of systemic diseases among medical students as compared to other studies which forms an integral part of medical curriculum. The students responses on enhancing dental curriculum and teaching aids for improved education tools can help the faculty provide a better teaching learning experience.

Oral manifestations of systemic disorders – part 1

Headlines Oral manifestations may be the first sign of a systemic condition or disease Clinical recognition of oral manifestations related to systemic diseases may be difficult and can delay diagnosis Oral conditions related to the treatment of systemic diseases are clinically important to recognize Oral health personnel should be educated to be able to identify and diagnose and manage oral manifestations of systemic diseases and conditions in a timely manner

Oral manifestations of Systemic Diseases: An Insight from Radiological Imaging

Oral manifestations of Systemic Diseases: An Insight from Radiological Imaging

Prevalence of Oral Manifestations of Systemic Diseases in Patients Visiting the Dental Outpatient Department of Sindh, Pakistan

OBJECTIVES The purpose of the study was to evaluate the awareness of oral health workers in identifying the prevalence of oral manifestations of systemic diseases in patients visiting the Dental Out-Patient Department of Sindh, Pakistan. METHODOLOGY A descriptive, cross-sectional survey-based study was conducted in Karachi, Pakistan, from October to December 2021. The study was conducted in various institutes from all over Sindh, Pakistan. An online, well-structured questionnaire was designed using Google Forms and distributed to the participants through social media platforms in the dental community. Using the Open-Epi software regarding a parent article, the sample size of this study was calculated. Keeping the confidence interval at 95% and the desired percentile at 50, the total sample size was calculated to be 100. Around 175 questionnaires were given out to the candidates. RESULTSThe results showed that 81% male and 19% female participated, including 45% postgraduate trainees, 30% house officers, and 25% general dentists. 80% detected 2-3 systemic diseases in a patient, with 75% observing oral manifestations preceding systemic illness diagnosis. The majority favoured treating underlying ailments (75%), and prevalent conditions included hypertension (90%), diabetes (80%), anaemia (75%), and lichen planus (40.7%). CONCLUSION Oral health workers play a vital role in the initial and early identification and multidisciplinary medical management of various systemic diseases. A coordinated approach between physicians and dentists in diagnosing and managing these conditions is necessary to achieve optimal clinical outcomes.

Variations of oral anatomy and common oral lesions

Several topics related to the oral cavity are briefly addressed in this article, from anatomical variations that, when recognized, avoid unnecessary investigations, to diseases that affect exclusively the mouth, mucocutaneous diseases, as well as oral manifestations of systemic diseases. A complete clinical examination comprises the examination of the mouth, and this approach facilitates clinical practice, shortening the path to diagnosis in the outpatient clinic as well as with in-hospital patients. The objective of this article is to encourage the examination of the oral cavity as a useful tool in medical practice, helping to recognize diseases in this location.

Evaluation of Awareness of General Practitioners Working in Yazd, Iran, Concerning Oral Diseases in 2015

Background: The incorporation of oral health promotion into general healthcare has been proposed by the World Health Organization. General practitioners (GPs) could play a vital role in the promotion of oral healthcare. Objectives: This study was designed to evaluate the awareness of oral and maxillofacial medicine specialty and its scope of practice among Iranian GPs. Methods: The present cross-sectional study was conducted in Yazd, Iran. A total of 95 GPs randomly filled out a close-ended questionnaire. Responses to the questionnaire were analyzed using descriptive and analytical statistics. The self-administered questionnaire comprised 35 items and covered the demographical details and characteristics of participants, in addition to their awareness of oral and maxillofacial medicine and its scope of practice. Finally, awareness scores were classified as weak, intermediate, and good. The data were analyzed using a t-test and Pearson correlation. A P-value ≤ 0.05 was considered statistically significant for all statistical analyses. Results: Only 24.2% of GPs had enough awareness. The mean score of total awareness about oral diseases was 11.82 ± 3. The mean scores of total awareness for the oral manifestations of systemic diseases, medical considerations in dentistry, and oral lesions were 3.59 ± 1.17, 3.96 ± 1.62, and 4.27 ± 1.65, respectively. Conclusions: According to this study, the awareness of GPs playing a key role regarding oral medicine and oral manifestations of systemic diseases was weak. It is recommended to revise the medical curriculum to incorporate related courses about common oral diseases into the medical curriculum. The aim will only be achieved by improving the coordination between dentists and GPs.

Management of Lichen Planus in a Post Liver Transplant Patient with Lupus Erythematosus, and Ulcerative Colitis; A Case Report

Background: Lichen planus (LP) is a chronic mucocutaneous inflammatory condition characterized by white striations and plaques or erythematous /erosive lesions in the oral cavity. LP has affected about 0.5 -1% of world population. Apart from the potential of autoimmune origin, the WHO classified oral LP (OLP) as a premalignant condition, with an increased risk of developing squamous cell carcinoma of the head and neck (SCCHN). Patients with LP have exhibited a higher susceptibility to other autoimmune diseases (about 25%). Case Presentation: A 51-year-old woman with a history of OLP and concurrent lupus erythematosus, transplanted Liver, and ulcerative colitis was referred to the Oral and Maxillofacial Medicine Department of Tehran Dental Faculty. A noteworthy point in this study, which was not commonly observed in previous reports, was the existence of OLP with three autoimmune diseases. The lichenoid oral ulcers of the patient were managed by modifying her drug regimen under consultation with a physician using systemic and topical corticosteroids, and, finally, cryotherapy. Conclusions: This case, not the first case of autoimmune diseases, illustrates the management of the challenges of an oral lesion accompanying other systemic diseases and highlights the importance of awareness of the oral manifestations of systemic diseases and their side effects. According to previous studies, the response of oral lesions to different treatments is unique, and the patient's lifestyle and his/her other systemic diseases influence the treatment success or failure. The patient's management protocol and its validity can be re-evaluated in future studies as clinical trial projects.

A review of the presentations and treatment of oral pigmentation.

BackgroundOral pigmentation can be either normal or abnormal discolouration of the oral mucosa.
 Objective: To help clinicians establish a better approach towards the care of patients with pigmented oral lesions and to establish early diagnosis and treatment of such conditions.
 Data source: Works of literature concerning oral pigmentations, clinical features and treatment were reviewed thoroughly from renowned electronic databases such as PubMed, Medline, Google Scholar, and Cochrane Library and personal clinical experience in managing such conditions. The following words were used for the search: oral pigmentation, aetiology, and clinical presentations.
 Findings: Oral pigmentation presents in various clinical patterns that can range from just physiologic changes to oral manifestations of systemic diseases and malignancies. Oral pigmentation may be physiological or pathological. Knowledge of the different presentations of oral pigmented lesions is quite crucial to improve and mastering the skill of differential diagnosis, definitive diagnosis and prompt treatment. The deposition of pigments in oral tissues may be due to various etiological factors. It can arise from intrinsic and extrinsic factors and can be physiological or pathological.
 Conclusion: A good understanding of the various presentations of oral pigmented lesions would aid in the proper diagnosis and treatment of the condition.

Systemic Diseases with Oral Manifestations and Their Impact on Health-Related Quality of Life

Abstract Health-related quality of life is a multidimensional concept established to evaluate the physical, psychological, and social impacts of health conditions on individuals’ well-being. Various tools for measuring health-related quality of life can be categorized into two subsets: generic and disease–specific instruments. The oral cavity can be stricken by a broad range of local and systemic diseases and their systemic treatment modalities. The most common systemic illnesses associated with oral lesions are hematologic disorders, endocrinopathies, neurological disorders, gastrointestinal conditions, mucocutaneous and rheumatic diseases, and neoplastic processes. Their manifestations in the oral cavity are, in most cases, rather nonspecific but should not be overlooked. Oral health is one of the most important parts of overall health, thus it has been proposed that poor oral health may affect health–related quality of life. The presence of oral manifestations of systemic diseases has a negative impact on the daily functioning of patients, decreasing their overall well-being. This article will review the most common systemic diseases with oral manifestations and their impact on the health–related quality of life. Oral health researchers should put a stronger emphasis on the patient-reported quality of life as a primary outcome in future clinical trials. The significance of this area has still not been widely understood in the current dental literature even though it could help improve patients’ health-related quality of life.

BROWN TUMOR OF HYPERPARATHYROIDISM: LATE DIAGNOSIS

A 44-year-old White male patient was admitted to a referral hospital with a fracture of the femur. Imaging exams revealed multiple radiolucent lesions on the lower limbs. A routine dental examination showed edentulism. The patient was submitted to an oral biopsy a few years earlier. A panoramic radiograph showed the recurrence of a previous lesion in the anterior region of the mandible. A new biopsy with histopathologic analysis revealed a giant cell lesion. Based on clinical and radiographic findings, a parathyroid hormone exam and calcium dosage were requested, confirming hyperparathyroidism. Given the results of the exams, the oral lesion was diagnosed as a brown tumor of hyperparathyroidism. Surgical removal with curettage was performed. The patient has also undergone medical treatment and is currently under observation. Given the above, the differential diagnosis of oral manifestations of systemic diseases is necessary, avoiding complications and reduction in the patient's quality of life.

A Multi-Centre Evaluation of Tongue Lesions in Nigeria Tertiary Institutions

Background: The tongue is a muscular hydrostat that forms the floor of the mouth, perform functions like mastication, speech, taste and osculation. The tongue is relatively affected by both oral and systemic conditions in all ages and acts as a “mirror” for oral manifestations of systemic diseases. Prevalence of tongue lesions varies due to demographic and/or geographic differences of the sample studied, differences in the diagnostic criteria, methodological approaches, and sampling methods employed. Objective: To determine the socio-demographic distribution of different categories of tongue lesions and their oral presentations. Methods: Information were retrospectively retrieved from Maxillofacial Clinical and Surgical day cases registers. Data such as age, gender; duration of lesion and location of lesions on the tongue and category of lesion were also extracted using relevant descriptive and inference statistics All statistical significance was set at p < 0.05. Results: Ninety- two cases were recruited retrospectively from two tertiary centers with a male preponderance of 53.3% (n= 49). The mean age of presentation of tongue lesions in the study is 41.1years  22.4 years, dorsum of the tongue presented the highest number of occurrences of tongue lesions (52.2%). The most common lesions on the dorsum of the tongue in this study are squamous cell carcinoma (OSCC), benign migratory glossitis and irritation fibroma. The mean age of presentation for benign lesion is 23years, inflammatory/reactive lesion 44.9years and malignant lesions 51.6years respectively. The mean duration of tongue lesions in our study is 9.1 months (median = 6 months), mean duration of presentation of benign lesions (14.8 months) was longer than that of malignant lesions (6.4 months). The association between duration and category of lesion is statistically significant at p < 0.0001. Conclusion: Delayed clinical presentation by patients and patronage of unorthodox traditional doctors contribute to the overtly increased incidence of oral malignancies in Sub-Saharan Africa; this coupled with improper or lack of accurate record keeping may have also culminated in this increased prevalence of oral malignancies. All tongue surfaces can be affected, gender predilections for any of the surfaces is yet to be affirmed by any study however aging is related to malignant occurrences.

Knowledge Attitude and Practice of Dental Practitioners towards Palliative Dental Care: A Cross-sectional Questionnaire Study

Introduction: Palliative care is active total care of patients whose disease is not responsive to curative treatment. In a multidisciplinary approach for rendering palliative care, a dentist’s role is vital, but overlooked. Oral cavity is home to numerous microorganisms aggravating disease process. A trained dentist helps treat and manage oral manifestations of systemic diseases from diagnosis to relief from pain and discomfort. Dental expression in palliative care is extended dental services to provide preeminent feasible oral care to terminally ill or advanced diseased patients. Oral conditions impact quality of life of patients and initiation and progression of these lesions may be related to the succession of disease, its treatment or both.
 Objectives: To evaluate the knowledge, attitude and practice of dental practitioners towards palliative dental care.
 Materials and Methods: A cross-sectional observational questionnaire-based study conducted on 50 dental academicians and practitioners across Mumbai which included specialists in Oral Medicine, Oral Surgery, Prosthodontics and Oral Pathology. A closed-ended, pre-tested, self-administered questionnaire would be prepared for the study.
 Results: All participants completed their masters in dental surgery. Eighty five percent participants had come across patients requiring palliative care. All except 4 male and 1 female respondent acknowledged importance of palliative care in dentistry. 56.8% participants were aware of hospitals providing palliative dental care. All participants considered palliative care to be interdisciplinary. 94 participants believed dental problems to be common in palliative care. Majority respondents suggested a sugar-free diet while 19 proposed a spicy diet for cases requiring palliative care. Fluoride based mouthwash was recommended by 40 participants and 30 recommended chlorhexidine based while 10 preferred alcohol-based. While 70 participants had not attended any seminars, workshops, symposiums and/ or conferences on palliative care, 80 were willing to do so.

Do doctors know about “Oral Medicine”?

Oral Medicine is a branch within dentistry that deals with orofacial diseases. In the absence of adequate awareness and formalized referral system, there has been “doctor hopping” by patients with many sophisticated and needless investigations and management approaches in simple orofacial diseases. The objective of the study was to know the awareness level of medical practitioners about the Oral Medicine specialty and the volume and patterns of referral of patients with oral diseases. Validated questionnaire was sent to 148 medical doctors having a clinical practice in B. P. Koirala Institute of Health Sciences. Frequency and proportion were calculated. A total of 94 medical practitioners responded to the questionnaire. Out of them, 86.18% of medical doctors were aware about the existence of the Oral Medicine specialty. Only 17.02% of total clinicians referred patients to the Oral Medicine department for oral manifestations of systemic diseases, 21.27% referred for facial and TMJ problems, 38.29% referred for oral mucosal lesions and 15.96% referred patients for salivary gland disorders. There is a need to advocate the scope of Oral Medicine specialty for fostering interprofessional practice for better patient care.

Knowledge about oral manifestations of systemic diseases among medical and dental students from Jordan: An interdisciplinary educational gap.

To assess the ability of medical students to recognize oral manifestation of selected systemic diseases and compare their performance with dental students. A total of 400 senior medical and dental students were approached to participate. The study protocol involved two parts; a self-administered survey and a direct interview involving clinical photographs for oral signs of systemic diseases. A total of 283 (70.8%) agreed to participate and completed the two- part study. The study population was made of 110 (38.9%) [82 females and 28 males] dental students, and 173(61.1%) [98 females and 75 males] medical students. The knowledge score regarding questions about the normal mouth and oral structures was 15.7 ± 6 out of 22. Dental students had a significantly higher knowledge score about normal mouth and oral structures (20.9 ± 4; range from 17 to 22) compared to medical students (10.6 ± 7; range from 4 to 21) (p = .029). The knowledge score regarding questions about oral manifestations of systemic diseases was 26.8 ± 6 out of 40. Dental students had a significantly higher knowledge score about oral manifestations of systemic diseases (30.8 ± 7; range from 15 to 37) compared to medical students (22.9 ± 4; range from 10 to 36) (p = .031). Only 24.3% (n = 42) medical students reported having adequate training to be able to distinguish between normal mouth and diseases. Nearly all medical students (91.3%; n = 158) felt that it is important to have more formal training in oral examination and disease diagnosis. Medical students lack adequate knowledge, diagnostic ability, and confidence with regard to diagnosis of oral signs of systemic diseases. To ensure that medical students have necessary skills in assessing oral diseases, curricula revisions and modifications are required, and specific oral health-related learning outcomes should be introduced and reinforced through clinical training.

A service evaluation of pediatric oral mucosal disease experience in a tertiary joint pediatric-oral medicine clinic

<h3>Objectives</h3> The true global prevalence of pediatric oral mucosal disease has historically proved difficult to determine, based on heterogeneity and inherent limitations in study designs and a largely descriptive narrative. The 2019 World Workshop on Oral Medicine VII: Relative Frequency of Oral Mucosal Lesions in Children, a Scoping Review quantified pediatric oral mucosal disease experience globally based on pooled and region-specific data from clinical studies and biopsy reports. The aim of this investigation was to retrospectively review clinical data to compare pediatric disease experience in a tertiary joint pediatric-oral medicine clinic at the Royal National ENT and Eastman Dental Hospital, UCLH, London, UK, with published global data from the world workshop. <h3>Methods</h3> Quantitative analysis was retrospectively performed on recorded clinical data from 22 joint clinics attended between January and December 2018, with recording of patient demographic characteristics, diagnosis, investigations, and management. <h3>Results</h3> Two hundred sixty-six patients (143 males, 128 females; age range, 8 months to 18 years) were seen in 2018. Referring clinicians included general dental practitioners (n = 54; 49%), secondary care medical and dental specialties (n = 33; 30%), community dental services (n = 15; 14%), and general medical practitioners (n = 9; 8%). Medical comorbidities were noted in 62 patients (23%). Idiopathic recurrent aphthous stomatitis (n = 65; 24%,), mucocele (n = 24; 9%), oral Crohn disease/orofacial granulomatosis (n = 18; 7%), and geographic tongue (n = 11; 4%) were the most commonly presenting conditions. Malignancy was the primary diagnosis in only 1 patient (mucoepidermoid carcinoma). Investigations performed included imaging (n = 27; 11%), blood tests (n = 26; 10%), and biopsy procedures (n = 23; 9%). Management included the use of topical analgesics (n = 71; 27%), topical corticosteroids (n = 94; 35%), topical calcineurin inhibitors (n = 19; 7%), and systemic immunomodulation (n = 22; 8%). <h3>Conclusions</h3> Similarity to world workshop conclusions was noted, with a predominance of benign oral mucosal disease within this patient demographic. Roughly 1 in 10 patients required investigation by imaging, blood testing, or biopsy. Although the world workshop data represented mostly transient conditions with an infectious or traumatic etiology, within this cohort, there was a greater representation of the oral manifestations of systemic disease, which may well represent the tertiary nature of referral to this unit.

Knowledge, Attitude and Perception of Oral Diseases Presented by the Patients to General Medicine Practitioners in the Suburban areas of Nagpur City.

General Medicine Practitioners (GPs) are often the first point of contact for advice and management in cases of dental related pain. The reasons for presentation to the General Practitioners, rather than the dentist, include non-classic presentation of dento-facial pain, lack of coordinated after hours dental care, poor patient education, patients’ prescription of their GP as the primary coordinator of integrated total health care and financial considerations. This study aims to assess the knowledge, attitude and awareness of the common oral diseases and to create awareness of the prevailing dental conditions among general practitioners, techniques for better diagnosis, and appropriate management protocols for different dental conditions.A questionnaire study was carried out among 130 General Practitioners in the suburban areas of Nagpur City using an online survey tool. 21 questions related to dental or denture-related problems and benign and malignant disease were presented in the questionnaire. The doctors have spent an average of 5 minutes to finish the survey. The data was analyzed using descriptive statistics. Out of 130 General Practitioners 71 were well versed about plaque and calculus, whereas 86% felt that referral of the patient to a dentist is the more appropriate way to treat a dental abscess. The results of the study show that general practitioners had good dental knowledge. They were well aware about most of the dental conditions, along with the various oral manifestations of systemic diseases, and life threatening conditions. It is essential that the general practitioners should keep their knowledge updated with time. Oral health education can be included in the medical curriculum to emphasize a positive attitude towards oral health.&#x0D;

Oral Pigmented lesions- A Short Review

Pigmentations can be commonly found in the mouth which are presents in various clinical patterns rangingfrom physiological changes to oral manifestations of systemic diseases and malignancies. Oral pigmentationcan be focal,multifocal or diffuse. Oral pigmentation can be exogenous, endogenous, physiological andpathological. Oral pigmentation is more likely to have a multifactorial etiology

A Survey of Oral Medicine Curriculum and Practice in India

Background: Oral Medicine specialists provide clinical care to patients with a wide variety of chronic diseases affecting the oral and maxillofacial region, oral manifestations of systemic diseases and behavioral disorders and provide general dental care to patients with medically compromised states. It is important to conduct studies that address the strengths and shortcomings of our specialty and the current system of its education and practice in order to yield highly skilled professionals and truly serve the oral health care needs of the public. Aim &amp; Method: This study aims to describe the current status of Oral Medicine curriculum and practice in India. A survey was designed to assess the current status of oral medicine education and clinical practice. The survey was sent to Oral Medicine Specialists across India to assess their opinion and analyze the benefits and shortcomings of the present system. Results: 52 respondents completed the survey from various states across India. More than 87% of respondents considered management of oral mucosal diseases, salivary dysfunction, oral manifestations of dermatological diseases, HIV, oral manifestations of systemic disease and facial pain as part of Oral Medicine. Only 27% of respondents reported participating in multidisciplinary clinics for treatment of patients, and 85% of respondents agreed to the need for presence of multidisciplinary clinics. 85% of respondents agreed to the suggestion of developing a curriculum for training in Special Care Dentistry for Oral Medicine postgraduates in India. Conclusion: Limitations to this survey study include a small sample size. Future efforts at defining the scope of oral medicine practice in India and improvements in training and education can help model future graduates and inspire undergraduates to choose Oral Medicine as a career.

Oral manifestations of systemic diseases

Oral manifestations of systemic diseases

Perfil de pacientes acometidos por lesões orais infecciosas em um centro de referência do Nordeste Brasileiro

INTRODUÇÃO: A cavidade oral constitui-se em uma importante porta de entrada para agentes infecciosos de inúmeras doenças com manifestações orais de doenças sistêmicas. OBJETIVO: Realizar um estudo clínico e epidemiológico dos pacientes portadores de doenças infecciosas, cujas lesões foram biopsiadas no ambulatório do Centro de Referência de Lesões Bucais. MATERIAIS E MÉTODOS: Foi realizado um estudo retrospectivo de corte seccional onde se verificou todos os prontuários dos pacientes com diagnóstico de doença infecciosa entre os anos de 1998 e 2015, comprovados através do exame clínico e/ ou histopatológico em um Centro de Referência de Lesões Bucais. RESULTADOS: Foram selecionados 384 prontuários baseados nos critérios de inclusão da amostra desta pesquisa. As infecções fúngicas foram as mais prevalentes com 299 casos (78%), sendo que 241(82%) pacientes eram do sexo feminino, com idade a partir de 40 anos, n=237 (87%). Houve uma associação estatisticamente significante para todos os grupos de lesões com a variável idade (p&lt;0,05). CONCLUSÃO: A lesão mais prevalente nesta pesquisa foi a Estomatite protética, uma variante clínica da Candidíase eritematosa e os resultados apontaram o uso de prótese como o principal fator de risco para o desenvolvimento desta infecção em cavidade oral.