Diabetes Mellitus

 • Increased glucose in the patients’ system implies

hyperglycemia also in saliva.
• Bacteria find this environment more conducive and therefore
these patients are more prone to dental caries, gingivitis, and
periodontal disease.
• An increased incidence of C. albicans and a mucormycosis (a
rare fungal infection of the palate and maxillary sinus)
• It's important to note that although not an oral change per say,
the patient with diabetes mellitus, experiences slow wound
healing and increased susceptibility to infection. Mucormycosis

Crohn’s Disease • Definition

Crohn’s disease or regional
ileitis is a chronic
inflammatory disease that
primarily affects the ileum and
other parts of the
gastrointestinal tract. • The
disease usually affects young
individual • Etiology Unknown; probably immunologically
mediated. • Clinical features: • Presents clinically with
abdominal pain, nausea, diarrhea, weight loss, low-grade fever,
and rectal bleeding. • Extra-abdominal involvement includes
arthritis,uveitis, and oral lesions.

Clinical features: • Oral lesions occur in 10–20% of patients and

are characterized by nodular swelling, which may be ulcerated. •
Diffuse raised nodules resulting in a cobblestone appearance of
the mucosa or mucosal tag lesions may occur. • Granulomatous
lip swelling, angular cheilitis, gingival swelling, and atypical
ulcerations may be seen. • Laboratory tests: Histopathological
examination. • Differential diagnosis Orofacial granulomatosis,
epulis fissuratum, pyogenic granuloma. • Treatment Topical
steroids, systemic steroids, sulfasalazine

Crohn’s disease: cobblestone appearance of the buccal mucosa

Leukemia • Infections, bruising, or hemorrhage of the oral
cavity may be caused by thrombocytopenia or leukopenia. •
Rarely, diffuse non-tender gingival enlargment, overall pallor of
tissues due to anemia or ulcerative gingivitis may be exhibited.

Leukemia • Leukemias are a group of malignant disorders of the

blood-forming tissues, characterized by defects in the
maturation and proliferation of leukocytes. • Etiology These
conditions are probably caused by a combination of genetic and
environmental factors (viruses, chemicals, radiation). • -
Leukemias are classified as acute and chronic, depending on the
clinical course, and myeloid or lymphocytic, according to the
histogenetic origin. • Clinical features: All forms of leukemia
can have oral manifestations. • The most common oral lesions
are ulcerations, spontaneous gingival hemorrhage, petechiae,
ecchymoses, tooth loosening, and delayed wound healing.
Gingival enlargement is a characteristic pattern, frequently seen
in patients with myelomonocytic leukemia. • Candidiasis and
herpetic infections are relatively common oral complications of
leukemia.

Laboratory tests Peripheral blood counts, bone-marrow

examination. • Differential diagnosis Agranulocytosis, cyclic
neutropenia, thrombocytopenic purpura, acute necrotizing
ulcerative gingivitis, gingival overgrowth due to drugs. •
Treatment Chemotherapy, bone-marrow transplantation,
supportive therapy.

Chronic lymphocytic leukemia: ulcer on the palate

Chronic lymphocytic leukemia: severe gingival enlargement and

ulcerations

Sjögren’s Syndrome • Sjögren’s syndrome is the 2nd most

common autoimmune disease with women in their mid-60’s
being the primarily afflicted. • Initial symptoms include dry eyes
and dry mouth due to gradual glandular dysfunction. • In some
cases, dysphagia, increased dental caries, increased
susceptibility to oral candidiasis, and difficulty wearing dental
prostheses will develop. • Treatment is generally symptomatic
and supportive. Moisture replacement therapies may ease the
symptoms of dryness. Nonsteroidal anti-inflammatory drugs
may be used to treat musculoskeletal symptoms. Corticosteroids
or immunosuppressive drugs may be considered in severe cases.

Sjögren’s Syndrome

Oral Manifestations of HIV/AIDS • May be first sign of HIV

infection • May lead to testing and diagnosis • Oral conditions
develop as immunosuppression progresses • Indicators of
change in immune status • Require definitive management •
Oral manifestations of HIV infection • Certain conditions
associated with risk of AIDS • May be first AIDS defining
condition Overall average prevalence: 30 - 50% In late stage
AIDS – upwards of 90%