Cardiovascular and Haematological System
- A heart attack can cause chest pain that may radiate to the jaw.
- Calcium channel blockers can lead to gingival hypertrophy.
- Nicorandil can cause major aphthous-like ulcer formation.
- Iron, folate, and vitamin B12 deficiencies can result in a beefy red tongue and angular chelitis.
- Sickle cell disease can cause dental pain, facial swelling, and increased risk of infection.
Respiratory System
- Steroidal inhalers used to treat respiratory conditions can increase the risk of dental caries, xerostomia, candidiasis, ulceration, and gingivitis/periodontitis.
Renal System
- Renal transplant patients taking immunosuppressant medication (ciclosporin) may experience gingival hyperplasia, aphthous ulceration, herpes simplex virus, oral leucoplakia, candidiasis infection, or Kaposis sarcoma.
Digestive System
- Dysphagia, difficulty in swallowing, can be caused by structural or neurological problems.
- Gastroesophageal reflux disease can lead to dental erosion.
- Crohn's disease can manifest as orofacial granulomatosis and can be treated with corticosteroids.
- Eating disorders such as anorexia nervosa and bulimia nervosa can cause severe palatal erosion and swollen parotid glands.
- Angular stomatitis and mouth ulcers can be seen in iron-deficient anemia and Crohn's disease.
Endocrine System
- Diabetes mellitus can increase the extent and severity of periodontal disease and the prevalence of dental caries due to xerostomia.
- Burning mouth syndrome, candidal infections, altered taste sensation, altered tooth eruption, and hypertrophy of the parotid glands are oral manifestations of endocrine disorders.
- Acromegaly is characterised by spacing of lower incisor teeth, widening of the mandible, visual field defects, headaches, and diabetes.
- Arthralgia and Carpal Tunnel Syndrome can impact oral hygiene practice, predispose to dental caries and periodontal disease, require enhanced prevention, and may need increased dose of steroids during dental treatment.
- Addisons disease is associated with skin hyperpigmentation, alabaster-colored pale skin, low blood pressure, postural hypotension, and increased pigmentation in palmer skin creases, nails, and gingiva.
- Skeletal disorders such as osteogenesis imperfecta (brittle bone disease), dentinogenesis imperfecta (affects teeth), and osteoporosis (decreased bone mineral density) have specific oral manifestations and may have a risk of medication-related osteonecrosis of the jaw (MRONJ).
Oral manifestations of systematic disease are signs and symptoms of disease occurring elsewhere in the body detected in the oral cavity and oral secretions. High blood sugar can be detected by sampling saliva. Saliva sampling may be a non-invasive way to detect changes in the gut microbiome and changes in systemic disease. Another example is tertiary syphilis, where changes to teeth can occur. Syphilis infection can be associated with longitudinal furrows of the tongue.
Mineral and vitamin deficiencies can cause the tongue to appear beefy red and feel sore. Those deficiencies are iron, folate, and vitamin B12. A hairy tongue may be an indication of Epstein Barr virus infection and is usually seen in those infected with human immunodeficiency virus. Other systemic diseases that can cause the tongue to form aphthous ulcers are: Crohn's disease and ulcerative colitis, Behcet's Syndrome, pemphigus vulgaris, herpes simplex, histoplasmosis, and reactive arthritis.
