Periodontal changes and hemorrhagic manifestations
The state of the tooth-supporting apparatus and gingiva is sensitive to hemostatic disorders and endocrine imbalances.
- Cushing's syndrome: Characterized by severe periodontal disease against the background of cerebral-pituitary pathologies. The mucosa of the alveolar processes becomes edematous and cyanotic. Gingival atrophy develops, deep periodontal pockets with suppuration form. X-rays reveal jaw osteoporosis, thinning of the cortical plate, widening of the periodontal ligament space, and resorption of interdental septa.
- Glanzmann's thrombasthenia: Genetic weakness of the platelet system. Manifests as gingival bleeding, epistaxis, and mucosal hemorrhages. Meanwhile, the platelet count and clotting time remain within normal limits, but clot retraction time is increased.
- Hemorrhagic diatheses: In Werlhof's disease, multiple petechiae and extensive hemorrhages suddenly appear in the oral cavity without signs of mucosal inflammation. A similar picture with recurrent submucosal petechiae and bleeding is characteristic of Wiskott-Aldrich syndrome (combined with chronic eczema).
- Gregg-Swan syndrome: Caused by maternal rubella in early pregnancy. The child exhibits gingivitis, delayed tooth eruption, and caries against the background of ocular and cardiac lesions.
Ulcerative, aphthous, and hyperkeratotic lesions of the oral mucosa
The oral mucosa frequently becomes a target in dermatoses and autoimmune pathologies.
- Behcet's syndrome: A severe disease in which oral mucosal lesions usually present as the first symptom. Small, sharply painful aphthae appear with a yellowish-gray coating and a bright pink halo. Large ulcers can lead to cicatricial deformity of the tongue.
- Grinspan-Potekaev syndrome: Includes the erosive-ulcerative form of lichen planus occurring against the background of diabetes mellitus and arterial hypertension.
- Wegener's granulomatosis: In the early stages, a necrotic process is triggered in the oral and nasal cavities. Patients experience sharp pain and burning. The palate becomes covered with telangiectasias, and the lips pucker. Later, necrosis spreads to the osteocartilaginous skeleton and internal organs.
- Bergeron's syndrome: Exfoliative marginal glossitis, occurring predominantly in children. Constantly migrating foci ("geographic" contours) with a whitish border appear on the bright red tongue against the background of papillary atrophy.
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Specific lip lesions and precancerous conditions
A number of symptom complexes require special oncological vigilance.
- Bowen's disease: An atypical precancerous dermatosis. Moist, reddish lesions covered with crusts and scales form on the mucosa, outwardly mimicking leukoplakia.
- Manganotti's syndrome: Precancerous erosion localized in the middle third of the lower lip (occurs mainly in men). The erosion lacks a firm base infiltration but frequently degenerates into epithelioma.
- Beals' syndrome: Deep lip inflammation with the formation of slowly deepening ulcers. Accompanied by salivary gland swelling, profuse salivation, and severe pain. The lower lip reflexively everts. Congenital forms are regarded as precancerous.
- Ascher's syndrome: A classic triad of unclear etiology: lip thickening with fold formation (mucosal duplication), drooping of the atrophic skin of the upper eyelids, and a mild goiter.
Hard dental tissue anomalies
Genetic and infectious factors are capable of shaping unique defects of the dentofacial system.
- Capdepont's syndrome: Hereditary hypoplastic dentinogenesis. Teeth have a brown or gray-blue color. Enamel is extremely fragile and rapidly chips during mastication, leaving exposed but non-sensitive dentin. X-rays show poor calcification, hypercementosis, and shortened roots.
- Hutchinson's syndrome: A marker of late congenital syphilis. Deformation of the upper central incisors, pronounced enamel hypoplasia, and susceptibility to caries are noted.
- Dubreuil-Chambardel syndrome: An atypical form of caries starting at age 14–17. The process affects exclusively the upper incisors and progresses until their complete destruction, after which it spreads to other teeth.
Other important conditions in practice
- Quincke's edema: Angioedema. Acute swelling of the face and lips. When spreading to the tongue, buccal mucosa, and epiglottis, it poses an immediate threat of asphyxia.
- Cowden syndrome: Multiple firm papules up to 3 mm in diameter grow on the gums, tongue, and cheeks, sometimes with signs of keratinization.
- «Tooth angina» syndrome: Pain on swallowing caused by difficult eruption of lower wisdom teeth. Inflammation spreads to the parapharyngeal space and lymph nodes.
- Zablotsky-Desyatovsky syndrome: A diagnostic sign of acute maxillary sinusitis. After blowing the nose, upon tilting the head forward and turning it toward the healthy side, pus is again visualized in the middle meatus.
Briefly: answers to topical questions
What are the clinical manifestations of Wiskott-Aldrich syndrome in the oral cavity?
The clinical manifestations of Wiskott-Aldrich syndrome affecting the mucous membranes are associated with recurrent thrombocytopenic purpura:
- multiple submucosal petechiae;
- ecchymoses;
- bleeding from the mucous membranes.
Additionally, the clinical picture of the syndrome includes chronic eczema, dystrophy, and allergic facial dermatitis. The disease is hereditary and associated with immunodeficiency.
How to memorize
The Grinspan-Potekaev triad is the rule of «Three Ds»: Dermatosis (ulcerative lichen), Diabetes, Pressure (arterial hypertension).
Class and exam questions
What radiological signs of periodontitis are observed in Cushing's syndrome?
Osteoporosis of the alveolar processes, thinning of the compact lamina, widening of the periodontal ligament space, and uniform atrophy of the interdental septa are detected.
What are the clinical manifestations of Capdepont's syndrome?
This is odontodysplasia, in which teeth turn gray-blue or brown. The enamel chips easily, while the dentin remains insensitive. It is accompanied by bite anomalies and root shortening.
What is the primary sign of Behcet's syndrome?
The disease typically manifests in the oral cavity. Small aphthae appear on an infiltrated base with a bright pink halo and a yellowish-gray coating.
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What else to study on this topic
- Congenital maxillofacial anomalies (Down, DiGeorge, Klippel-Feil syndromes).
- Mucocutaneous pigmentations and hemangiomatoses (Maffucci, Bandler syndromes).
- Manifestations of immunodeficiency states in the oral cavity (Down-Wiseman, Wiskott-Aldrich syndromes).
- Specific tongue changes (rhomboid glossitis in Brocq-Pautrier syndrome).
- Temporomandibular joint dysfunction (Costen syndrome).
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Other topics in "Chapter 15. Semiotics in Dentistry"
Symptomatology of hard dental tissue lesionsSymptomatology of pulp and periodontal diseasesSymptomatology of oral mucosal diseasesSymptomatology of jawbone and TMJ diseasesCosten syndrome
The entire section "Chapter 15. Semiotics in Dentistry"Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.