Symptomatology of oral mucosa diseases

Pathologies with pronounced tongue changes

Many systemic diseases manifest with specific glossitis that alters the relief, color, and sensitivity of the tongue.

• Moeller-Hunter (Hunter) syndrome. Classic exfoliative glossitis, a marker of pernicious anemia, sprue, or pellagra. It begins with bright red spots on the tip and lateral margins of the tongue, accompanied by severe burning during eating. In the advanced stage, the tongue becomes smooth and glossy ("lacquered") due to atrophy of the papillae. Dysgeusia (taste distortion), flaccidity of the tongue with dental impressions on the margins, and complete absence of coating are characteristic. The gums are not involved.
• Melkersson-Rosenthal syndrome. Manifests with the classical triad: granulomatous cheilitis (lip swelling), facial nerve palsy, and plicated macroglossia. The combination of severe tongue swelling and deep folds produces a specific "cobblestone" sign.
• Plummer-Vinson syndrome. A precancerous condition occurring almost exclusively in women, associated with iron and B vitamin deficiency. It manifests as sideropenic dysphagia, Hunter's glossitis, mucosal pallor, cheilitis, and multiple chalky spots on dull tooth enamel.

Vascular and pigmented disorders

A group of hereditary and congenital dysplasias characterized by vascular or pigmented formations on the oral mucosa.

• Osler and Rendu-Osler syndrome. Multiple hereditary telangiectasias and small angiomas. In the oral cavity, they are localized on the lips, tongue, and buccal mucosa. These lesions frequently bleed, leading to secondary posthemorrhagic anemia.
• Peutz-Jeghers-Touraine syndrome. A hereditary phacomatosis characterized by brownish-yellow or bluish-brown pigmented spots (lentiginous elements) on the vermilion border of the lips and the oral mucosa. This sign is always associated with widespread gastrointestinal polyposis.
• Sturge-Weber-Krabbe syndrome. Encephalofacial neuroangiomatosis. Characterized by a unilateral facial port-wine stain (nevus flammeus), angiomas on the lips and gums, as well as glaucoma and epileptiform seizures.
• Recklinghausen syndrome. Neurofibromatosis characterized by café-au-lait skin spots and axillary freckling. Soft, purplish-pink, dome-shaped neurofibromas appear on the tongue, lips, and cheeks in the oral cavity (in 5–10% of patients).

Gum and dental lesions in systemic diseases

Specific changes in hard dental tissues and periodontium often serve as the key to diagnosing complex genetic and metabolic syndromes.

• Papillon-Lefèvre syndrome. Combines marked palmoplantar keratoderma with severe periodontal disease. Patients exhibit pathological periodontal pockets, abscesses, and massive caries. In adults, this inevitably leads to tooth loss.
• Papillon-Léage-Psaume syndrome (oral-facial-digital syndrome). A complex of anomalies including hypertelorism, short lips, and mandibular hypoplasia. Oral findings include an immobile lobulated tongue, cleft teeth, frequent enamel absence, multiple caries, and labial frenulum hypertrophy.
• Stainton-Capdepont syndrome. Manifests as almost complete absence of tooth enamel. The exposed dentin has a yellow-brown color and reduced hardness.
• Mikulicz's disease. Systemic reactive swelling of the salivary and lacrimal glands. Their atrophy leads to severe xerostomia (dry mouth) and, consequently, multiple caries.

Severe dermatoses and reactions involving the oral cavity

Mucosal changes frequently accompany systemic dermatological pathologies and acute allergic reactions.

• Stevens-Johnson syndrome. An extremely severe form of erythema multiforme exudativum with acute intoxication and fever up to 40 °C. Oral mucosal involvement makes speech and eating practically impossible.
• Sézary syndrome. Malignant reticular erythroderma. The oral mucosa becomes bright red, and telangiectasias appear on the palate. Patients complain of sharp pain and severe burning; the lips are dry and wrinkled.
• Vesiculovascular syndrome. Occurs in cardiac patients. Following trauma, blisters with hemorrhagic content form on the mucosa. A key diagnostic criterion is a negative Nikolsky's sign. Erosions after blister rupture epithelialize very rapidly (within 1–2 days).
• Miescher syndrome (I). Chronic inflammatory macrocheilia of allergic or tuberculous etiology. The lips swell sharply but retain their elasticity. The tongue and cheeks may be involved.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Neurological syndromes with maxillofacial manifestations (Sluder, Riley-Day).
• Hereditary dyskeratoses and their mucosal manifestations (Mendes da Costa, Siemens).
• Specific manifestations of fluorosis and the effect of excess fluoride on the gastrointestinal tract (Spira syndrome).
• Abortive form of neurofibromatosis (Leschke syndrome) and the "electric doorbell button" sign.
• Jaw and tooth crown developmental anomalies in mucopolysaccharidoses (Morquio syndrome).

Other topics in "Chapter 15. Semiotics in Dentistry"

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