Makindo Medical Notes

🦷 Medical conditions and dental health: Systemic diseases, drugs, and deficiencies can all leave characteristic oral signs. ⚠️ Persistent, unexplained oral lesions always warrant further investigation to exclude malignancy or systemic disease.

📖 About

• Many medical conditions impact oral health, producing characteristic oral manifestations.
• Understanding these links helps dentists and doctors work together for holistic patient care.

🧪 Common Medical Categories

• 🌍 Systemic conditions (e.g. diabetes, HIV, pregnancy, osteoporosis, cardiovascular disease)
• 🛡️ Autoimmune disorders (e.g. Sjögren’s, pemphigus)
• 🧬 Genetic conditions (e.g. amelogenesis imperfecta, dentinogenesis imperfecta, ectodermal dysplasia)
• 💊 Medications & treatments (e.g. phenytoin, bisphosphonates, fluorosis)
• 🍊 Nutritional deficiencies (e.g. scurvy, calcium deficiency)

🌍 Systemic Conditions

• Diabetes mellitus: periodontal disease, candidiasis, delayed healing.
• Osteoporosis: alveolar bone loss, ↑ risk of tooth loss, implant complications.
• HIV/AIDS: candidiasis, hairy leukoplakia, Kaposi sarcoma.
• Pregnancy: pregnancy gingivitis, ↑ periodontal risk → adverse pregnancy outcomes.
• Eating disorders: erosion from vomiting (bulimia), enamel hypoplasia (anorexia).
• Cardiovascular disease: drug-induced dry mouth (antihypertensives, β-blockers).

🛡️ Autoimmune Disorders

• Sjögren’s syndrome: severe xerostomia, rampant caries, candidiasis.
• Pemphigus vulgaris: fragile oral bullae, painful erosions, secondary infection risk.

🧬 Genetic Conditions

• Amelogenesis imperfecta: enamel defects, discoloured/pitted teeth.
• Dentinogenesis imperfecta: blue-grey or amber teeth, brittle with fractures.
• Ectodermal dysplasia: hypodontia, conical teeth, enamel hypoplasia.

💊 Medications & Treatments

• Fluorosis: enamel mottling, brown discolouration.
• Xerostomia-inducing drugs: antihypertensives, antidepressants, anticholinergics → ↑ caries & periodontal risk.
• Bisphosphonates: risk of osteonecrosis of jaw after extractions.

🍊 Nutritional Deficiencies

• Vitamin C deficiency (scurvy): bleeding gums, poor wound healing, tooth loss.
• Calcium deficiency: enamel hypoplasia, brittle teeth, alveolar bone weakness.

🔎 Classic Oral Signs & Systemic Links

• 🔵 Blue Burton’s line: lead poisoning.
• 🟤 Yellow/brown teeth: tetracycline use in childhood.
• 🦷 Hutchinson’s incisors: congenital syphilis (notched, peg-shaped).
• 🟤 Brown mottling: fluorosis.
• ⚫ Blue-black pigmentation: haemolytic anaemia.
• 🟣 UV-fluorescent dark teeth: congenital erythropoietic porphyria.
• 🤢 Erosion + halitosis: bulimia nervosa (acid exposure).

🔬 Investigations

• 🦷 Comprehensive dental exam (caries, enamel defects, periodontal health).
• 📷 Imaging: OPG/periapical X-rays; bone density scans if osteoporosis/bisphosphonates.
• 🧪 Labs: glucose, B12, folate, iron, calcium, HIV testing where appropriate.
• 🔬 Biopsy: suspicious leukoplakia/erythroplakia → exclude malignancy.

💊 Management

• 🎯 Treat the underlying disease: e.g. optimise diabetes, manage HIV, replace deficiencies.
• 🦷 Dental care: regular scaling, fluoride, restorations, sealants.
• 💊 Medication adjustments: avoid xerostomia-inducing drugs where possible; saliva substitutes/stimulants.
• ⚠️ Special caution: bisphosphonates → avoid extractions if possible; liaise with max-fax if surgery needed.

🌟 Prognosis

• Varies with underlying condition & timeliness of management.
• Early recognition of systemic-dental links prevents serious complications.
• Best outcomes with multidisciplinary care (dentist + GP + specialist).

📚 References

• Kumar, V., Abbas, A.K., & Aster, J.C. (2020). Robbins and Cotran Pathologic Basis of Disease (10th ed.).
• American Dental Association: Systemic Health and Oral Health
• Mayo Clinic: Dental Health and Systemic Diseases
• NIH & WHO Oral Health Resources.