Oral Manifestations of Systemic Diseases: Updated Clinical Review

Systemic diseases affect more than internal organs—they often present oral signs that can be essential for early diagnosis.

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Due to its high vascularity and immune role, the oral cavity frequently reflects systemic conditions. In modern dentistry, recognizing these signs is key to preventive care and interdisciplinary treatment.

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✅ Systemic Diseases and Their Oral Manifestations

1. Diabetes Mellitus
➤ Definition: A chronic metabolic disorder characterized by persistent hyperglycemia.
➤ Oral manifestations:
° Xerostomia (dry mouth)
° Advanced periodontal disease
° Delayed wound healing
° Oral candidiasis
➤ Common signs and symptoms: Gingival bleeding, tooth mobility, halitosis, recurrent oral infections.

2. Iron Deficiency Anemia
➤ Definition: A lack of iron leading to decreased oxygen-carrying capacity of the blood.
➤ Oral manifestations:
° Pale oral mucosa
° Atrophic glossitis (smooth, sore tongue)
° Angular cheilitis
➤ Common signs and symptoms: Burning sensation in the mouth, altered taste, oral ulcers.

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3. HIV/AIDS
➤ Definition: Infection caused by the human immunodeficiency virus, impairing the immune system.
➤ Oral manifestations:
° Pseudomembranous candidiasis
° Kaposi's sarcoma
° Oral hairy leukoplakia
° Necrotizing gingivitis/periodontitis
➤ Common signs and symptoms: White lesions, persistent ulcers, oral pain, gingival bleeding.

4. Systemic Lupus Erythematosus (SLE)
➤ Definition: A multisystem autoimmune disease affecting connective tissues.
➤ Oral manifestations:
° Painless oral ulcers
° Erythematous or purpuric lesions
° Xerostomia (often secondary to Sjögren’s syndrome)
➤ Common signs and symptoms: Mild pain, difficulty chewing, mucosal and lingual changes.

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5. Chronic Kidney Disease (CKD)
➤ Definition: Progressive, irreversible loss of kidney function.
➤ Oral manifestations:
° Uremic breath odor
° Oral ulcerations
° Gingival bleeding
Enamel hypoplasia (especially in children)
➤ Common signs and symptoms: Metallic taste, oral pain, delayed tooth eruption in children.

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✅ Recommendations for Dental Practice

° Conduct thorough medical histories that screen for systemic illnesses.
° Treat oral signs as potential indicators of undiagnosed systemic disease.
° Work collaboratively with physicians for interdisciplinary care.
° Educate patients on the oral-systemic health connection.
° Schedule frequent cleanings and periodontal evaluations for at-risk patients.

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💡Conclusions
Oral signs of systemic diseases serve as critical indicators for early diagnosis and comprehensive treatment. Timely recognition of these signs can improve patient outcomes, reduce complications, and enhance quality of life. Dentists play a key role in identifying these manifestations and guiding patients to appropriate medical care.

📚 References

✔ Chávez, E. M., et al. (2022). Oral health considerations in patients with chronic kidney disease. Journal of Clinical Nephrology and Renal Care, 8(1), 110. https://doi.org/10.23937/2572-3286.1510110

✔ Kottoor, R., et al. (2020). Oral manifestations in patients with systemic lupus erythematosus. Lupus, 29(3), 274–281. https://doi.org/10.1177/0961203320903073

✔ López-López, J., et al. (2021). Oral manifestations of iron deficiency anemia: A clinical approach. Clinical Oral Investigations, 25(1), 123–130. https://doi.org/10.1007/s00784-020-03418-z

✔ López-Pintor, R. M., et al. (2020). Diabetes mellitus and oral health: A bidirectional relationship. Medicina Oral, Patología Oral y Cirugía Bucal, 25(4), e559–e566. https://doi.org/10.4317/medoral.24012

✔ Patton, L. L., et al. (2021). Oral manifestations of HIV infection and treatment: A clinical guide. Oral Diseases, 27(S1), 59–68. https://doi.org/10.1111/odi.13742

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