Systemic Lupus Erythematosus

 Systemic lupus erythematosus (SLE) is an autoimmune disease. In this

disease, the immune system of the body attacks healthy tissues. It can
affect the skin, joints, kidneys, brain, and other organs.
Oral manifestations

Drug induced stomatitis and oral ulceration

Potential Problems Related to Dental Care

1. Systemic manifestations.

2. Possible bleeding tendency.

3. Infection susceptibility.

4. Adrenal suppression (taking corticosteroids).

5. Infective endocarditis (rare).

 Leukemia
Oral Manifestations
1. Infection. 2. Ulceration
3. Gingival bleeding 4. Ecchymoses
5. Petechiae 6. Gingival hyperplasia
7. Soft tissue and osseous lesions
8. Paresthesias—numbness, burning, tingling
9. Candidiasis 10. Lymphadenopathy
Oral Manifestations of leukemia
Potential Problems Related to Dental Care

1. Prolonged bleeding 2. Infection

3. Delayed healing
 Diseases which contra-indicate
any kind of dental treatment
 Leukemia: excessive hemorrhage after extraction, delayed wound
healing
 Hemophilia: decrease factor 8 lead to severe and fatal bleeding.
 Addison's disease: should be controlled by exogenous steroids
before surgery to avoid adrenal crisis which may be fatal.
 Hyperthyroidism "Toxic type" should be controlled at first to avoid
thyroid crisis.
 Congestive heart failure "advanced type".
Diseases which endanger dentist
 Diseases which require special precautions because of close
contact between the detnist and the patients on the dental
chair.
 Active tuberculosis is obviously a disease requiring special
precautions during dental operations. (Face mask, use
conventional speed not high speed, adequate sterilization).
 Recent history of infection of viral hepatitis should alert the
dentist to be cautions in contacting the patient's blood and
saliva directly, and to take special care to autoclave all
instruments to prevent transmission of the disease to another
patient.
Examination
Techniques
 The common basic techniques of examination are:

1- Visual inspection.

2- Palpation.

3-Percussion.

4- Probing.

5-Auscultation

6- Aspiration
 1- Inspection:
It is the technique of examination which uses the visual senses. By

inspection, assessment may be made of the colour of the skin and mucosa;

surface contours and proportions of the body and its parts; functional

movement, and various bodily states. Any deviation from normal should be

observed. Inspection of the mouth must be done in a systematic manner and

follow some plan or pattern.

2- Palpation:
It is the art of using the sense of touch to detect normal or alterations from normal
in tissue.

It can detect

1- the surface changes as dryness, roughness or smoothness or abnormal

temperature.

2-Consistency of any tissue or organ which may be soft, firm or hard.

The induration of tissues in cases of malignancy can be detected only by

palpation.
Digital palpation

one finger of the hand e.g hard palate exostosis or sharp margins.
Bidigital palpation:

Means manipulation of the tissues between two fingers of one hand

Bimanual palpation:

Means manipulation of the tissues by using the two hands or two

fingers of both hands. Bimanual palpation is used in examination

of the floor of the mouth.

 3- Percussion:
It is the technique of striking the tissues
with fingers or an instrument so that the
examiner may listen for the resulting sounds
and evaluate the response of the patient to this
procedure if painful or not.
secondary to pulp degeneration or trauma.
 Percussion of teeth is valuable for the
evaluation and localization of inflammation of
the periodontal membrane in cases of
periodontal disease (periodontitis, periodontal
abscess), periapical inflammatory reaction
A sound tooth with healthy periodontium will "feel" firm and resistant
and will produce solid sound on percussion, while teeth with
periodontal disease and sufficient bone destruction will "feel" soft or
will not be resistant to percussion and produce a dull sound.
 The technique of percussion of muscle and

bone consists of sharply tapping the area to be

tested with the tips of two or three fingers. This

method of percussion is of value in observing

muscle reflex mechanism, muscle tenderness,

hypertonicity of the muscles of mastication.

 4- Probing:
This technique is most commonly
used in the oral cavity. The most
obvious examples of this is the use of
dental explorer for detecting dental
caries and pulp exposure and the use
of calibrated periodontal probe in
measuring the depth of gingival
sulcus or periodontal pocket.
 5- Auscultation:
Auscultation is the act of
listening for sounds produced within
the body. It is used to detect
tempromandibular joint troubles such
as clicking and snapping (TMJ
Dysfunction syndrome) or clicking of
ill fitting dentures with porcelain
teeth.
6- Aspiration:
Aspiration is withdrawal of fluids
from a body cavity. The area aspirated
may be limited to soft tissues or may be
central in bone. The aspirate is the
material withdrawn. When nothing can
be withdrawn, the needle tip should be
moved to adjacent areas because
several attempts may be required to
obtain an aspirate.
In solid lesions such as neoplasms
with minimal vascular content, nothing may
be aspirated. Empty spaces, such as occur
in an air embolism or traumatic bone cysts,
have no aspirate or only a small amount of
blood-tinted fluid. Aspiration of pus
indicates an inflammatory process. The
aspirate may be used for culture and
sensitivity tests to identify the pathogen
and its best treatment.
 Straw-colored or blood-tinted fluid
may indicate a cyst, whereas the
aspiration of blood may have several
interpretations. If several milliliters of
blood are aspirated easily, a vascular
lesion such as a hemangioma should be
suspected. Aspiration of suspected
lesions is best performed under local
anesthesia with a large needle of 16 to
20 gauge.
Examination of the tongue

Examination of the lateral Proper use of the mirror to

borders of the tongue. aid in the examination.
Have the patient raise the tongue to the roof of the mouth to 
observe the ventral surface
 The tissues of the tongue should feel soft and resilient with no palpable 
indurations or masses. The clinician should identify the normal anatomy of the
tongue including:
Dorsal surface – papillae (filiform, fungiform, circumvallate), median sulcus, 
sulcus terminalis
Lateral borders – foliate papillae 

Ventral surface – lingual veins, plica fimbriata, lingual frenum 

Atypical findings on the dorsal surface of the tongue are common. They include: 
fissuring (Figure 52), scalloping (Figure 53), benign migratory glossitis (Figure 54)
and enlarged papillae, among others. A lingual thyroid may rarely be found on
the posterior dorsal surface at the foramen cecum. Lingual varicosities are a
common finding on the ventral surface of the tongue, especially in older
patients. The Glands of Blandin-Nuhn (minor salivary glands found on the ventral
surface of the tongue) may become enlarged prompting the need for a referral
or diagnostic procedure to confirm the origin.
Salivary duct stone
 these nodes should be small (less than 1 cm), non-tender and 
mobile. Remember to correlate findings from the medical history
and general appraisal of the patient to the observations made
during the head and neck examination. For example, a previous
history of cancer should cause the clinician to be more suspicious of
newly appearing palpable nodes than if there is no history of
cancer. If suspicious nodes are discovered, the patient should be
referred to a physician for immediate evaluation. Figures 11 through
18 depict the examination techniques for the following lymph
nodes.
 The major lymph nodes of the head and neck area should be palpated with
the patient in an upright position. Findings which should be noted in the patient
record include enlarged palpable nodes, fixed nodes, tender nodes and
whether the palpable nodes are single or present in groups. Single or multiple
non-tender, and fixed nodes are very suspicious for malignancy. Groups of
tender nodes usually occur in conjunction with some type of acute infection.
Tounge tie
Fissured tounge
Median rhomboid glossitis
 Median rhomboid glossitis is a condition characterized by an area of redness
and loss of lingual papillae on the central dorsum of the tongue, sometimes
including lesions of the tongue and palate. It is seen in patients using inhaled
steroids and smokers, and is usually a kind of chronic atrophic oral
candidiasis, but hematinic deficiency and diabetes should be excluded.[3]

 The lesion is usually symmetric, well demarcated, erythematous and

depapillated, which has a smooth, shiny surface
Stensen,s duct
Wartons duct
Geographic tounge
 Cranial nerves
 [Link]
 The olfactory nerve transmits information regarding
a person’s sense of smell to the brain.
 II. Optic nerve
 The optic nerve transmits information to the brain
regarding a person’s vision.
 III. Oculomotor nerve
 Theoculomotor nerve helps control muscle
movements of the eyes.
 IV. Trochlear nerve
 The trochlear nerveTrusted Source also has a role in
eye movement.
V. Trigeminal nerve

The trigeminal nerve is the largest cranial nerve and has

both motor and sensory functions.

Its motor functions help a person to chew and clench the

teeth. It also gives Trusted Source sensation to muscles in the
tympanic membrane of the ear.

Its sensory division has three parts that connect to sensory

receptor sites on the face:
.
The ophthalmic part gives sensation to parts of the eyes, including
the cornea, mucosa in the nose, and skin on the nose, the eyelid,
and the forehead.

The maxillary part gives sensation to the middle third of the face,
side of the nose, upper teeth, and lower eyelid.

The mandibular part gives sensation to the lower third of the face,
the tongue, mucosa in the mouth, and lower teeth.

Trigeminal neuralgia is a common disorder of the trigeminal nerve

that can cause intense pain and facial tics.
VI. Abducens nerve

The abducens nerve also helpsTrusted Source control eye movements.

VII. Facial nerve

The facial nerve also has both motor and sensory functions.

The facial nerve is consists ofTrusted Source four nuclei that serve different functions:

movement of muscles that produce facial expression

movement of the lacrimal, submaxillary, and submandibular glands

the sensation of the external ear

the sensation of taste

The four nuclei originate in the pons and medulla and join together to travel to the
geniculate ganglion.

Bell’s palsy is a common disorder of the facial nerve, which causes paralysis on one side of
VIII. Vestibulocochlear nerve

The vestibulocochlear nerve helpsTrusted Source with a person’s hearing and balance.

IX. Glossopharyngeal nerve

The glossopharyngeal nerve possessesTrusted Source both motor and sensory functions.

The sensory function receives information from the throat, tonsils, middle ear, and back of
the tongue. It also has a role in the sensation of taste on the back of the tongue.

The motor division provides movement to the stylopharyngeus, a muscle that allows the
throat to shorten and widen.

The glossopharyngeal nerve starts in the medulla oblongata in the brain and leaves the
skull through the jugular foramen, which leads to the tympanic nerve.
X. Vagus nerve

The vagus nerve hasTrusted Source a range of functions, providing

motor, sensory, and parasympathetic functions.
XI. Accessory nerve

The accessory nerve providesTrusted Source motor function to some

muscles in the neck.
XII. Hypoglossal nerve

The hypoglossal nerve is a motor nerve that suppliesTrusted Source the

tongue muscles. It originates in the medulla.

Disorders of the hypoglossal nerve can cause paralysis of the tongue,

most often occurring on one side.