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DABOM: Oral Manifestations of Systemic Disease and Medical Management

DABOM · Work through your exam, one topic at a time.

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Oral Manifestations of Systemic Disease and Medical Management

Domain 6 tests whether you can recognize oral signs of systemic disease and modify dental management accordingly. The exam favors questions that link a mucosal or periodontal finding to an underlying condition, medication, or organ failure.

Endocrine disease

  • Diabetes mellitus is associated with periodontal disease, candidiasis, xerostomia, delayed healing, and lichenoid reactions; optimize glycemic control before elective surgery.
  • Hypothyroidism can cause macroglossia and delayed eruption; hyperthyroidism may be associated with osteoporosis and caries.
  • Cushing syndrome causes moon facies and hypertension; Addison disease causes hyperpigmentation.

Hematologic disease

  • Iron deficiency anemia causes angular cheilitis, glossitis, and pallor.
  • B12 or folate deficiency causes glossitis, aphthae, and neurologic findings.
  • Leukemia may present with gingival hyperplasia, petechiae, and ulceration.
  • Thrombocytopenia causes petechiae and purpura.

Gastrointestinal and renal disease

  • Crohn disease causes cobblestone mucosa, linear ulcers, skin tags, and fistulae.
  • Ulcerative colitis may cause aphthae and pyostomatitis vegetans.
  • GERD is associated with erosion and halitosis.
  • Renal failure causes uremic stomatitis and requires drug dose adjustment.

Infection and nutrition

  • HIV infection causes candidiasis, hairy leukoplakia, Kaposi sarcoma, and periodontal disease.
  • Syphilis causes a chancre, mucous patches, and gumma.
  • Scurvy causes gingival bleeding; vitamin deficiencies affect mucosal integrity.

Worked example

A 40-year-old man has recurrent aphthae, fatigue, diarrhea, and weight loss. The differential includes Crohn disease, celiac disease, B12 or folate deficiency, iron deficiency, and HIV. Order CBC, ferritin, B12, folate, celiac serology, and HIV testing; refer to gastroenterology. Treating the ulcers with topical steroids without investigating the cause would delay diagnosis.

Traps that cost marks

  • Missing HIV infection when oral candidiasis or hairy leukoplakia is present.
  • Failing to adjust drug doses in renal or hepatic disease.
  • Labeling recurrent oral findings as idiopathic.
  • Missing leukemia in a patient with gingival hyperplasia and petechiae.
  • Performing elective surgery without controlling diabetes.