ORAL CAVITY- A SIGN OF SYSTEMIC DISEASES

The oral cavity is a unique site, due to the company of hard and soft tissues in close approximation. It has various functions like respiration, speech, mastication and digestion. It is a chief entrance point for many pathogens in the body. The oral cavity might well be thought as porthole to the body because oral manifestations escort many systemic diseases. In a lot of instances, oral involvement precedes the appearance of other symptoms or lesions at other locations. These oral manifestations must be properly predicted if the patient is to receive proper diagnosis and referral for treatment. A dentist thus can regularly be exposed to such conditions and play a key role in the diagnostic process of various systemic diseases. Apt knowledge of these oral manifestations is essential for early diagnosis, treatment and referral of cases. This article is proposed as a general overview of conditions that have oral manifestations but also involve other organ systems.


INTRODUCTION
The mouth is a reflection of health or disease, a guard or early caution system. As

Nutritional Deficiencies
Nutritional diseases are well thought-out to be the most common diseases, and also the most common diseases to go ignored. Due to rapid cell turnover of the oral mucosa, nutritional deficiencies may present earliest with oral manifestations the changes may occur in the color of the oral mucosa and also the papillae of the dorsum of the tongue in various nutritional deficiencies [4].

Hematological Disorders
The oral cavity may be the site of the major  [11]. It has the characteristic radiological finding of punched out lesions of the skull and jaw [12]. As the disease causes immunosuppression it may cause oral hairy leukoplakia and candidiasis [13,14] .Amyloid deposits when occurs in the tongue may lead to macroglossia [15]. lymphadenopathy [17].

Ulcerative colitis
Ulcerative colitis has been associated with destructive oral ulcerations resulting from immune-mediated vasculitis [18]. These are similar to aphthous ulcers, but appear less frequently than lesions of Crohn's disease.
Pyostomatitis vegetans characterized by multiple painless intraepithelial micro abscesses connecting in linear or serpentine tracks mostly on the labial mucosa, soft palate and ventral tongue may be seen.
Pyostomatitis gangrenosum is the extreme variant with large, long-lasting and destructive ulcers, which cause significant tissue scarring [19].

Celiac disease
This is a chronic intestinal disease caused by intolerance to gluten associated with poor 883 Journal of Medical Pharmaceutical and Allied Sciences (Vol-6_I-11_2017) 01; 879-891 digestion and absorption of the majority of nutrients and vitamins, which may affect both developing dentition and oral mucosa [20]. Enamel hypoplasia is the most common manifestation in untreated celiac children and adolescents [21].  [20].
Ulcers are the most common type of oral lesions presenting in a popular or erosive form, generally with an erythematous margin [24].

Anorexia & bulimia nervosa
The dentists and dental hygienists may be the first health care providers to assess the physical and oral effects of anorexia nervosa reactions of the oral mucosa [28].

Metabolic and Endocrine Disorders
Oral manifestations may result from abnormal hormonal regulation. in the oral soft tissue [3].

Diabetes mellitus
There are many oral manifestations of diabetes mellitus, some having been The long-standing lesions may produce significant cortical expansion [33].

Hypercortisolism
The patient may present with a variable

Dermatologic Diseases
In number of dermatologic diseases oral manifestations appear alone or prior to the generalskin changes. The environment of the oral cavity is subject to significant local irritation and thus may present the most significant signs and symptoms of the condition.

Lichen planus
The oral manifestations of lichen planus may occur weeks or months before the appearance of the skin lesions. The oral lesions are characterized by presence of striae of Wickham, and the clinical presentation may range from radiating white striae to vesiculobullous, atrophic, or erosive form [4].
Lesions involve the lips, buccal mucosa, palate, gingiva and floor of the mouth and appear as gray or yellowish-white plaques; as silvery white, scaly lesions with an erythematous base; as multiple papular eruptions, which may be ulcerated; or as small, papillary, elevated lesions with a scaly surface [4].

Erythema multiforme
Oral manifestations include hyperemic macules, papules or vesicles, which may become eroded or ulcerated and bleed freely. The tongue, palate, buccal mucosa and gingiva are commonly involved [4].

Stevens Johnson's syndrome
Oral lesions may be extremely severe and so painful that mastication is impossible.
Mucosal vesicles or bullae occur which rupture and leaves surfaces covered with a thick white or yellow exudate. The lips may exhibit ulcerations with bloody crusting and are painful [4].

Acanthosis nigricans
The tongue and lips are most commonly involved. There are papillomatous growths involving the dorsum of tongue, lips and buccal mucosa. Gingival enlargement is also seen [4].

Pemphigus
The bullae tend to rupture as soon as they The tongue can lose mobility and become smooth in appearance as the palatal rugae flatten [37]. Salivary hypo function can also be present, although usually to a lesser degree than in Sjogren's syndrome. Radio graphically, the periodontal ligament space is often thickened [1].

Lupus erythematosus
The oral lesions in the discoid form In up to 30% of patients with SLE, salivary gland involvement may occur concomitantly, leading to secondary Sjogren's syndrome and severe xerostomia [39].

Rheumatoid arthritis
The Temporomandibular joint (TMJ) is often involved in rheumatoid arthritis. This