"Hair-on-end" appearance of the surface of the skull is a radiological feature of What is your answer

1. Congenital hemolytic jaundice

2. Chronic iron deficiency anemia 1. Saw tooth rete pegs
Good 2. Hugging pattern inflammatory cells
morning 3. Thalassemia
3. Hydropic / Basal cell degeneration are histological features of
4. Secondary polycythemia of cyanotic congenital heart
disease A. Oral graft-versus-host disease (GVHD)
5. Sickle cell anemia B. lichenoid drug reaction
C. lichenoid amalgam reaction
D. Lichen Planus

Polycythemia Vera Usually, asymptomatic.

If symptoms occur:
• The cause remains unknown
• pruritis(itchy skin)
• chronic myeloproliferative disease • vertigo(dizzy)
• characterized by a predominant proliferation of the Clinical • gastrointestinal pain
• headache
erythroid cell line and primary bone marrow dysfunction Manifestations • paresthesias
that results in hemorrhage, thrombosis, and increased RBC Clinical Manifestations
• fatigue, weakness
mass. • Can be • visual disturbances
• Both erythrocytes and megakaryocytes play essential roles in • tinnitus,
causing complications of the disease • plethora(an excess of a bodily fluid, particularly
blood)

Rare with less than 30 years

Pernicious Anemia Triad: Oral Manifestations

1]weakness
• PATHOGENISIS: UNKNOWN
• Glossitis
• Atrophy of gastric mucosa resulting in 2]painful tongue • Painful and burning sensations
failure to secrete the "intrinsic factor." Clinical
Supposedly, this "intrinsic factor" is a • Tongue is generally inflamed, "beefy red" in
3]Numbness and tingling of extremities color
substance present in normal gastric
juice which is responsible for Loss of appetite, weight. • Shallow ulcers resembling aphthous ulcers
absorption of vitamin B12 the person occur on the tongue.
with this fail to absorb vitamin B12. Nausea, vomiting, abdominal pain • Loss or distortion of taste
Diagnosis/Investigations Cause Cause

• Measurement of serum vitamin

B12 levels

• Schilling test: serologic testing

for parietal cell and intrinsic
factor antibodies.
• (which measures cyanocobalamin absorption by increasing urine
radioactivity after an oral dose of radioactive cyanocobalamin)

Cause Cause
• The Pathologic:
Two major categories: physiologic and pathologic. • excessive blood loss
The physiologic : • hemorrhoids, peptic ulcers, esophageal varices, or carcinoma or from
1. Nutritional deficiency/Inadequate diet excess uterine bleeding in women.
2. Menstrual iron losses • increased gastrointestinal blood loss from chronic use of aspirin or
other NSAIDs
3. Pregnant women
4. Malabsorption Clinical Manifestations

• Glossitis and stomatitis are recognized oral manifestations of

Clinical Manifestations anemia Investigations/ Definitive
• Dietary iron deficiency anemia or anemia of chronic disease
should be suspected in every case of Diagnosis
Chronic fatigue 1. glossitis
2. Glossodynia/burning mouth
pallor of the conjunctivae, lips, and oral mucosa, Delayed healing Oral 3. angular cheilitis
1. Peripheral blood smear
Manifestations 4. erythematous mucositis/generalized oral mucosal atrophy 1. bone marrow
2. Complete blood count
brittle nails with spooning, cracking, and splitting of nail beds 5. oral candidiasis for RBC iron
6. recurrent oral ulcers 2. Serum ferritin
3. Complete blood count
palpitations, Shortness of breath, 7. pale oral mucosa Hb 3. serum
8. atrophic changes of the tongue, giving a smooth red tongue transferrin
appearance /atrophy of the dorsal tongue papillae 4. mean corpuscular
hemoglobin receptor
numbness and tingling in fingers and toes, and bone pain. concentration
 Plummer-Vinson syndrome
Agranulocytosis
• PV is a rare syndrome
with the classic triad • Reduced quantity of Leukocytes
• It is often classified with etiology
1. Dysphagia • Primary: unknown
2. Iron deficiency anemia • Secondary: drugs
• Anti-neoplastic, antibiotics, anti-convulsants, anti-
3. Upper esophageal
If don’t eat …….. webs or strictures
inflammatories,
phenothiazines
anti-thyroid agents, diuretics, and

• Any age, F>M

• More common with health professions: easy asses of drugs

ORAL CONSIDERATIONS

• cervical lymphadenopathy
• Oral infections, and oral ulcers.
• Spontaneous gingival bleeding is common when the platelet
count falls below 20,000/mm3

•Rapid loosing of teeth due to necrosis of PDL

So..
•Gingival bleeding AND hyperplasia
24

Oral manifestations
Hair on end appearance, Step ladder Seen in the diploic space on skull radiographs, and has the appearance of long, thin vertical
striations that look like hair standing on end
Similar appearances can be seen at magnetic resonance (MR) imaging and computed
tomography .

Sickle cell anaemia Thalassemia

Enamel hypomineralization Bi maxillary Prognathism

Pallor

• Teeth – delayed eruption

• pallor of the oral mucosa
• Osteomyelitis – due to hypovascularity of bone marrow

• Interruption of blood supply can result in an anesthesia of inferior alveolar nerve.

• Pulpal necrosis 25
Investigation/ Diagnosis Oral Health Considerations: IDA
• The HbS solubility test (Sickledex) Kyphosis Class II short roots

• Prenatal screening by (DNA) 1. For dental patients with extremely low hemoglobin levels, physician
analysis of amniotic fluid at 14 to consultation prior to surgical treatment is recommended
16 weeks can be ordered to 2. general anaesthesia should be avoided
investigate alterations and
3. clinical bleeding
mutations in the genes that
produce hemoglobin components 4. faulty wound healing
Taurodontism Thin Lamina dura & Enlarged bone marrow spaces
5. increased risk for ischemic heart disease
Thalassemia 29

Leukemia diffuse gingival enlargement

Pennies on a plate “popcorn cell”

Radiographic features
• Displacement of teeth and tooth buds by the
enlarging tumor, resulting in the impression of
“teeth floating in air,” and “sun-ray”
sun ray appearance on x-ray is seen in
• Ewing sarcoma
Reed-Sternberg cell • Hemangioma
Multinucleated/Hodgkin’s Lymphoma/Disease
• Osteosarcoma
DD

• Fibroma
• peripheral giant cell granuloma (RED/ dark)
• peripheral ossifying fibroma
• Hemangioma (RED/ dark)
• Lipoma (yellow)
• Peripheral odontogenic tumour
• Oral focal mucinosis
• Kaposi's sarcoma (RED/ dark)
• bacillary angiomatosis

• non-Hodgkin’s lymphoma

• metastatic cancer may present as a red gingival mass

• Langerhans Cell Histiocytosis (RED/ dark)

Biopsy findings are

definitive in establishing
Herring bone
the diagnosis.

Who am I?
Malignant tumor of Blood vessel? ?? ; deeper examples may appear pink.

Enlarged fungiform papillae

??

Radiologically: ( NF1) Neurilemmoma (schwannoma)

• enlarged mandibular foramen
• Enlargement or branching of the mandibular canal
• Increase in dimension of the coronoid notch.
??? ???

Just like
that……

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harder you study,
the luckier you'll
get!”