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Multidisciplinary model of Healthcare
Having a dry mouth, when salivary glands don't make sufficient saliva to prevent the drying of the mouth
Small superficial lesions that appear in the soft tissues of the mouth or at the base of the gums
It is a gum disease that causes irritation, redness and swelling
Permanently damaged areas in the hard surface of your teeth that develop into tiny openings or holes
Patients who suffer from certain types of heart conditions are at risk for developing infective endocarditis (IE) after undergoing invasive dental procedures
caused by the colonization of bacteria in the heart that reach transient high levels in the bloodstream after soft-tissue manipulation during dental procedures.
patients with certain types of heart conditions be treated prophylactically with antibiotics prior to the dental procedure to prevent IE
Gingival and periodontal lesions
antihypertensive drugs can often cause side-effects, such as xerostomia, gingival overgrowth, salivary gland swelling or pain, lichenoid drug reactions, erythema multiforme, taste sense alteration, and parasthesia.
Ischemic Heart Disease
Gingival hyperplasia due medication
Calcium channel blockers cause gingival hyperplasia in some patients
Periodontitis is related
It is most commonly related to the common COPD pathogen invasor Pseudomonas aeruginosa which excretes 2-amino acetophenone --> Causing halitosis or "bad breath". (Tungare S, Zafar N, Paranjpe AG, 2021).
It is an exclusively lesion in tobacco smoker, caused by the concentrated heat stream of smoke from tobacco products. It is generally asymptomatic or slightly irritating. (Cade, J, 2022)
Extrinsic tooth stains
Mainly caused by nicotine and tar y chronic smokers, The nicotine and tar from smoking seeps into the tooth's enamel through tiny pores, leaving the teeth discolored. The tar adds a brown tinge to the teeth while the nicotine, when combined with oxygen, causes yellowing.
COPD patients commonly have reduced salivary secretions due to the commonly used drugs for treating COPD + colonization of Methicillin-resistan staphylococcus aureus and Pseudomonas aeruginosa due to antibiotic suppression of the normal oral bacteria --> Bacterial pneumonia can subsequently result from aspiration of these organisms.Patients with an exacerbation of chronic bronchitis commonly have anaerobic Fusobacterium nucleatum and Prevotella bacterias too. (Devlin J. 2014). Also, the decrease in oxygen in the bloodstream caused by smoking inhibits proper gum healing.
The anaerobic bacteria cause inflammation and accumulation of neutrophils using different mediators and enzymes which destroy connective tissue, If periodontitis is left untreated--> there will be loss of support of the teeth--> loss of the teeth. (Spiropoulou, A. et al, 2017)
Oral cavity squamous cell carcinoma
Smoking is the principal risk factor for this type of carcinoma. The main characteristic of COPD is systemic inflammation which may directly contribute to oral epithelium with genetically altered keratinocytes. Stem/progenitor cells in the basal cell layer of oral epithelium will acquired genetic changes that can suffer an initial transformation which may have clonal expansion of clones of precancerized cells, manifesting as leukoplakia or as erythroplakia. (Bouckaert M, et al, 2016)
If it has already become malignant, it can be seen as a necrotic ulcer with irregular raised indurated borders or as a broad-based exophytic mass with a surface texture that can be relatively smooth, verrucous or pebbled (Bouckaert M, et al, 2016).
Premalignant mucosal lesions: Leucoplakia
Premalignant mucosal lesions: Erythroplakia
Main causes of COPD: It is a chronic inflammatory disease in the lungs that causes obstructed airflow from the lungs, it's main causes are related to long-term exposure to irritants that damage your lungs and airways. Being cigarrete exposure the number 1 cause.
Nicotine promotes the effect on Streptococcus mutans growth, metabolic activity, cell aggregation, acids production and EPS synthesis. Streptococcus mutans is a crucial pathogen involved in the formation of dental caries. (Liu, S., et al, 2018)
Bluish-purple macules and plaques on the oral mucosa (hard palate, gingiva and tongue are most commonly affected).
is a microorganism that is normally found in the lining of the mouth, however in immunocompromised patients it tends to proliferate excessively and cause severe symptoms, generally
white patches on the tongue or inside the cheeks
Hairy leukoplakia of the lateral borders of the tongue
virus. White, hyperplastic, corrugated lesion on the lateral border of the tongue. Might be an early indicator of immunocomprimissed system.
Infectious mononucleosis is characterized in patients with HIV by the high risk of presenting more notorious symptoms, among them pharyngitis and palatine petechiae.
It presents as vesicles on the buccal mucosa, which usually ulcerate forming erosions with stellate and erythematous edges. They are usually painful and heal in 8-10 days.
Linear gingival erythema
and very characteristic in HIV patients. It lesions affect only the gingiva of the anterior teeth, and might be accompanied with discomfort and bleeding.
. It presents as painful ulcers that persist for several weeks, they can be found anywhere on the oral mucosa but are usually more common on the tongue, palate and buccal mucosa.
Painful punched-out sores on oral mucosa.
Necrotizing ulcerative periodontitis
It is the most serious form of periodontal disease in HIV.It is characterized by soft tissue loss due to ulcerations and/or necrosis, and its most severe presentations shows teeth loss.
Syphilis oral warts
Salivary gland enlargement
Some forms of presentation
Signs of mouth cancer may include red sores that do not heal.
Mouth cancer can present as a sore on the lip that does not heal.
Signs of mouth cancer may include bleeding, swelling, white patches, or redness in the mouth.
Intraoral melanoma in the upper maxillary gingiva. The main lesion in the premaxillary gingiva stands out, with satellite lesions in the vestibular mucosa and palatine raphe.
Melanoma of the intraoral mucosa in the hard palate (typical location). The purplish-black color of the main lesion predominates with browner foci of satellite lesions in the posterior palatal region.
Primary oral manifestations
Localized or generalized gingival inflammation, sometimes even accompanied by gingival hyperplasia due to extramedullary neoplastic infiltrations of the oral mucosa. Greenish lymphatic tumor masses that appear in the oral mucosa and are called "chloroma". Destruction of the alveolar bone with mobility, pain or displacement of the teeth. Cervical lymphadenopathy. Dental pain sometimes due to leukemic infiltration of the pulp.
Secondary oral manifestations
Pale mucous membranes. Oral mucosal erythema or cyanosis. Painful and even necrotic erosions and ulcerations. Hemorrhages, petechiae or bruises at the slightest trauma (even from chewing food). Proliferation of bacterial, viral and fungal infections. Recurrent yeast infections are common at this point, as are herpetic gingivostomatitis or necrotizing ulcerative gingivitis (NUG). Hairy leukoplakia, proliferation of viral warts or even necrosis due to the presence of mucormycosis in the nasal cavity that progresses to the palate and oral cavity.
Devlin J. (2014). Patients with chronic obstructive pulmonary disease: management considerations for the dental team. British dental journal, 217(5), 235–237.
Tungare S, Zafar N, Paranjpe AG.(2021). Halitosis.StatPearls Retrieved on June 9, 2022 from
Cade, J.(2022). Nicotine Stomatitis(Smoker’s palate). Medscape. Retrieved on June 9, 2022 from
Spiropoulou, A., Lagiou, O., Lykouras, D., KiriakosKarkoulias, K., & Spiropoulos, K. (2017). Periodontitis and Chronic Obstructive Pulmonary Disease. In (Ed.), Insights into Various Aspects of Oral Health. IntechOpen.
Liu, S., Wu, T., Zhou, X., Zhang, B., Huo, S., Yang, Y., Zhang, K., Cheng, L., Xu, X., & Li, M. (2018). Nicotine is a risk factor for dental caries: An in vivo study. Journal of dental sciences, 13(1), 30–36.
Bouckaert M, Munzhelele TI, Feller L, Lemmer J, Khammissa RAG (2016) Should we continue intra-peritoneal chemotherapy in advanced ovarian cancer patients?. Integr Cancer Sci Therap. 3: DOI: 10.15761/ICST.1000207.