Oral
Manifestations Related to Endocrine System
The gingivae and tongue frequently exhibit changes
during times of hormonal fluctuations. Marginal gingivitis characterized by
hyperemia producing a deep raspberry color of the gum margin, associated with
hyperplasia in the interdental papillae, is not uncommon during menstruation.
Poor oral hygiene resulting in increased debris is often a contributing cause.
In pregnancy, a chronic
marginal gingivitis is fairly common, beginning in the second month and often
continuing after delivery. Symptoms range from slight hyperplasia and bleeding
to mulberry-like swellings or fungoid proliferations, frequently called the
pregnancy tumor. Fibrous epulides occurring prior to pregnancy are markedly
stimulated in growth. Clinically, the gum shows proliferation of a granulation
type of tissue, which appears edematous and turgid. Histologically, there is
hydropic degeneration of the epithelium, loss of keratin, and proliferation of
rete pegs, with infiltration and fibrinous exudate in the corium.
Menopause is often accompanied by alterations in
taste and burning, dryness, and soreness of the oral mucosa, especially of the
tongue. Objective signs include papillary flattening, fusion, and glazing,
similar to vitamin B deficiency states, occasionally resembling the acute
redness and pebbly appearance of the mild pellagrous tongue. A special form of desquamative
gingivitis is sometimes associated with menopause, causing recurrent
denudation of the gingivae or buccal mucosa, which may be painful.
Increased pigmentation of the
skin and mucosal membranes is an early sign of Addison disease. This
pigmentation is caused by a deposition of melanin; it appears only in chronic
primary deficiency of the adrenal cortex and is not a result of insufficiency
from pituitary dysfunction. In the oral cavity, melanin may be deposited in the
mucosa of the lips, cheek, and tongue and along the gingivae. The color of the
pigmentation varies from a pale brown to a dark blue, depending on the
severity of the disease. Though produced by other mechanisms, increased
deposits of dark pigments along the oral mucosa occur in other conditions, such
as hemochromatosis, malaria, liver cirrhosis, alkaptonuria, and argyrosis.
Diabetes mellitus, in a controlled state, seldom pro- duces
characteristic lesions of the mouth. Mucosal findings in poorly controlled
diabetes may present as deeply reddened and dry, with an abundance of
calcareous deposits and soft detritus around the teeth. Pronounced gingival
recession, periodontal bone loss, ulceration, and loosening of teeth are other
associated phenomena. Acromegaly is caused by an excess of growth
hormone secretion, resulting in coarsening facial features and soft tissue
swelling of the hands and feet. Prognathism, or protrusion of the jaw,
is a consequence of overgrowth of the mandible. Additionally, oral features
seen in acromegaly include macroglossia, malocclusion of the teeth, and
widening of the dentition.
Multiple oral findings are
seen in children with hypothyroidism, including macroglossia caused by
an edematous infiltrate, edematous lips, and malocclusion. The deciduous teeth
are retained beyond the normal shedding time, resulting in a delay in tooth
eruption.
Multiple endocrine
neoplasia (MEN) is a term
encompassing several distinct syndromes each of which involves endocrine gland
tumors. Mucosal neuromas are a part of MENIIB (sometimes referred to as
MEN 3), which also includes medullary thyroid cancer, pheochromocytoma, and a
marfanoid body habitus. The mucosal neuromas are multiple asymptomatic, soft
painless papules or nodules that are most often present on the lips and tongue
but can also be found on the buccal mucosa, gingiva, and palate. The lesions
consist of hyperplastic bundles of nerves surrounded by thick- ened perineurium
situated within a normal submucosal connective tissue stroma.
