Preface| Volume 25, ISSUE 2, Pxiii, September 2017

Oral Manifestations of Systemic Diseases

      The orofacial region comprises an intricate combination of components seen in other organ systems in the body, to include mucous membranes, skin, nerves, muscles, ligaments, bone, and exocrine glands. This is in addition to the unique features of the oral cavity to include the dentition, periodontium, and salivary milieu. Consequently, the orofacial region reflects an individual’s overall systemic health, and issues that arise here may be the initial presentation or a complication of a systemic condition. For instance, enlarged gingiva may be an early manifestation of a hematologic malignancy through leukemic infiltration of the gingiva. When a unique orofacial abnormality and condition presents that necessitates a thorough history taking and workup, the process may uncover a systemic condition that would impact any subsequent dental or surgical management of the patient, by affecting either their ability to tolerate or recover from treatment or the prognosis or outcome of the proposed treatment.
      The goal of this issue of the Atlas of the Oral and Maxillofacial Surgery Clinics of North America is to provide a brief comprehensive overview to aid providers in the approach to and identification of systemic conditions that appear in the orofacial region, as presented by international oral medicine experts. This begins with an overview of the fundamentals in approaching a patient, which would necessitate a thorough medical history, comprehensive medical evaluation, and appropriate subsequent tests (eg, laboratory and imaging studies, biopsies, cultures).
      The individual articles in this issue are delineated by organ systems and disease states. The oral cavity, at the one end of the gastrointestinal tract, would naturally be prone to lesions from a gastrointestinal disorder, such as oral ulcers and cobblestone lesions seen in patients with inflammatory bowel disease. Immunodeficient patients may be more prone to orofacial infections or unique lesions of infectious causes. Patients with high caries rate and salivary hypofunction may provide an initial opportunity to diagnose an underlying autoimmune condition such as Sjögren’s syndrome. Therapies and drugs targeted toward systemic disorders may cause oral complications in the form of hyposalivation, immunosuppression, allergic reactions, osteonecrosis, and/or other oral lesions. Hematologic disorders may result in increased oral bleeding that would impact dental and surgical care, or may have initial oral manifestations such as enlarged gingiva, as previously mentioned. Naturally, the mouth, with its complex oral ecosystem, is commonly subject to viral, bacterial, and fungal infections. Multiorgan disorders, or disorders of the endocrine system, have various manifestations in the oral cavity and orofacial region. Dermatologic disorders have unique presentation in the oral cavity, as evidenced by various mucosal conditions such as lichen planus.
      The information and images of more common and/or significant conditions in this issue are intended to serve as a quick reference for providers as they encounter them in their clinical practice. This array of conditions further emphasizes the orofacial region and oral cavity as a reflection of a patient’s overall health.