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.