ORAL' MANIFESTATIONS IN SYSTEMIC DISEASES ...

H. H. STONES
observed during the three years commencing in 1942. Most observers
have been unable to establish any correlation between low plasma levels
of ascorbic acid and the more frequent type of gingivitis (Restarski and
Pijoan, 1944).
It may happen that a patient is suffering from a deficiency of more
than one of the vitamin components and in this case the clinical features
of the various deficiencies may occur together; as already mentioned
this particularly happens in connection with the vitamin B complex and
may also occur with vitamins B and C. Further, and particularly in
nutritionally neglected old and middle aged cases, there may be an
anaemia in which the blood picture shows a marked reduction both in
the haemoglobin and red cell count.
Hence these possibilities must be evaluated when instituting treatment
and any suspected deficiency including that of iron must be covered.
THE ORAL MANIFESTATIONS OF THE BLOOD DYSCRASIAS
In the blood dyscrasias a variety of oral manifestations may be
produced depending on the particular disease. As will be seen, in some
conditions they are but slight and in others severe. It is very important
for the dental practitioner to recognise the signs as he may be in a
position to be the first to examine a patient with a serious or fatal
disease, or sometimes if he operates without appreciating its significance,
the patient may be subjected to a dangerous risk. It is proposed to
mention representative types that illustrate the effect on the oral mucosa.
The aetiology and haematology are reviewed by Sturgis (1948) and
Whitby and Britton (1950).
Hypochromic Anaemia
Idiopathic hypochromic anaemia.-This usually occurs in young and
adult women and is caused by a deficient absorption of iron, which is
frequently associated with the hypochlorhydria that so often accompanies
the condition.
The blood picture usually shows that the red cell count is somewhat
reduced and red blood corpuscles are smaller than normal. The colour
index is low, being about 0 5 to 0 6 while the haemoglobin is reduced
to 40 per cent. or 50 per cent.
The oral mucosa is pale and there is a tendency to bleed from the
gingivae. The tongue is occasionally smooth due to atrophy of the
filiform papillae, and sometimes shows indentations from the teeth.
The general symptoms include pallor, breathlessness and palpitation.
There may be koilonychia, that is atrophic, thin and spoon-shaped nails.
The condition improves following the oral administration of iron
preparations.
Plummer-Vinson Syndrome.-This condition usually occurs in middle
aged females. It is associated with hypochromic anaemia and sometimes
with hypochlorhydria. There may be an associated vitamin B complex
deficiency.
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