The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition _ _____________________
Jaw and tongue claudication with chewing or talking are also common and can mimic temporomandibular joint, myofascial, or odontogenic pain. Because jaw claudication is one of the most important symptoms of giant cell arteritis, the index of suspicion should be raised when older patients complain of jaw pain while eating. Symptoms of giant cell arteritis include headache, fever, anorexia, and weight loss. Less commonly, patients report having a dry cough, sore throat, tongue pain, an inability to open the jaw, and choking sensations. Lesions in the breast or ovary are also seen. Healthcare providers should look for a prominent temporal artery, absent temporal artery pulsation, and tenderness of the temporal artery, as each of these signs is independently associated with an increased risk for giant cell arteritis (Farina et al., 2023). BEHÇET’S DISEASE Behçet’s disease is a multisystemic vasculitis. It is an inflam- matory disease that typically occurs between the second and fourth decade of a person’s life. Behçet’s disease is not typically found in the United States. Recurrent oral aphthous ulcers, genital ulcers, and ocular and skin lesions are hallmarks of this disease. In one study, researchers observed oral aphthous ulcers in 100% of the 250 study participants with Behçet’s disease and ocular lesions in 54% of these patients (Ali et al., 2023). Oral lesions associated with Behçet’s disease are characterized by recurrent and painful ulceration of the oral mucosa. The ulcers often subside spontaneously over several weeks but recur in days to months. Oral ulcers occurring at least three times over a 12-month period are a key diagnostic feature of Behçet’s disease. In appearance, the ulcers look like conventional aphthae or recurrent aphthous stomatitis but tend to be more frequent and clustered together. The ulcers usually occur on the non- keratinized oral mucosa, with the mucous membranes of the lips, the buccal mucosa, the floor of the mouth, the soft palate, and the undersurface of the tongue as the most common sites. GRANULOMATOSIS WITH POLYANGIITIS Granulomatosis with polyangiitis , formerly called Wegener’s granulomatosis (Mayo Clinic, 2022b), is a multisystemic disease characterized by the triad of necrotizing granulomata affecting the upper and lower respiratory tracts, glomerulonephritis, and disseminated vasculitis (NIH, 2024). Oral lesions are reported to occur in 10% to 62% of patients with granulomatosis with polyangiitis, although oral lesions are rare as a presenting feature (5% to 6% of patients). Common characteristics of granulomatosis with polyangiitis are generalized vasculitis (inflamed blood vessels), inflamma- tory lesions in the respiratory tract, and necrotizing glomerulo- nephritis (kidney inflammation). The mouth, eyes, ears, nose, throat, and kidneys may undergo granulomatous changes.
Hyperplastic gingivitis , also known as strawberry gingivitis , is the most common oral manifestation of granulomatosis with polyangiitis (Dhalkari et al., 2020). These lesions often have a pebbly or granular surface. Other, less common, symptoms include a cough or cranial nerve palsy. When the disorder involves the nasal septum and sinuses, the midface may col- lapse and result in the formation of a “saddle nose” (Cleary et al., 2021). To avoid serious or fatal consequences, patients presenting with oral features of granulomatosis with polyangiitis should be promptly diagnosed and referred for medical management. Other oral manifestations include poor healing after extrac- tion, tooth mobility, cranial nerve palsies, and parotid gland swelling. Early diagnosis and treatment are critical to preventing or limiting tissue damage. Treatment of granulomatosis with poly- angiitis typically involves prednisone and cyclophosphamide regimens (Garner & Khalidi, 2020). KAPOSI’S SARCOMA Kaposi’s sarcoma is a low-grade vascular neoplasm of endothelial origin that is caused by Kaposi sarcoma-associated herpesvirus , also known as human herpesvirus 8 (KSHV/HHV8) infection (ACS, 2024). Most people infected with the virus do not develop Kaposi’s sarcoma, but the cancer sometimes devel- ops in individuals with a weakened immune system. It is the most common HIV-associated malignancy (Naik et al., 2020). The several types of Kaposi’s sarcoma are classic, endemic, transplant-associated, and epidemic or AIDS-related. Although it typically involves the mucocutaneous areas, Kaposi’s sarcoma may also affect lymph nodes and internal organs. Lymphedema may affect the face and neck. Early oral lesions may be asymptomatic, whereas the advanced lesions may cause pain, become secondarily infected, interfere with speech, disrupt mastication, or cause dysphagia. Lesions, which can vary in size from a few millimeters to a few centimeters, may be pink, bluish-purple, or deep brown. Treatment of Kaposi’s sarcoma can include highly active antiretroviral therapy, chemotherapy, surgical excision, and photodynamic therapy (Valantin et al., 2022).
SELECTED MANAGEMENT CONSIDERATIONS
Dental professionals increasingly look to evidence-based treat- ment options for guidance in the context of oral health. To many practitioners, these recommendations serve as important tools to help make informed choices about best practices in achieving better outcomes. Healthcare associations have published various guidelines that provide direction on pivotal features of dental management in patients with cardiovascular
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