Oral manifestations of systemic disease — formative SAQs

SAQ 1 — The pale tired child with swollen bleeding gums (10 marks, 15 minutes)

A six-year-old boy presents with two weeks of fatigue, easy bruising and progressively swollen, painful, bleeding gums. On examination he is pale, the gums are diffusely boggy, enlarged and bleed on touching, and there are petechiae on the palate and bruising on the shins. His temperature is 38.6 degrees Celsius. [1]

a) What is the most likely diagnosis, and which two features in the mouth mark it as systemic rather than simple gingivitis? (2 marks) [1]

b) Name the single most urgent investigation and the immediate safety actions you would take for this child. (4 marks) [1]

c) Give two reasons why you would give empiric broad-spectrum antibiotics while awaiting results, and name the team you would transfer him to. (2 marks) [1]

d) Explain why the gingival infiltration will not respond to mouthwash or improved oral hygiene, and what will resolve it. (2 marks) [1]

SAQ 2 — The child with chalky teeth, aphthae and poor growth (10 marks, 15 minutes)

A nine-year-old girl is referred for "bad teeth". Her permanent central incisors and first molars carry chalky, symmetrical pits and grooves; she has recurrent aphthous ulcers and cracked, red corners of the mouth. Her height has crossed two centiles downward. There is no abdominal pain. [2]

a) Name the underlying systemic diagnosis the oral and growth findings point to, and give the oral sign that is its hallmark. (2 marks) [2]

b) Give the panel of investigations you would send, naming the serology and the test you would add to exclude IgA deficiency. (4 marks) [2]

c) Outline the two-handed management, naming the disease-directed therapy and the oral-care measures. (2 marks) [2]

d) Explain to the family why the existing dental defects are permanent even though the treatment is essential, and name two systemic benefits of that treatment. (2 marks) [2] [3]