Education And Debate

Lesson of the Week: Value of opinion by oral physician in diagnosing Wegener's granulomatosis

BMJ 1994; 309 doi: (Published 09 July 1994) Cite this as: BMJ 1994;309:111
  1. J M Zakrzewska, consultant oral physician,
  2. J Feehally, consultant nephrologista,
  3. J J H Gilkes, consultant dermatologist Leicester General Hospital, Leicester LE5 4PWa
  1. a Joint Department of Maxillofacial Surgery and Oral Medicine, Eastman Dental Hospital and University College Hospital, London WC1X 8LD
  1. Correspondence to: Dr Zakrzewska.
  • Accepted 10 January 1994

Adequate and appropriate oral biopsy by an oral physician may help diagnose potentially life threatening systemic disease

It has long been appreciated that the mouth is the mirror of the rest of the body. Many systemic diseases have oral symptoms, which often coincide with widespread evidence of disease. In some cases, however, oral symptoms may be the sole presenting sign of systemic disease. This may cause difficulty in diagnosis, yet little attention is paid to examination of the oral cavity in medical undergraduate training. It is therefore important that patients with oral lesions are referred to specialists in oral medicine for diagnosis, investigation, and management. We report on a patient in whom the diagnosis and treatment of a potentially life threatening systemic disease was delayed owing to poor appreciation of the clinical importance of oral lesions.

Case report

A 53 year old woman presented with a history of bleeding gingiva. She had had ulcerative colitis for 12 years, which was controlled by sulphasalazine treatment. Her general dental practitioner had extracted all her remaining teeth on the assumption that her bleeding gingiva and mobile teeth were due to periodontal disease. No biopsy specimen was taken at this time. Dentures were made, but she could not tolerate them, and the gingiva continued to bleed.

She was next seen by an oral surgeon, who, …

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