THIS PRESENTATION IS ABOUT THE CLASSIFICATION OF ORAL AUTOIMMUNE DISORDERS AND LUPUS ERYTHEMATOSUS IN DETAIL . USEFUL FOR DENTAL STUDENTS

1. CLASSIFICATION OF AUTOIMMUNE
DISORDERS
BY,
NAVANEETH KRISHNA

2. INTRODUCTION
 The term” immunity” means the resistance exhibited by the
host towards injury, caused by microorganisms and their
products .
 The term “immunodeficiency” is used to describe an individual
who is not capable of mounting a normal immune system.
 Autoimmunity is condition in which individuals immunesystem
fails to recognize its own tissues and attacks as if they were
foreign matter.

3. Classification of immunological disorders affecting oral
cavity
1. IMMUNODEFICIENCY DISORDER
 PRIMARY IMMUNODEFIENCIES
I. B cell immunodeficiencies
• X linked agammaglobulinemia
II. T cell immunodeficiencies
III. Thymic hypoplasia (DiGeorge syndrome)
IV. Chronic mucocutaneous candidiasis
V. Combined immunodeficiencies
VI. Severe combined immunodeficiencies(SCID)
VII. Wiskott-Aldrich syndromeDeficiency of innate immunity/Phagocyticdysfunction
VIII. Chediak Higashi syndrome
IX. Lazy leukocyte syndromeJob's syndrome Secondary immunodeficiencies

4.  SECONDARY IMMUNODEFICIENCES
 Malnutrition - Protein deficiency
 Metabolic disorders – Diabetes
 Infections like tuberculosis, AIDS
 Drugs - Cytotoxic drugs, immunosuppretherapy
 Drugs - Cytotoxic drugs, immunosuppretherapy
 Leukaemia
 Hodgkin's and non-Hodgkin's lymphoma
 Nephrotic syndrome
 Multiple myeloma
 Sarcoidosis

5. 2. AUTOIMMUNE DISORDERS
 Mucosal diseases
 Oral Lichen Planus
 Pemphigus Vulgaris –
 Bullous Pemphigoid
 Mucous membrane pemphigoid (MMP)
 Erythema Multiforme-
 PsoriasisEpidermolysis
 Bullosa Aquisita - Chronic ulcerative stomatitis-
 Graft versus host reaction

6.  Mucosa disease of unquestionable autoimmunemechanism
• Recurrent apthous stomatitis
• Oral submucous fibrosis
 Others systemic disorders (connective tissuedisorders)
• Systemic lupus erythematosus
• Rheumatoid arthritis
• Sjogren's syndrome
• Reiter's Syndrome
• Behcet's disease
• Scleroderma

7. • Gastrointestinal diseases
• Pernicious anaemia
• Crohn's disease
3. Allergic/Hypersensitvity disorders
• Type I reactions
• Anaphylaxis reaction to drugs like penicillin, latex
• Angioedema
• Type II reactions
• Autoimmune conditions
• Type III reactions
• Lupus erythematosus

8.  Type IV reactions
Stomatitis medicamentosa
• Erythema multiforme
• Stevens-Johnson syndrome
• Lichenoid reaction
• Fixed drug reaction
• Contact allergic stomatiti/Stomatitis venerate
• Burning mouth syndrome
• Orofacial granulomatosis

9. LUPUS ERYTHEMATOSUS
 Lupus erythematosus (LE) is immunologically mediated
condition (autoimmune).
 Most common "collagen vascular" or "connective tis- sue
disorders.
 The name "lupus" comes from the meaning wolf and refers
to the erythematous red ulcerations on the face.
 Aetiology
 Autoimmune:
 Immunocomplexes consisting chiefly of nucleic acid and
antibody

10.  Genetic factors:
 Genes that increase the risk of SLE are HLA-DR 2 and HLA-DR3.
 Infections:
 Ebstein-Barr virus
 Cytomegalovirus
 Varicella zoster virus
 Environmental factors:
 Exposure to pollutants
 Hormonal factors
 Ultraviolet light
 Smoking
 Possibly diet

11.  Endocrine factors:
 A hormonal component to SLE is suggested by incidence in
women.
 Types
 ■ Systemic lupus erythematosus (SLE)
 ■ Discoid lupus erythematosus (DLE)

14.  Oral Manifestations
 Mucosal lesions:
 Presence of desquamative gingivitis, marginal gingivitis or erosive mucosal
lesions.
 Appear clinically identical to reticular or lichen planus.
 The lesions are characterized by erythematous cen- tral zone, surrounded by
white radiating striae giving a brush border appearance or hyperkeratotic
plaques on the buccal mucosa, palate and tongue.
 Unlike lichen planus, the distribution of lesions is usually asymmetric,
peripheral striae are faint and the oral lesions rarely occur in the absence of
skin lesions.

15.  Xerostomia: Leads to caries and candidiasis.
 Glossodynia, dysgeusia, dysphagia.
 Root canal calcification, delayed primary and permanent tooth eruption and
twisted root formation.
 Angular cheilitis, ANUG (Acute necrotizing ulcerative gingivitis).
 TMJ disorders: Arthralgia, arthritis.

16.  Laboratory Findings
 Anaemia, leukopenia, thrombocytopenia
 LE cell phenomenon - Positive
o It is Rosette of neutrophils surrounding a pale nuclear mass apparently derived
from a lymphocyte.
o Occurs as a result of antibody combining with DNA from nuclei of damaged
cells.
 Coomb's test-Positive
 Serum gammaglobulin increased.

17.  Autoantibodies found in patients with SLE are:
o Antinuclear antibody
o Antibody to double-stranded DNA
o Anti-Smith antibody
o Anti-Ro antibody
o Antiphospholipid antibody

18.  American College of Rheumatology Criteria of Classification of
Systemic Lupus Erythematosus and Rheumatoid Arthritis:
1. Malar rash
2. Discoid rash
3. Photosensitivity
4. Oral or nasal ulcerations 5. Nonerosive arthritis involving two or
more joints
6. Renal disorder
7. Neurologic disorder (seizures or psychosis in the ab- sence of
offending drugs)

19. Malar rash or butterfly rash

20.  8. Haematologic disorder (haemolytic anaemia, leukope- nia,
lymphopenia or thrombocytopenia)
 9. Immunologic disorder (anti-DNA, anti-Sm, antiphos- pholipid
antibodies, a positive test result for lupus anti- coagulant using a
standard method, or a false-positive serologic test for syphilis)
 10. Antinuclear antibody
*The presence of four or more are considered positive for diagnosis
of SLE.

21.  Differential Diagnosis for Oral Lesions
a) Lichen planus
 In lichen planus lesion is bilateral, symmetrical while in LE lesion is
unilateral and asymmetrical.
 Peripheral striae are faint in LE compared to lichen.
 In LE the oral lesions rarely occur in the absence of skin lesions while in
lichen lesion can occur only in oral cavity.
b) Lichenoid reaction
In case of lichenoid, there should be presence of metallic restoration, drugs
or tobacco.

22. TREATMENT

23. REFERENCES
 TEXTBOOK OF ORAL MEDICINE AND RADIOLOGY BY PEEYUSH
SHIVHARE
 SHAFER’S TEXTBOOK OF ORAL PATHOLOGY