A 42-year-old woman comes to the emergency department due to worsening jaw pain over the past week. She is unable to chew solid foods on the left side because of severe throbbing pain. The patient has had several "tooth infections" over the last year despite meticulous oral hygiene. Physical examination shows facial edema over the left mandible. Multiple teeth have decay and gingival recession, and gentle tapping of the left second molar elicits pain. This patient's current disease process is most likely to develop secondary to which of the following underlying conditions?

Question

A 42-year-old woman comes to the emergency department due to worsening jaw pain over the past week.  She is unable to chew solid foods on the left side because of severe throbbing pain.  The patient has had several "tooth infections" over the last year despite meticulous oral hygiene.  Physical examination shows facial edema over the left mandible.  Multiple teeth have decay and gingival recession, and gentle tapping of the left second molar elicits pain.  This patient's current disease process is most likely to develop secondary to which of the following underlying conditions?

Quizplus · Accepted Answer

11ec160b_38aa_78dc_9249_d7ba848925d0_MD0001_00 Sjögren syndrome (SS) is an autoimmune disorder that is most common in middle-age women and is characterized by inflammation of exocrine glands (eg, salivary, lacrimal, vaginal). It can occur as an isolated disorder or in association with another autoimmune syndrome (eg, rheumatoid arthritis). Patients typically have severe dry mouth (xerostomia) due to insufficient saliva production. Saliva has numerous antibacterial and antifungal proteins, along with organic and inorganic components which protect tooth enamel. Patients with SS have a higher rate of thrush, dental caries, and other complications of odontogenic infections (eg, osteomyelitis of the mandible) because of the loss of these protective factors in saliva. Reduction in tear production from the lacrimal glands can cause corneal dryness and damage, and loss of vaginal lubrication in female patients is associated with dyspareunia (painful intercourse) and frequent infections (eg, candidal, bacterial). Biopsy of the salivary glands is diagnostic and shows a lymphocytic infiltrate, often with germinal centers. (Choice A) Acromegaly is characterized by overproduction of growth hormone, typically due to a somatotroph pituitary adenoma. Cranial effects include enlarged facial features, prognathism, and increased spacing between the teeth. (Choice B) Crohn disease can affect the entire gastrointestinal tract from the mouth to the anus. Aphthous ulcers are the most common oral manifestation of this disease. (Choice C) Oral manifestations of riboflavin (vitamin B₂) deficiency include angular cheilosis, stomatitis, and glossitis. (Choice D) Selective IgA deficiency is usually asymptomatic, although it is associated with an increased risk for giardiasis and recurrent sinopulmonary infections caused by encapsulated bacteria (eg, Streptococcus pneumoniae, Haemophilus influenzae). Educational objective: Sjögren syndrome is characterized by autoimmune inflammation of exocrine glands (eg, salivary, lacrimal, vaginal). Patients typically have severe dry mouth (xerostomia) due to reduced saliva production, which can lead to an increased rate of dental caries and other oral infections (eg, thrush) because of the loss of protective factors in saliva. Biopsy of the salivary glands shows a lymphocytic infiltrate, often with germinal centers. __________ References: Epidemiology of Sjögren's syndrome-from an oral perspective. (http://www.ncbi.nlm.nih.gov/pubmed/27891302)

A 42-Year-Old Woman Comes to the Emergency Department Due to Worsening