Sir,
We read with great interest the article on Orocrinology by Mathew et al.[1] The article has focussed on stepwise oral examination, its importance and the possible findings pertaining to endocrine conditions. We really appreciate the attempt by the authors and have little doubt that it would be a ready reckoner for many clinicians. In this context we would like to add a couple of more points that are relevant to oral examination and endocrinology that were not mentioned in the review:
Lip and tongue examination may include abnormal movements also in addition to physical findings enumerated in the article. For instance, labial and lingual tremors are an important accompaniment of thyroxtoxicosis[2] and often overlooked during physical examination
In the section on mandibular examination, the causes of proganthism and mandibular afflictions due to acromegaly, fibrous dysplasia, cherubim, and jaw tumor associated with hyperparathyroidism were mentioned. We would like to add Paget disease of bone also as an important cause in the list. Occasionally, Paget disease of bone may present as isolated mandibular involvement to the extent that in the nuclear bone scan this is called “Lincoln sign."[3]
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REFERENCES
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