Oral Pathology 1

Front 1

Impetigo

Back 1

- Superficial skin infection caused by Staph pyogens and/or aureus
- Contagious and easily spread; peak occurrence during summer or early fall in hot moist climates
- Superficial vesicles that quickly rupture and become covered in a thick, amber crust
- Facial lesions often around nose and mouth
- Many cases arise in areas of damaged skin; pre-existing dermatitis, cuts, scratches, insect bites
- Dx: culture of organism
- Tx: topical or systemic antibiotic

Front 2

Tonsillolithiasis

Back 2

- Common
- Enlarged crypts filled w/ yellowish debris; varies from soft to fully calcified
- Variable size; solitary or multiple
- May present as radiopacities overlying the midportion of the ascending ramus
- Tx: none necessary unless assoc. w/ clinical symptoms

Front 3

Primary Syphilis

Back 3

- Painless ulceration= "chancre"
- 3 to 90 days after exposure
- <2% are oral
- Lip, tongue, palate, gingiva, tonsils
- Resolves spontaneously in 3-8 weeks

Front 4

Secondary Syphilis

Back 4

- Develops 4-10 weeks after initial infection
- Erythematous maculopapular cutaneous eruption
- Painless generalized lymphadenopathy
- Mucous patches of oral mucosa
- Split papules at angles of mouth

Front 5

Tertiary Syphilis

Back 5

- Develops after a latency period of 1-30 years
- Approx. 30% of patients affected
- May affect any tissue; CNS, vascular
- "Gumma" formation
- Oral involvement may produce palatal perforation

Front 6

Congenital Syphilis

Back 6

- Saddle nose deformity
- Saber shins
- Hutchinson's Triad:
1) Hutchinson's incisors and mulberry molars
2) Ocular interstitial keratitis
3) 8th cranial nerve deafness

Front 7

Histopathology of Syphilis

Back 7

- Primary and secondary lesions show intense plasmacytic infiltrate
- Gumma is characterized by granulomatous inflammation
- Spirochetes can be identified using the Warthin-Starry stain

Front 8

Tuberculosis

Back 8

- Droplet transmission
- Only 5% of infected pts progress to active disease w/in 2 yrs after exposure
- Low grade fever, night sweats, fatigue, weight loss
- Chronic bloody cough

Front 9

TB- Oral lesions

Back 9

- Rather uncommon
- Solitary chronic painless ulcer
- Most common on gingiva and tongue
- May be due to hematogenous or direct implantation of organisms

Front 10

TB- Diagnosis

Back 10

- + PPD
- Chest radiograph
- Culture (4-6 weeks)
- ID organism in biopsy or sputum
- Molecular testing

Front 11

TB- Histopathology

Back 11

- Usually necrotizing granulomatous inflammation ("caseous necrosis")
- Multinucleated giant cells
- Organism stain using the acid fast method (Ziehl-Neelsen stain)

Front 12

TB- Tx

Back 12

- Isoniazid (INH), rifampin, pyrazinamide daily for 2 mo
- Then INH and rifampin for 4 mo
- Ethambutol or streptomycin also used

Front 13

TB- Dental considerations

Back 13

- Must distinguish between active and inactive disease based on Hx, symptoms, med consultation
- Anti-TB therapy works relatively rapidly resulting in a non-infectious state in two weeks

Front 14

TB- Prognosis

Back 14

- Good w/ immunocompetent patient
- Problems arise when pts fail to take prescribed meds properly
- Emergence if resistant strains

Front 15

Actinomycosis

Back 15

- Caused by any of the several species that inhabit the mouth
- Often assoc. w/ local trauma
- 25% abdominal, 15% pulmonary, and 55% cervicofacial

Front 16

Cervicofacial Actinomycosis

Back 16

- May follow dental extraction or untreated dental disease
- Diffuse swelling and erythema
- Draining sinus tract
- "Sulfur granules"- colonies of organisms in purulent exudate

Front 17

Actino- Histopathology

Back 17

- Filamentous bacteria that form colonies
- Bacterial colonies surrounded by neutrophils
- Adjacent tissue may show granulomatous inflammation or granulation tissue

Front 18

Actino Tx

Back 18

- Removal of offending tooth
- High-does antibiotics, usually IV PCN for 2 weeks, then oral PCN for 2 weeks
- Periapical actinomycosis usually responds to less aggressive Tx
- Good prognosis w/ appropriate therapy