Outcome 7 Microbial Disease Of The Oral Cavity

Front 1

Inflammation

Back 1

• A NON_SPECIFIC response to injury by living and non living agents.

•Classification is based on:

-Nature

-Duration

-Severity

Front 2

Immune Response

Back 2

•A SPECIFIC reaction to cell injury

•Humoral Immunity

•Cellular immunity

Front 3

Infection

Back 3

• Tissue response to invasion and injury by microorganisms

Front 4

Infestation

Back 4

•Presense of microorganism

•No inflammatory response

Front 5

Why is oral Mucosa highly resistant to infection

Back 5

1. Protected by stratified squamous epithelium2. Areas subjected to stress are protected bykeratinized epithelium

3. Enzymes in saliva destroy some types of bacteria

4. Abs in the saliva aid in destruction of bacterialcells

Front 6

The development of an infection will alsodepend on?

Back 6

1. Virulence of the agent

2. Number of pathogenic microorganisms

3. Type of microorganism

Front 7

Periodontal Disease

Back 7

• Includes conditionsthat affect the gingiva,periodontal ligament,and alveolar bone

Front 8

Simple Gingivitis

Back 8

• Inflammation of thegingiva

• No loss of attachmentor bone

• Usually chronic

Clinical Features:

-edematous

-red and glossy

-bleeds easily

Front 9

Necrotizing Ulcerative Gingivitis

Back 9

• Ulceromembranous stomatitis

• Vincent’s stomatitis (Trench mouth)

• Bacterial associated withother factors

– Affects individuals with adepressed immune system

– Associated with localirritants

– NOT contagious

Front 10

Clinical Features of Necrotizing Ulcerative Gingivitis

Back 10

• Bad breath (halitosis)

• Bad taste

• Gingival bleeding

• Painful gingivitis (redness, swelling, ulcers)

• General malaise, loss of appetite, fever

Front 11

Periodontitis

Back 11

• Follows untreatedgingivitis

Clinical Features :

• Varying degrees of gingivitis with alterations in colour

• Epithelial detachment onto cementum forming atrue periodontal pocket

• Extensive tooth migration and mobility

• Accumulation of pus causes swelling and pain

Front 12

Osteomyelitis

Back 12

-• Untreatedperiodontitis results infurther bonedestruction

• Formation ofperiodontal abscesses

Front 13

Gonorrhea

Back 13

• Caused by Neisseriagonorrhea

• Gram negative diplococcus

• Primary sites of infection

– Genitalia– Anal canal– Pharynx

Front 14

Symptoms of Gonorrhea

Back 14

• Burning or itchingsensation

• Dryness

• Increased salivation

• Bad breath

• Fetid breath

• Fever

• Submandibularlymphadenopathy

Front 15

Syphilis

Back 15

• Causative agent ->T. pallidum(spirochete) - bacterium

• Oral-sexual contact (acquired)

• May also be congenital
Clinical Stages

– 1º chancre

– 2º fever, rash

– 3º gummas (paralysis, insanity)

– Congenital syphilis

Front 16

Primary Syphilis

Back 16

• Chancre

• Occurs at the portal of entry (usualy lips)

• Destructive sore

• ~20 days after contact

• Progression– Macule -> Papule -> Ulcer

*The lips are themost commonextragenital sitefor primarysyphilis

Front 17

Secondary Syphilis

Back 17

• Generalized maculopapular lesions on the skin• Occurs 6-8 weeks after exposure

• Mucous patches on oral mucosa

• Multiple, painless, grayish-white plaques cover theerosion

• Surface is smooth and opalescent

• Highly infectious lesions

• Spirochetes can cross the placenta

Front 18

Condyloma Lata

Back 18

•Wart- like lesions

•Tend to occur around the genitalia

•Do not confuse with Condyloma acuminata which iscaused by HPV

Front 19

Tertiary Syphilis

Back 19

• 5-20 years after initial infection

• Affects ~ 1/3 of untreated patients

• Lesions are destructive

• Generally non-infective

1. Gumma

2. Diffuse syphilitic glossitis

Front 20

Gumma

Back 20

• Granuloma

• Characterized byproliferative changes,necrosis and giant cellformation

• Palate and tongue arecommon sites

• Feels firm and appearsnodular

Front 21

Hutchinsonian Triad OfCongenital Syphilis

Back 21

– MULBERRY MOLAR (HYPOPLASIA OF TEETH WITHWIDE SPACING)

– RHAGADIS LINEAR SCARS AT CORNER OF MOUTH

– SADDLE NOSE – a flat bridge of the nose

Front 22

Tuberculosis

Back 22

• Chronic granulomatomatous inflammation

•Mycobacterium

Reservoirs - Humans -M. Tuberculosis
-Cattle -M.Bovi factors thatfavor spread of communicable diseases

Transmission of TB

• Respiratory secretions from patientwith active pulmonary lesions

• Consumption of milk or other dairyproducts from tuberculous cattle

Front 23

Types of Lesions in Tuberculosis

Back 23

1. Exudative ulcerative lesions

2. Granulomas / Tubercle

Front 24

Factors thatfavor spread of communicable disease

Back 24

– Poor living conditions

– Low socioeconomic status

– Low native resistance

– Compromised immunity from debilitating orimmunosuppressed conditions

Front 25

Exudative Ulcerative Lesions

Back 25

• Acute inflammatory reaction

• Engulfment of the bacilli in an exudate of polysand lymphs

• May subside and heal, progress and lead tonecrosis or develop into a granuloma

• Tongue is the most common site

Front 26

Granuloma/Tubercle

Back 26

• Productive or proliferative lesion

• No exudate

• Most of the bacilli live in the center

• Eventually the tubercle may becomefibrous at the periphery and calcifiedwithin

• Bacilli remain viable for years

• Tongue is a frequent site

Front 27

Differential Diagnoses

Back 27

• Indolent ulceration

• Nodular

• Granulomatouslesion

Front 28

Primary Tuberculosis

Back 28

• Childhood

• First infection

• As the hypersensitivity develops the exudate isresorbed and heals

• Most frequently occurs in the lower 2/3rds ofthe lungs

Front 29

Reinfection Tuberculosis

Back 29

• Chronic disease

• Formation of tubercules/granulomas

• Caseous necrosis

Front 30

Lupus Vulgaris

Back 30

• TB of the skin

• Reddish-brownnodules on the face

• Nodules may becomescaly or ulcerate

• Scarring

Front 31

Scrofula

Back 31

• Tuberculous CervicalLymphadenitis

• TB infection of thesubmaxillary and cervicallymph nodes

• Large firm masses

• Extension of TB in the oralcavity

Front 32

Control of Active Infection

Back 32

• Isolation

• Precautions (private room, ventilation)

• Treatment (multi-drug treatment)

• Control of contacts– Quarantine not indicated– BCG

• Epidemic controls– Cases must be documented– X-ray screening of immigrants

Front 33

Actinomycosis

Back 33

• Caused by Actinomycesisraeli

• Fungus-like bacterium

• Anaerobic

•Most cases involve the cervical facial area

•Lumpy Jaw

Front 34

Clinical Features of Actimomycosis

Back 34

• Painless, hard reddish-bluenodules appear over the upperpart of the neck, under the earor in the submandibular area

• Abscesses burrow toward the surface

• Discharge yellow purulent exudate (pus) -> contains foul smelling sulfur granules

Front 35

Candidiasis

Back 35

• Yeast Infection

• Normal flora of skin,mouth, and GI tract

• Candida albicans

Front 36

Several Forms Of Oral Candidiasis

Back 36

• Pseudomembranous Candidiasis

• Erythematous Candidiasis

• Denture Stomatitis (chronic atrophiccandidiasis)

• Chronic Hyperplastic Candidiasis (Candidalleukoplakia)

• Angular cheilitis

Front 37

PSEUDOMEMBRANOUS CANDIDIASIS

Back 37

• A white curdlike material ispresent on the mucosalsurface

• Underlying mucosa iserythematous

• A burning sensation canoccur

• Patient may complain of ametallic taste in the mouth

Front 38

ERYTHEMATOUS CANDIDIASIS

Back 38

• A red painful mucosa is the presentingcomplaint

• May be localized or generalized

Front 39

DENTURE STOMATITISCHRONIC ATROPHIC CANDIDIASIS

Back 39

• MOST COMMON TYPE AFFECTINGTHE ORAL MUCOSA

• Presents as erythematous mucosabut is limited to the mucosacovered by the full or partialdenture

• Lesions vary from petechiae-like tomore generalized and granular

• Asymptomatic and often discoveredduring routine examination

Front 40

CHRONIC HYPERPLASTIC CANDIDIASISCANDIDAL LEUKOPLAKIA

Back 40

• Appears as a white lesion that does not wipeoff

• Will respond to antifungal medication

Front 41

ANGULAR CHEILITIS

Back 41

• Candida organisms are often the cause ofangular cheilitis

• Erythema and fissuring at the corners of themouth

•"Perlche"

Front 42

Virus

Back 42

• Nucleoprotein particle

• May produce tissue necrosisor inflammation

• May produce tissuehyperplasia, warts orneoplasia

Front 43

Herpes Virus

Back 43

• Enveloped icosahedralDNA virus

• Member of theherpesviridae family

• 8 known human herpesviruses
• 3 sub families

• Life-long latentinfection with periodicreactivation

Front 44

Herpes Simplex Virus Type 1 VS. Type 2

Back 44

Type 1 • Enveloped icosahedralDNA virus

• Member of theherpesviridae family

• 8 known human herpesviruses

• 3 sub families

Type 2 • Causes genital andanal lesions

Front 45

Herpes Simplex 1

Back 45

• Cold sores or fever blisters

• Represents recurrentdisease

• Occurs when the host’sresistance is lowered

• Oral mucosa is rarelyinvolved

• Vesicles

• Ulcers

• Crusting

•"Herpes Labialis"

Front 46

Herpes Simplex 2

Back 46

• Causes genital and anal lesions

Differential Diagnosis(Include any condition that presents with vesicles orulcers)

• Aphthous stomatitis– no fever, no vesicles

• Herpangina– Confined to the oropharynx (Coxsackie virus)

• ANUG– no vesicles

Front 47

Herpetic Keratitis

Back 47

• Serious

• Ulceration of the cornea due to repeated infection may lead to blindness

Front 48

Herpetic Whitlow

Back 48

A whitlow or felon is an infection of the tip of the finger

Front 49

Shingles

Back 49

•Varicella-Zoster Virus(Human herpes virus 3)

•Affects Adults

•Unilateral

1.Small bumps

2. Turns to blisters

3. Crust over

4. Disappears

5. Last weeks to years after the rash disappears

•Very painful

Front 50

Herpangina

Back 50

• An acuteoropharyngitis causedby a Coxsackie virus

• Affects children andyoung adults

• Uniform vesicles with redmargins on the palate andposterior oral tissues

• Ulceration

• Erythema

Front 51

Epstein Bar Virus

Back 51

• Human herpes virustype 4• Attacks B-lymphocytesand epithelial cells

Example: Infectious Mono

• Relationship between EBV and oncogenesis

– Burkitt’s lymphoma

– Nasopharyngeal carcinoma

Front 52

Hairy Leukoplakia

Back 52

• Opportunisticinfection related toEBV

• Found primarily in HIVinfected patients

• Lateral surface of thetongue is the mostcommon site

Front 53

Human Herpes Virus-8

Back 53

• The gene of HHV-8 acts as a vascular switch

• Turns ON the synthesis of angiogenic factors

• RESULT: Kaposi’s Sarcoma

Front 54

Human Papilloma Virus

Back 54

• Formationof a benign outgrowthof cells wart/papilloma

•Skin warts

•Genital Warts (condylomas)

Front 55

Condyloma acuminatum

Back 55

• Infectious lesion

• Verrucous or papillary growth

• Keratinized cells act as the host for the virus

• Characteristically located in the anogenitalregion

Front 56

Hand, Foot and Mouth Disease

Back 56

• Common illness in infants andchildren

• A viral infection of the skin and oralmucosa characterized by vesiculareruptions restricted to the hands andfeet and in the mouth.

Front 57

Measles

Back 57

• Measles virus is a RNAparamyxovirus

• Highly infectious

• Immunization is necessary

• "Koplik’s spots" (pathognomic)