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INFECTIOUS

DISEASES OF
THE ORAL
REGION
Anatomy of the Mouth
General Information
• ORAL CAVITY
(mouth)
- a complex
ecosysytem suitable
for growth and
interrelationships of
many types of
microorganisms
saliva
- secreted by the salivary and mucous
glands help control the growth of
opportunistic oral flora.
- contains enzymes ( including
lysozyme), immunoglobulins (IgA), &
buffers to control the near neutral pH
& continually flushed microbes & food
particles thru the mouth.
• The Normal Flora
– Oral cavity provides an environment
favorable to microorganism growth
– Flora of children is similar to adults
– Bacterial counts range 10,000,000 –
10,000,000,000 organisms/ml of saliva
– Modifies microbial population
– Age, anatomic relationship, eruption of teeth,
presence of decayed teeth, diet, oral hygiene,
antibiotic therapy, systemic disease, cancer therapy
• NOT all residents of oral • Infections from
flora are pathogens nonodontegenic
• Progression of initiating causes (facial trauma,
infection (by oral surgical manipulation,
streptococci)  tonsillitis)
predominance of oral • Staph.aureus
anaerobes occurs • Streptococcus spp.
• Periodontal infections • Infections originating
are polymicrobial solely from dental
periapical tissues
• Anareobic
Viral Infections of the Oral
Region
• Cold sores, Fever
Blisters,
Herpes Labialis
• HSV1 commonly manifests as
herpetic gingivostomatitis
• direct contact with people who have
draining lesions
• asymptomatic carriers
• ↑ incidence: 2-4 yrs.old
• infants protected by maternal
antibodies
Incubation period: 6 days

Small vesicles

Coalesce to form larger lesions


Severe cases: lip, gingivae, oral
mucosa, pharynx

Healing: 1-2 wks


Gradual crusting
Re-epithelization
• Latency:
– Continue throughout life
– Reactivation triggered by
• Actinic radiation
• Emotional/physical stress

• Recurrent disease:
– Vesicles along mucocutanoeus border
– Painfuly for 2 days  crusting & complete healing
in 7-8 days
– Up to 50% adults suffer
• Unaware of recurrent cold sores, thereby transmit
the disease
• Odontogenic infection
of primary molars
• Superficial spread of
cellulitis that follows
the platysma muscles
 cheek  neck 
anterior chest wall
• Group A streptococci
Cold sores, Fever Blisters,
Herpes Labialis
-A small sore situated on the face or in
the mouth that causes pain, burning, or
itching before bursting and crusting
over. The favorite locations are on the
lips, chin or cheeks and in the
nostrils. Less frequented sites are the
gums or roof of the mouth (the palate).
- crust & heal w/n a few days
- reactivation may be caused by:
> trauma
> fever
> physiologic changes or disease
Cold sores, Fever
Blisters,
Herpes Labialis
- the infection may be severe &
extensive in immunosupressed
individuals
- caused by herpes simplex virus
type 1
( HSV 1) or herpes simplex type 2
( HSV 2)
HSV 1 & HSV 2
- also known as human herpesvirus 1
and human herpesvirus 2.
- are DNA viruses in the Family
Herpesviridae
- these may also infect genital tract,
although genital herpes infections are
usually caused by HSV 2.
Bacterial Infections of the Oral
Cavity
• Dental Caries
• Gingivitis
• Periodontitis
Dental Caries
- tooth decay or cavities
- starts when external surface
( the enamel) of a tooth is
dissolved by organic acids, which
are produced by masses of
microorganisms attached to the
tooth ( dental plaque)
- commonly caused by S.
Mutans
• Pattern of tooth
decay affecting
mainly the primary
upper incisors and
frequently the
upper and lower
primary molars
• Practice of putting the
child to bed with a
nursing bottle filled
with sugar-containing
drink (milk, juice,
softdrink)
• Can destroys entire
primary dentition as it
erupts
• Extension of
microorganism
throuroot apex
leads to formation
of abscess
• Radiographic
evidence of bone
destruction ≅ 7-14
days
• Indications that tooth • Chronic abscess
has become – Looseness of tooth
abscessed: – Suppuration from
– Sensitivity to heat draining sinus tracks
stimulus (relieved by or gingival crevice
cold)
– Radiolucency on
– Sensitivity to radiographs
percussion
• cellulitis  swollen
– Tenderness to finger
pressure on the
face, pain, fever and
alveolar process malaise
•Prevalent in all
ages
• Severe in diabetics,
compromised hosts
•Poor oral hygiene
Gingivitis
- inflammation of the gingiva (
gums ) and abnormal loss of
bone that surrounds the teeth
and holds them in place
- caused by toxins secreted
by bacteria in "plaque" that
accumulate over time along
the gum line.
Periodontitis

- inflammation of the
periodontium ( tissues
that surround and
support the teeth,
including the gingiva &
supporting bone)
• Severe infection
• Progresses years
before recognition
– Hypertrophied
gingivae
– purulent discharge
– Painless
 Localized periodontal
hygiene
 Meticulous oral
hygiene
• Localized to the molar &
incisor regions
• Deep gingival pocketing &
severe bone resorption, in
otherwise healthy
children
• Etiology: gram negative
anaerobe
A.actinomycetemcomitan
s
 Tetracyline + periodontal
surgery
• Trench mouth,
Vincent’s infection
• Caused by
fusiform bacilli and
spirochetes
• Frank ulceration at
tips of interdental
papillae  (+)
spontaneous
bleeding
• Impaction of
microorganism &
debris under the soft
tissue overlying the
crown of a tooth (often
mandibular 3rd molar)
• Polymicrobial
• Prevotella, Porphyromonas
spp., Treponema denticola,
Streptococcus milleri)
Lower 3rd molars lie in proximity to the pterygomandibular space ( a
portion of the masticator space)
Infection spreads to masticator
space

Trismus

Deep parapharyngeal space involvement

Therapy: local I&D, extraction of offending tooth


Penicillin, hospitalization (in presence of fever and
trismus)

Resolution expected < 7days


Four Microbial Activities
1. Formation of dextran ( a
polysaccharide ) from sugars by
streptococci
2. Acid formation of lactobacilli
3. Deposition of calculus by Actinomyces
species
4. Secretion of inflammatory substances (
endotoxin) by Bacteroides species.
• Pseudomembranous necrotic exudate along
marginal gingivae & interdental papillae
• Pain, foul breath & taste, thick ropy saliva,
malaise, occasional fever
• Therapy:
– Penicillin
– Localized gingival curettage
– oral rinse with 0.5% hydrogen peroxide or
0.12% Chlorhexidine
Acute Necrotizing Ulcerative
Gingivitis ( ANUG ), Vincent’s
Angina,
Trench Mouth
Disease Characteristics:
“ trench mouth”
- originated in World War 1, where
soldiers developed the infection while fighting
in trenches.
- usually the result a combination of
poor oral hygiene, physical or emotional stress,
and poorm diet.
- involves painful, bleeding gums and
tonsils, erosion of gum tissue & swollen lymph
nodes beneath the jaw.
- causes extremely bad breath.
- noncontagious
Acute Necrotizing Ulcerative
Gingivitis ( ANUG ), Vincent’s
Angina,
Trench Mouth
Pathogens:
- Trench mouth is a synergistic infection
involving 2 or more species of anaerobic bacteria
of the indigenous oral microflora.
- most commonly involved bacteria are
Fusobacterium nucleatum ( an anaerobic, Gram-
negative bacillus) and Treponema vincentii ( a
spyrochete)
- other commonly involved anaerobic Gram-
negative bacilli are Bacteroides spp., Prevotella
intermedius and Prevotella melaninogenica.
Prevention and Control.
- can be prevented thru good oral hygiene
FUNGAL INFECTIONS
OF THE ORAL CAVITY

• Thrush
• Pseudomembranous
type
• Creamy, white plaque
that is rubbed off easily
 exposed reddened
surface mucosa

• Therapy:
• Nystatin, Clotrimazole,
Fluconazole, Amphothericin B
Disease Characteristics:
- a yeast infectionof the oral
cavity.
- common in infants, elderly
patients, and immunosupressed
individuals.
- white, creamy patches occur
on tongue, mucous membranes,
and the corners of the mouth
- can be a manifestation of
disseminated Candida infection
( candidiasis )
Thrush

Pathogens: the yeast, Candida


albicans, and other related species

Diagnosis: Observation of yeast cells,


and pseudohyphae ( stringa of
elongated buds) in microscopic
examination of wet mounts, and
culture confirmation.
• AIDS patients suffer an intractable
form of oral thrush, caused by a
newly-described species, Candida
dubliniensis. This organism is more
resistant to antifungal therapy than
Candida albicans. AIDS patients may
also present with Kaposi sarcoma
tumors in the oral cavity.
Prepared by:
Naval, Clancy Anne G.
Carmelottes, Iroland
Contreras, Ma. Aloha Regina
Dominguez, Leeanel Marielle