ACTINOMYCOSIS, TUBERCULOSIS, LEPROSY, SYPHILIS, NOMA

y Causative bacteria: filamentous, anaerobic y y

y y

gram positive Actinomyces israelii A part of normal oral flora present in dental caries Predisposing factors include trauma or surgical procedure allowing the bacteria to invade an anaerobic area Site of involvement: upper neck, jaws, perioral area CLINICAL FEATURES
y Deep suppurative abcess with draining sinuses y Purulent exudate containing sulphur granules

y Initially infection is acute

causing pain and swelling y Causes osteomyelitis in jaw bone y The soft tissue abcess drain through sinus tracts y The sulphur granules in the exudate is actually calcified bacterial colonies

y TREATMENT
y Surgical debridement and drainage of sinus

y Causative bacteria: Acid fast Mycobacterium

tuborculosis y Chronic granulomatous infection of lungs y 2 types of infection: primary and secondary y Oral lesions associated with secondary TB

y MODE OF SPREAD

PRIMARY
Aerosole Lungs

MACROPHAGES
Phagocytosed Replication

Disemination
Lysis of infected cell Spread to organs

y CLINICAL FEATURES
y Chronic ulcer with y y y y

indurated borders Tosillar swelling May involve bone Cervical lymph nodes May relate to osteomyelitis

y TREATMENT
y Isoniazid y Rifampicin

y Also known as HANSEN S DISEASE y Caused by Mycobacterium leprae y Moderately contageious y Two forms of leprosy:
y Tuberculoid leprosy y Lepromatous leprosy

y Tuberculoid type is a limited form

constituting of erythematous skin eruptions along with peripheral nerve involvement leading to sensory loss

y Lepromatous leprosy produces

severe disfigurement of face. It causes collapse of nasal bridge and disfigurement of hands y In oral cavity, ant maxilla, lip and tongue involved is seen y Maxillary damage can lead to breathing problems

y Diagnosis depends upon history of contact with an

infected patient y TREATMENT

y Chemotherapeutic drugs including dapsone, rifampin

etc

y Traponema pallidium y Mode of transmission: sexual contact, infected mother

to child y Occur in four forms:

y Primary y Secondary y Tertiary y Congenital

y After 3_4 weeks of primary infection y Lip and tip of tongue

Firm nodule

Surface breaks down

Ulcer (chancre)

y Painless chancer resembling y y y y

a carcinoma clinically Painless Regional lymphadenopathy Treatment most effective at this stage After 8 to 9 weeks, healing occurs

y 1 to 4 months after infection y Mild systemic effects like fever, sore y y y y

throat etc Initially a rash occurs, consisting of coppery macules Usually give rise to flat ulcers covered by grayish membrane Snail track ulcers or mucous patches Discharge from ulcers containing spirochetes

y 3 or more years after infection y GUMMA is the characteristic y y

y y

lesion Palate, tongue and tonsil Gumma begins as a swelling with yellowish centre, which undergoes necrosis leaving an indolent ulcer Ulcer has punched out edges Floor has a leathery appearance

y Gumma after undergoing

necrosis can cause scarring y If present in the palate ,it may distort the palate leading to its perforations in the palate

y Due to transplacental infections y If severe, it can lead to death of infant y Less severe forms do not appear for 12 months y Initially a rash, leading to destruction of bones,nerves. y Hutchinson triad consisting of blindness, deafness and

dental anomalies y Screwdriver incisors, mulberry molars important dental anomalies

y DIAGNOSIS:
y Screening tests like VENEREAL DISEASE RESEARCH

LABORATORY test, RAPID PLASMA ANTIGEN test most frequently used y FTA-ABS most effective y Immunoflorescent staining
y TREATMENT:
y Pencilline G benzathine

y Noma means to devour y Rapidly progressive, opportunistic infection caused by

normal flora components including fusobacterium, provetella etc y PREDISPOSING FACTORS

y Poverty y Poor oral hygiene y Poor sanitation y Malnutrition y malignancy

y Recent illness y Immunodeficiency disorder

y CLINICAL FEATURES:
y Children 1 to 10 yrs of age y Begins in gingiva as NUG y NUG extends either in bone or soft tissue causing NUM y Greyish to bluish black discolouration of overlying skin y Necrosis in theses areas y Fetid odour, pain, fever, malaise etc y Scalp, neck, face, ear and shoulders

y TEATMENT:
y Penicillin y Metronidazole

1.DNA VIRUS INFECTIONS

A. HERPES VIRUS INFECTIONS

i.Herpes simplex ii.Varicella zoster iii.Cytomegalo virus iv.Epstein barr virus

y Two immunological types are seen

1.HSV1 causes oral and pharyngeal infections 2.HSV2 causes genital infections
y Prodromal symptoms precede the

oral lesions by 1-2 days

y Incubation period :2-12 days

y ORAL MANIFESTATIONS

1. Appearance of generalized acute marginal gingivitis 2. Several small gingival ulcers seen

ORAL MANIFESTATIONS CONTD 3. Small thin walled vesicles surrounded by an inflammatory base seen which rupture leaving shallow round discrete ulcers on all portions of oral mucosa 4. Posterior pharynx reveals inflammation 5.Submandibular and cervical lymph nodes are enlarged and tender

HERPES SIMPLEX CONTDuu

" MANAGEMENT OF ORAL LESIONS

1.Antiviral therapy: Acyclovir, famciclovir, valacyclovir 2.Suppportive therapy a.Aspirin for fever b.Fluids to maintain hydration and electrolyte balance c.Topical anaesthetic eg dyclonine hydrochloride 0.5% prior to meals if the patient has difficulty eating and drinking

y Herpes labialis is an

infection of the lip comonly caused by HSV-1 y It causes small blisters or sores on or around the mouth commonly known as cold sores or fever blisters y The sores typically heal within 23 weeks, but the herpes virus remains dormant in the facial nerves, following orofacial infection, periodically reactivating (in symptomatic people) to create sores in the same area of the mouth or face at the site of the original infection known as Recurrent herpes labialis

y It is responsible for two major clinical manifestations

y y y y

1. Chicken pox(Varicella) 2. Shingles(Herpes zoster) Chickenpox is a generalized primary infection that occurs the first time an individual contacts the virus Lesions of localized herpes zoster are seen when varicella zoster virus becomes reactivated Prodromal period: 2-4 days Incubation period: 10-21 days

y ORAL MANIFESTATIONS

1.Shooting pain, paresthesia, burning and tenderness appear along the course of the affected nerve 2.Unilateral vesicles on an erythematous base then appear in clusters 3.Vesicles change into ulcers

ORAL MANIFESTATIONS CONTD

4.HZ of the geniculate ganglion i.e.RAMSAY HUNT syndrome is a rare form of the disease characteized by Bells palsy, unilateral vesicles of the external ear and vesicles of the oral mucosa

y COMPLICATION

Postherpetic neuralgia which is defined as pain remaining for over a month after the mucocutaneous lesions have healed y MANAGEMENT 1.Antiviral therapy: Acyclovir ,famciclovir,valacyclovir 2.Therapy for post herpetic neuralgia: Application of capsaicin a substance extracted from hot chilli peppers.If it is ineffective,tricyclic antidepressant or gabapentin is indicated

y ORAL MANIFESTATIONS

1.Non specific ulcerations that usually appear as a single ulcer without preceding vesicles on any oral mucosal tissue which are painful and tend to heal poorly y MANAGEMENT 1.Intravenous gancyclovir

y ORAL MANIFESTATIONS
1.Infectious mononucleosis: Acute gingivitis, stomatitis, the appearance of white or gray membrane in various areas, palatal petechiae and occasional oral ulcers

y 2.Burkitts lymphoma: y Swelling of the affected y jaw or other facial bones, y loosening of the teeth and y swelling of the lymph y nodes which are nontender y and rapidly growing in y the neck or below the jaw

y 3.Nasopharyngeal carcinoma:

4.Oral hairy leukoplakia: Asymptomatic white lesion most commonly on the lateral borders of tongue

y MANAGEMENT

Antiviral therapy: Eg Acyclovir

B. POX VIRUS INFECTIONS i.Smallpox ii.Molluscum contagiosum

y It is an acute viral disease which before the discovery of

vaccination by Jenner, was epidemic in nature. y On December 9, 1979, the WHO Global Commission for the Certification of Smallpox Eradication declared : 1. Smallpox eradication has been achieved throughout the world 2.There is no evidence that it will return as an endemic disease

Incubation period : 6 weeks

y ORAL MANIFESTATIONS

1.Lesions tumorlike in nature because of the typical localized epithelial proliferation caused by the virus

ORAL MANIFESTATIONS CONTD 2.Lesions hemispheric in shape, usually about 5mm in diameter with a central umbilication which may be keratinized and are normal or slightly red in color 3.Sites: Lips, tongue and buccal mucosa 4. They are generally not painful, but they may itch or become irritated.

y MANAGEMENT

1.Surgical excision 2.Topical application of drugs such as podophyllin or cantharidin

2.RNA VIRUS INFECTIONS a.Paramyxovirus i.Measles ii.Mumps

y Highly contagious viral illness y Incubation period :10-12 days y ORAL MANIFESTATIONS
y Koplik spots (rash on mucous

membranes)occur 2-3 days before the cutaneous rashes y These spots occur on the buccal mucosa which appear as bluish, white specks surrounded by a bright red margin

y ORAL MANIFESTATIONS CONTD

-Palatal and pharyngeal petechiae as well as generalized inflammation, congestion, swelling and focal ulceration of the gingiva , palate and throat y COMPLICATIONS 1.Bronchial pneumonia 2.Encephalitis 3.Otitis media

y IMMUNIZATION

-Should be administered with mumps and rubella as MMR subcutaneously -2 doses given a. A first dose is given at 9 months of age b. Second dose is given at 15-18 months of age for adequate immunity

y It is an acute contagious viral infection

characterized chiefly by unilateral or bilateral swelling of the salivary glands, usually the parotid y Bilateral parotid involvement occurs in about 70% of cases , submandibular gland involvement in 10% of cases y It is transmitted through droplet nuclei or saliva or fomites y Incubation period: 2-3wks

y It is an acute contagious viral infection

characterized chiefly by unilateral or bilateral swelling of the salivary glands, usually the parotid y Bilateral parotid involvement occurs in about 70% of cases , submandibular gland involvement in 10% of cases y It is transmitted through droplet nuclei or saliva or fomites y Incubation period: 2-3wks

y ORAL MANIFESTATIONS

1.Age: Mostly children between 4-6 yrs 2.Salivary gland enlargement, frequently elevating the ear ,which lasts for about 1 week

y ORAL MANIFESTATIONS CONTD..

4.Pain upon mastication 5.Pain and tenderness may be severe during the rapid phase of parotid enlargement and swelling reaches its maximum in about 3 days. It remains at its peak for 2-3days and then gradually subsides y COMPLICATIONS 1.Meningitis 2.Encephalitis 3.Oophoritis 4.Orchitis y TREATMENT Symptomatic and Vaccination (MMR)

y 2.RNA VIRUS INFECTIONS

b.PICORNA VIRUS
I. Coxsackie virus

y Causative agent Coxsackie virus A4 type y Very contagious and Passed on by:

y Unwashed hands y Surfaced contaminated by feces y Sneezes or coughs y Majority of cases affect young children ages 3-10 y Incubation period : 2-10 days

y ORAL MANIFESTATIONS

1.Lesions start as punctate macules which quickly change nto vesicles involving the posterior pharynx ,tonsils, faucial pillars and soft palate 2.Vesicles rupture into small 12mm ulcers

y MANAGEMENT

The disease is usually mild and heals without treatment in 1 week y SUPPORTIVE TREATMENT a.Fluids for proper hydration b.Topical anaestthetic when eating or swallowing is difficult

y 2.RNA VIRUS INFECTIONS

C.RETRO VIRUS I.HIV

y Acquired immunodeficiency

syndrome(AIDS) is caused by the HIV and is characterized by immunosuppression, which leads to a spectrum of clinical manifestations that include opportunistic infections, secondary neoplasm and neurologic manifestations

y Infection is transmitted vertically

from mother to child y Window period

y The time between viral infection and seroconversion y HIV is present in body fluids and can be transmitted, but the HIV

serology is nonreactive

1.Fungal infections 4.Non specific ulcerations a.Oral Candidiasis a.Apthous ulcers 2.Viral infections b. Drug induced ulcerations a.Herpes virus infections 3.Bacterial infections 5.Kaposis sarcoma a.Linear gingival erythema 6.Non Hodgkins lymphoma b.Necrotizing ulcerative 7.Oral hairy leukoplakia gingivitis c.Necrotizing ulcerative periodontitis

LINEAR GINGIVAL ERYTHEMA y 2-3 mm distinct band of fiery redness at the marginal gingiva around the teeth

NECROTIZING ULCERATIVE GINGIVITS

-Spontaneous gingival bleeding -Mild to moderate gingival pain

NECROTIZING ULCERATIVE PERIODONTITS

-Deep seated bone pain -Spontaneous gingival bleeding -Halitosis -Tooth mobility

APTHOUS ULCERS -Recurrent,round, shallow and painful ulcers -Typically found on non-keratinized oral mucosa

y KAPOSIS SARCOMA

-Human herpes vius type 8 is involved -Manifests as red-blue or purple-blue macules or nodules -Most common site is palate

y NON-HODGKI NS LYMPHOMA

-Presents as a large, painful, ulcerated mass on the palate or gingival tissues

y ORAL HAIRY LEUKOPLAKIA

-Corrugated surface of the epithelium on the lateral margin of the tongue

y DIAGNOSIS

1.Viral culture 2.Polymerase chain reaction 3.Enzyme linked immunosorbent assay 4.Western blot analysis

1.Candidiasis 2.Histoplasmosis

y It is an opportunistic infection caused by a yeast like fungus,

Candida albicans y It is classified as i. Mucocutaneous candidiasis -Oral candidiasis -Candidal esophagitis -Intestinal candidiasis ii. Systemic candidiasis

y CLASSIFICATION OF ORAL CANDIDIASIS

1.Acute a. Acute pseudomembranous b. Acute atrophic 2.Chronic a. Chronic hyperplastic b. Chronic mucocutaneous c. Chronic atrophic

ACUTE PSEUDOMEMBRANOUS -Soft ,white elevated plaques resembling milk curds -Can be easily scraped off , exposing red areas

y ACUTE ATROPHIC

-A type of erythematous candidiasis -Occurs as a sequelae to a course of broad spectrum antibiotics -Lesions appear red or erythematous -The only variety which is painful

CHRONIC HYPERPLASTIC -Lesions consists of firm , white persistent plaques -Leukoplakia type of candidasis

CHRONIC MUCOCUTANEOUS 1.Familial 2.Localized 3.Candidiasis endocrinopathy syndrome 4.Diffuse

CHRONIC ATROPHIC -Occurs in edentulous patients with denture sore mouth

TREATMENT Antifungal agents -Topical agents : Eg-Nystatin or Clotrimazole -Systemic agents : Eg- Fluconazole

y Also known as Darlings disease y It is a generalized fungus infection caused by the organism

Histoplasma capsulatum

y ORAL MANIFESTATIONS

1.Nodular, ulcerative or vegetative lesions on the buccal mucosa, gingiva, tongue, palate or lips 2.The ulcerated areas are usually covered by a non specific gray membrane and are indurated

y TREATMENT

Antifungal agents Eg: Amphotericin B

1.Shafers Text book of Oral Pathology 2.Burkets Oral Medicine 3.Text book of Pedodontics-Shobha Tandon 4. http://www.medicinenet.com 5. http://www.askdrsears.com 6. http://www.vaccineinformation.org

Thank you