Chapter 4 Infectious Diseases - PowerPoint PPT Presentation

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Chapter 4 Infectious Diseases

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Title: Chapter 4 Infectious Diseases


1
Chapter 4 Infectious Diseases
  • Bacterial Infections

2
Inflammatory and immune response to infection
  • Inflammatory response is a nonspecific response
    and results in edema and the accumulation of a
    large number of white blood cells ate the site
  • Immune system response is highly specific
    Specific antibodies are formed in response to
    specific antigens
  • Microorganisms are antigens

3
Opportunistic infection
  • Decrease in salivary flow
  • Antibiotic administration
  • Immune system alterations
  • Change oral flora so that organisms that are
    usually nonpathogenic are able to cause disease

4
Impetigo
  • Skin infection caused by Streptococcus pyogenes
    and Staphylococcus aureus
  • May itch (pruritus)
  • Regional lymphadenopathy may be present
  • Normally found on skin (non-intact skin is
    necessary to contract
  • Oral manifestation - resembles recurrent herpes
    simplex

5
Tuberculosis
  • Infectious chronic granulomatous disease
  • Usually caused by Mycobacterium tuberculosis
  • Primary infection of the lung
  • Inhaled droplets containing bacteria lodge in the
    alveoli of the lungs
  • Ulcerations can appear when organisms are carried
    in sputum to oral cavity
  • Routine dental treatment is deferred for patients
    with active TB
  • An antigen called Purified Protein Derivative
    (PPD) is injected into the skin

6
Actinomycosis
  • Infection caused by a filamentous bacterium
    called Actinomyces israelii
  • Formation of abscesses that tend to drain by the
    formation of sinus tracts
  • Organisms are common inhabitants of the oral
    cavitypredisposing factors are unknown

7
Syphilis
  • Caused by the spirochete Treponema pallidum.
  • Transmitted by direct contact
  • Can penetrate mucous membranes, but needs a break
    in tissue to penetrate it
  • Usually transmitted through sexual contact with a
    partner with active lesions
  • Blood or transplacental innoculation

8
Syphilis
  • Stages of Syphilis
  • (1) Primary - oral lesion - chancre
  • (2) Secondary- oral lesion - mucous patch
  • (3) Latent - no oral lesion
  • (4) Tertiary - oral lesion - gumma

9
Necrotizing Ulcerative Gingivitis
10
Necrotizing Periodontal Diseases
  • NUG- an acute infection isolated in the gingiva
    (formerly known as ANUG)
  • NUP is a similar infection that has progressed
    to include attached periodontal ligament and bone
    loss
  • (AAP, 2000)

11
Necrotizing Periodontal Diseases
  • Signs and symptoms
  • Gingiva is painful and erythematous
  • Necrosis of interdental papillae (blunted)
  • Foul odor
  • Metallic taste
  • Sloughing of the necrotic tissue presents as a
    pseudomembrane over the tissues

12
Necrotizing Periodontal Diseases
  • Unique in their clinical presentation, etiology
    and pathogenesis
  • If NUP is combined with HIV marginal necrosis of
    the gingiva and a very rapid loss of alveolar
    bone is seen
  • severe pain and bleeding without any provocation
  • perhaps because of immunodeficiency there have
    been reports of tooth loss in only three to six
    months after onset

13
Necrotizing Periodontal Diseases
14
NUG
  • Acute recurring gingival infection of complex
    etiology
  • Characterized by necrosis of the papillae often
    described as punched-out
  • Spontaneous bleeding and pain
  • Pain is what make necrotizing periodontal
    diseases very different from plaque-induced
    gingivitis and periodontitis

15
NUG
  • Known by many names over the years
  • Trench mouth
  • Vincents infection
  • Fuso-spirochetal gingivitis
  • ANUG (misnomer b/c acute is clinical
    description)
  • No chronic form of NUG
  • Recurrence

16
NUP
  • Progression of NUG into the underlying attached
    gingiva causing periodontal pocketing
  • Bone loss
  • May occur if of recurrences of NUG or
    underlying systemic conditions such as AIDS
  • AIDS/NUP originally called HIV_P
  • If associated with recurrences conservative
    treatment is very successful
  • No so with AIDS patients

17
NPD
  • One of the few emergency dental hygiene
    appointments
  • Extreme pain
  • Gross debridement
  • Anesthetic helps ease pain during procedure
  • Sonic or ultrasonic
  • Education about the cause of the disease
  • Nutritional counseling
  • Vitamin recommendations
  • Oral hygiene instruction
  • No antibiotics

18
Pericoronitis
  • Inflammation of the mucosa around the crown of a
    partially erupted or impacted tooth
  • Trauma from an opposing molar and impaction of
    food under the soft tissue flap (operculum)
    covering the distal portion of the third molar
  • Treatment includes mechanical debridement and
    irrigation of the pocket and systemic
    antibiotics. Extraction of the impacted molar is
    usually necessary to prevent recurrence.

19
Osteomyelitis
  • An inflammatory process within medullary
    (trabecular) bone that involves the marrow spaces
  • No change is seen on the radiograph unless the
    disease has been present for more than one week

20
(moth eaten) radiolucent lesion with
irregular margins usually in the posterior
mandible fragments of necrotic bone may be
visible in the radiolucent areas
21
Tonsillitis and Pharyngitis
  • Inflammatory conditions of the tonsils and
    pharyngeal mucosa
  • Can be caused by different organisms
  • Streptococcal bacterial infection closely
    resembles tonsillitis and pharyngitis that are
    caused by viruses
  • Strep throat caused by group A, beta hemolytic
    streptococci are significant

22
Strep throat
  • Scarlet fever - usually occurs in children
  • Tonsillitis and pharyngitis
  • Fever, red skin rash, petechiae on the soft
    palate and strawberry tongue
  • Rheumatic Fever - childhood disease that follows
    strep infection
  • Inflammatory reaction involving heart, joints,
    and CNS
  • Heart valve damagebacterial endocarditis
    prophylactic pre-medication is necessary

23
Fungal Infections
  • Candidiasis
  • Moniliasis (Thrush)
  • Overgrowth the yeast-like fungus Candida albicans
  • Encompasses a group of mucosal and cutaneous
    conditions with a common etiologic agent from the
    Candida genus of fungi most common oral mycotic
    infection
  • Part of the normal oral flora especially if
    dentures are worn

24
Candida albicans overgrowth can result from many
different conditions
  • Antibiotic therapy
  • Cancer chemotherapy
  • Corticosteroid therapy
  • Dentures
  • Diabetes Mellitus
  • HIV infection
  • Hypoparathyroidism
  • Infancy
  • Multiple Myeloma
  • Primary T-lymphocyte deficiency
  • Xerostomia

25
Types of Oral Candidiasis
  • Pseudomembranous
  • Erythematous
  • Chronic atrophic (denture stomatitis)
  • Chronic hyperplastic (candidal leukoplakia)
  • Angular cheilitis

26
Pseudomembranous Candidiasis
27
More candidiasis
28
Angular Cheilitis
  • Candida organism most often causes
  • Appears as erythema and/or fissuring at the
    labial commissures
  • Can be caused by other factors (e.g.,
    nutritional, factitial)

29
Angular cheilitis
Condition is most often bilateral
30
Median Rhomboid Glossitis
  • An asymptomatic, elongated, erythematous patch of
    atrophic mucosa of the mid-dorsal surface of the
    tongue due to a chronic Candida albicans
    infection
  • Central Papillary Atrophy of the Tongue

31
Median Rhomboid Glossitis
32
Viral Infections
  • Papillomavirus infection
  • HPVs identified in oral lesions, normal mucosa
    and implicated in neoplasia
  • Verruca vulgaris or common wart - autoinoculation
    occurs through finger contactlooks like a
    papilloma

33
Primary Herpetic Gingivostomatitis
  • Painful
  • Erythematous
  • Edematous
  • Most common in children 6mos to 6 yrs.
  • Perioral skin, vermillion border of lips oral
    mucosa

34
Recurrent herpes simplex infection Herpes Labialis
  • Form of recurrent herpes simplex
  • Papules on the commissure of the lips.
  • Most common type of recurrent oral herpes simplex
    infection occurs on the vermilion border of lips
  • Cold sore or fever blister

35
Recurrent herpes simplex infection
  • Intraorally - occurs on keratinized mucosa that
    is fixed to bone
  • Most commonly hard palate and gingiva
  • Tiny clusters of vesicles or ulcers that can
    coalesce to form a single ulcer with an irregular
    border
  • Prodromal symptoms pain, burning, tingling
  • Heal without scarring in 1-2 weeks
  • Transmitted by direct contact
  • Primary infection occurs at the site of
    inoculation
  • Amount of virus is highest in vesicle stage

36
Herpetic Whitlow
  • Herpes simplex virus. Can occur when fulcruming
    on same tooth and instrument punctures finger
  • Very painful, even debilitating

37
Herpes simplex can also spread to eyes.
  • Inform patients with herpes to be very careful
    not to self inoculate. If they have open
    vesicles it can be spread to other areas of the
    body such as eyes or mucous membranes around
    genitalia.
  • Learn table 4-2 on differences between aphthous
    ulcers and herpes simplex (page 142)

38
Herpes Zoster
  • Caused by the Varicella-Zoster virus
  • Common name is Shingles
  • Respiratory aerosols and contact with secretions
    from skin lesions transmit the virus
  • Unilateral distribution of oral and skin lesions
  • Painful vesicles that progress to ulcers
  • Same virus that causes Chicken Pox (Varicella)

39
Epstein-Barr Virus Infection
  • Infectious Mononucleosis
  • Most common in late adolescents and young adults
    in upper socioeconomic classes (transmitted by
    close contact)
  • Hairy Leukoplakia
  • Most common in HIV infected people
  • Nasopharyngeal carcinoma - rare neoplasm
  • Burkitts Lymphoma - rare neoplasm

40
Coxsackievirus infections
  • Herpangia - vesicles on the soft palate fever,
    malaise, sore throat, difficulty swallowing
    (dysphagia)erythematous pharyngitis
  • Mild to moderate and resolves in less than 1 week
  • Hand-Foot and Mouth Disease - occurs in epidemics
    in children less that 5 years of age
  • Painful vesicles and ulcers anywhere in mouth
  • Lesions resolve spontaneously within 2 weeks

41
Human Immunodeficiency Virus (HIV) Acquired
immunodeficiency syndrome (AIDS)
  • Most individuals experience an acute disease that
    occurs shortly after infection with HIV
  • Sexual contact, blood or blood product
  • contact, infant to mother
  • Acute disease resolves and no signs or symptoms
    of disease exist for some time
  • Most patients eventually have a progressive
    immunodeficiency

42
HIV AIDS
  • of CD4 lymphocytes decreases
  • Fatigue, opportunistic infections (oral
    candidiasis)
  • As the immune system becomes profoundly
    deficient, life threatening opportunistic
    infections and neoplasms occur
  • Most severe result of infection with HIV is AIDS

43
AIDS Diagnosis
  • See table 4-3 (page 147)
  • Severe CD4 lymphocyte depletion
  • Pneumocystic carinii pneumonia
  • Esophageal candidiasis
  • Kaposis sarcoma
  • Pulmonary tuberculosis
  • Recurrent pneumonia
  • Invasive cervical cancer

44
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45
Oral Manifestations
  • Most common oral lesion associated with HIV
    infection is Oral Candidiasis

Unexplained oral candidiasis should be referred
to a physician for a cause. Very early sign of
developing immunodeficiency.
46
Herpes Simplex and HIV
Treated with Acyclovir an antiviral medication
47
Acyclovir Resistant Herpes Simplex in HIV patient
48
Herpes Zoster in HIV infected person
49
Oral Hairy Leukoplakia - Epstein-Barr Virus
50
Papillomavirus Infections and HIV
51
Kaposis Sarcoma
  • Opportunistic neoplasm that occurs in patients
    with HIV infections
  • HHV-8 associated with this neoplasm
  • Neoplasm is a mass of newly formed tissue in
    which the growth of tissue is uncontrolled and
    progressive

52
Kaposis Sarcoma
53
Lymphoma in HIV patients
  • Non-Hodgkins Lymphoma
  • Malignant tumor
  • Non-ulcerated, necrotic or ulcerated masses

54
Gingival and Periodontal Disease in HIV infected
persons
  • Linear Gingival Erythema (LGE)
  • NUP

55
Apthous Ulcerations and HIV
56
Mucous melanin pigmentation
  • Probably AZT pigmentation
  • AZT is chemical ingredient in many AIDS drugs
    such as Retrovir, Combivir and Trizivir,
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