Title: Chapter 4 Infectious Diseases
1Chapter 4 Infectious Diseases
2Inflammatory 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
3Opportunistic 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
4Impetigo
- 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
5Tuberculosis
- 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
6Actinomycosis
- 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
7Syphilis
- 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
8Syphilis
- Stages of Syphilis
- (1) Primary - oral lesion - chancre
- (2) Secondary- oral lesion - mucous patch
- (3) Latent - no oral lesion
- (4) Tertiary - oral lesion - gumma
9Necrotizing Ulcerative Gingivitis
10Necrotizing 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)
11Necrotizing 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
12Necrotizing 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
13Necrotizing Periodontal Diseases
14NUG
- 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
15NUG
- 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
16NUP
- 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
17NPD
- 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
18Pericoronitis
- 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
21Tonsillitis 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
22Strep 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
23Fungal 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
24Candida 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
25Types of Oral Candidiasis
- Pseudomembranous
- Erythematous
- Chronic atrophic (denture stomatitis)
- Chronic hyperplastic (candidal leukoplakia)
- Angular cheilitis
26Pseudomembranous Candidiasis
27More candidiasis
28Angular 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)
29Angular cheilitis
Condition is most often bilateral
30Median 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
31Median Rhomboid Glossitis
32Viral 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
33Primary Herpetic Gingivostomatitis
- Painful
- Erythematous
- Edematous
- Most common in children 6mos to 6 yrs.
- Perioral skin, vermillion border of lips oral
mucosa
34Recurrent 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
35Recurrent 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
36Herpetic Whitlow
- Herpes simplex virus. Can occur when fulcruming
on same tooth and instrument punctures finger - Very painful, even debilitating
37Herpes 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)
38Herpes 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)
39Epstein-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
40Coxsackievirus 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
41Human 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
42HIV 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
43AIDS 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(No Transcript)
45Oral 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.
46Herpes Simplex and HIV
Treated with Acyclovir an antiviral medication
47Acyclovir Resistant Herpes Simplex in HIV patient
48Herpes Zoster in HIV infected person
49Oral Hairy Leukoplakia - Epstein-Barr Virus
50Papillomavirus Infections and HIV
51Kaposis 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
52Kaposis Sarcoma
53Lymphoma in HIV patients
- Non-Hodgkins Lymphoma
- Malignant tumor
- Non-ulcerated, necrotic or ulcerated masses
54Gingival and Periodontal Disease in HIV infected
persons
- Linear Gingival Erythema (LGE)
- NUP
55Apthous Ulcerations and HIV
56Mucous melanin pigmentation
- Probably AZT pigmentation
- AZT is chemical ingredient in many AIDS drugs
such as Retrovir, Combivir and Trizivir,