23. Oral Mucosal Infections

Question 1

[T/F] C. Albicans is dimorphic

Answer 1

True
- exist in yeast or hyphae forms
- conversion to hyphae form is associated w disease progression

Question 2

[T/F] Candida spps are opportunistic pathogens

Answer 2

True. ‘Disease of the Diseased’ of the
- very young, very old, very sick, very dry
- when host defenses are compromised

Question 3

[T/F] Candida albicans is not commensal

Answer 3

False
- actually normal oral commental in 45-60%
- also commensal in vagina

Question 4

What does the Germ tube test test for?

Answer 4

C. Albicans & C. Dubliniensis
- germ tube formation inoculated in serum at 37 degrees celsius
- only these 2 species will convert to hyphae from from yeast form
- will notice germ tubes (outgrowth/pouching produced by spores)

Question 5

What are some conditions that can arise due to C. Albicans?

Answer 5

1. Angular chelitis in denture wearers
2. Denture stomatitis
3. White vaginal discharge w itch
4. Oropharyngeal/pseudomembranous candidiasis (oral thrush)

Question 6

Which medication is a good topical anti-fungal to combat against C. Albicans?

Answer 6

Nystatin
(issa polyene)

Question 7

How does oropharyngeal/pseudomembranouse candidiasis (oral thrush) present?

Answer 7

• white patches on tongue that can be wiped off to revel erythmatous surface
• associated w HIV
• yeast & pseudohyphae (under microscope)

Question 8

What is the difference between angular chelitis and denture stomatitis?

Answer 8

Angular chelitis refers to the inflammation at the angles of the mouth/lip area

Denture stomatitis occurs usually under the base of upper dentures (esp well fitted ones)

• but related, when u see angular chelitis, also gotta look under denture to check for denture stomatitis

Question 9

Denture-induced stomatitis occurs more often on which arch?

Answer 9

Upper dentures
- especially well fitted ‘perfect’ ones
- saliva cannot wash through => perfect for candida to proliferate
- lower dentures usually dh cuz got saliva flow

Question 10

Angular cheilitis can be due to..

Answer 10

1. Angular cheilitis
2. Staph aureus

Question 11

Name the the bacterial infections that can occur in the oral mucosa?

Answer 11

1. Syphilis
2. ANUG
3. Tuberculosis
4. Actinomycosis
5. Osteromyelitis of the jaw

Question 12

What is ANUG?

Answer 12

Acute Ulcerative Necrotising Gingivitis

Question 13

What is the tx for ANUG?

Answer 13

• oral debridement, improve OHI
• H2O2 or chlorhexidine irrigation
• penicillin or metronidazole

Question 14

What is Actinomycosis?

Answer 14

• chronic sinus tract infection
• sulphur granules is not actually sulphur, just looks like it
• issa yellow purulent material
• not a fungal infection

Definition:
Chronic, suppurative infective bacterial disease of the upper neck, perioral areas and/or jaws w interconnecting draining sinus tract containing sulphur granules

Question 15

Cervicofacial actinomycosis presents most commonly in the..

Answer 15

Mandible

Question 16

What bug causes Actinomycosis?

Answer 16

Actinomyces israelii
- anaerobic gram +ve bacteria

Question 17

How is Actinomycosis treated?

Answer 17

• surgical drainage of abscess
• prolonged administration of AB
  -> penicillins, erythromycin/clindamycin
• clindamycin would be rlly good for dent conditions cuz 1. Penetrates bone 2. Targets anaerobes BUT it causes CDAD, so we only reserve it for serious infections

Question 18

Why do pxs who get IV drip likely get infection by S. Aureus?

Answer 18

S. Aureus resides on skin
- when needle pokes through skin
- S. Aureus can get in