Chapter 4 Flashcards
whether an organism can cause disease depends on what
- the microorganism
- the body’s defenses
what are the 2 types of microorganisms divided according to
- pathogenic (disease causing)
- nonpathogenic (non disease causing)
what are the classes of infectious disease that can gain entry to the body
- bacterial
- fungal
- viral
- protozoan
- helminthic
what is an opportunistic infection
- when an organism that usually is nonpathogenic causes disease
what is an infectious disease
- microorganisms that penetrate epithelial surfaces as foreign bodies and stimulate a response
what are a few different routes of infection
- transferred through the air on dust particles or water droplets
- some may require intimate and direct contact
- some may be transferred by hands or objects
what can affect oral flora
- changes in salivary flow
- administration of antibiotics
- changes in the immune system
what happens when microorganisms penetrate the epithelial surfaces as foreign bodies
- stimulate the inflammatory response: nonspecific response that results in edema and the accumulation of a large number of white blood cells
- stimulate the immune system: a highly specific response that results in the production of antibodies to the microorganisms that act as antigens
what is tonsillitis/pharyngitis
- often caused by bacteria/viruses
- streptococcal, influenza, epstein barr
what is strep throat and scarlet fever caused by and what are common symptoms
- endotoxins of group A beta-hemolytic streptococci
- produces rash on body and strawberry tongue – fungiform papillae are prominent
what is rheumatic fever
- can follow strep infection
- affects the heart, joints, CNS
what is tuberculosis caused by
- usually an organism called mycobacterium tuberculosis
- chief form of disease is an infection of the lungs caused by the bacteria
- this organism is resistant to destruction by macrophages
- after being engulfed, they multiply in the macrophages and then disseminate in the bloodstream
what are signs and symptoms of tuberculosis
- fever, chills, fatigue and malaise, weight loss, persistent cough
what is miliary tuberculosis
- involvement of organs such as kidney and liver in widespread areas of the body – enters bloodstream and becomes systemic
- potential oral lesions but they are rare. appear as painful, nonhealing, superficial or deep slowly enlarging ulcers
when is tuberculosis contagious
- when it is active
how is tuberculosis spread
- coughing
- laughing
- sneezing
- singing
- talking
how can we diagnose tuberculosis
- oral lesions: identified by biopsy and microscopic examination
- chronic granulomatous lesions with areas of necrosis surrounded by macrophages, multinucleated giant cells, and lymphocytes
- tissue may be stained to reveal organisms
how do we test for TB
- skin test: an antigen is injected into the skin (purified protein derivative – mantoux test)
- a positive inflammatory reaction occurs if the person has previously been exposed to the antigen
- chest radiographs may be taken after a positive skin test to see if lung damage/disease is present
- sputum test for culture purposes
how can we treat TB
- combination medications, including isoniazid and rifampin
- tx may continue for 6 mo or years
- ptes usually become noninfectious shortly after tx begins
- pte’s physician should be consulted to determine whether pte is infectious
what causes syphillis
- spirochete Treponema pallidum
- transmitted by direct contact: the organisms die when exposed to air and changes in temperature
- can penetrate mucous membranes, but not intact skin
- usually transmitted through sexual contact but may be transmitted through transfusion of infected blood or to a fetus from an infected mother
what are the 3 stages of syphilis
- within about 21 days of contact, but can be sooner or up to 90 days
- primary stage
- secondary stage
- tertiary stage
what is the primary stage
- within about 21 days of contact, but can be sooner or up to 90 days
- lesion of the primary stage is a chancre (shang-ker)
- forms where the spirochete enters the body (mouth, anus, penis, vagina)
- highly infectious BUT painless so can go un-noticed
- heals spontaneously (within 3-6 weeks) and the disease enters a latent period
what is the secondary stage
- diffuse eruptions occur on skin and mucous membranes
- mucous patches: oral lesions that appear as multiple, painless, grayish white plaques covering ulcerated mucosa
- these lesions are the MOST INFECTIOUS
- undergo spontaneous remission but may recur for months or years
- fever, malaise, swollen lymph nodes, fatigue
- latent stage occurs after this (period of remission)
what is the tertiary stage
- can be 10-30 years later
- chiefly involves the cardiovascular system and the nervous system
- lack of muscle coordination, paralysis, numbness, dementia
- multiple organ involvement – eyes, heart, joints
- gumma: a firm mass, noninfectious, a destruction lesion that can result in perforation of the palatal bone
overall, what are the oral lesions found in all 3 stages of syphillis
- primary: chancre
- secondary: mucous patch
- latent: none
- tertiary: gumma
what is congenital syphilis
- transmitted from an infected mother to the fetus
- may cause serious and irreversible damage
- facial and dental abnormalities
- hutchinson teeth, mulberry molars
how do we diagnose and treat syphilis
- lesions on skin may be diagnosed by dark-field microscopy
- diagnosis confirmed by blood tests including VDRL and fluorescent terponemal antibody absorption test (FTA-ABS)
- tx: penicillin and retested
what is necrotizing ulcerative gingivitis
- a painful, erythematous gingivitis with necrosis of interdental papillae (“punched out papillae”), foul odor and metallic taste
- most likely caused by both a fusiform bacillus and a spirochete (borrelia vincentii)
- associated with decrease resistance to infection
- systemic symptoms: fever, malaise, lymphadenopathy
- “trench mouth”: stress, smoking, poor nutrition, poor OHI contributory
how do we diagnose and treat NUG
- diagnosis: necrosis results in cratering of the interdental papillae. sloughing off necrotic tissue causes a pseudomembrane over the tissue
- treatment: gentle debridement, CHX or hydrogen peroxide rinse. Antibiotics (metronidazole or penicillin)
what is pericoronitis
- inflammation of mucosa
- around partially impacted or erupted molar (operculum)
- proliferation of bacteria
- immunodeficiency increases risk
how do we diagnose and treat pericoronitis
- dx: clinical appearance; swollen, erythematous, painful
- tx: debridement and irrigation, antibiotics, extraction of impacted molar
what is acute osteomyelitis
- acute inflammation of the bone marrow
- most commonly the result of extension of a periapical abscess
- may follow fracture of a bone
- may result from bacteremia
how do we diagnose acute osteomyelitis
- identification of the causative organism is based on culture results
- tx is based on antibiotic sensitivity testing
what is the treatment and prognosis of acute osteomyelitis like
- drainage of the area
- appropriate antibiotics
- surgical debridement may also be required
- prognosis is good
what is chronic osteomyelitis
- a longstanding inflammation of bone
- the involved bone is painful and swollen
- radiographs reveal a diffuse and irregular radiolucency that can eventually become opaque
- known as chronic sclerosing osteomyelitis when radiopacity develops
what is the non-treated acute phase of chronic osteomyelitis like
- more painful and infected
- radiolucent to opaque
- also present post radiation therapy
how do we diagnose and treat chronic osteomyelitis
- dx: biopsy, culture test
- tx: debridement, antibiotics, hyperbaric oxygen (reduces cell death and infection while maintaining tissue viability)
what is candidiasis
- a fungal infection
- yeast like fungus
- most common oral fungal infection
- candida albicans: normal oral flora, overgrowth, due to imbalance, may causes
- the outcome of an overgrowth of candida albicans is candidiases
what can cause candidiasis
- antibiotics
- cancer chemotherapy
- corticosteroid therapy
- dentures
- diabetes
- HIV infection
- hypoparathyroidism
- infancy
- multiple myeloma
- primary T lymphocyte deficiency
- xerostomia
how can we identify candidiasis
- scraping of the lesion
what is pseudomembranous candidiasis
- a white curdlike material is present on the mucosal surface
- the mucosa is erythematous underneath
- the patient may complain of a burning sensation and/or metallic taste
what is erythematous candidiasis
- the presenting complaint is an erythematous, often painful mucosa
- sometimes accompanied by depapillation of the tongue
- may be localized to one area or oral mucosa or be more generalized
what is denture stomatitis and what is another name for it
- chronic atrophic candidiasis
- most common type of candidiasis
- the mucosa is erythematous, but the change is limited to the mucosa covered by a full or partial denture
- the pattern follows the outline of the RPD or denture
- usually asymptomatic
what is chronic hyperplastic candidiasis
- a white lesion that does not wipe off the mucosa
- it will respond to antifungal medication
- a lesion that does not respond to antifungal meds should be biopsied
what is angular cheilitis
- erythema or fissuring at the labial commissures
- most commonly from candida, but may be caused by other factors such as nutritional deficiencies
what is chronic mucocutaneous candidiasis
- a severe form that usually occurs in patients who are severely immunocompromised
- the patient has chronic oral and genital mucosal candidiasis and skin lesions as well
what is median rhomboid glossitis
- an erythematous, often rhomboid shaped, flat to raised area on the midline of the posterior dorsal tongue
- candida has been identified in some lesions, and some lesions disappear with antifungal treatment
- the response is not consistent though
what is the human papillomavirus
- over 200 types of HPV have been identified
- most are common, treatable and non cancerous
- transmission can be as simple as skin-to-skin or STD
- infection usually clears within 1 year (6 mos-3 years), 5% are “persistent” (can cause cancer)
which type of HPV is commonly responsible for cervical cancer and oropharyngeal cancers
- HPV 16
where do we usually see oral cancer caused by HPV
- back of tongue, tonsillar pillars, oropharynx
where do we usually see oral cancers caused by smoking and alcohol
- buccal mucosa, floor of mouth, alveolar ridge, anterior tongue, lateral borders
which types of HPV are most commonly associated with warts
- HPV 6 and 11
which types of HPV are most commonly associated with cancer
- HPV 16, 18, 31, 33, 45, 52 and 58
what are signs and symptoms of an HPV infection
- hoarseness
- continual sore throat, throat infection not responding to antibiotics
- pain when swallowing or difficulty swallowing
- pain when chewing
- continual lymphadenopathy
- non-healing oral lesions
- bleeding in the mouth or throat
- ear pain
- lump in throat or feeling that something is stuck in throat
what is verruca vulgaris
- common wart
- a papillary oral lesion caused by a papillomavirus
- usually transmitted from skin to oral mucosa
- autoinoculation usually occurs through finger sucking or fingernail biting
- usually a white, papillary, exophytic lesion that closely resembles a papilloma
how do we diagnose verruca vulgaris
- biopsy and histologic examination revels the light microscopic features of this lesion
- immunologic staining may help identify viruses
how do we treat verruca vulgaris
- conservative surgical excision, lesion may recur
- patients with finger lesions should refrain from finger sucking or fingernail biting to prevent re-inoculation
what is condyloma acuminatum
- a benign papillary lesion caused by a papillomavirus
- genital warts
- generally transmitted by sexual contact
- may be trasmitted to the oral cavity through oral-genital contact or self-inoculation
- papillary, bulbous pink masses that can occur anywhere in the oral mucosa; multiple lesions may be present
how do we treat condyloma acuminatum
- conservative surgical excision
- recurrence is common
what is focal epithelial hyperplasia
- aka Heck disease
- characterized by the presence or multiple white-ish to pale pink nodules distributed throughout the oral mucosa
- most common in children
- lesions are generally asymptomatic and do not require tx
- resolve spontaneously within a few weeks
what is a herpes simplex infection
- two major types of herpes simplex:
1. type I: oral infections
2. type II: genital - herpes simplex is one of a group of viruses called human herpes viruses (HHV)
what is primary herpetic gingivostomatitis
- the oral disease caused by initial infection with herpes simplex virus
- painful, erythematous and swollen gingiva and multiple tiny vesicles on perioral skin, vermillion border of lips and oral mucosa may be seen
- the vesicles progress to form ulcers
- the patient may have systemic symptoms such as fever, malaise, and cervical lymphadenopathy
- most commonly occurs in children between 6 months and 6 years of age – the majority of infections are thought to be subclinical
what are all of the herpes simplex infections in the family of viruses
- HSV1: oral infections: primary and secondary/recurrent
- HSV2: genital herpes
- (3) varicella zoster: chicken pox and shingles (secondary)
- (4) epstein barr: mononucleosis
- (5) cytomegalovirus
- (6 and 7) roseola
- (8) kaposi’s sarcoma
what is cytomegalovirus
- mono-like symptoms
- congenital – deafness and mental retardation
- rare severe congenital disease
- immunocompromised – HIV
what is roseola
- fever and skin rash
what is kaposi’s sarcoma associated with
- AIDS
when recurrent herpes simplex infection is found in the mouth, how does it present
- occurs intraorally on keratinized mucosa that is attached to bone
- painful groups of small vesicles that ulcerate and coalesce to form a single ulcer with an irregular border
when is herpes most infectious
- during vesicle stage
how do we diagnose herpes
- mainly based on clinical appearance
- changes in epithelial cells can be seen microscopically
how do we treat recurrent herpes simplex infection
- antiviral drugs where appropriate
- acyclovir
- not been shown to be consistently effective in treating lesions except in immunocompromised patients
what is varicella-zoster
- causes both chicken pox (varicella) and herpes zoster (shingles)
- resp aerosols and contact with secretions from skin lesions transmit the virus
what are chicken-pox
- a highly contagious disease
- causes vesicular and pustular eruptions of skin and mucous membranes
- systemic symptoms include headache, fever and malaise
- usually occurs in children
what is herpes zoster
- shingles
- secondary chickenpox in an adult
- characterized by unilateral, painful eruptions of vesicles along the distribution of a sensory nerve
- any branch of the trigeminal nerve may be involved if lesions affect the face
- vesicles are often preceded by pain, burning or paresthesia
- the disease usually lasts for several weeks. neuralgia may take months to resolve
how do we diagnose varicella zoster
- generally made based on clinical features
- biopsy or smear may show the same type of virally altered epithelial cells seen in herpes simplex infection
how do we treat varicella
- antiviral, steroids – should syart within couple of days of rash
- contagious to those who have NOT had chicken pox – during the time when vesicles are actively present and not crusted over – when new continue to come even if old have crusted
what is the epstein barr virus
- mono
- implicated in several diseases, including infectious mononucleosis, nasopharyngeal carcinoma, burkitt lymphoma, and hairy leukoplakia
what are signs and symptoms of epstein barr and how is it transmitted
- characterized by sore throat, fever, generalized lymphadenopathy, enlarged spleen, malaise and fatigue
- petechiae may appear on the palate
- occurs primarily among adolescents and young adults
- often transmitted by kissing
what is hairy leukoplakia
- an irregular, corrugated, white lesion most commonly occurring on the lateral border of the tongue
- epstein barr virus is considered to be the cause of the lesion
- occurs most commonly in patients infected with HIV but has also been reported in patients who are not HIV +
what are coxsackievirus infections
- causes several different infectious diseases
- may be transmitted by fecal-oral contamination
- three have distinctive oral lesions
what are the 3 distinctive oral lesions of coxsackievirus
- herpangina
- hand-foot-and-mouth disease
- acute lymphonodular pharyngitis
what is hand foot and mouth disease
- usually occurs in epidemics in children less than 5 years old
- multiple macules or papules occur on the skin, typically on feet, toes, hands and fingers
- oral lesions are painful vesicles that can occur anywhere in the mouth
- resolves within 2 weeks
how do we diagnose and treat hand foot and mouth disease
- dx: the distribution of skin lesions and mild systemic symptoms help differentiate the condition from herpes simplex infection
- tx: generally not required
what is measles and what are oral symptoms
- caused by a type of virus called paramyxovirus
- highly contagious disease causing systemic symptoms and a skin rash
- koplik spots may occur in the oral cavity; small erythematous macules
- starts as fever about 10-12 days after exposure and around 14 days rash will appear
what are the mumps
- a viral infection of the salivary glands
- most commonly causes bilateral swelling of the parotid glands
- transmitted thru saliva or mucus droplets
- contagious a few days before and 5 days after swelling presents itself = isolate
how are HIV and AIDs transmitted
- sexual contact with an infected person
- contact with infected blood and blood products
- infected mothers to their infants
what cells does HIV and AIDS attack
- CD4 T helper lymphocytes
what is the definition of AIDS
- HIV infections with severe CD4 lymphocyte depletion
- less than 200 CD4 lymphocytes per microliter of blood
what is the normal CD4 lymphocyte count
- 550-1000 CD4 lymphocytes per microliter of blood
how do we test for HIV
- 2 antibody tests are used to determine if a person is infected
- ELISA (enzyme linked immunosorbent assay) is used first
- when this test is positive twice, it is followed by the Western blot test
how soon after an HIV infection can you be diagnosed with it
- antibodies to HIV usually begin to become detectable about 6 weeks following infection
- in some people, antibodies may not be detectable for 6 months or up to a year
- this is called the window of infectivity
what is the window of infectivity
- how long it takes for the body to build up antibodies to an antigen
what is a viral load
- the amount of HIV circulating in the serum being tested
what is HAART
- highly active antiretroviral therapy
what are the 12 oral lesions associated with AIDS
- oral candidiasis
- herpes simplex
- herpes zoster
- hairy keukoplakia
- HPV infections
- kaposi’s sarcoma
- lymphoma
- spontaneous gingival bleeding
- gingival and periodontal disease
- aphthous ulcers
- salivary gland disease
- mucosal melanin pigmentation
what is oral candidiasis in HIV + patients
- generally signals the beginning of progressively severe immunodeficiency
what is the symptom of herpes simplex in HIV positive patients indicative of
- when the immune system becomes deficient, the infection appears as persistent, superficial, painful ulcers that may be located anywhere in the oral cavity
- an ulceration due to herpes simplex that has been present for more than 1 month “meets the criteria for the diagnosis of aids”
what is the symptom of herpes zoster in HIV + patients indicative of
- generally follows the usual pattern when it occurs in a person who is HIV positive
- the facial and oral area, the lesions follow branches of the trigeminal nerve
- it is a sign of developing immunodeficiency
what is an HPV infection in an HIV positive patient
- papillary oral lesions from several different papillomaviruses have been described in persons with HIV infection
- may have normal colour or be erythematous
- may be persistent and occur in multiple oral locations
- may be associated with antiretroviral treatment
what is kaposi’s sarcoma
- an opportunistic neoplasm that may occur in patients with HIV infection
- oral lesions appear as reddish-purple, flat or raised lesions
- may be seen anywhere in the oral cavity, most commonly on the palate and gingiva
how do we diagnose and treat kaposi’s sarcoma
- dx: biopsy
- tx: surgical excision, radiation tx, chemotherapy
what is lymphoma
- a malignant tumor that may occur in association with HIV infection, non-hodgkin’s
- appears as a non-ulcerated, necrotic, or ulcerated mass
- may be surfaced by ulcerated or normal-coloured erythematous mucosa
how do we diagnose and treat a lymphoma
- dx: biopsy and histological exam
- tx: chemotherapeutic drugs
how does gingival and periodontal disease appear in HV + patients
- unusual forms of gingival and periodontal disease may develop
- linear gingival erythema
- NUP
what is linear gingival erythema and how do we treat it
- 3 characteristic features:
1. spontaneous bleeding
2. punctate or petechiae-like lesions on attached gingiva and alveolar mucosa
3. a bandlike erythema of the gingiva that does not respond to therapy - LGE occurs independently of oral hygiene status
- tx: debridement and chx rinses 2x daily for 2 weeks
what is NUP
- characterized by intense erythema and extremely rapid bone loss
- necrotizing stomatitis: extensive focal areas of bone loss along with features of NUP
how do we treat gingival and periodontal disease in HIV patients
- scaling, root planing, soft tissue curettage
- intrasulcular lavage, chx mouthrinse, systemic metronidazole
why do we often see spontaneous gingival bleeding
- a decrease in platelets may occasionally be seen in patients with HIV
- due to an autoimmune type of thrombocytopenic purpura
- in these patients, “a platelet count and bleeding time should be considered before deep scaling procedures”
