Final 1 - Infections of the Oral Cavity Flashcards
Actinomycosis Clinical Features
Bacterial infection (tricky, sounds fungal, but it’s not!)
Periapical is the most common orofacial type - can also see on face and neck
Firm swelling with drainage
Visible abscess
Actinomycosis Histological Appearance
Sulfur granules! (yellow granules in pus)
Filamentous Gram positive bacteria
Radiating Neutrophil band
Actinicomycosis Treatment
Penicillin
I guess Amoxicillin works if we need to write the prescription
Other soft tissue bacterial infection Clinical Features
Associated with immunocompromised pts
Abscess with pain, swelling, drainage
Other soft tissue bacterial infection Treatment
Identify underlying problem
Incision and drainage
Culture
Antibiotics (Amoxicillin)
Superficial Fungal Infections
Candida (C. albicans)- Acute, Chronic, Median Rhomboid Glossitis
Deep Fungal Infections
Histoplasmosis
Zygomycosis
Aspergillosis
Cryptococcosis
Candida Predisposition Factors
Hyposalivation Dentures Diabetes Iron/B12 deficiency Immunocompromise
Acute Candidiasis Clinical Features
Rapid onset
Pseudomembranous (Thrush):
Yellow-white plaques and papules that scrape off red base
Atrophic: Angular chelitis
Angular Chelitis Clinical Features
Acute candidiasis of corners of mouth
Cracked, fissured, weepy
Chronic Candidiasis Clinical Features
Atrophic: bright, red sore area under denture
Hyperplastic: chronic muco-cutaneous candidiasis
Looks like leukoplakia, doesn’t wipe off
Candidiasis Treatment
Nystatin Suspension
Topical Antifungals
Fluconazole if systemic needed
Treat denture with chlorox (plastic) or nystatin (metal)
Median Rhomboid Glossitis Clinical Features
Candida infection of midline tongue anterior to circumvallate papillae
Candidiasis Histological Appearance
Penetrating hyphae, spores
Deep Fungal Infections Clinical Appearance
Persistent single necrotic ulcer (fungi occlude blood vessels)
Zygomycosis - persistant sinus infection in diabetics
Cryptococcosis - meningitis in HIV
Viral Infections
Herpes Simplex Erythema Multiforme Varicella-Zoster Post-herpetic Neuralgia Hairy Leukoplakia CMV HHV-8 HPV Coxsackie virus & Enterovirus
Herpes Simplex Pathology
Primary herpetic gingivostomatitis
Lives in ganglia & can reactive (especially during stress, trauma)
Young, immunocompromised
Herpes Simplex Clinical Features
Mucosal sores - vesicles, ulcers
Herpes labialis, gingiva
Herpes Simplex Treatment
Hydration
Topical pain control (lidocaine)
Antivirals (Acyclovir, Valcyclovir)
Culture to rule out shingles
Erythema Multiforme
Hypersensitivity reaction to HSV
Crusting, hemorrhagic blisters and ulcers on lips
Steven-Johnson Syndrome - eye & genital involvement
Erythema Multiforme Treatment
Antivirals
Pain control - lidocaine & benedryl
Varicella-Zoster Clinical Features
Primary - Chicken Pox
multiple itchy red vesicles all over
Secondary - Shingles
single dermatome, unilateral
multiple painful red vesicles
Varicella-Zoster Treatment
Hydration
Antivirals
Pain control
Hairy Leukoplakia Pathology
EBV infection in epithelial cells
Immunocompromised
Hairy Leukoplakia Clinical Features
White plaque on lateral tongue or buccal mucosa
Painless, vertical fissures
May also have candida infection
Hairy Leukoplakia Treatment
No tx unless candida (antifungal)
CMV Infection Clinical Features
Single/multiple persistant large painful ulcers
Immunocompromised
CMV Treatment
Biopsy
Antiviral
HHV-8 Pathology
Associated with Kaposi sarcoma in AIDS
HHV-8 Treatment
For Kaposi sarcoma:
Biopsy
Excision
Radiation
HPV Pathology
> 100 subtypes
Warts or dysplasia leading to SCC
Verruca vulgaris - white keratotic projections
Papilloma - soft, pink
Condyloma - large
HPV Treatment
Excision if needed
Coxsackie virus & Enterovirus Treatment
Supportive care
Coxsackie virus and Enterovirus Clinical Features
Hand-Foot-Mouth disease
Children
Oropharyngeal ulcers
Lesions on hands and feet
Mycobacterial Infections
Tuberculosis
Leprosy
Mycobacterium avian (MAI)
Tuberculosis
Primary - lung
Secondary - nodules or ulcer in mouth (mucosa, tongue)
Caseating granulomas
Leprosy
Mycobacterium leprae attacks nerve fibers
Painless deformation, auto-amputation
Non-caseating granulomas
Leprosy Treatment
Dapsone
MAI
Rare, seen with HIV
Rarely causes granulomas
Spirochetal Infections
Borrelia vincentis - NUG
Syphillis
Borrelia burgdorferi - Lyme
NUG Treatment
Necrotizing Ulcerative Gingivitis
Antibiotics
Syphilis Clinical Features
Primary - chancre - painless ulcer
Congenital - Hutchinson incisor, Mulberry molar
