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BDS4 ORAL MED > infectious disease of oral cavity > Flashcards

infectious disease of oral cavity Flashcards

1
Q

what is a type of fungal infection

A

Candida

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2
Q

how do candida infections arise

A
  • can harmlessly colonise on mucocutaneous surfaces (commensal)
    if conditions right can invade into deeper tissues and cause infection
    (opportunistic infection)
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3
Q

what is the host defence for candida

A

-systemic
-local

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4
Q

what is local defence for candida

A
  • Oral mucosa
    • Physical barrier
    • Innate immunity (lysozyme, T cells, phagocytes)
  • Oral microbiome
    • Competition and inhibition
  • Saliva
    • Mechanical cleansing
    • Antimicrobial peptides (mucins, defensins, histatins)
    • IgA antibodies
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5
Q

what is systemic defence for candida

A

immune system - adaptive immunity

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6
Q

local risk factors for oral candidiasis

A
  • Xerostomia
  • Poor oral hygiene
  • Dental appliances (dentures)
  • Mouth piercings
  • Smoking
  • Irradiation to the mouth/salivary glands
  • Inhaled/topical corticosteroids (e.g. asthmatics)
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7
Q

systemic risk factors for oral candidiasis

A
  • Extremes of age (neonates, elderly)
  • Malnutrition
  • Diabetes
  • HIV/AIDS
  • Haematinic deficiency
  • Broad-spectrum antibiotics
  • Chemotherapy
  • Haematological malignancy
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8
Q

how to manage candidal infection

A
  • manage predisposing factors
  • improve OH and denture hygiene
    -topical antifungals
  • systemic antifungals
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9
Q

which systemic and topical antifungals can be used for managing candidal infections

A
  • miconazole gel - 20mg/g - pea sized amount 4 times daily - NO warfarin and statins
    -nystatin oral suspension - 100,000 units/ml - 4x daily for 7 days
    -fluconazole capsule - 50mg 1x daily 7 days
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10
Q

white presentations of candidate infections

A
  • acute pseudomembranous candidosis
  • chronic hyperplastic candidosis
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11
Q

red presentations of candidal infections

A
  • denture related stomatitis
  • acute erythematous candidosis
  • median rhomboid glossitis
  • angular cheilitis
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12
Q

what is acute pseudomembranous candidosis and how does it present

A
  • thrush
    -candida cells mixed with epithelial cells and plaque
  • neonates or diseased adults
  • looks like a white slough which can be rubbed of and has erythematous base
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13
Q

how to diagnose acute pseudomembranous candidosis

A
  • clinical
  • microbiology - oral swab/rinse
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14
Q

management of acute pseudomembranous candidosis

A
  • Predisposing factors need to be investigated and dealt with***
  • Oral hygiene
  • Topical:
    • Miconazole oral gel
    • Nystatin oral mouthwash
  • Systemic (if topical treatment is ineffective, infection is extensive or severe):
    • Fluconazole capsules
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15
Q

what is chronic hyperplastic candidosis

A
  • candidal leukoplakia
  • found in labial commissure
    -white or speckled red/white
  • can be malignant - 12%
  • bilateral
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16
Q

what is a risk factor for chronic hyperplastic candidosis

A
  • smoking - candid production of carcinogen
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17
Q

how to diagnose chronic hyperplastic candidosis

A
  • incisional biopsy - H&E staining
  • PAS stain
  • give fluconazole before biopsy - so no false positive
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18
Q

management of chronic hyperplastic candidosis

A

-smoking cessation
- systemic anti fungal
-follow up with OM for dysplasia

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19
Q

what is denture related stomatitis

A

Candidal infection of mucosa beneath a dental appliance
- upper denture
-common in elderly

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20
Q

risk factors for denture related stomatitis

A

-elderly
-dry mouth
-high sucrose diet
-bad OH
- acrylic resin and soft liners
-overnight denture wear

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21
Q

what makes up denture related stomatitis

A
  • candida
    can also have staph and strep
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22
Q

how to classify denture related stomatitis

A

Newtons classifications of denture stomatitis

  1. localised inflammation (pinpoint)
  2. generallised erythema covering the denture bearing area
  3. granular type
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23
Q

management of denture related stomatitis

A
  • OH
    -denture hygiene - remove at night, brush , chlorhexidine , dilute hypochlorite
  • antifungals - if rest fail
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24
Q

what is acute erythematous candidosis

A
  • red
  • atrophic candidosis
  • burning
    -palate affected
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25
predisposing factors to acute erythematous candidosis
- Recent broad-spectrum antibiotics - Corticosteroids - Diabetes - HIV - Nutritional factors
26
how to diagnose and manage acute erythematous candidosis
- oral rinse/swab - clinical - medical referral , antifungals
27
what is median rhomboid glossitis
- depapillation - midline of tongue -kissing lesion might transfer to palate
28
who is at risk of median rhomboid glossitis
- smokers - those using steroid inhalers -denture wearers
29
management of median rhomboid glossitis
- Predisposing factors - Oral / denture hygiene - Topical antifungal - Systemic antifungal
30
what is angular cheilitis
Infection of mucocutaneous region around corners of mouth, often with associated dermatitis often have intra oral candidate infection too
31
what type of infection is angular cheilitis
- Candida (particularly denture wearers) - Staphylococcus and streptococcus
32
signs and symptoms of angular cheilitis
- soreness - erythema - fissuring - crusting - bleeding -saliva pooling
33
diagnosis of angular cheilitis
- Usually a clinical diagnosis (look for other candidosis*) - Swab for microbiology (culture and sensitivity)
34
management of angular cheilitis
- denture hygiene and OH - topical anti fungal - miconazole cream - if bacterial - sodium fusidate ointment -if dermatitis - combined miconazole and hydrocortisone cream/ointment
35
what dose of sodium fusidate is given in angular cheilitis
- 2% - angle of mouth 4x daily - 10 days max
36
in what situation is miconazole and hydrocortisone cream given instead of ointment
cream - wet surface ointment - dry
37
what is a viral infection
- needs a host - has acute and latent infection -majority self limiting
38
types of viral infection
- **Herpes simplex virus** - **Human Immunodeficiency Virus** - **Hepatitis C** - **Coxsackie virus**
39
what are HHV
family of DNA viruses transmitted via saliva, respiratory secretions and direct contact encountered early in life latency and reactivation
40
what is HSV1
herpes simplex virus 1 - oral primary : lesions in mouth latency reactivation when immunosuppressed spread through saliva
41
what is the primary infection in HSV1
primary herpetic gingivostomatitis
42
what is HSV2
-anogenital -sexual transmission
43
symptoms of HSV 1
- Fever - Malaise - Red, fiery, oedematous gingivae - Vesicles -> ulcers
44
how to diagnose primary herpetic gingivostomatitis
- clinical -viral swab
45
management of primary herpetic gingivostomatitis
- Largely **supportive*** - Fluids, paracetamol, soft diet, Chlorhexidine to aid oral hygiene, Difflam mouthwash - Pregnant women and neonates – urgent specialist care (severe complications) = systemic antivirals
46
herpes lies dormant where in latent period
- trigeminal ganglion
47
what is secondary infection of HSV1/2 known as
- recurrent herpes simplex virus -herpes labalis - cold sores
48
why might herpes reactivate
- Sunlight (UV radiation) - Unwell (fever) - Tissue injury - Stress - Immunosuppression - Hormonal (menstrual cycle)
49
what is prodromal period in herpes
pain, burning, tingling, itching (up to 48hrs before)
50
how might recurrent herpes present
- painful -crops of ulcer -scab within 72 hrs - resolution by 10 days -intra orally or on lips
51
management of HSV1/2
- Avoidance of triggers - **Antivirals in prodrome period** - **Aciclovir 5% cream** every 2 hours (herpes labialis) - **Aciclovir 200mg tablets** five times per day for 5 days for intra-oral herpes
52
complications of HSV1/2
- Disseminated herpes infection (immunocompromised) - Bell’s palsy - Erythema multiforme - Herpetic whitlow (fingers) - Eye disease (herpetic keratoconjunctivitis)
53
what is varicella
“chickenpox” (primary infection in children) highly contagious
54
where does varicella lie dormant
dorsal root ganglion
55
what is zoster
shingles (reactivation in adults)
56
symptoms of varicella
- Fever - Malaise - Truncal rash – itchy, papules, vesicles, scabs - Oral ulcers
57
management of varicella
- Supportive for most - Immunocompromised, pregnant women and neonates = specialist care
58
where does zoster present
- Classically in one sensory dermatome - Trigeminal divisions = face and oral cavity
59
how does zoster present
- Rash in one dermatome → scabs - Pain before, during and after lesions - Vesicles and ulcers intra-orally
60
management of zoster
- Aciclovir 800mg tablets within 72 hours of onset - Can help healing, minimise post-herpetic neuralgia - Refer all patients to their GP - Immunocompromised - specialist
61
complications of zoster
Post-herpetic neuralgia – persisting > 6 months after mucocutaneous healing “burning” pain Ramsay Hunt syndrome – reactivation within geniculate ganglion (CN7)
62
what is EBV
90-95% of population have been infected epstein barr virus - glandular fever - latency - reactivation
63
how may EBV present in reactivation
- Oral hairy leukoplakia ** - Burkitt’s lymphoma - Nasopharyngeal cancer
64
how to diagnose EBV
- incisional biopsy -immunohistochemistry - investigation for HIV
65
what is OHL
- HIV positive patients - when CD4 counts drop - Also seen in chemotherapy, leukaemia - Lateral aspect tongue
66
HHV8 what is it
- Virus (cancer) in endothelial cells of blood and lymphatic vessels - Stimulates proliferation -cause of kaposi sarcoma
67
where is HHV8 most commonly seen
- Most common on face - Oral = hard palate, gingivae or tongue
68
how to diagnose HHV8
-incisional biopsy
69
risk factors for HHV8
- HIV/AIDS - Following organ transplant
70
management of HHV8
- Underlying immunosuppression – HAART in HIV - Excision - Cryotherapy - Intralesional vinblastine - chemotherapy agent - Chemotherapy (disseminated disease)
71
what is HIV
- RNA virus – blood borne - Sexual transmission, needlestick injuries, splashes, vertical transmission - destroys CD4 T helper cells
72
treatment of HIV
- ART - PrEP - PEP
73
what happens as HIV progresses
- AIDS -immunocompromised
74
how to test for HIV
- blood test -looking for antibodies and p24 antigen
75
what is ART in HIV
- Halt HIV replication - normal CD4 count and undetectable viral load - Can cause oral hyperpigmentation
76
name some aids defining illnesses
- Kaposi sarcoma - Pneumocystis jirovecii pneumonia (PCP) - Cytomegalovirus infection - Tuberculosis - Oral candidosis - Acute necrotising ulcerative gingivitis - Oral hairy leukoplakia - Non-Hodgkin’s lymphoma - Aphthous-like ulcers
77
what is Hep C
- RNA virus -infects liver - > chronic infection
78
treatment of hep C
- no vaccine -treated with antiviral medications 8-12 weeks
79
complications of hep C
- Liver cirrhosis (dental implications) - Hepatocellular carcinoma - Oral lichen planus
80
what is coxsackie virus
- RNA virus -hand foot mouth - herpangina
81
how is coxsackie spread
- faecal oral - saliva
82
what is hand foot and mouth
- self limiting - 7-10 days - children -vesiciles/blisters in affected areas
83
what is herpangina
- Numerous vesicles -> ulcers - Soft palate - Uvula - Fauces
84
management of coxsackie
- Supportive - Fluids - Paracetamol, ibuprofen - Soft diet - Chlorhexidine to aid oral hygiene - Difflam mouthwash
85
what are some bacterial infections
- Periapical infection - Periodontal infection - Pericoronal infection - Bacterial sialadenitis - Sexually transmitted infections: syphilis, gonorrhoea, chlamydia - Tuberculosis
86
risk factors for STI
- Previous STI - Age under 25 years - A new sexual partner - More than one sexual partner in the last year - No condom use - Paying for sex - Socioeconomic deprivation - Chemsex
87
what is syphillis
- STI - Spirochete Treponema pallidum - primary ,secondary and tertiary phases
88
what other conditions may syphillis look like
aphthous stomatitis, traumatic ulceration, oral cancer, vesiculobullous disorders
89
what is primary syphillis
- Chancre at site of inoculation - Painless ulcer - Usually genital, but can be oral - Self-limiting – heals by 8 weeks - Associated lymphadenopathy in 80% - Untreated, infection spreads lympho-vascular
90
what is secondary syphillis
- 4-6 weeks after initial infection - Non-specific symptoms - Lethargy, malaise, fever, musculoskeletal pain, rash - Mucosal white patches
91
what is tertiary syphillis
- Progression from untreated infection - Presents 1 – 30 years after inoculation - Gummatous lesions - Granulomatous inflammation - Neurosyphilis - Dementia, cranial nerve palsies - Cardiovascular syphilis - Aortic aneurysms
92
how to diagnose syphillis
- - Incisional biopsy – for microscopy and immunohistochemistry - Blood test – IgG and IgM antibodies to Treponema pallidum - High false positives
93
management of syphillis
- By sexual health specialist (GUM clinic) - STAT dose of IM benzylpenicillin (“benpen”) - Screening for other STIs - Contact tracing
94
what are gonorrhoea and chlamydia
STI Primarily affects urethra, endocervix, rectum, pharynx
95
how may gonorrhoea and chlamydia present in males and females
- Male – urethral discharge, dysuria - Female – altered vaginal discharge, dysuria - can be asymptomatic
96
how to diagnose gonorrhoea and chlamydia
- Clinical (oral - Specialist- vulvovaginal or urethral swabs (NAAT), swab for microscopy culture and sensitivity
97
management of gonorrhoea and chlamydia
- By sexual health specialist (GUM clinic) - Gonorrhoea- STAT dose of IM ceftriaxone / Chlamydia- 7 days oral doxycycline - Screening for other STIs - Contact tracing
98
what is TB
infection by mycobacterium tuberculosis transmitted by respiratory secretions - Infects macrophages in lung - From there can disseminate via bloodstream to almost any organ - Fever, weight loss, night sweats - Cough, haemoptysis
99
risk factors for TB
- Close contact with TB patient - Born in high-prevalence regions (India, Pakistan, Somalia, Eritrea, Romania) - HIV - Diabetes - Leukaemia - Alcohol excess - Socioeconomic deprivation - Homelessness
100
how to manage TB
- combination antibiotics - 3-6 months
101
how may TB present orally
- Ulceration - Lip swelling - Granulomatous inflammation - Orofacial granulomatosis - Crohn’s disease
102
how to diagnose TB orally
Incisional biopsy – H+E staining, Ziehl-Neelsen staining

BDS4 ORAL MED (12 decks)

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