Infectious Diseases of the Oral Cavity Flashcards
What is the name of the spirochete that causes syphilis?
Treponema pallidum
Describe primary syphilis.
- chancre presents as painless ulcer with indurated margin
- most commonly presented on genitals but primary lesions may arise on oral mucosa
- associated with a painless regional lymphadenopathy
- resolves without therapy in 3-12 weeks
Describe secondary syphilis.
- develops following latent period of several weeks
- fever, flu-like symptoms, generalized lymphandenopathy
- maculopapular rash develops with variable cutaneous and oral mucosal distribution
- oral mucosal “mucous patches” range from subtle to dramatic in appearance
- symptoms and lesions resolve over a 6 to 8 week period
During what stage do serological tests return positive for syphilis?
Secondary
Describe tertiary syphilis.
- develops in ~1/3 of untreated patients
- while the most serious aspects of tertiary syphilis consist of cardiovascular/neurovascular manifestations, oral lesions do occur
What are two lesions that affect the oral cavity in tertiary syphilis?
- Syphilitis glossitis
- Gumma - focal destructive granuloma
- develops mainly on skin and mucosa, but can affect viscera and bones
- palate commonly involved (mucosa and bone)
Describe congenital syphilis.
- treponema pallidum can cross placental barrier during 3rd trimerster of prgenancy
- congenital manifestations can range from minor flu-like symptoms and skin rash to major organ malformation and spontaneous abortion
What is Hutchinson’s triad of congenital syphilis?
- interstitial keratitis (eye infection that often leads to blindness)
- VIII cranial nerve damage (deafness)
- mulberry molars and hutchinson’s incisors
Which stages of syphilis have lesions infectious by contact?
- primary and secondary
- tertiary stage has no spirochetes so it’s not transmissible
What species causes tuberculosis?
Mycobacterium tuberculosis
What caused a change in frequency of oral lesions from bovine tuberculosis?
- routine pasteurization of milk
What about TB now causes oral lesions and where are they most common?
- a hematogenous spread of disseminated TB or direct implantation from coughing up infect sputum (most common)
- most common on tongue, palate and gingiva
Describe an oral lesions caused by TB.
- present as chronic, indurated ulcer that can be mistake for squamous cell carcinoma, esp. if cervical lymph node involvement.
How long are oral lesions caused by TB infectious for?
until 2 weeks after systemic therapy initiated
Describe Actinomycosis.
- Caused by actionomyces israeli species
- anaersobic gram-positive filament
- normal oral flora, but also found in carious lesions and necrotic pulp canals
What signifies a colony of A. israeli?
- if pus draining from a chronic lesion contains small yellow granules (“sulphur granules)”
How do you treat actinomycosis?
long-term, high-dose antibiotic regime and surgical debridement.
What is Oral Candidiasis?
an opportunistic infection caused by candida albicans - a commensal form of yeast in most healthy mouths
- occurs commonly in uncontrolled diabetics, AIDS patients, people using predisposing medications (xerostomic inducing)
What are examples of predisposing medications to oral candidiasis?
- corticosteroids
- broad spectrum antibiotics
- cancer chemo therapy (immune suppressant causing mouth ulcers)
What’s the difference between thrush and atrophic oral candidiasis?
Thrush - pseudomembranous candidiasis (rubs off)
Atrophic - less apparent in diagnosis, but more common than thrush, presents with red area
What is definitive for a diagnosis of oral candidiasis?
- cytology smear is superior to culture
What type of infection is herpes simplex?
Viral
What population of adults are seropositive for HSV-1?
90%
Describe primary herpetic gingivostomatitis.
- incubation period - several days to 2 weeks
- prodrome: fever, headache, cervical lympadenopathy
- attached or unattached mucosa
- self-limiting
- acute episode resolves in 7-10 days, without scarring
- virus migrates along periaxonal sheath of trigeminal nerve to trigeminal ganglion, where it may remain in a latent or quiescent state
- reactivation/recurrent lesions occur in 35% of seropositive individuals
