LO 5 Flashcards
Infectious Diseases
Numerous infectious diseases can affect the tissues of the oral cavity, such as ___________
- Bacterial, fungal, and viral infections are the most common
- Oral cavity can be the primary site of involvement in an infectious disease
- Microorganisms that initially invade the oral tissues can cause a local infection, systemic infection, or both
Describe an opportunistic infection
- Changes such as the following affect the oral microflora so that organisms that are usually nonpathogenic are able to cause disease:
- Decrease in salivary flow
- Antibiotic administration
- Immune system alterations such as immunosuppression
Dental caries and periodontal disease clearly are __________ that are important to dental hygienists
infectious diseases
The dental hygienist frequently encounters oral infectious diseases and must be able to recognize their ___________
clinical features and significance
Describe impetigo
- A bacterial skin infection
- Caused by Streptococcus pyogenes and Staphylococcus aureus
- Usually seen in young children
- Requires nonintact skin for infection
- Extremely infectious- no tx during active infection
- Treatment: Topical or systemic antibiotics
Describe Tonsillitis and Pharyngitis
- Inflammatory conditions of the tonsils and pharyngeal mucosa
- Clinical features may include sore throat, fever, tonsillar hyperplasia (enlargement), and erythema of the oropharyngeal mucosa and tonsils
- May be spread by contact with infectious nasal or oral secretions
- Group A β-hemolytic streptococci: Scarlet fever and rheumatic fever
Describe Scarlet Fever
- Usually occurs in children most commonly
- Fever (high)
- Generalized red skin rash caused by a toxin released by the bacteria
- Oral manifestations in addition to streptococcal tonsillitis and pharyngitis include:
1. Petechiae on the soft palate
2. Strawberry tongue - Fungiform papillae are red and prominent, with the dorsal surface of the tongue exhibiting either a white coating or erythema - No tx during active infection
Describe Rheumatic Fever
- A childhood disease that follows a group A β-hemolytic streptococcal infection
- Characterized by an inflammatory reaction involving the heart, joints, and central nervous system
- Heart valve damage may occur
- This may require that the patient be premedicated before dental hygiene treatment
- Seek medical clearance before initiating treatment
Describe tuberculosis
- Usually caused by the organism Mycobacterium tuberculosis
- Rare oral ulcerations
- Painful, Nonhealing, Slowly enlarging ulcers
- Signs and symptoms include: Fever, Chills, Fatigue, Malaise, Weight loss, Persistent cough
What is Miliary tuberculosis?
A severe and disseminated (widespread) form of tuberculosis
What is Scrofula or tuberculous lymphadenitis?
Tuberculosis of the Submandibular and cervical lymph nodes
How can you test for tuberculous?
- Oral lesions: Biopsy - Chronic granulomatous lesions with areas of necrosis surrounded by macrophages, multinucleated giant cells, and lymphocytes
- Skin test
- Chest radiographs
What is important to understand about TB as a dental hygienist?
- An increase has been reported in the number of both reported cases and cases that are resistant to standard drug regimens
- Tuberculosis incidence has been related to HIV infection and increased immigration from countries where tuberculosis is endemic
- It is considered an occupationally transmitted disease in dentistry - Standard precautions can prevent transmission; If the patient has active tuberculosis, routine treatment can be deferred; Use of an N95 is recommended to prevent transmission
Describe the treatment and prognosis for tuberculosis
- Combination medications, including isoniazid (INH), rifampin, and rifapentine
- Treatment may continue for months or years
- The patient’s physician should be consulted to determine whether the patient is infectious
Describe Actinomycosis
- An infection caused by a filamentous bacterium: Actinomyces israelii
- Draining abscesses
- Treatment: Long-term, high doses of antibiotics
Describe Syphilis
- Caused by a spirochete: Treponema pallidum
- Organisms die when exposed to air and changes in temperature
- Primary stage results in flu like symptoms whole the organism proliferates
- Transmitted by - Direct contact, autoinoculation (touching a sore and then touching an opening in the epidermis); Sexual contact; Transfusion of infected blood to a fetus from an infected mother
Describe the secondary stage of Syphilis
- 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; They undergo spontaneous remission but may recur for months or years
Describe the tertiary stage of Syphilis
- Chiefly involves the cardiovascular system and the nervous system
- Gumma - A firm mass; Noninfectious; A destructive lesion that can result in perforation of the palatal bone
Describe Congenital Syphilis
- Treponema pallidum can cross the placenta and enter the fetal circulation
- Causes serious, irreversible damage to the child, including facial and dental abnormalities
- Hutchinson’s incisors and mulberry molars
Describe the diagnosis and treatment of syphilis
- Lesions on skin may be identified by dark-field microscopy
- Blood tests include Venereal Disease Research Laboratory (VDRL) test and fluorescent treponemal
- Treatment - Penicillin
Describe Necrotizing Ulcerative Gingivitis (NUG)
- A painful, erythematous gingivitis with necrosis of interdental papillae
- Most likely caused by both a fusiform bacillus and a spirochete (Borrelia vincentii)
- Associated with decreased resistance to infection
Describe the diagnosis and treatment of Necrotizing Ulcerative Gingivitis (NUG)
Diagnosis:
1. Necrosis results in cratering of the interdental papillae
2. Sloughing of necrotic tissue causes a pseudomembrane to form over the tissue
Treatment:
1. Gentle debridement
2. Antibiotics if fever is present
3. OHI
4. Referral to MD for primary treatment
Describe Pericoronitis
- Inflammation around the crown of a partially erupted, impacted tooth
- Most commonly a lower third molar
- Operculum present
- Trauma from an opposing molar and impacted food under the soft tissue flap (operculum) may precipitate
Describe the Treatment and Prognosis
for Pericoronitis
- Mechanical debridement
- Irrigation of the pocket
- Systemic antibiotics
- Often the long-term solution is removal of the offending tooth or laser gingival flap
Describe Acute Osteomyelitis
- Acute inflammation of the bone and bone marrow
- Most commonly the result of a chronic periapical abscess
- May follow fracture of a bone
- May result from a bacteremia
Describe the diagnosis and treatment of Acute Osteomyelitis
Diagnosis
1. Nonviable bone
2. Necrotic debris
3. Acute inflammation
4. Bacterial colonies in marrow spaces
Treatment
1. Drainage of purulent exudate
2. Antibiotics
Describe Chronic Osteomyelitis
- A long-standing 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
Describe treatment for Chronic Osteomyelitis
- Debridement
- Administration of systemic antibiotics
- Some patients may require hyperbaric oxygen treatment to kill offending bacteria
List the common bacterial infections
- Impetigo
- Tonsillitis and Pharyngitis
- Scarlet Fever
- Rheumatic Fever
- Tuberculosis
- Actinomycosis
- Syphilis
- Necrotizing Ulcerative Gingivitis
- Pericoronitis
- Acute/chronic Osteomyelitis
Describe Candidiasis
- The outcome of an overgrowth of Candida albicans
- This can result from many different conditions - Antibiotics, cancer chemotherapy, corticosteroid therapy, dentures, diabetes mellitus, HIV infection, hypoparathyroidism, infancy, multiple myeloma, primary T-cell deficiency, xerostomia
- Often related for dentures and improper denture care
- The organisms can be identified in a scraping of the lesion
What are the types of oral candidiasis?
- Pseudomembranous candidiasis
- Erythematous candidiasis
- Denture stomatitis
- Chronic hyperplastic candidiasis
- Angular cheilitis
Describe 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 a metallic taste
- Cottage cheese layer can be removed leaving red, raw tissue exposed
Describe Erythematous Candidiasis
- The presenting complaint is of an erythematous, often painful mucosa
- May be localized to one area of oral mucosa or be more generalized
Describe Denture Stomatitis (Chronic Atrophic Candidiasis)
- The most common type of candidiasis
- The mucosa is erythematous, but the change is limited to the mucosa covered by a full or partial denture
- Most common on the palate and maxillary alveolar ridge
- Usually asymptomatic