LO 5 Flashcards
Infectious Diseases
1
Q
Numerous infectious diseases can affect the tissues of the oral cavity, such as ___________
A
- 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
2
Q
Describe an opportunistic infection
A
- 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
3
Q
Dental caries and periodontal disease clearly are __________ that are important to dental hygienists
A
infectious diseases
4
Q
The dental hygienist frequently encounters oral infectious diseases and must be able to recognize their ___________
A
clinical features and significance
5
Q
Describe impetigo
A
- 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
6
Q
Describe Tonsillitis and Pharyngitis
A
- 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
7
Q
Describe Scarlet Fever
A
- 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
8
Q
Describe Rheumatic Fever
A
- 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
9
Q
Describe tuberculosis
A
- 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
10
Q
What is Miliary tuberculosis?
A
A severe and disseminated (widespread) form of tuberculosis
11
Q
What is Scrofula or tuberculous lymphadenitis?
A
Tuberculosis of the Submandibular and cervical lymph nodes
12
Q
How can you test for tuberculous?
A
- Oral lesions: Biopsy - Chronic granulomatous lesions with areas of necrosis surrounded by macrophages, multinucleated giant cells, and lymphocytes
- Skin test
- Chest radiographs
13
Q
What is important to understand about TB as a dental hygienist?
A
- 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
14
Q
Describe the treatment and prognosis for tuberculosis
A
- 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
15
Q
Describe Actinomycosis
A
- An infection caused by a filamentous bacterium: Actinomyces israelii
- Draining abscesses
- Treatment: Long-term, high doses of antibiotics
16
Q
Describe Syphilis
A
- 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
17
Q
Describe the secondary stage of Syphilis
A
- 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
18
Q
Describe the tertiary stage of Syphilis
A
- 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
19
Q
Describe Congenital Syphilis
A
- 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
20
Q
Describe the diagnosis and treatment of syphilis
A
- Lesions on skin may be identified by dark-field microscopy
- Blood tests include Venereal Disease Research Laboratory (VDRL) test and fluorescent treponemal
- Treatment - Penicillin
21
Q
Describe Necrotizing Ulcerative Gingivitis (NUG)
A
- 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
22
Q
Describe the diagnosis and treatment of Necrotizing Ulcerative Gingivitis (NUG)
A
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
23
Q
Describe Pericoronitis
A
- 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
24
Q
Describe the Treatment and Prognosis
for Pericoronitis
A
- Mechanical debridement
- Irrigation of the pocket
- Systemic antibiotics
- Often the long-term solution is removal of the offending tooth or laser gingival flap
25
Describe Acute Osteomyelitis
1. Acute inflammation of the bone and bone marrow
2. Most commonly the result of a chronic periapical abscess
3. May follow fracture of a bone
4. May result from a bacteremia
26
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
27
Describe Chronic Osteomyelitis
1. A long-standing inflammation of bone
2. The involved bone is painful and swollen
3. Radiographs reveal a diffuse and irregular radiolucency that can **eventually become opaque**
4. Known as chronic sclerosing osteomyelitis when radiopacity develops
28
Describe treatment for Chronic Osteomyelitis
1. Debridement
2. Administration of systemic antibiotics
3. Some patients may require hyperbaric oxygen treatment to kill offending bacteria
29
List the common bacterial infections
1. Impetigo
2. Tonsillitis and Pharyngitis
3. Scarlet Fever
4. Rheumatic Fever
5. Tuberculosis
6. Actinomycosis
7. Syphilis
8. Necrotizing Ulcerative Gingivitis
9. Pericoronitis
10. Acute/chronic Osteomyelitis
30
Describe Candidiasis
1. The outcome of an overgrowth of Candida albicans
2. 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
3. Often related for dentures and improper denture care
4. The organisms can be identified in a scraping of the lesion
31
What are the types of oral candidiasis?
1. Pseudomembranous candidiasis
2. Erythematous candidiasis
3. Denture stomatitis
4. Chronic hyperplastic candidiasis
5. Angular cheilitis
32
Describe Pseudomembranous Candidiasis
1. A white curdlike material is present on the mucosal surface
2. The mucosa is erythematous underneath
3. The patient may complain of a burning sensation and/or a metallic taste
4. Cottage cheese layer can be removed leaving red, raw tissue exposed
33
Describe Erythematous Candidiasis
1. The presenting complaint is of an erythematous, often painful mucosa
2. May be localized to one area of oral mucosa or be more generalized
34
Describe Denture Stomatitis (Chronic Atrophic Candidiasis)
1. The most common type of candidiasis
2. The mucosa is erythematous, but the change is limited to the mucosa covered by a full or partial denture
3. Most common on the palate and maxillary alveolar ridge
4. Usually asymptomatic
35
Describe Chronic Hyperplastic Candidiasis (Candidal Leukoplakia)
1. A white lesion that does not wipe off the mucosa
2. It will respond to antifungal medication
3. A lesion that does not respond to antifungal medication should be biopsied (premalignant?)
36
Describe Angular Cheilitis
1. Erythema or fissuring at the labial commissures
2. Most commonly from Candida, but may be caused by other factors such as nutritional deficiency
37
Describe Chronic Mucocutaneous Candidiasis
1. A severe form that usually occurs in patients who are severely immunocompromised
2. The patient has chronic oral and genital mucosal candidiasis as well as skin lesions
38
Describe Median Rhomboid Glossitis
1. An erythematous, often rhomboid-shaped, flat to raised area on the midline of the posterior dorsal tongue
2. Candida has been identified in some lesions, and some lesions disappear with antifungal treatment
39
Describe the Diagnosis of Median Rhomboid Glossitis
1. A mucosal smear is obtained and sent to the laboratory for staining and examination
2. In some patients, candidiasis is persistent and recurrent
3. It may be a sign of a severe underlying medical problem
40
Describe deep fungal infections
1. Oral lesions may be caused by deep fungal infections such as histoplasmosis, coccidioidomycosis, blastomycosis, and cryptococcosis
2. They all primarily involve the lungs
3. Client’s who are immunosuppressed or suffering from any type of COPD should be assessed before aerosol generating procedures are used during debridement
41
Describe Diagnosis of Deep Fungal Infections
1. Made by biopsy and microscopic examination
2. Oral lesions are preceded by involvement of the lungs
3. Oral lesions are chronic, nonhealing ulcers that can resemble squamous cell carcinoma
42
Describe Mucormycosis (Phycomycosis)
1. Rare fungal infection
2. The organism is commonly found in soil and usually is nonpathogenic
3. Infection may occur with diabetic and debilitated patients
4. The disease can present as a proliferating or destructive mass in the maxilla
43
Describe Aspergillosis
1. Rare fungal infection
2. Caused by fungus aspergillosis, a common mold that is ubiquitous in both indoor and outdoor environments
3. Some patients may develop a fungal ball, or mycetoma
44
Describe Human Papillomavirus Infection
1. More than 130 types of human papillomavirus (HPV) have been identified - Verruca vulgaris; Condyloma acuminatum; Focal epithelial hyperplasia
2. Also implicated in neoplasia
3. HPV is a small DNA virus with an affinity toward squamous epithelium.
4. Immunocompromised individuals at greater risk
5. Females most likely to be infected in genital regions
6. Can be spread through sexual interaction or auto inoculation- A person scratches a sore and touches uninfected skin
7. Always refer to oral surgeon and MD once suspected HPV is noted
45
Describe Verruca Vulgaris (Common Wart)
1. The lesions may be well-circumscribed, pedunculated (stalk-like), or sessile (immobile)
2. The lesions have a cauliflower-like appearance, finger like projections
3. Combination of white/red/pink
4. Color may be from white to pink and can be found on the lips or any mucosal surface.
5. Biopsy and histologic examination
6. Conservative surgical excision - lesion may recur
7. Patients with finger lesions should refrain from finger sucking and fingernail biting to prevent reinoculation
46
Describe Condyloma Acuminatum
1. A benign papillary lesion caused by a papillomavirus
2. Generally transmitted by sexual contact
3. May be transmitted to the oral cavity through oral-genital contact or self-inoculation
4. Papillary, bulbous pink masses that can occur anywhere in the oral mucosa - Multiple lesions may be present
5. Treatment - Conservative surgical excision; Recurrence is common
47
Describe Multifocal Epithelial Hyperplasia
(Heck Disease)
1. Characterized by the presence of multiple whitish to pale pink nodules distributed throughout the oral mucosa
2. Most common in children
3. Lesions are generally asymptomatic and do not require treatment
4. Resolve spontaneously within a few weeks
48
Describe Herpes Simplex Infection
1. There are two major forms of herpes simplex viruses: Type 1 and type 2
2. Oral infections are caused mostly by type 1 and genital infections are most (not always) but commonly caused by type 2
3. Herpes simplex is one of a group of viruses called human herpesviruses (HHVs)
49
Describe Primary Herpetic Gingivostomatitis
1. Initial infection with herpes simplex virus
2. Painful, erythematous, and swollen gingiva and multiple tiny vesicles on perioral skin, vermilion border of lips, and oral mucosa may be seen
3. The vesicles progress to form ulcers
4. The patient may have systemic symptoms such as fever, malaise, and cervical lymphadenopathy
5. Most commonly occurs in children ages 6 months and 6 years
50
Describe Recurrent Herpes Simplex Infection
1. The virus tends to persist in a latent state
2. Usually in nerve tissue of the trigeminal ganglion
3. It is estimated that one third to one half of the population in the United States experiences recurrent herpes simplex infection
4. Characterized by small fluid filled vesicles that coalesce (grow together)
5. Affects the trigeminal nerve, virus travels down nerve when activated
6. The most common location for recurrent infection is on the lips: Herpes labialis
7. Recurrent infections caused by certain stimuli; Stress, Sunlight, Menstruation, Fatigue, Fever
51
Describe the location and symptoms of Recurrent Herpes Simplex Infection
1. Occurs intraorally on keratinized mucosa that is attached to bone
2. The patient may have prodromal symptoms such as pain, burning, or tingling-a sign that a herpes lesion will soon appear
3. Highest amount of virus is in the vesicle stage
4. No treatment during active infection
5. Transmitted by direct contact with an infected individual
6. Can cause an eye infection
7. The primary infection occurs at the site of inoculation
52
Describe Herpetic whitlow
A painful infection of the fingers caused by a primary or secondary infection
53
Describe diagnosis and treatment of Recurrent Herpes Simplex Infection
Diagnosis
1. Based on clinical appearance
2. Changes in epithelial cells can be seen microscopically
Treatment
1. Antiviral drugs when appropriate
2. These drugs have not been shown to be consistently effective in treating lesions except in immunocompromised patients
54
Describe Varicella-Zoster Virus
1. Causes both chickenpox (varicella) in the primary infection and shingles in the reactivated infection stage (herpes zoster)
2. Respiratory aerosols and contact with secretions from skin lesions transmit the virus
3. Contagious and very itchy
55
Describe Herpes Zoster: **Shingles**
1. Secondary chickenpox in an adult
2. Characterized by a unilateral, painful eruption of vesicles along the distribution of a sensory nerve
3. Any branch of the trigeminal nerve may be involved if lesions affect the face
4. Vesicles are often preceded by pain, burning, or paresthesia
5. The disease usually lasts for several week - Neuralgia may take months to resolve
56
Describe treatment of Varicella-Zoster
1. Varicella generally is treated with supportive care
2. Antiviral drugs may be used for immunocompromised patients and for patients with herpes zoster
57
List the types of Epstein-Barr Virus Infection
1. Infectious mononucleosis
2. Nasopharyngeal carcinoma
3. Burkitt lymphoma
4. Hairy leukoplakia
58
Describe Infectious Mononucleosis
1. Characterized by - Sore throat, Fever, Generalized lymphadenopathy, Enlarged spleen, Malaise, Fatigue, Petechiae may appear on the palate
2. In the United States, infectious mononucleosis occurs primarily among adolescents and young adults
3. Often transmitted by kissing
59
Describe Epstein-Barr Virus: Hairy Leukoplakia
1. An irregular, corrugated, white lesion most commonly occurring on the lateral border of the tongue
2. It occurs most commonly in patients infected with HIV
60
Describe Coxsackievirus Infections
1. Transmitted by - Fecal-oral contamination, Saliva, Respiratory droplets
2. Three distinctive oral lesions - Herpangina, Hand-foot-and-mouth disease, Acute lymphonodular pharyngitis
61
Describe Coxsackievirus Infection: Herpangina
1. Characterized by - Fever, Malaise, Sore throat, Difficulty in swallowing (dysphagia), Vesicles on the soft palate, Erythematous pharyngitis
2. Resolves in less than 1 week without treatment
62
Describe Coxsackievirus Infection: Hand-Foot-and-Mouth Disease
1. Usually occurs in epidemics in children younger than 5 years of age
2. Multiple macules or papules occur on the skin, typically on the feet, toes, hands, and fingers
3. Oral lesions are painful vesicles that can occur anywhere in the mouth, fever and malaise
4. Resolves within 2 weeks
63
Describe Coxsackievirus Infection: Acute Lymphonodular Pharyngitis
1. Characterized by fever, sore throat, and mild headache
2. Hyperplastic lymphoid tissue of the soft palate or tonsillar pillars appears as yellowish or dark pink nodules
3. Lasts several days to 2 weeks and does not usually require treatment
64
Describe Coronaviruses and COVID-19
1. Coronaviruses: Group of enveloped RNA viruses that belong to the Coronaviridae family
2. Severe acute respiratory syndrome (SARS)
3. Middle East respiratory syndrome (MERS)
4. Coronavirus disease 2019 (COVID-19) - First reported in Wuhan, China; Greatest achievement has been the creation of vaccines that prevent transmission, infection, and severity
65
Describe the measles
1. Caused by a type of virus called a paramyxovirus
2. A highly contagious disease causing systemic symptoms and a skin rash, hydrocephalus
3. Koplik spots, small erythematous macules, may occur in the oral cavity, blueish colour
66
Describe the mumps
1. A viral infection of the salivary glands
2. Most commonly causes bilateral swelling of the parotid glands
3. Permanent damage may occur
67
Describe the spectrum of HIV
1. Many individuals experience an acute disease shortly after infection with HIV, but others are asymptomatic
2. Infected individuals may not have any signs or symptoms of disease (latency) for some time, but in most patients a progressive immunodeficiency develops
3. As the immune system becomes deficient, life-threatening opportunistic infections and cancers occur
4. Not considered a ‘fatal’ condition anymore with proper long term antiviral therapy
68
How is AIDS diagnosed?
1. The current definition of AIDS includes HIV infection with severe CD4 lymphocyte depletion
2. Fewer than 200 CD4 lymphocytes per microliter of blood
3. The normal level is between 550 and 1000
4. Person is extremely immunocompromised and open to opportunistic infections/cancers
69
Describe the clinical manifestations of AIDS
1. An initial infection may be asymptomatic (latent period) lasting up to 12 years
2. Some people may develop lymphadenopathy
3. Others may develop an acute illness resembling mononucleosis or flu like symptoms
4. After an acute illness, some individuals may have persistent lymphadenopathy - Many become completely asymptomatic
5. The virus infects cells of the immune system -
6. In time, the immune system becomes deficient
7. AIDS-related complex is the occurrence of several signs and symptoms together - Oral candidiasis, Fatigue, Weight loss, Lymphadenopathy
8. Antibodies to HIV usually begin to become detectable about 6 weeks after infection - In some people, antibodies may not be detectable for 6 months or up to a year or longer; This is called the “window of infectivity”
9. The spectrum of HIV infection includes everything from an asymptomatic infection to “full-blown” AIDS
70
What does HIV stand for?
Human immunodeficiency virus
71
What does AIDS stand for?
Acquired immunodeficiency syndrome
72
Describe the medical management of AIDS
1. Tests such as polymerase chain reaction (PCR) are used to measure the amount of HIV circulating in serum - The measured amount is called the viral load
2. Measurement of the viral load along with the CD4 lymphocyte count is used to assess HIV infection
3. Managed with combinations of antiretroviral drugs and drugs used to treat opportunistic infections
73
List the oral manifestations of AIDS
1. Many oral lesions are associated with HIV infection and AIDS - Some lesions indicate developing immunodeficiency and predict AIDS in patients who are HIV positive
2. Oral lesions develop because of deficiency in cell-mediated immunity and depletion of T-helper cells - Oral lesions include opportunistic infections, tumors, and autoimmune-like diseases
3. Oral candidiasis
4. Herpes simplex infection
5. Herpes zoster
6. Hairy leukoplakia
7. HPV infections
8. Kaposi sarcoma
9. Lymphoma
10. Gingival and periodontal disease
11. Spontaneous gingival bleeding
12. Aphthous ulcers
13. Salivary gland disease
14. Mucosal melanin pigmentation
74
Describe Oral Candidiasis (Thrush) in HIV patients
1. Treatment: Antifungal medications
2. Recurrence is common
3. In HIV-positive patients, it generally signals the beginning of progressively severe immunodeficiency
75
Describe Herpes Simplex Infection in HIV patients
An ulceration resulting from herpes simplex that has been present for more than 1 month “meets the criteria for the diagnosis of AIDS”
76
Describe Herpes Zoster infection in HIV patients
1. Generally follows the usual pattern when it occurs in a person who is HIV positive
2. In the facial and oral area, the lesions follow branches of the trigeminal nerve
3. It is a sign of developing immunodeficiency
77
Describe Hairy Leukoplakia in HIV patients
1. Caused by Epstein-Barr virus
2. A predictor of AIDS in HIV-positive individuals
3.Treatment: None
78
Describe Human Papillomavirus Infection in HIV patients
1. Associated with HIV infection
2. May have normal color or be erythematous
3. May be associated with antiretroviral treatment
79
Describe Kaposi Sarcoma in HIV patients
1. An opportunistic neoplasm that may occur in patients with HIV infection
2. Most commonly located on the palate and gingiva
3. Dark purple lesion
4. Expands rapidly
5. Diagnosis - biopsy
6. Treatment - Surgical excision, Radiation treatment, Chemotherapy
80
Describe Lymphoma in HIV patients
1. A malignant tumor that may occur in association with HIV infection
2. Appears as a nonulcerated, necrotic, or ulcerated mass
3. May be surfaced by ulcerated or normal-colored erythematous mucosa
4. Often an enlargement of the lymph node upon palpation
5. Diagnosis - Biopsy and histologic examination
6. Treatment - Chemotherapeutic drugs
81
Describe Gingival and Periodontal Disease in HIV patients
1. Unusual forms of gingival and periodontal disease may develop in patients with HIV
2. Linear gingival erythema (LGE)
3. Necrotizing ulcerative periodontitis (NUP)
82
Describe Linear Gingival Erythema (LGE) in HIV patients
1. Three characteristic features include - Spontaneous bleeding; Punctate or petechiae-like lesions on attached gingiva and alveolar mucosa; A bandlike erythema of the gingiva that does not respond to therapy
2. LGE occurs independently of oral hygiene status
83
Describe Necrotizing Ulcerative Periodontitis (NUP) in HIV patients
1. Characterized by intense erythema and extremely rapid bone loss
2. Necrotizing stomatitis - Extensive focal areas of bone loss along with features of NUP
84
Describe the treatments for Gingival and Periodontal Disease in HIV patients
1. Scaling
2. Root planing
3. Soft tissue curettage
4. Intrasulcular lavage
5. Chlorhexidine mouth rinse
6. Systemic metronidazole
85
Describe Spontaneous Gingival Bleeding in HIV patients
1. A decrease in platelets may occasionally be seen in patients with HIV
2. It may be due to an autoimmune type of thrombocytopenic purpura
3. In these patients, a platelet count and bleeding time should be considered before deep scaling procedures
86
Describe Aphthous Ulcers in HIV patients
1. There appears to be an increase in the number of these ulcers in patients with HIV infection
2. Ulcers resembling major aphthous ulcers appear as deep, persistent, painful ulcers
3. They respond to steroids
87
Describe Salivary Gland Disease in HIV patients
1. Bilateral parotid gland enlargement may occur in patients who are HIV positive
2. May be related to medication or salivary gland disease
