Mouth Diseases Flashcards
Describe herpes simplex virus
An enveloped double stranded DNA virus
How is HSV1 transmitted
Oral secretions during close contact
Who gets primary gingivostomatitis
Primary school children
Clinical presentation of primary gingivostomatitis
Systemic upset (fever, local lymphadenopathy)
Vesicles and ulcers on lips, buccal mucosa and hard palate
May take up to 3 weeks to resolve
Most frequent manifestations of a primary HSV infection
Pharyngitis, gingivostomatitis
When do primary infections present following HSV exposure
2-12 days
Pathophysiology of HSV infection
Inoculation at mucosal surfaces
Viral replication in epidermis and dermis and infection of nerve endings
Latent infection establishes in the sensory ganglia
Reactivates intermittently
What can cause reactivation of a latent HSV infection
Immunodeficiency, stress, exposure to sunlight, fever, trauma
Recurrent form of HSV infection
Herpes labialis
What’s another name for herpes labialis
Cold sores
What is herpetic whitlow
HSV infection of the finger
Risk factors for herpetic whitlow
Occupational hazards for dentists and anaesthetists
How can we prevent herpetic whitlow
WEAR GLOVES
Complication of HSV
Herpes simplex encephalitis
Clinical presentation of herpes simplex encephalitis
Rapid onset of fever, headache, seizures, focal neurological signs, impaired consciousness
Investigation for HSV
Swab and PCR
Management of symptoms of HSV
Acyclovir
What is herpangina
Viral infection which causes fever and faithful papilla-vesiculo-ulcerative oral exanthem
What commonly causes herpangina
Coxsackie virus (enterovirus)
How do we transmit coxsakie virus
Oral ingestion of virus that is shed from the GI or URT of infected individuals
who does herpangina usually affect
Children
Clinical presentation of herpangina
High fever
Vesicles and ulcers in the soft palate
Hyperaemia and yellow/greyish papulovesicular lesions
Investigation of herpangina
PCR
Management of herpangina
Supportive: usually self limiting
What causes hand foot and mouth disease
Coxsackie virus
How does hand foot and mouth disease present
Oral exanthem and a macular, maculopapular or vesicular rash of the hands and feet
Investigation for hand foot and mouth disease
PCR
Management of hand foot and mouth disease
Supportive
How do we acquire primary syphillis
Direct sexual contact with the infectious lesions of another person
Clinical presentation of primary syphillis
Mainless indurated ulcers at the site of entry of bacterium treponema pallidum
Where is primary syphillis usually seen
Most commonly genital but can also be oral and pharyngeal
Where (geographically) is mucosal leishmaniasis usually seen
Africa and the americas
How does mucosal leishmaniasis present
Involvement of mucosal tissues of the nose, oral cavity, and the pharynx by leishmania spp
Where is Behçet’s disease commonly seen
Middle East and Asia
Most common feature of Behçet’s disease
Recurrent oral ulcers
Other features of Behçet’s disease
Genital ulcers and uveitis
How is Behçet’s diagnosed
Recurrent oral ulcers at least 3 times a year plus 2 of the following:
Recurrent genital ulcers, eye lesions, skin lesions, positive pathergy test
Name some drugs which can cause mouth ulcers
NSAIDs, beta blockers and sulfonamides
Name some skin diseases that can present with oral ulcers
Lichen planus, pemphigus, pemphigoid
What’s another name for aphthous uclers
Canker sores
What are aphthous ulcers
Recurrent small, shallow, painful sores that form on the inside of the mouth
Where in the mouth can you get aphthous ulcers
Inside of the lips and cheeks or underneath the tongue
When do aphthous ulcers begin
In childhood
Risk factors of recurrence of aphthous ulcers
Genetics, trauma, stress, smoking cessation, hormonal imbalance, diet
What other condition are aphthous ulcers linked to
Coeliac disease
How long do aphthous ulcers last
Less than 3 weeks
Clinical presentation of aphthous ulcers
Ulcers are round and have inflammatory halos
Confined to mouth
No systemic disease
What is another name for candidiasis
Oral thrush
What is candidiasis
Fungal mouth infection
What causes candidiasis
Candida albicans
Risk factors for candidiasis
Post antibiotics, immunosuppression, smokers, inhaled steroids
Clinical presentation of candidiasis
White patches on red, raw mucous membranes in the throat and mouth
Management of candidiasis
Nystatin or fluconazole
What does squamous cell papilloma arise from
Stratified squamous epithelium
Incidence of squamous cell papilloma
<5 years and between 20-40
What is squamous cell papilloma linked to
HPV exposure - types 6,11
How does squamous cell papilloma present
Painless lesion
Where do squamous cell papilloma commonly present
Mucosa of the hard and soft palate
What do squamous cell papillomas look like macroscopically
Exophytic, sessile or pedunculated mass
Microscopic presentation of squamous cell papilloma
Finger like projection, fibrovascular core covered by stratified squamous epithelium
Management of squamous cell papilloma
Most cases do nothing
Management options: cryotherapy, topical salicylic acid and surgical excision
