Oral Manifestations Flashcards by Peter Duncan

Describe 4 types of oral manifestation of syphilis

Primary
Secondary
Tertiary
Congenital

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What bacterium is responsible for syphilis?

Treponema pallidum

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What is used to treat syphilis?

Penicillin

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Describe oral manifestations of primary syphilis

Primary chancre in mouth
Infectious lesion
Heals in under 5 weeks

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Describe oral manifestations of secondary syphilis

Systemic
Snail track ulcers
Mucosal changes
Very infectious
Lymphadenopathy

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Describe oral manifestations of tertiary syphilis

Occurs if bacteria present and untreated for long time

- Gumma occurs

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What is gumma?

Necrotising ulcerative lesion, usually found in the heart palate, which can cause perforation into nasal cavity

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Describe oral manifestations of congenital syphilis

Teeth are affected (deciduous teeth usually spared)
Smaller teeth than usual
Abnormal occlusal surfaces of permanent molars
Hutchinson’s incisors (notched)

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What is the main way syphilis is diagnosed?

Serology (may need follow up due to short window of primary infection)

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Why is dark ground microscopy not used to identify syphilis in the mouth?

Commensal treponemes will lead to a false positive

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What serological technique is used to identify syphilis in the mouth?

PCR

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What bacterium causes gonorrhoea?

Neisseria gonorrhoeae

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Describe the oral manifestations of gonorrhoea

Oral infection
Variable presentation (can be asymptomatic)
Can cause pharyngitis and cervical lymphadenopathy

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How is gonorrhoea diagnosed?

PCR

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What bacterium is responsible for chlamydia?

Chlamydia trachomatis

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How does chlamydia present?

Long lasting throat discomfort

- Can be asymptomatic

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How is chlamydia diagnosed?

PCR

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How is chlamydia treated?

Single dose of azithromycin

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What bacterium is responsible for TB?

Mycobacterium tuberculosis

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Describe the manifestations of TB

Painful ulcers (esp on tongue) with cervical lymphadenopathy
Primary infection usually in lungs

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Name 2 methods of diagnosing TB

Biopsy

- Ziehl-Neelsen staining

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How is TB treated?

Antibiotic combination (usually 3)

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Why is TB treated using several antibiotics?

It quickly becomes resistant to antibiotic

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What is an example of an atypical mycobacteria?

Mycobacterium avium-intracellulare

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Name 3 oral manifestations of staphylococcus aureus?

- Oral discomfort - Mucosal inflammation - Mucosal bleeding

In what 2 groups of patients is staphylococcus aureus most likely to be found?

1. Elderly | 2. Immunocompromised

Name 2 treatments of staphylococcus aureus

1. Oral lavages | 2. Antibiotics (flucloxacillin)

Name 4 general patterns of viral infections

1. Slow chronic infection 2. Acute infection - Chronic infection 3. Acute infection - Latency - Reactivation 4. Acute infection - Viral clearane

Name 5 examples of Herpes viruses

1. Herpes simplex virus 2. Epstein-Barr virus 3. Varicella zoster virus 4. Cytomegalovirus 5. Human Herpes virus

What pattern of viral infections do Herpes Simplex viruses follow?

Acute infection - Latency - Reactivation

What family do Herpes viruses belong to?

Herpesviridae

Name 3 subfamilies of Herpes viruses

1. Alpha 2. Beta 3. Gamma

Name 3 viruses in the α subfamily of Herpes viruses

1. HSV-1 2. HSV-2 3. VZV

Name 3 viruses in the β subfamily of Herpes viruses

1. CMV 2. HHV-6 3. HHV-7

Name 2 viruses in the γ subfamily of Herpes viruses

1. EBV | 2. HHV-8

Name 3 properties of Herpes viruses

1. Spherical enveloped capsid 2. dsDNA 3. Replicated in nucleus

What is the major difference between HSV-1 and HSV-2?

HSV-1 causes both oral and genital infections whereas HSV-2 causes genital infections only

Describe the pathogenesis of HSV-1 in the oral cavity

- Primary infection presenting as gingivostomatitis - Latency where the virus ascends into the trigeminal ganglion - Reactivation presenting as cold sores

What is herpes labalis?

Recurrent cold sores

Where does the HSV-2 virus lie dormant?

Sacral ganglion

Describe the transmission of HSV-1

- Not very infectious - Close contact required - Shed for long periods in saliva by people with no symptoms

Describe vesicle formation in HSV-1

- Found in mucous membrane or skin - Ballooning degeneration of epithelial cells in the prickle cell layer - Leads to vesicle formation

Name 3 ways in which HSV-1 may present outside the oral cavity

1. Whitlow 2. Genital 3. Asymptomatic

Name 3 areas outside the oral cavity where HSV reactivation can occur

1. Genital 2. Herpes keratitis 3. Encephalitis

Name 4 factors which could trigger Herpes labialis

1. Menstruation 2. Sun exposure 3. Febrile illness 4. Stress

What is Herpes keratitis?

HSV reactivation which infects the cornea of the eye

Name 2 primary complications of HSV infections

1. Neonatal infection is often fatal (congenital transmission) 2. Eczema herpeticum

How is the diagnosis of HSV carried out?

- Swab or vesicle fluid | - PCR

Name 2 ways gingivostomatitis is treated

1. Supportive measures (fluids, analgesics) | 2. Oral aciclovir

Name 2 ways in which cold sores are treated

1. Topical aciclovir / penciclovir | 2. Prophylactic oral aciclovir (cases of frequent recurrence)

Name the way in which severe infections of HSV are treated i.e. immunocompromised or encephalitis

High dose IV aciclovir

Describe the pathogenesis of VZV

- Primary infection presenting as chicken pox - Latency where the virus moves into sensory ganglion - Reactivation presenting as shingles

What antibodies are detected if a person has been infected with VZV?

ZVG IgG

Give 2 reasons why VZV is very infectious

- It can be spread by droplet transmission | - A person is infectious 2 days before onset of rash

Describe 4 types of lesions

1. Macule (flat) 2. Papule (raised) 3. Vesicle (fluid filled) 4. Pustule (pus filled)

Name 2 complications of VZV in children

1. Septic skin complications including cellulitis | 2. CNS disease

Name a complication of VZV in neonates / immunocompromised

Generalised infection

Name 3 complications of VZV in adults

1. Pneumonia 2. Encephalitis 3. Zoster

Describe the epidemiology of EBV

- Everyone IgG positive by age 25 - Salivary transmission - Asymptomatic infection in children - Infectious mononucleosis in teenagers

Describe the presentation of infectious mononucleosis

- Fatigue / Headache - Rash - Enlarged tonsils - White fibrinous exudate confined to tonsils - Petechial lesions on the palate

Name 2 ways in which EBV may be diagnosed

1. Heterophile antibodies | 2. Specific EBV IgM test

What is a potential presentation of EBV in a very immunocompromised patient?

Oral hairy leukoplakia

Describe hand foot and mouth disease

- Enteroviruses - Mostly in children - Usually not dangerous

Describe oral manifestation of measles

Koplic's spots (clustered, white lesions on buccal mucosa)

What is the main presentation of papilloma virus infections?

Warts