Oral medicine Flashcards
Name 5 bacterial infections of the mouth
- Scarlet fever
- Tuberculosis
- Syphilis
- Congenital syphilis
- Gonorrhea
Describe symptoms and oral manifestations of scarlet fever
-Infectious disease of 4-8yr old
-May be delayed type hypersensitivity to streptococcal erythrogenic toxin
Symptoms:
-sore throat
-general malaise
-fever
-characteristic red rash
Oral:
-mucosa reddened
-strawberry tongue –> raspberry tongue
-lasts for 14 days
Treatment:
penicillin
Describe symptoms and oral manifestations of tuberculosis
Mycobacterium tuberculosis
-more common in immunocompromised and elderly
-less common in Western countries
Oral involvement:
-rare, usually due to open pulomary infection or coexisting HIV
-deep painful ulcer with raised borders, gradually increasing in size - most commonly posterior dorsum tongue
-histopath –> necrotizing granuloma with Langhan’s giant cells and epitheloid cells
-Ziehl-Nielsen stain reveals mycobacteria
-previous infection sometimes seen on facial views –> radio-pacities due to calcifications within lymph nodes
Treatment:
-chest physician
-combination chemotherapy
Describe symptoms and oral manifestations of syphilis
STI caused by Treponema Pallidum
- lesion (chancre - firm, painless, ulcerated nodule) at site of inoculation. Genitalia/ anus/ lips/ tongue. Highly infectious. Marked cervical lymphadenopathy. Resolves spontaneously 1-2 months
- lesion after 2-4 months - cutaneous rash, condylomata (genital warts), malaise, fever, headache, snail-track ulcers. Serology positive. Resolve within 12 weeks but can be recurrences for up to a year.
- lesion. Several years later in 30% pts. Gumma formation - necrotic granulomatous reaction usually affecting palate or tongue, which enlarges, ulcerates and may perforate palate. Non-infection. Causes CNS involvement and vasculitis
Treatment: penicillin
Describe symptoms and oral manifestations of congenital syphilis
Due to T. Pallidum crossing placental barrier
-Leads to appearance of saddle nose, frontal bossing, sensorineural deafness, Hutchinson incisors (peg-shaped with notch), and Mulberry (moon) molars
Describe symptoms and oral manifestations of gonorrhoea
-15x more common than syphilis
-non-specific stomatitis or pharyngitis with frequent persisting ulcers and purulent gingivitis
-Neisseria gonorrhoeae (gram-negative intracellular diplococci)
Treatment: high-dose penicillin
Name 10 viral infections of the mouth
- Herpes simplex
- Varicella zoster
- Chickenpox
- Singles
- Herpangina
- Hand, foot and mouth
- Human papilloma virus
- Measles
- Glandular fever (infectious mononucleosis)
- Reiter syndrome
Describe symptoms and oral manifestations of Reiter syndrome
= reactive arthritis (causative agent unknown but appears to be 2-3 weeks post-infective response
-urethritis, arthritis, conjunctivitis +/- oral ulcers/ erosions
-predominantly young males
-associated with HLA B27 in 80% patients - leucocytosis and > ESR are common
Describe symptoms and oral manifestations of Herpes simplex (HSV1 and HSV2)
-most common viral infection affecting the mouth
-type 1 is dominant pathogen causing oral infection
Primary HSV: varies widely in severity (increased with age, often asymptomatic in 80%). In infancy, widely mistaken as ‘teething’
-single episode widespread stomatitis and unstable mucosa with vesicles –> shallow painful ulcers; enlarged, tender cervical lymph nodes; halitosis; coated tongue; fever; general malaise 10-14 days
-treatment: bed rest, topical and systemic analgesia, soft or liquid diet with extra fluid intake and prevention of 2. infection (chlorhex MW) usually adequate. Severely ill or immunocompromised –> systemic acyclovir
Recurrent HSV (seen in up to 30% pts)
-herpes labialis = cold sore
-reactivation of 1. which is believed to lie dormant in dorsal root, and autonomic or cranial nerve ganglia (trigeminal or geniculate = facial)
-precipitating factors: trauma, immunosuppression, exposure to sunlight, stress, febrile illness
-prodromal phase (burning/ tingling) over 24 hours, followed by vesiculation and pain
-lesions may respond to 5% aciclovir cream or 1% penciclovir if used in prodromal stage
-systemic aciclovir in immunosuppressed or frequent recurrences
Describe symptoms and oral manifestations of varicella zoster
= HSV 3
-neurogenic DNA virus
-1. infection = chickenpox (varicella)
-Reactivation infection = shingles (zoster)
Chickenpox: itchy, vesicular, cutaneous, centripetal rash
-peak age 5-9 years
-rarely affects oral mucosa
-patients contagious 1-2 days before rash until all lesions crusted
Singles
-commoner in immunocompromised, alcoholic and elderly
-unilateral lesion never crossing midline
-pain, then facial or oral lesions (vesicles –> ulcers) may arise in area supplied by branches of affected
trigeminal nerve
-lasts 2-4 weeks with scarring and pigmentations
-15% leads of severe post-herpetic neuralgia which may last for years
Treatment: aciclovir in first 3 days for immunocompromised, ophthalmologist if eye is involved
Describe symptoms and oral manifestations of herpangina
-Caused by coxsackie A virus
-usually confined to children
-widespread small ulcers on oral mucosa with fever and general upset
-clinically resembles herpetic stomatitis but appears on uvula, palate and fauces (throat) with no gingivitis
-may be preceded by sore throat and conjunctivitis
-can also be mistaken as ‘teething’
-self-limiting in 10-14 days
-spread by faeco-oral route
Describe symptoms and oral manifestations of hand, foot and mouth disease
-Caused by Coksackie virus (usually A16, less commonly 5 and 10)
-similar to herpangina but lesions are present throughout oral cavity
-paular, vesicular rash on hands and feet + nasal congestion
-vesicles break down to leave painful superficial ulcers particularly on the palate
-gingivae rarely involved
-self-limiting 10-14 days
Treatment as herpetic stomatitis
Describe symptoms and oral manifestations of human papilloma virus
Assoc with squamous cell papilloma, conyloma acuminatum (genital warts), focal epithelial hyperplasia (Heck’s disease) and verruca vulgaris (verrucas)
-HPV 16 & 18 assoc with oropharyngeal cancer
-linked with cervical cancer
Treatment:
-local surgery +/- interferon for benign growths
-conventional cancer treatment
Describe symptoms and oral manifestations of measles
Prodromal phase: Koplik spots buccal mucosa
Few days later: muaculo-papular rash starts behind ears and spreads to face and trunk
-Complications: pneumonia and encephalitis –> neurological deficits in 40% with 15% mortality
Describe symptoms and oral manifestations of glandular fever
-Mostly children and young adults and spread by infected saliva
-varies widely in severity
-symptoms: sore throat, generalised lymphadenopathy, fever, headaches, malaise, often maculo-papular rash
-there may be hepatosplenomegaly
Oral manifestations may mimic 1. hepatic gingivostomatitis + petechial haemorrhages at junction of hard and soft palate +/- bruising
Cause: usually Epstein-Barr virus, less commonly cytomegalovirus
Early HIV can mimic this
Treatment: as for primary herpes
