Download Chapter 4 Infectious Diseases

Chapter 4 Infectious Diseases
Bacterial Infections
Inflammatory and immune response
to infection
Inflammatory response is a nonspecific
response and results in edema and the
accumulation of a large number of white
blood cells ate the site
Immune system response is highly specific
Specific antibodies are formed in response
to specific antigens
Microorganisms are antigens
Opportunistic infection
Decrease in salivary flow
Antibiotic administration
Immune system alterations
Change oral flora so that organisms
that are usually nonpathogenic are
able to cause disease
Impetigo
Skin infection – caused by Streptococcus
pyogenes and Staphylococcus aureus
May itch (pruritus)
Regional lymphadenopathy may be
present
Normally found on skin (non-intact skin is
necessary to contract
Oral manifestation - resembles recurrent
herpes simplex
Tuberculosis
Infectious chronic granulomatous disease
Usually caused by Mycobacterium tuberculosis
Primary infection of the lung
Inhaled droplets containing bacteria lodge in the
alveoli of the lungs
Ulcerations can appear when organisms are
carried in sputum to oral cavity
Routine dental treatment is deferred for patients
with active TB
An antigen called Purified Protein Derivative
(PPD) is injected into the skin
Actinomycosis
Infection caused by a filamentous
bacterium called Actinomyces israelii
Formation of abscesses that tend to
drain by the formation of sinus tracts
Organisms are common inhabitants of
the oral cavity…predisposing factors
are unknown
Syphilis
Caused by the spirochete Treponema
pallidum.
Transmitted by direct contact
Can penetrate mucous membranes, but
needs a break in tissue to penetrate it
Usually transmitted through sexual contact
with a partner with active lesions
Blood or transplacental innoculation
Syphilis
Stages of Syphilis:
(1) Primary - oral lesion - chancre
(2) Secondary- oral lesion - mucous
patch
(3) Latent - no oral lesion
(4) Tertiary - oral lesion - gumma
Necrotizing Ulcerative Gingivitis
Necrotizing Periodontal Diseases
NUG- an acute infection isolated in
the gingiva (formerly known as
ANUG)
NUP – is a similar infection that has
progressed to include attached
periodontal ligament and bone loss
(AAP, 2000)
Necrotizing Periodontal Diseases
Signs and symptoms
Gingiva is painful and erythematous
Necrosis of interdental papillae (blunted)
Foul odor
Metallic taste
Sloughing of the necrotic tissue presents
as a pseudomembrane over the tissues
Necrotizing Periodontal Diseases
Unique in their clinical presentation,
etiology and pathogenesis
If NUP is combined with HIV marginal
necrosis of the gingiva and a very
rapid loss of alveolar bone is seen
severe pain and bleeding without any
provocation
perhaps because of immunodeficiency
there have been reports of tooth loss in
only three to six months after onset
Necrotizing Periodontal Diseases
NUG
Acute recurring gingival infection of
complex etiology
Characterized by necrosis of the papillae
often described as “punched-out”
Spontaneous bleeding and pain
Pain is what make necrotizing periodontal
diseases very different from plaqueinduced gingivitis and periodontitis
NUG
1.
2.
3.
4.
5.
6.
Known by many names over the years
Trench mouth
Vincent’s infection
Fuso-spirochetal gingivitis
ANUG (misnomer b/c “acute” is clinical
description)
No chronic form of NUG
Recurrence
NUP
Progression of NUG into the underlying
attached gingiva causing periodontal
pocketing
Bone loss
May occur if # of recurrences of NUG or
underlying systemic conditions such as
AIDS
AIDS/NUP originally called HIV_P
If associated with recurrences conservative
treatment is very successful
No so with AIDS patients
NPD
One of the few “emergency” dental hygiene
appointments
Extreme pain
Gross debridement
Anesthetic helps ease pain during procedure
Sonic or ultrasonic
Education about the cause of the disease
Nutritional counseling
Vitamin recommendations
Oral hygiene instruction
No antibiotics
Pericoronitis
Inflammation of the mucosa around the
crown of a partially erupted or impacted
tooth
Trauma from an opposing molar and
impaction of food under the soft tissue flap
(operculum) covering the distal portion of
the third molar
Treatment includes mechanical
debridement and irrigation of the pocket
and systemic antibiotics. Extraction of the
impacted molar is usually necessary to
prevent recurrence.
Osteomyelitis
An inflammatory process within
medullary (trabecular) bone that
involves the marrow spaces
No change is seen on the radiograph
unless the disease has been present
for more than one week
*(“moth
eaten”) radiolucent lesion with irregular
margins
*usually in the posterior mandible
*fragments of necrotic bone may be visible in the
radiolucent areas
Tonsillitis and Pharyngitis
Inflammatory conditions of the tonsils
and pharyngeal mucosa
Can be caused by different organisms
Streptococcal bacterial infection
closely resembles tonsillitis and
pharyngitis that are caused by viruses
Strep throat caused by group A, beta
hemolytic streptococci are significant
Strep throat
Scarlet fever - usually occurs in children
Tonsillitis and pharyngitis
Fever, red skin rash, petechiae on the soft
palate and “strawberry tongue”
Rheumatic Fever - childhood disease that
follows strep infection
Inflammatory reaction involving heart,
joints, and CNS
Heart valve damage…bacterial
endocarditis prophylactic pre-medication is
necessary
Fungal Infections
Candidiasis
Moniliasis (“Thrush”)
Overgrowth the yeast-like fungus Candida
albicans
Encompasses a group of mucosal and
cutaneous conditions with a common
etiologic agent from the Candida genus of
fungi; most common oral mycotic infection
Part of the normal oral flora especially if
dentures are worn
Candida albicans overgrowth
can result from many different
conditions
Antibiotic therapy
Cancer chemotherapy
Corticosteroid therapy
Dentures
Diabetes Mellitus
HIV infection
Hypoparathyroidism
Infancy
Multiple Myeloma
Primary T-lymphocyte deficiency
Xerostomia
Types of Oral Candidiasis
Pseudomembranous
Erythematous
Chronic atrophic (denture stomatitis)
Chronic hyperplastic (candidal
leukoplakia)
Angular cheilitis
Pseudomembranous Candidiasis
More candidiasis
Angular Cheilitis
Candida organism most often causes
Appears as erythema and/or fissuring
at the labial commissures
Can be caused by other factors (e.g.,
nutritional, factitial)
Angular cheilitis
Condition is most often
bilateral
Median Rhomboid Glossitis
An asymptomatic, elongated,
erythematous patch of atrophic
mucosa of the mid-dorsal surface of
the tongue due to a chronic Candida
albicans infection
Central Papillary Atrophy of the
Tongue
Median Rhomboid Glossitis
Viral Infections
Papillomavirus infection
HPV’s identified in oral lesions,
normal mucosa and implicated in
neoplasia
Verruca vulgaris or common wart autoinoculation occurs through finger
contact…looks like a papilloma
Primary Herpetic Gingivostomatitis
Painful
Erythematous
Edematous
Most common in
children 6mos to 6
yrs.
Perioral skin,
vermillion border of
lips & oral mucosa
Recurrent herpes simplex infection
Herpes Labialis
Form of recurrent
herpes simplex
Papules on the
commissure of the
lips.
Most common type of
recurrent oral herpes
simplex infection
occurs on the
vermilion border of lips
“Cold sore” or “fever
blister”
Recurrent herpes simplex infection
Intraorally - occurs on keratinized mucosa that is
fixed to bone
Most commonly hard palate and gingiva
Tiny clusters of vesicles or ulcers that can
coalesce to form a single ulcer with an irregular
border
Prodromal symptoms = pain, burning, tingling
Heal without scarring in 1-2 weeks
Transmitted by direct contact
Primary infection occurs at the site of inoculation
Amount of virus is highest in vesicle stage
Herpetic Whitlow
Herpes simplex
virus. Can occur
when fulcruming
on same tooth and
instrument
punctures finger
Very painful, even
debilitating
Herpes simplex can also spread to
eyes.
Inform patients with herpes to be very
careful not to self inoculate. If they
have open vesicles it can be spread
to other areas of the body such as
eyes or mucous membranes around
genitalia.
Learn table 4-2 on differences
between aphthous ulcers and herpes
simplex (page 142)
Herpes Zoster
Caused by the Varicella-Zoster virus
Common name is Shingles
Respiratory aerosols and contact with
secretions from skin lesions transmit the
virus
Unilateral distribution of oral and skin
lesions
Painful vesicles that progress to ulcers
Same virus that causes Chicken Pox
(Varicella)
Epstein-Barr Virus Infection
Infectious Mononucleosis
Most common in late adolescents and
young adults in upper socioeconomic
classes (transmitted by close contact)
Hairy Leukoplakia
Most common in HIV infected people
Nasopharyngeal carcinoma - rare
neoplasm
Burkitt’s Lymphoma - rare neoplasm
Coxsackievirus infections
Herpangia - vesicles on the soft palate
*fever, malaise, sore throat, difficulty
swallowing (dysphagia)…erythematous
pharyngitis
Mild to moderate and resolves in less than 1
week
Hand-Foot and Mouth Disease - occurs in
epidemics in children less that 5 years of
age
Painful vesicles and ulcers anywhere in mouth
Lesions resolve spontaneously within 2 weeks
Human Immunodeficiency Virus
(HIV) & Acquired immunodeficiency
syndrome (AIDS)
Most individuals experience an acute
disease that occurs shortly after infection
with HIV
Sexual contact, blood or blood product
contact, infant to mother
Acute disease resolves and no signs or
symptoms of disease exist for some time
Most patients eventually have a
progressive immunodeficiency
HIV & AIDS
# of CD4 lymphocytes decreases
Fatigue, opportunistic infections (oral
candidiasis)
As the immune system becomes
profoundly deficient, life threatening
opportunistic infections and
neoplasms occur
Most severe result of infection with
HIV is AIDS
AIDS Diagnosis
See table 4-3 (page 147)
Severe CD4 lymphocyte depletion
Pneumocystic carinii pneumonia
Esophageal candidiasis
Kaposi’s sarcoma
Pulmonary tuberculosis
Recurrent pneumonia
Invasive cervical cancer
Oral Manifestations
Most common oral lesion associated
with HIV infection is Oral Candidiasis
Unexplained oral candidiasis should be referred
to a physician for a cause. Very early sign of
developing immunodeficiency.
Herpes Simplex and HIV
Treated with Acyclovir an antiviral medication
Acyclovir Resistant Herpes Simplex
in HIV patient
Herpes Zoster in HIV infected
person
Oral Hairy Leukoplakia - EpsteinBarr Virus
Papillomavirus Infections and HIV
Kaposi’s Sarcoma
Opportunistic neoplasm that occurs in
patients with HIV infections
HHV-8 associated with this neoplasm
Neoplasm is a mass of newly formed
tissue in which the growth of tissue is
uncontrolled and progressive
Kaposi’s Sarcoma
Lymphoma in HIV patients
Non-Hodgkin’s
Lymphoma
Malignant tumor
Non-ulcerated,
necrotic or
ulcerated masses
Gingival and Periodontal Disease in
HIV infected persons
Linear Gingival
Erythema (LGE)
NUP
Apthous Ulcerations and HIV
Mucous melanin pigmentation
Probably AZT
pigmentation
AZT is chemical
ingredient in many
AIDS drugs such
as: Retrovir,
Combivir and
Trizivir,