Oral Pathology LO 5

humoral immunity

This type of immunity is antibodies. An effective defence against some microorganisms

Cell-mediated immunity

This type of immunity is T-cell lymphocytes and T killer cells. An effective defence against other infections such as intracellular bacteria, viruses, and fungi.

Bacterial, fungal, and viral

Numerous infectious diseases can affect the tissues of the oral cavity. These 3 are the most common.

Opportunistic infection

Changes such as decrease in the salivary flow, antibiotic administration, and immune system alterations such as immunosuppression affect the oral microflora so that organisms that are usually nonpathogenic are able to cause disease.

Infectious

Dental caries and periodontal disease are ——————— diseases that are important to dental hygienists.

Impetigo

A bacterial skin infection. Caused by streptococcus pyogenes and staphylococcus aureus. Usually seen in young children. Requires non intact skin for infection. Extremely infectious — no treatment during active infection. Treatment: topical or systemic antibiotics.

Tonsillitis and pharyngitis

These 2 are 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. This type of bacteria is also related to scarlet fever and rheumatic fever.

Scarlet fever

Usually occurs in children most commonly. Involves a high fever, and generalized red skin rash caused by a toxin released by the bacteria. The oral manifestations in addition to streptococcal tonsillitis and pharyngitis include petechiae on the soft palate, strawberry tongue (fungi form papillae are red and prominent, with the dorsal surface of the tongue exhibiting either a white coating or erythema). No tx during active infection.

Rheumatic fever

Most common in children. Characterized by an inflammatory reaction involving the heart, joints, and central nervous system. Heart valve damage may occur. This may require the patient to be premeditated before the dental hygiene treatment. Seek medical clearance before initiating treatment.

Tuberculosis

Bacterial infection caused by Mycobacterium tuberculosis. Rare oral ulcerations are painful, non healing, and slowly enlarging. Signs and symptoms: fever, chills, fatigue, malaise, weight loss, persistent cough. Miliary ——————— is widespread and Scrofula or ——————— lymphadenitis is submandibular and cervical lymph nodes. Treatment may continue for months or years.

Tuberculosis

Chronic granulomatous lesions with areas of necrosis surrounded by macrophages, multinucleated giant cells, and lymphocytes are found with ———————. Require a biopsy, skin test, and/or chest radiographs.

HIV infections

——— infections have been related to increased incidence of tuberculosis along with increased immigration from countries where tuberculosis is an endemic.

Actinomycosis

An infection caused by a filamentous bacterium: actinomyces israelii . Involves draining abscesses. Treatment: long term, high doses of antibiotics.

Syphilis

A bacterial infection caused by a spirochete: Treponema pallidum. Organisms die when exposed to air and changes in temurature. Primary stages result in flu like symptoms while the organisms proliferates. Transmitted by autoinoculation (touching a sore and then touching an opening in the epidermis), sexual contact, and/or transfusion of infected blood to a fetus from an infected mother.

Secondary

This is the ——————— stage of a syphilis infection. 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.

Tertiary

This is the ——————— stage of a syphilis infection. Chiefly involves the cardiovascular system and the nervous system. Something called a gumma may appear. It's a firm mass usually on the hard palate, non infectious, a destructive lesion that can result in perforation of the palatal bone.

Hutchinson's incisors and mulberry molars

These 2 tooth anomalies are caused by congenital syphilis.

Necrotizing ulcerative gingivitis (NUG)

A painful, erythematous gingivitis with necrosis of the interdental papilla. Most likely caused by both a fusiform bacillus and a spirochete. Associated with decreases resistance to infection. Diagnosis: necrosis results in cratering of the interdental papillae, sloughing of necrotic tissue causes a pseudomembrane to form over the tissue. Treatment: gentle debridement, ABs if a fever is present, OHI, and referral to MD for primary treatment.

Pericoronitis

A bacterial infection characterized by the inflammation around the crown of a partially erupted impacted tooth. Most commonly a third mandibular molar. There is an operculum present. Trauma from an opposing molar and impacted food under the soft tissue flap (operculum) mar precipitate. Treatment: mechanical debridement, irrigation of the pocket, systemic ABs, often the long-term solution is removal of the offending tooth or laser the gingival flap.

Acute osteomyelitis

Bacterial infection. Acute inflammation of the bone and the bone marrow. Most commonly the result of a chronic periapical abscess. May follow fracture of a bone, may result from a bacteremia. Can be fatal. Diagnosis: nonviable bone, necrotic debris, acute inflammation, bacterial colonies in marrow spaces. Treatment: drainage of purulent exudate, and ABs.

Chronic osteomyelitis

A long-standing inflammation of bone. The involved bone is painful and swollen. Radiographs reveal a diffuse and irregular radiolucency that can eventually become opaque. Known as chronic sclerosing ———————— when radiopacity develops.

Candidiasis

A fungal infection. The outcome of the overgrowth of Candida albicans. 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. Often related for dentures and improper denture care. The organisms can be identified in a scraping of the lesion.

Pseudomembranous Candidiasis

A type of candidiasis. A white curdlike material is present on the mucosal surface. The mucosa is erythematous underneath. The patient may complain of a burning sensation and/or a metallic taste. Cottage cheese layer can be removed leaving red, raw tissue exposed.m,

Erythematous candidiasis

A type of candidiasis infection. The presenting complaint is of an erythematous, often painful mucosa. May be localized to one area of oral mucosa or more generalized.

Denture stomatitis.

A type of candidiasis infection. The most common. The mucosa is erythematous, but the change is limited to the mucosa covered by a full or partial denture. The most common on the palate and maxillary alveolar ridge. Usually asymptomatic.

Chronic hyperplastic candidiasis (candidal leukoplakia)

A type of candidiasis infection. A white lesion that does not wipe off the mucosa. It will respond to antifungal medication. A lesion that doesn't respond to an antifungal medication should be biopsies as it may be premalignant.

Angular cheilitis

Erythema or fissuring at the labial commissures. Most commonly from candida infections but may be caused by other factors such as nutritional deficiency.

Chronic mucocutaneous candidiasis

A severe form of candidiasis infection that usually occurs in patients who are severely immunocompromised. The patient has chronic oral and genital mucosal candidiasis as well as skin lesions.

Median rhomboid glossitis

An erythematous, often rhomboid shaped, flat to raised area on the middle of the posterior dorsal dengue. Candida has been identified in some lesions, and some lesions disappears with antifungal treatment. Diagnosis and treatment: a mucosal smear is obtained and sent to the lab for staining and examination. In some patients, candidiasis is persistent and recurrent. It may be a sign of a severe underlying medical problem.

Deep fungal infections

Oral lesions may be caused by ———— ————— infections such as histoplasmosis, coccidioidomycosis, blastomycosis, and cryptococcosis. They all primarily involve the lungs. Client's who are immunosupressed or suffering from any type of COPD should be assessed before aerosol generating procedures are used during debridement. Diagnosis: made by a biopsy and microscopic examination. Oral lesions are preceded by involvement of the lungs. Oral lesions are chronic, non-healing ulcers that can resemble squamous cell carcinoma.

Mucormycosis (phycomycosis)

Rare fungal infection. The organism is commonly found in soil and usually is nonpathogenic. Infection may occur with diabetic and debilitated patients. This disease can present as a proliferating or destructive mass in the maxilla.

Aspergillosis

Rare fungal infection caused by fungus aspergillosis, a common mold that is ubiquitous in both indoor and outdoor environments. Some patients may develop a fungal ball or mycetoma.

Human papillomavirus infection.

More than 130 types of this infection have been identified such as Verruca vulgaris, Condyloma acuminatum, focal epithelial hyperplasia, etc. also implicated in neoplasia. A small DNA virus with an affinity toward squamous epithelium. 7-10 of the worlds population have some form of cutaneous or mucosal —————. Numbers are rising. Can be spread through sexual interactions or autoinoculation (a person scratches a sore and touches uninfected skin).

Gardasil

This vaccine has been shown to provide protection from some harmful HPV strains ( HPV 6,11,16,18) which are shown to cause cancer in regions it affects. Always refer to an MD or oral surgeon if HPV is suspected.

Verruca vulgaris

The lesions may be well-circumscribed, pedunculated (stalk-like), or sessile (immobile). The lesions have a cauliflower-like appearance, finger like projections. Combination of white/red/pink. Colour may be from whiter to pink and can be found on the lips or any mucosal surface. Pt should refrain from putting their fingers in their mouths as it can cause reinoculation.

Condyloma acuminatum

A benign papillary lesion caused by a papillomavirus. Generally transmitted by sexual contact. May be transmitted to the oral cavity through oral-genital contact or self-inoculation. Papillary, bulbous pink masses that can occur anywhere in the oral mucosa. Multiple lesions may be present. Recurrence is common even with surgical excision.

Multifocal epithelial hyperplasia ( Heck disease)

Characterized by the presence of multiple whitish to pale pink nodules distributed throughout the oral mucosa. Most common in children. Lesions are generally asymptomatic and do not require tx. Resolve spontaneously within a few weeks.

Herpes simplex infection

There are 2 major forms of ————— ————— viruses: type 1 and type 2. Oral infections are caused mostly by type 1 and genital infections are caused mostly by type 2. ————— ————— is one of a group of viruses called human —————————— (HHVs).

Primary herpetic gingivostomatitis

The initial infection with herpes simplex virus. Painful erythematous , and swollen gingiva and multiple tiny vesicles on perioral skin, vermillion boarder of lips, and oral mucosa may be seen. The vesicles progress to form ulcers. Patients may have symptoms such as fever, malaise, and cervical lymphadenopathy. Most commonly occurs in children ages 6 months to 6 years. No tx during infection.

Recurrent herpes simplex infection

HHV virus tends to persist in latent state. Usually in nerve tissue of the trigeminal ganglion. It is estimated that 1/3 — 1/2 of the USA experiences this. Characterized by small fluid filled vesicles that coalesce (grow together). Affects the trigeminal nerve, virus travels down nerve when activated.

Herpes labialis

The name of cold sores.

Vesicle stage

The highest amount of virus is in the ————— stage.

Herpetic whitlow

A painful infection off the fingers caused by primary or secondary infection.

Varicella-Zoster Virus

Causes both chicken pox and shingles in the reactivated infection stage. Respiratory aerosols and contact with secretions from skin lesions transmit the virus. Contagious and very itchy.

Chicken pox

Varicella is:

Shingles

What is herpes zoster? Characterized by a unilateral, painful eruption of vesicles along the distribution of a sensory nerve. Any branch of the trigeminal nerve may be involved if lesions affect the face. Usually lasts for several weeks. Neuralgia may take months to resolve.

Immunocomprimised

If a patient had shingles, you would only give them antiviral drugs if the were:

Epstein-Barr virus

This causes infectious mononucleosis (mono), nasopharyngeal carcinoma, Burkitt lymphoma, and hairy leukoplakia.

Infectious mononucleosis (mono)

This is caused by the Epstein-Barr virus. Characterized by sore throat, fever, generalized lymphadenopathy, enlarged spleen, malaise, fatigue, petechiae may appear on the palate. In the USA, this occurs primarily among adolescence and young adults. Often transmitted by kissing.

Hairy leukoplakia

An irregular, corrugated, white lesion most commonly occurring on the lateral border of the tongue. Occurs mostly in pts infected with HIV.

Premalignant

Leukoplakia is always considered:

Herpangina

Coxsackievirus infection. Characterized by fever, malaise, sore throat, difficulty swallowing (dysphasia), vesicles on the soft palate, erythematous pharyngitis. Resolves in less than a week without treatment.

Hand-foot-and-mouth disease

Coxsackievirus infection. Usually occurs in epidemics in children younger than 5 years of age. Multiple macules or papules occur on the skin, typically on the feel, toes, hands, and fingers. Oral lesions are painful vesicles that can occur anywhere in the mouth, fever and malaise. Resolves within 2 weeks.

Acute lymphonodular pharyngitis

Coxsackievirus infection. Characterized by fever, sore throat, and mild headache. Hyperplastic lymphoid tissue of the soft palate or tonsillar pillars appears as yellowish or dark pink nodules. Lasts several lays to 2 weeks and does not usually require treatment.

Coronaviruses

Group of enveloped RNA viruses that belong to the coronavisidae family. Examples: Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), coronavirus disease 2019 (covid 19).

Measles

Caused by a type of virus called a paramyxovirus. A highly contagious disease causing systemic symptoms and a skin rash, hydrocephalus (swelling of the brain), Koplik spots, small erythematous macules, may occur in the oral cavity, blueish colour.

Mumps

A viral infection of the salivary glands. Most commonly causes bilateral swelling of the parotid glands. Permanent damage may occur.

HIV

—.—.—. Is transmitted by: sexual contact with an infected person, contact with infected blood and blood products, from infected mothers to their infants ( risk can be reduced). The virus infects cells of the immune system, particularly the CD4 T-helper lymphocytes. This type of lymphocyte participates in cell mediated immunity and in regulating the immune response.

AIDS

The current definition of —.—.—.—. Includes HIV infection with severe CD4 lymphocyte depletion. Fewer than 200 CD4 lymphocytes per micrometer of blood. The normal level of CD4 is between 550-1000. Initial infection may be asymptomatic (latent period lasting up to 12 years). Some may develop lymphadenopathy, others may develop an acute illness resembling mononucleosis or flu like symptoms.

6 weeks

Antibodies to HIV usually begin to become detectable about — weeks after the initial infection. In some people, ABs may not be detectable for 6 months or up to a year or longer. This is called the "window of infectivity).

Viral load

Tests such as polymerase chain reaction (PCR) are used to measure the amount of HIV circulating in serum. The measured amount is called the:

CD4 lymphocyte

Measurement of the viral load along with the ———- ——————— count is used to assess HIV infection.

kaposi sarcoma

An opportunistic neoplasm that may occur in the patients with HIV infection. Most commonly located on the palate and gingiva. Dark purple lesion that expands rapidly. Biopsy is indicated if suspected. Tx: surgical excision, radiation treatment, chemotherapy (not good due to HIV already suppressing immune system).

Lymphoma

A malignant tumour that may occur in association with HIV infection. Appears as a non-ulcerated, secretin, or ulcerated mass. May be surfaces by ulcerated or normal coloured erythematous mucosa. Often an enlargement of the lymph node upon palpation.

Linear gingival erythema (LGE)

3 characteristic features include: spontaneous bleeding, punctuate or petechiae like lesions on the attached gingiva and alveolar mucosa. A band like erythema of the gingiva that goes not respond to therapy. Occurs independently of OH status.

Necrotizing ulcerative periodontitis (NUP)

Characterized by intense erythema and extremely rapid bone loss. Necrotizing stomatitis —> extensive focal areas of bone loss along with features of:

Spontaneous gingival bleeding

A decrease in platelets may occasionally be seen in patients with HIV. May be due to an autioimmune type of thrombocytopenic purpura. In these patients, a platelet found and bleeding time should be considered before deep scaling procedures.

Aphthous ulcers.

There appears to be an increase in the number of these ulcers in patients with HIV. Ulcers resembling major ————— ————— appear as deep, persistent, painful ulcers. Respond to steroids.