Oral Pathology Quiz 4

What bacteria cause impetigo?

Streptococcus pyogenes and Staphylococcus aureus.

Where does impetigo most commonly occur, and in whom?

Skin of the face or extremities, in young children.

What skin condition is necessary for impetigo to infect?

Non-intact skin spread by direct contact.

What do impetigo lesions look like?

Vesicles that rupture, or longer-lasting bullae.

Do fever and malaise typically occur with impetigo?

No, they generally do not occur.

What classic description is used for impetigo lesions?

"Cornflakes glued to skin."

How is impetigo diagnosed and treated?

Clinical presentation or bacterial culture of the lesions. Topical or systemic antibiotics.

What is tonsillitis/pharyngitis?

Inflammatory conditions of the tonsils and pharyngeal mucosa.

Why are antibiotics used to treat strep throat?

To prevent rheumatic fever.

What causes scarlet fever?

Group A, beta-hemolytic strep infection, in children.

What is the classic skin rash of scarlet fever?

"Sunburn with goose pimples" (exanthem), with Pastia lines in skin folds.

What is the classic oral finding in scarlet fever?

"Strawberry tongue" — red, prominent fungiform papillae, white coating then generalized erythema.

What causes rheumatic fever?

Follows a group A, beta-hemolytic strep infection (usually pharyngitis/tonsillitis).

What body systems does rheumatic fever affect?

Heart, joints, and CNS.

What long-term complication can rheumatic fever cause?

Permanent heart valve damage.

What precaution is needed for dental hygiene treatment in RHD patients?

Antibiotic prophylaxis.

What are the systemic symptoms of primary pulmonary TB?

Lung infection: Fever, chills, fatigue, malaise, weight loss, persistent cough.

What is miliary TB?

Widespread TB via the vascular system, involving the kidney and liver.

What is scrofula?

Tuberculous lymphadenitis of the submandibular/cervical lymph nodes.

Where do oral TB lesions most commonly occur, and what do they look like?

Tongue and palate; painful, nonhealing, slowly enlarging ulcers that can mimic SCC.

How is TB diagnosed?

Biopsy and microscopic examination.

What does a positive PPD skin test indicate?

A Type IV hypersensitivity reaction from previous TB exposure.

What precaution should be taken for a patient with active TB in a dental setting?

Defer routine dental treatment and use universal precautions.

What organism causes actinomycosis?

Actinomyces israelii.

What is actinomycosis?

Formation of abscesses that tend to drain by formation of sinus tracts.

What are "sulfur granules"?

Tiny, bright yellow bacterial colonies seen in the pus of actinomycosis.

What commonly precedes an actinomycosis infection?

Trauma, a nonvital tooth, periodontal infection, extraction, or mucosal abrasion.

What organism causes syphilis?

Treponema pallidum, a spirochete.

How is syphilis usually transmitted?

Sexual contact with an active lesion (also transfusion or transplacental transmission- mom to fetus).

What is the primary syphilis lesion, and what is it like?

A chancre — a clean-based ulcer at the inoculation site; very infectious; heals on its own.

What is the secondary-stage lesion of syphilis, and when does it appear?

Mucous patches — appear about 6 weeks after the chancre; painless, grayish-white plaques; the most infectious stage.

What is the tertiary syphilis lesion?

A gumma — a noninfectious, destructive mass that can ulcerate.

Where does a gumma typically occur, and what serious complication can it cause?

Tongue or palate; a palatal gumma can perforate the palatal bone.

What organ systems are affected by tertiary syphilis?

Cardiovascular and central nervous systems.

How is congenital syphilis transmitted?

From an infected mother, across the placenta, to the fetus.

What is the Hutchinson triad?

Hutchinson incisors/mulberry molars, interstitial keratitis, and 8th cranial nerve deafness.

How is syphilis treated?

Penicillin.

What are the clinical features of NUG?

Painful, erythematous gingiva with necrosis of the interdental papillae.

What other symptoms accompany NUG?

Foul odor, metallic taste, a necrotic pseudomembrane, fever, cervical lymphadenopathy.

How is NUG treated?

Debridement, chlorhexidine or diluted H2O2 rinse, ± metronidazole or penicillin.

What is pericoronitis?

Inflammation of the mucosa around the crown of a partially erupted or impacted tooth.

Where does pericoronitis most commonly occur?

Around the mandibular third molar.

What contributes to pericoronitis?

Compromised host defenses, minor illness, immunodeficiency, or trauma from an opposing tooth.

How is pericoronitis treated?

Mechanical debridement/irrigation and systemic antibiotics; extraction of the impacted tooth is usually needed to prevent recurrence.

What is acute osteomyelitis?

Acute inflammation of bone and bone marrow.

What commonly causes acute osteomyelitis?

Extension of a periapical abscess, bone fracture/surgery, or bacteremia.

When does acute osteomyelitis become visible on radiograph?

After it has been present for more than 1 week.

How is acute osteomyelitis treated?

Drainage, plus antibiotics chosen by sensitivity testing.

What is chronic osteomyelitis?

Long-standing inflammation of the bone.

What can cause chronic osteomyelitis?

Inadequately treated acute osteomyelitis, Paget's disease, sickle cell disease, or bone irradiation.

What does chronic osteomyelitis look like radiographically?

Diffuse, irregular radiolucency that can become radiopaque.

How is chronic osteomyelitis diagnosed?

Biopsy, showing chronic inflammation of the bone and marrow.

How is chronic osteomyelitis treated?

Debridement and systemic antibiotics; hyperbaric oxygen in some patients.

What organism causes candidiasis, and what are its other names?

Overgrowth of Candida albicans; also called moniliasis or thrush.

Who commonly develops candidiasis?

Denture wearers, linked to antibiotics, chemo, corticosteroids, diabetes, HIV, xerostomia, newborns.

What does pseudomembranous candidiasis look like?

White, curd-like plaques that wipe off, with erythematous mucosa underneath.

What does erythematous candidiasis look like?

Painful red mucosa localized or generalized, aka 'antibiotic sore mouth.'

What is denture stomatitis?

Erythematous, usually nonpainful mucosa covered by full or partial, common on palate/maxillary ridge.

What is chronic hyperplastic candidiasis?

A non-wipeable white lesion that clears with antifungals; possibly premalignant-controversial.

What is angular cheilitis?

Erythema/fissuring at the labial commissures, often with a nutritional deficiency and intraoral candidiasis.

What is median rhomboid glossitis?

A rhombus-shaped area of candidal organisms on the dorsal tongue.

What is chronic mucocutaneous candidiasis?

Severe immunodepression with chronic oral, genital, skin, and nail lesions (part of APECED syndrome).

How is candidiasis diagnosed?

Culture or smear.

What organisms cause the deep fungal infections, and where do they primarily involve?

Histoplasmosis, coccidiomycosis, blastomycosis, cryptococcosis; primarily the lungs.

Where is histoplasmosis endemic?

The Midwestern U.S.

Where is coccidiomycosis endemic?

San Joaquin Valley, California ('valley fever').

Where is blastomycosis endemic?

The Ohio-Mississippi basin.

How is cryptococcosis acquired, and who is at high risk?

Inhaling organisms in dust from bird (pigeon) droppings; high risk in HIV/AIDS patients.

What do oral lesions of deep fungal infections look like?

Chronic, nonhealing ulcers resembling squamous cell carcinoma.

How are deep fungal infections diagnosed?

Biopsy with special stains, plus tissue culture.

What is another name for mucormycosis?

Phycomycosis.

Where is mucormycosis commonly found, and who is at risk?

Common in soil; infects medically compromised patients, especially diabetics.

Where does mucormycosis occur, and what serious complication can it cause?

Nasal cavity, maxillary sinus, hard palate; can cause palatal perforation.

How is mucormycosis diagnosed?

Biopsy/culture.

How does aspergillosis compare to mucormycosis?

Similar, but non-invasive in immunocompetent individuals, forming a mycetoma (fungal ball).

How does aspergillosis appear radiographically?

As a radiopacity in the sinuses on a panoramic film.

How is HPV spread, and how many types exist?

Direct contact; over 130 types, with high- and low-risk subtypes.

Which HPV types are high-risk?

Types 16, 18, and 33.

What is verruca vulgaris?

A common wart caused by HPV type 2 (low-risk) transmitted by direct contact. Lips/ sucking fingers/fingernail biting.

What does verruca vulgaris look like?

White, papillary, exophytic lesion; koilocytes (vacuolated clear cells) seen in the epithelium.

How is verruca vulgaris treated?

Conservative surgical excision, with reinforcement to prevent autoinoculation.

What is condyloma acuminatum?

A benign papillary lesion transmitted by sexual/oral-genital contact or self-inoculation.

What does condyloma acuminatum look like?

Papillary, sessile/bulbous masses; tongue, buccal mucosa, palate, gingiva, alveolar ridge, etc. / pink in color.

What is multifocal epithelial hyperplasia?

AKA Heck disease; caused by HPV types 13 and 32. Multiple white to pink nodules in the mouth.

Who is most affected by Heck disease, and how does it resolve?

More common in children; resolves on its own within weeks to months.

What are the different types of Herpes viruses?

type 1 = oral, type 2 = genital.

What is primary herpetic gingivostomatitis?

The first HSV-1 infection — painful, erythematous, swollen gingiva with vesicles/ulcers, fever, malaise, lymphadenopathy.

Who is typically affected by primary herpetic gingivostomatitis?

Children age 6 months to 6 years (or anyone not previously exposed).

How long does primary herpetic gingivostomatitis last?

It heals on its own within 1-2 weeks.

What is recurrent herpes simplex?

Persists in latent state in nerve tissue of the trigeminal ganglion.

What is the most common form of recurrent HSV?

Herpes labialis: cold sore = fever blister.

What can trigger recurrent HSV outbreaks?

Sunlight, menstruation, fatigue, fever, or emotional stress.

What are the prodromal symptoms of recurrent HSV?

Tingling and burning.

What is herpetic whitlow?

HSV infection of the fingers.

How is herpes simplex diagnosed?

Clinically, by viral culture, or by biopsy/smear (Tzanck cells, positive about 50% of the time).

How is herpes simplex treated?

Usually resolves on its own in 1-2 weeks; antiviral drugs (acyclovir) work best at the prodrome.

What virus causes chickenpox and shingles?

HHV-3 (varicella-zoster virus).

How is chickenpox spread, and what does it look like?

Respiratory droplets or direct contact; vesicular/pustular eruptions with fever, headache, malaise.

What is herpes zoster (shingles)?

A recurrence of VZV, often in older adults with a history of chickenpox.

What is shingles associated with, and what is its distribution pattern?

Depressed cell-mediated immunity; unilateral distribution that does not cross the midline.