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FUNGI VIRUS BACTERIA

DISEASE

The oral focal infection theory A concept generally negleted for several decades, is controversial yet has gained renewed interest with progress in clasification and identification of oral microorganisms. Additionally, recent evidence associating dental with artherosclerosis and other chronic disease has also helped resurrect the focal infection theory

Pathways of infection arising from oral bacteria

The three pathway that may link oral bacteria to secondary disease distant from the oral nidus are :
1. Metastatic infection attributable to transient bacteria in the blood 2. Metastatic immunologic injury 3. Metastatic toxic injury

The scientific evidence weak a it is best supports of first pathway of transient bacteriemias of oral origin

Mechanical prosthetic valve (arrow)

Odontogenic infection

Caries dental

pulpitis Necrosis of the pulp pulp polyp

Periapical abscess

Periodontal infection

Periodontal abscess

Gingivitis

ANUG

Salivary infection

Mucositis

Recurent Apthous Stomatitis Minor RAS Mayor

Penyakit Infeksi Bakteri Spesifik di Rongga Mulut Sifilis Gonorrhea Tuberkulosis Lepra

SIFILIS

1.Sifilis acquired Sifilis primer Sifilis sekunder Sifilis tertier 2.Sifilis kongenital

Penyebab: Treponema Pallidum

Patogenesis
Kontak seksual --- lesi primer ( chancre ) ---- hilang--lesi sekunder -----hilang --- tertier Transfusi darah --- lesi sekunder --- hilang --- tertier Kongenital ----- plasenta ibu yang terinfeksi ---tidak ada lesi primer

Sifilis Primer
- Berkembang pada tempat masuknya kuman, 3-4
minggu - Lesi chancre -- plak keras, sedikit meninggi, ulserasi, bulat, indurasi dengan tepi bergulung, coklat berkrusta, dimulai dengan bercak atau papula --- ulser - Diameter 5 mm - beberapa cm - Tidak sakit - Hilang spontan sesudah 10 hari - Lesi dapat satu atau multiple. - Pembesaran kelenjar limfe regional

Manifestasi di rongga mulut - Lesi chancre


- Lokasi bibir, mukosa mulut, lidah, palatum lunak, tonsil faring, jarang pada gusi - Sedikit sakit karena infeksi sekunder - Ulser ditutupi lapisan putih keabuan - Pada ekstra oral bibir--- krusta coklat - Dapat multiple

Diagnosa
- Riwayat kontak dengan penderita - Smear mulut tidak terlihat - Pemeriksaan darah negatif - Eksudat dengan darkfield microscope positif pada akhir stadium primer

Diagnosa Banding -Lesi herpes pada bibir -Squamous cell carcinoma stadium awal -Lesi trauma kronik -Tuberkulosis

Sifilis Sekunder
Tanda-tanda umum
- Terjadi 3-6 minggu setelah lesi primer - Lokasi tidak berhubungan dengan lesi primer - Erupsi difus pada kulit dan mukosa - Makula papula pada kulit - Pada mukosa dan kulit yang lembab terjadi : mucous patch split papula dan condyloma latum Mucous patch : area kecil, licin, eritematus atau erosi superfisial, putih keabuan pada genital dan mulut, multiple dan tidak sakit Split papula : Lesi doble papula pada area intertrigenus Condyloma latum : Papula besar, lembab, abu-abu, pada mukokutan yang lembab

Manifestasi di rongga mulut


Mucous patch - Lokasi pada lidah, mukosa bukal, tonsil, faring dan bibir pada gusi jarang - Lesi yang paling menular - Plak berwarna putih keabuan, sedikit meninggi, permukaan ulserasi, dasar eritematus - Bentuk ovoid atau tidak teratur - Multiple dan tidak sakit - Pada lidah, papilla hilang diatas lesi berbatas jelas - Trauma pada lesi dapat sakit dan berdarah

Split Papula - Lokasi pada komisura bibir berupa fisur yang membagi dua bibir atas dan bawah oleh papula - Dapat terjadi pada dorsum lidah - Tidak spesifik Condyloma latum - Jarang pada mulut - Berwarna abu-abu silver, rata, seperti kutil, ulserasi - Tidak sakit

Diagnosa Banding Mucous patch - Lesi herpes masa penyembuhan

- Lesi traumatik
- Eritema multiform - Kandidiasis - Proses alergi Split Papula - Angular cheilitis karena defisiensi Vitamin atau kurangnya ruang inter maksilar Diagnosa : Tes serologis biasanya positif

Sifilis Tertier
Tanda-tanda umum
- Asimtomatik atau simtom kompleks - Lesi gumma pada kulit, mukosa, liver, testis, tulang - Dapat melibatkan sistem kardiovaskular, CNS, jaringan dan organ tertentu - Neurosifilis ---- tabes dorsalis dan general paresis Tabes dorsalis --- colum, spinal cord, root ganglia posterior General paresis ---- jaringan cerebral

Manifestasi di rongga mulut


- Lesi gumma , berupa massa nodular yang padat , ulserasi, nekrose, pada palatum --- perforasi palatum - Lokasi : palatum, lidah, kelenjar ludah, tulang rahang - Pada lidah --- atropi papilla, lidah keras --- luetic bald tongue - Tabes dorsales ---- rasa sakit kepala dan leher, kehilangan rasa pengecapan, nekrosis spontan pada prosessus alveolaris - General paresis ---- paresis bibir, lidah, hidung, pipi ulserasi tidak sakit pada palatum, septum hidung, kematian pulpa spontan - Atropik lidah ---- epidermoid carcinoma

Diagnosa Banding
- Gumma ---- Fraktur yang tidak sembuh-sembuh Osteomielitis yang lama bertahan Karsinoma

Tindakan dokter gigi


- Menghindari penularan ---- sifilis primer dan sekunder - Sebagai case finder -Mencegah bakterial endokarditis

Perawatan
- Sifilis primer, sekunder dan laten -- Benzathine penisilin G - Bila alergi penisilin --- tetrasiklin atau eritromisin

Sifilis kongenital ( prenatal sifilis )


Tanda-tanda umum - Manifestasi pada 2 tahun pertama kehidupan
- Tidak ada lesi primer - Rinitis, hidung sumbat, kehilangan berat badan, tumit berkerut dan bersisik - Makula, papula, bula, vesikel, deskuamasi superfisial. - Kulit berkerut dan bersisik - Petechie, mucous patch, condyloma latum - Kepala bentuk empat segi, lobus frontal menonjol - Manifestasi lanjutan sesudah 2 tahun, interstitial keratitis, vaskularisasi kornea, ketulian, artopati - Umur 10-12 tahun, saddle nose, deformiti tulang hidung perforasi palatum

Umur 10-12 tahun - Saddle nose, deformiti tulang hidung atau perforasi palatum - Melibatkan tulang fasial dan gigi - Dapat terjadi frontal bosse, maksila yang pendek, palatum yang tinggi, mulberry molar.

Tanda khas
- Triad Hutchinson : Hipoplasia Incisivus dan Molar Ketulian syaraf 8 Keratitis interstitial

Manifestasi di rongga mulut


1. Post Rhagadic scarring pada mulut - daerah linear merah tembaga ditutupi krusta lunak pada bibir - Bila sembuh seperti sikatrik 2. Perobahan pada gigi - Perobahan bentuk, warna dan ukuran gigi - Resorbsi akar yang berkurang pada gigi desidui - Hipoplasia gigi pada I, C dan M satu permanen bentuk obeng, runcing pada I, bud shaphe pada M DD dengan terapi Tetrasiklin atau Riketsia 3. Perobahan dentofasial : malokklusi dan open bite

Diagnosa
- Riwayat dilahirkan ibu penderita sifilis - Lesi-lesi yang khas

Perawatan
Injeksi Penisilin

Fungal infection Are oral fungal infections common ?


No, most are associated with an underlying systemic condition immunosuppression

imunodeficiency syndrome anemia diabetes uremia leukemia

cancer therapy

Patients who have conditions that modify the normal oral environment are at increased risk of fungal infection Among these individuals are patients with _ xerostomia _ have taken broad spectrum antibiotics

Diagnosis of oral fungal infection based on :


History Clinical appearance Culture Potassium hydroxide preparation Biopsy

What is the most common fungal infection to affect the mouth?

Oral candidiasis caused by Candida Albicans

What is the typical clinical presentation of oral candidiasis ?

Pseudomembranous candidiasis Hyperplastic candidiasis Erythematous candidiasis Angular cheilitis

Pseudomembranous candidiasis ( Thrush ) Most typical clinical presentation of the infection White, cottage cheesy-looking raised lesions Most often of tongue or palate Can be scrapped off, leaving a painful, raw bleeding base

Hyperplastic Candidiasis
Less common As area leukoplakia at corners of the mouth or the cheeks Unlike pseudomembranous forms, these lesions cannot be scraped off

Erythematous Candidiasis Most often present on the dorsal surface or edges tongue and palate The degree of mucosal erythema may be variable Patients with this form of candidiasis often complain of a burning mouth

Angular cheilitis

Viral infection
Are viral infections of the mouth common or rare ? Viral infections are among the most common causes of oral lesions

Symptoms of acute viral infections that affects the mouth

Vesicles or rupture small ulcers History suggesting viremia : fever, malaise, myalgia, upper respiratory symptoms, anorexia Pain associated lesions

Group of viruses for most oral infections: HS type 1,2 Varicella-zoster virus The epstein-barr virus Cytomegalovirus Herpes virus 6,7,8 ( infectious in immunocompromisefd patient

HIV HAS BEEN ISOLATED FROM BODY FLUIDS :


HUMAN BLOOD. SEMEN VAGINAL SECRETIONS. BREAST MILK. TEARS. URINE. SALIVA. CEREBROSPINAL FLUID. AMNIOTIC FLUID.

DIAGNOSTIC TESTING FOR HIV : 1. Detection of serum antibody ELISA. 2. Detection of viral antigen in patients blood or tissue WESTERN BLOT TEST.

PREVALENSI

: 40 90%

HIV-related lesions have particular significance because : - They are often the first sign of HIV disease. - They have prognostic value. - They are a frequent cause a morbidity and mortality. - Knowledge and proper treatment can add to the quality of life of HIV patients.

SAN FRANSISCO, AUG. 17, 1990 : I. CANDIDIASIS. A. Pseudomembranous candidiasis. B. Erythematous candidiasis. C. Angular cheilitis. II. GINGIVITIS / PERIODONTITIS. A. HIV associated gingivitis. B. HIV associated periodontitis.

III. NECROTIZING STOMATITIS. IV. HERPES SIMPLEX. A. Intra oral form. B. Perioral form. V. CYTOMEGALOVIRUS.

VI. VARICELLA ZOSTER VIRUS VII. APHTHOUS ULCERATION. A. Minor. B. Mayor. C. Herpetiform.

VIII. HAIRY LEUKOPLAKIA.

IX. HIV SALIVARY GLAND DISEASE. X. ORAL KAPOSI SARCOMA.

XI. ORAL WARTS / PAPILOMA. A. Papilloma. B. Focal epithelial hyperplasia.

TREATMENT OF THE ORAL LESIONS ASSOCIATED WITH HIV INFECTION.


CONDITION I. Candidiasis THERAPY Antifungal (topical and / or systemic). Plaque removal, debridement, chlorhexidine, povidone iodine.

II. HIV- associated gingivitis

CONDITION HIV- associted periodontitis

THERAPY Plaque removal, debridement, chlorhexidine, metronidazole. Debridement, chlorhexidine, metronidazole. If not self limiting, if prolonged, if frequently recurrent acyclovir. Oral Acyclovir.

Necrotizing stomatitis III. Herpes simplex

IV. Herpes zoster

CONDITION V. Aphthous ulcer

THERAPY Topically steroid Usually no treatment, severe acyclovir Excision, laser, radiation, chemotherapy Excisison, laser Salivary stimulation, artificial saliva.

VI. Hairy leukoplakia

VII. Kaposi sarcoma

VIII. Oral wart IX. Xerostomia

HIV
The main targets for the virus are cells expressing the CD4 membrane reseptor, such as T4 helper lymphocyte, macrophages and monocyte Viral replication occures within the CD4 cel, leading to its destruction and loss of function. As a result the number of CD4 cell declines, and the patient become at high risk for opportunistic infections.

Many medication used to treat HIV have side effect


Abacavir Flycotsine Foscarnet Ganciclovir Hydroxyurea Interferon oral ulceration myelosuppression ou &m m ou xerostomis,metallic taste & m Lopinavir u&x Pentamidine mt Rifampin salivary discoloration Ritonavir perioral paresthesia Saquinavir p, neutropenia, thrombocytopenia TMP/SMZP myelosup,ou, glositis Dideoxycytidine my & ou Zidovudine Neutropenia

VIRUS
Viral infection causing, or associated with diseases of the oral mucosa :

VIRUS
Herpes Simpleks 1 & 2

PENYAKIT
Primary Gingivostomatitis Herpetica Herpes Labialis Recurrent Herpes Intra Oral Recurrent Herpetic Whitlow Chickenpox Herpes Zoster Herpangina Hand, foot and mouth disease

Varicella - Zoster Coxsakie A

Viral infection causing, or associated with diseases of the oral mucosa :

VIRUS

PENYAKIT

Cytomegalovirus Salivary gland disease Epstein Barr Virus Paramyxovirus Papilomavirus HIV Hairy leukoplakia Measles Viral warts Manifestasi oral HIV

HERPES SIMPLEX VIRUS INFECTION


Family herpesviridae

Herpes simplex virus 1 Herpes simplex virus 2 Cytomegalovirus Varicella-zoster virus Varicella Epstein Barr virus Human herpes virus-6 virus Human herpes virus-7 virus Human herpes virus-8 virus-

Herpes Simplex virus 1 perioral, eyes Herpes Simplex virus 2 genitals TRANSMISSION : 1. Airbone droplets 2. Intimate contact

HERPES SIMPLEX VIRUS INFECTION

PRIMARY INFECTION

RECURRENT INFECTION

CHARACTERISTIC PROPERTY OF HERPES VIRUS :


after primary infection latent in cell host reactivated by variety factors recurrent infection Trigger factors : - Fever - Emotional stress - Ultraviolet radiation - Menstruation - Hormones - Immunosuppression - Ionizing radiation

PATHOGENESIS OF HSV-1 INFECTIONS :


Host (seronegative)
HSV

Primary disease or Subclinical infection

Recurrent infection or Shedding asymptomatic Reactivation

Host (seropositive) latent virus

Resolution

PRIMARY HSV-1 INFECTION :


- Seronegative for HSV - Children, young adult - Does not imply clinical signs & symptoms subclinical - Incubation periode : several days 2 weeks - Primary Gingivostomatitis Herpetica Herpetic Whitlow

PRIMARY GINGIVOSTOMATITIS HERPETICA.

CLINICAL APPEARANCES : - Prodromal symptoms : fever, malaise, nausea, headache, lymphadenopathy. - Vesicle rupture round/oval ulcers, greyshallow, grey-white pseudomembrane, surrounded by erythema area. - Ulcers can coalescent large ulcers. - Pain, disorders of swallowing, eating, secondarily infected. - Location: any intra oral. - Acute gingivitis marginalis gingiva are swollen with red edges that bleed easily. - Heal : 10 12 days self limiting disease, without scar.

Treatment :
Goals : 1. To shorten the current attack. 2. To prevent recurrences. Medications : Analgesics. Vitamin. Anaesthetic topical. Antivirus.

RECURRENT HSV INFECTION :


- Affect 20 40% 0f adult population. - Antibody for HSV was present. - Reactivation of latent virus by trigger factors. - Recurrent Herpes Labialis Recurent Herpes Intra Oral Herpetic Whitlow.

RECURRENT HERPES LABIALIS.


CLINICAL APPEARANCES : - Prodromal symptoms : mild fever, tingling, burning or pain in which lesions will appear. - Vesicles on the vermillion border of lip rupture shallow ulcer. - Yellow crust formation. - Problems : pain, cosmetic disfigurement, psychosocial effect. - Heal : 1 2 weeks without scar. - Recurrences is variable.

RECURRENT HERPES INTRAORAL.


CLINICAL APPEARANCES : - Prodromal symptoms mild. - Vesicles rupture ulcers. - Intraorally. Recurrent Herpes Labialis maybe seen concurently with the intraoral lesions or they occur alone.

HERPETIC WHITLOW :

- Primary or secondary HSV infection involving the finger. - Because of the physical contact with infected individual. - Fever, lymphadenopathy. - Pain, redness, swelling are prominent. - Duration : 4 6 weeks. - Locations : paronychial, eponychial or subungal portions of the distal phalanges, finger. other area of the finger.

VARICELLA ZOSTER VIRUS


DNA untai ganda Neurotropic Penularan : kontak langsung, infeksi droplet. Infeksi primer dan rekuren bersifat laten

Varicella zoster virus

PRIMARY INFECTION

RECURRENT INFECTION

CHICKENPOX / VARISELA

HERPES ZOSTER / SHINGLES

Hospes (seronegative)

Primary infection ( Chickenpox )

Recurrent infection ( Herpes zoster )

Hospes (seropositive ) Latency virus

Reactivation : - age -Immunosupression, dll Immunosupression,

VARICELLA ( CHICKENPOX ) :
- seronegative individual. - children. - incubation periode : 2 3 weeks. - prodromal symptoms : fever, chills, malaise, headache. - rash vesicles pustula / ulcerations. - heal : 2 weeks self limiting. - intra oral : not consistently involved. discrete/scattered vesicles rupture shallow round ulcer surrounded by red halo.

HERPES ZOSTER :
Clinical appearancess : - Gejala prodromal : parastesi, gatal, rasa terbakar, nyeri di daerah dermatom yg terlibat. - Dermatom yg terlibat : T5, C3, L1, L2, s. trigeminal - Ruam makulopapular vesikel ulser dengan dasar eritematus krusta. - Distribusi unilateral. - Intra oral : vesikel ruptur ulkus. Cab. Maksilaris : palatum lunak, mukosa bibir atas, uvula mukosa pipi. Cab. Mandibularis : lidah, gimngiva, mukosa bibir bawah.

TREATMENT :
- Bed rest. - Local applications of heat. - Topical anesthetic. - Antiviral. - Analgesics. - tranquilizers.

LOCALIZED FUNGAL INFECTIONS ORAL CANDIDIASIS

CRYPTOCOCOSIS HISTOPLASMOSIS GEOTRICHOSIS BLASTOMYCOSIS Rarely affect the oral cavity

DEEPDEEP-SEATED FUNGAL INFECTIONS ASPERGILOSIS

ORAL CANDIDIASIS
A SUPERFICIAL INFECTION OF ORAL MUCOUS CAUSED BY THE YEASTLIKE FUNGUS CANDIDA ALBICANS

Denture wearing

FACTORS PREDISPOSING TO ORAL CANDIDIASIS : LOCAL FACTORS SYSTEMIC FACTORS


Physiological Old age, infancy, pregnancy Endocrine disorders Diabetes Melitus Nutritional deficiencies Iron, folate, vit.B 12 Malignancies Leukemia Immune defects HIV / AIDS Drugs / medication Broad spectrum antibiotics Corticosteroids Cytotoxic drugs

Saliva Xerostomia, low pH Commensal flora HighHigh-carbohydrate diet Smoking tobacco

CLASSIFICATION OF ORAL CANDIDIASIS :


TYPE
ACUTE : ACUTE PSEUDOMEMBRANOUS CANDIDIASIS = ORAL TRUSH ACUTE ATROPHIC CANDIDIASIS = ANTIBIOTIC SORE TONGUE

CLINICAL

Creamy / white patches on the surface of curdoral mucous; forming confluent; curd-like pseudomembranes. Pseudomembranes can be scraped off to reveal raw, erythematous base. Small lesions, usually on the tongue, with reddening / inflammation of surrounding tissue

TYPE
CHRONIC : Chronic Atrophic Candidiasis = Denture Stomatitis Chronic hyperplastic Candidiasis = Candida Leukoplakia

CLINICAL
Chronic erythema and edema of upper palate localized to occluded / traumatized tissue White patch adherent to mucous on an erythematous base which is not removable by digital pressure. Usually on the anterior buccak mucous Erythema, fissure and encrustations at corners of mouth.

Angular cheilitis =Perleche

DIAGNOSIS :
CLINICAL APPEARANCES + LABORATORIUM EXAMINATIONS : * Culture * Cytologic * Serology

TREATMENT :
To correct predisposing factors

Antifungal drugs

To correct sources of infection

ANTIFUNGAL DRUGS

POLYENE

AZOLES

A. AMFOTERICIN B B. NYSTATIN

A.IMIDIAZOLE : - Clotrimazole - Ketoconazole - Miconazole B. TRIAZOLE : - Fluconazole - Itraconazole

Penyakit Infeksi Bakteri Spesifik di Rongga Mulut Sifilis Gonorrhea Tuberkulosis Lepra

SIFILIS

1.Sifilis acquired Sifilis primer Sifilis sekunder Sifilis tertier 2.Sifilis kongenital

Penyebab: Treponema Pallidum

Patogenesis
Kontak seksual --- lesi primer ( chancre ) ---- hilang--lesi sekunder -----hilang --- tertier Transfusi darah --- lesi sekunder --- hilang --- tertier Kongenital ----- plasenta ibu yang terinfeksi ---tidak ada lesi primer

Sifilis Primer
- Berkembang pada tempat masuknya kuman, 3-4
minggu - Lesi chancre -- plak keras, sedikit meninggi, ulserasi, bulat, indurasi dengan tepi bergulung, coklat berkrusta, dimulai dengan bercak atau papula --- ulser - Diameter 5 mm - beberapa cm - Tidak sakit - Hilang spontan sesudah 10 hari - Lesi dapat satu atau multiple. - Pembesaran kelenjar limfe regional

Manifestasi di rongga mulut - Lesi chancre


- Lokasi bibir, mukosa mulut, lidah, palatum lunak, tonsil faring, jarang pada gusi - Sedikit sakit karena infeksi sekunder - Ulser ditutupi lapisan putih keabuan - Pada ekstra oral bibir--- krusta coklat - Dapat multiple

Diagnosa
- Riwayat kontak dengan penderita - Smear mulut tidak terlihat - Pemeriksaan darah negatif - Eksudat dengan darkfield microscope positif pada akhir stadium primer

Diagnosa Banding -Lesi herpes pada bibir -Squamous cell carcinoma stadium awal -Lesi trauma kronik -Tuberkulosis

Sifilis Sekunder
Tanda-tanda umum
- Terjadi 3-6 minggu setelah lesi primer - Lokasi tidak berhubungan dengan lesi primer - Erupsi difus pada kulit dan mukosa - Makula papula pada kulit - Pada mukosa dan kulit yang lembab terjadi : mucous patch split papula dan condyloma latum Mucous patch : area kecil, licin, eritematus atau erosi superfisial, putih keabuan pada genital dan mulut, multiple dan tidak sakit Split papula : Lesi doble papula pada area intertrigenus Condyloma latum : Papula besar, lembab, abu-abu, pada mukokutan yang lembab

Manifestasi di rongga mulut


Mucous patch - Lokasi pada lidah, mukosa bukal, tonsil, faring dan bibir pada gusi jarang - Lesi yang paling menular - Plak berwarna putih keabuan, sedikit meninggi, permukaan ulserasi, dasar eritematus - Bentuk ovoid atau tidak teratur - Multiple dan tidak sakit - Pada lidah, papilla hilang diatas lesi berbatas jelas - Trauma pada lesi dapat sakit dan berdarah

Split Papula - Lokasi pada komisura bibir berupa fisur yang membagi dua bibir atas dan bawah oleh papula - Dapat terjadi pada dorsum lidah - Tidak spesifik Condyloma latum - Jarang pada mulut - Berwarna abu-abu silver, rata, seperti kutil, ulserasi - Tidak sakit

Diagnosa Banding Mucous patch - Lesi herpes masa penyembuhan

- Lesi traumatik
- Eritema multiform - Kandidiasis - Proses alergi Split Papula - Angular cheilitis karena defisiensi Vitamin atau kurangnya ruang inter maksilar Diagnosa : Tes serologis biasanya positif

Sifilis Tertier
Tanda-tanda umum
- Asimtomatik atau simtom kompleks - Lesi gumma pada kulit, mukosa, liver, testis, tulang - Dapat melibatkan sistem kardiovaskular, CNS, jaringan dan organ tertentu - Neurosifilis ---- tabes dorsalis dan general paresis Tabes dorsalis --- colum, spinal cord, root ganglia posterior General paresis ---- jaringan cerebral

Manifestasi di rongga mulut


- Lesi gumma , berupa massa nodular yang padat , ulserasi, nekrose, pada palatum --- perforasi palatum - Lokasi : palatum, lidah, kelenjar ludah, tulang rahang - Pada lidah --- atropi papilla, lidah keras --- luetic bald tongue - Tabes dorsales ---- rasa sakit kepala dan leher, kehilangan rasa pengecapan, nekrosis spontan pada prosessus alveolaris - General paresis ---- paresis bibir, lidah, hidung, pipi ulserasi tidak sakit pada palatum, septum hidung, kematian pulpa spontan - Atropik lidah ---- epidermoid carcinoma

Diagnosa Banding
- Gumma ---- Fraktur yang tidak sembuh-sembuh Osteomielitis yang lama bertahan Karsinoma

Tindakan dokter gigi


- Menghindari penularan ---- sifilis primer dan sekunder - Sebagai case finder -Mencegah bakterial endokarditis

Perawatan
- Sifilis primer, sekunder dan laten -- Benzathine penisilin G - Bila alergi penisilin --- tetrasiklin atau eritromisin

Sifilis kongenital ( prenatal sifilis )


Tanda-tanda umum - Manifestasi pada 2 tahun pertama kehidupan
- Tidak ada lesi primer - Rinitis, hidung sumbat, kehilangan berat badan, tumit berkerut dan bersisik - Makula, papula, bula, vesikel, deskuamasi superfisial. - Kulit berkerut dan bersisik - Petechie, mucous patch, condyloma latum - Kepala bentuk empat segi, lobus frontal menonjol - Manifestasi lanjutan sesudah 2 tahun, interstitial keratitis, vaskularisasi kornea, ketulian, artopati - Umur 10-12 tahun, saddle nose, deformiti tulang hidung perforasi palatum

Umur 10-12 tahun - Saddle nose, deformiti tulang hidung atau perforasi palatum - Melibatkan tulang fasial dan gigi - Dapat terjadi frontal bosse, maksila yang pendek, palatum yang tinggi, mulberry molar.

Tanda khas
- Triad Hutchinson : Hipoplasia Incisivus dan Molar Ketulian syaraf 8 Keratitis interstitial

Manifestasi di rongga mulut


1. Post Rhagadic scarring pada mulut - daerah linear merah tembaga ditutupi krusta lunak pada bibir - Bila sembuh seperti sikatrik 2. Perobahan pada gigi - Perobahan bentuk, warna dan ukuran gigi - Resorbsi akar yang berkurang pada gigi desidui - Hipoplasia gigi pada I, C dan M satu permanen bentuk obeng, runcing pada I, bud shaphe pada M DD dengan terapi Tetrasiklin atau Riketsia 3. Perobahan dentofasial : malokklusi dan open bite

Diagnosa
- Riwayat dilahirkan ibu penderita sifilis - Lesi-lesi yang khas

Perawatan
Injeksi Penisilin

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