Professional Documents
Culture Documents
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
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
Odontogenic infection
Caries dental
Periapical abscess
Periodontal infection
Periodontal abscess
Gingivitis
ANUG
Salivary infection
Mucositis
Penyakit Infeksi Bakteri Spesifik di Rongga Mulut Sifilis Gonorrhea Tuberkulosis Lepra
SIFILIS
1.Sifilis acquired Sifilis primer Sifilis sekunder Sifilis tertier 2.Sifilis kongenital
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
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
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
- 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
Diagnosa Banding
- Gumma ---- Fraktur yang tidak sembuh-sembuh Osteomielitis yang lama bertahan Karsinoma
Perawatan
- Sifilis primer, sekunder dan laten -- Benzathine penisilin G - Bila alergi penisilin --- tetrasiklin atau eritromisin
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
Diagnosa
- Riwayat dilahirkan ibu penderita sifilis - Lesi-lesi yang khas
Perawatan
Injeksi Penisilin
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
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
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
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.
THERAPY Plaque removal, debridement, chlorhexidine, metronidazole. Debridement, chlorhexidine, metronidazole. If not self limiting, if prolonged, if frequently recurrent acyclovir. Oral Acyclovir.
THERAPY Topically steroid Usually no treatment, severe acyclovir Excision, laser, radiation, chemotherapy Excisison, laser Salivary stimulation, artificial saliva.
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.
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
VIRUS
PENYAKIT
Cytomegalovirus Salivary gland disease Epstein Barr Virus Paramyxovirus Papilomavirus HIV Hairy leukoplakia Measles Viral warts Manifestasi oral HIV
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
PRIMARY INFECTION
RECURRENT INFECTION
Resolution
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.
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.
PRIMARY INFECTION
RECURRENT INFECTION
CHICKENPOX / VARISELA
Hospes (seronegative)
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.
ORAL CANDIDIASIS
A SUPERFICIAL INFECTION OF ORAL MUCOUS CAUSED BY THE YEASTLIKE FUNGUS CANDIDA ALBICANS
Denture wearing
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.
DIAGNOSIS :
CLINICAL APPEARANCES + LABORATORIUM EXAMINATIONS : * Culture * Cytologic * Serology
TREATMENT :
To correct predisposing factors
Antifungal drugs
ANTIFUNGAL DRUGS
POLYENE
AZOLES
A. AMFOTERICIN B B. NYSTATIN
Penyakit Infeksi Bakteri Spesifik di Rongga Mulut Sifilis Gonorrhea Tuberkulosis Lepra
SIFILIS
1.Sifilis acquired Sifilis primer Sifilis sekunder Sifilis tertier 2.Sifilis kongenital
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
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
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
- 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
Diagnosa Banding
- Gumma ---- Fraktur yang tidak sembuh-sembuh Osteomielitis yang lama bertahan Karsinoma
Perawatan
- Sifilis primer, sekunder dan laten -- Benzathine penisilin G - Bila alergi penisilin --- tetrasiklin atau eritromisin
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
Diagnosa
- Riwayat dilahirkan ibu penderita sifilis - Lesi-lesi yang khas
Perawatan
Injeksi Penisilin