Rupture of

cause
by:Microbial effect —> Herpetic withlow vesicles

Candidiasis
Kawasaki disease (mucocutanoeus lymph node syndrome)

cause
by:immune related
imbalance,suppression
deficiency
Not of Microbial cause
 -

29

Cytomegalovirus associated ulceration

Coxsackie A virus —> Hand, foot and mouth disease

The acute specific fevers (Kopliks spots) —> In the progromal stage of measles
 -

7
ž Stomatitis: inflammation of the mucosal
frequent
lining of any of the structures of the
feature
mouth.
ž Ulcer: a break in epithelial continuity,
which is a frequent feature of stomatitis.
-in soft
tissue notbone

ž Vesicle: fluid filled cavity or sac (<0.5cm)

ž Bullae: fluid filled cavity or sac (>0.5cm)
 macule (sigmented Lesion

color lesion
pagule projection same

"RoS"
ž Ulcer

ž Vesicle
Roof floor
W W

very thin layer Base ofmucosa

of epi. cells

~pressure
Rupture 7 Ulceration with preceding vesiculation
ž 1)Vesiculo-bullous diseases

ž 2)ulceration without preceding vesicle

-

ž It could infective or non-infective

7
-

-
 Very contagious:‫معدي‬
, sses, esse
1! -
7

OR gingivo-stomatitis

Dormant main complain:

intrigiminal gangilia ⑧ Tingling pain (paresthesia)
common
most L
·
. child refuse eat drink

ž Caused by herpes simplex virus type 1… dehydration . .

⑧
upset + fatigue

ž Transmission by close contact, more common in 1

systemic signs

immunocompromised(HIV)…
in adults
Is Jessi
Bullae 3;0 -1!

ž Dome shaped vesicles (2-3)cm in hard palate &

pressure dorsum of the tongue.
Rupture of vesicles leaving sharp defined,shallow,
I

ž
painful ulcers. >=

· Shallow
.yellewish to Greenish base
Red
margin
·
 ž Accumulation of fluid in prickle layer
ž Presence of ballooning degeneration..of viral damaged cells
Granulosum
Roof:- &
Corneum

Fluid

Floor:
flats
Histopathologicals
clinical
jit
not

Lecture
v

ballooning degeneration..

Vesicle
 7

ž Diagnosis: by clinical feature, smear Virus1;561

examination, and rising antibody titre…

H. Antiviral i
Geese ones
$17;

ž Treatment : Aciclovir (rinse) (200-400mg

upset + fatiguensia Sib
daily
Influidis:- My dehydrations I1
infection
Sec.
-

x7days), bed rest, fluids and soft diet, tetracycline

rinses in mild cases.. ( good hydration, IV fluids

After primary
infection (Primary
herpetic stomatitis), the

latent virus can be

reactivated as
Herpes labialis
 2
Very contagious:‫معدي‬

ž Latent virus reactivated causing cold sores (fever

blisters) • Common cold & infections.
• Exposure to strong sunshine.

ž Triggering factors… •• Emotional

Menstruation.
upsets or local irritation or stress, such as dental treatment.

ž Note that antibodies of primary infection are not

protective.. prodromal paraesthesia or
burning sensations,
ž It has consistent clinical course.. >
Then
Topical
ž Treatment: penciclovir cream 2 hourly V
Erythema
Then form
↑
and don’t wipe it.
7 W
Vesicles (After 1-2 hour)
When giving dental treatment in mucocutaneous junction of the lips,
but can extend onto the adjacent skin.
Enlarge, coalesce and weep exudate
W
Rupture (After 2 or 3 days)
To prevent and crust

90% Finally
W

10% intraorally Heal without scarring.

W
 Very contagious:‫معدي‬

2a

finger 51 Virus
Lip 11g 11J;

ž It is herpetic cross-infection, because it is

contagious infections..
ž Aciclovir can improve prognosis..
 ⚠

-)
in primary latent virus
Chickenpox
virus

· children: -ill,"s
non-immune L
while reactivation

- Adults:-
Characterised by:
3 • Pain, irritation, tenderness (first signs) + vesicular rash + stomatitis in the dermatome corresponding to the affected ganglion
• Unlike herpes labialis, recurrences —> very rare + heal —> but scarring of the skin.

ž Can be found in trigeminal area.. verves si

ž It is reactivation of varicella-zoster virus which cause
chickenpox, causing vesicular rash in the related
dermatome..
form on one side of the face and in the mouth *Does cross the mid-Line Not

ž Clinical course…up to the midline of related ganglion..

-10% V2
mostly Difficulttorelive

ž Postherpetic neuralgia in elderly Herpes zoster is a hazard in:

• Immunodeficiency patients (eg. Organ
I

ž Ramsay hunt syndrome transplant patients, AIDS) (5 times)

VZV in facial nerve —> (1) facial paralysis NOT Bell’s palsy • Can be an early complication of some
(2) loss of taste on one side of the anterior tongue + *
tumours, particularly Hodgkin’s disease, AIDS.
(3) vesicles on the tongue, hard palate and in the external auditory canal.

I's;5. Id i ↓

pain of trigem. Zostor1) 8.

toothache//,
V

dental extraction
W

rash follows
Sbs!zosters,
-
extractions
ž Treatment High dose!!
Aciclovir (800mg 1x5x7) orally
* -'95
I

Analgesics + Antipyretics
-

Prednisolone (Corticosteroid)

In immunodeficient patients
"4
L
orally,I .,

intravenous aciclovir is better why??

 either the mouth or the extremities alone may be affected.
4
Vesiculo-bullous ·
2
vesicule
months2,; $ss i

It is mild viral infection, causing ulceration of the mouth and

ž
deep-seated vesicular rash in extremities…foot
around Hand mainly
of
fingers toes j's$1s
base or
- s1
Roofs
ž Caused by Coxsackie A virus , with incubation period 3-10 days
i4

ž oral ulcers cause little pain, rare to see oral vesicles, with very
mild systemic upset…
ž Features of skin vesicular rash, gingivitis is not a feature.
ž Diagnosis by history or serology
ž No specific treatment , rare complications may occur.. if infection) severe
5-
-
Support hydration
main complain:
⑧ Tingling pain (paresthesia)
·
. child refuse eat drink
. . dehydration
⑧
upset + fatigue
systemic signs

Box
2
 j .=
= I

-
 · it'snotthe main cause of this ulcer
it's
pessenger sulcer
- ·
iifor other virus
<
⑧
Response to ganciclovir (antiviral)

ž It is a part of herpes simplex virus group, and it is a

complication of immunodeficiency (AIDS)latter, —> life-threatening.
ž Oral ulcer mimics aphthous ulceration , they are
raised with rolled borders
ž Affecting masticatory and non-masticatory
mucosa

ž Microscopic features
-

ž Owl eye intranuclear inclusion

 ⚠

fever

St ~skin rash
-

&

ž In the prodromal stage of measles------- soral manifestation

E
"Spot* uker

diagnosis kopliks spot are found in the buccal

mucosa and soft palate -----
1

pathognomonic of measles
E

Another disease:also viral infection

ž In glandular fever palatal petechiae or

Anterior pillar of fauces:
ulceration involving the fauces platoglossal arch
>
>

Posterior pillar of fauces:

platopharynx arch

St
-
⑤< 5 -;841 -1
against measles, mumps, and rubella
 3

ž Children are more affected, with fever

-

Skin

oral mucositis ,ocular and cutaneous

2 L 3 V

lesion and cervical lymphadenopathy

4 L

ž Oral lesions
- Mucosal erythema Red+frusioner
·

2 Swelling of the ligual papillae(strawberry

tongue)
 ⚠

4 Tb
by Mycobacterium

ž Found in immunocompetent patients with pulmonary disease

with chronic cough Lunggi
Syphilitic leukoplakia
ox
jie ž Ulcer found in mid-dorsum of the tongue
star shape
12
uker 11
ž
-
Augular or stellate , overhanged or irregular borders with pale
floor

After swa
ž Pathology
-

Tuberculous granuloma are seen in the floor of the ulcer ,

-

Chest radiographs show advanced infection

↑

Diagnosis by biopsy, chest x-ray, or sputum specimen

...

ttt: multiple chemotherapeutic agent (multiple drug therapy) At: isoniazid

isoniazid INH in combination with three other drugs— ritamycine
rifamycins, streptomycin, pyrazinamide and ethambutol
 1 13
-
,?
7
Syphilitic leukoplakia

S
Bacteria
it

By
can cause
Treponema pallidum
>
Infective lesion

ž Primary syphilis

Chancre
Firm nodule
—> —>

-
Cm

Breaks down

Rounded ulcer with raised indurated edges

Resemble a carcinoma, particularly if on the lower lip.

FTA-abs test
ž Secondary syphilis
. . I's 41 -:30-
tonsils
...

affect lateral borders of the tongue

>

lips
I

Snail track ulcers flat ulcers covered by greyish membrane and may be irregularly linear
[d5s--(jgd;

Raised Lesion not uker

Mucosal patches
coalesce —> form well-defined
rounded areas
W

S
 Late-stage syphilis —> develops in 3 or more years after infection.
palate
>

Tertiary syphilis Gumma

Affect
>

tongue
ž tonsils

Swelling (yellowish centre) ⑧

&

Gr Necrosis of center
⑧

painless indolent deep ulcer

(punchedout edges)
"s es''jissss. 98 s
Soft
The floor is depressed and pale (wash-leather)

Heals with severe scarring

(distort the soft palate or tongue, or perforate
the hard palate or destroy the uvula)
 Bacteria

By Treponema pallidum

To distinguish active syphilis from false positives:

(lipoidal antigen) test

Tertiary syphilis Gumma

Non-specific tests as in the VDRL & Rapid Plasma Reagin (RPR)
ž
Specific tests include: 7 Used in combination
• Treponema pallidum haemagglutination assay (THPA)
• Fluorescent treponemal antibody absorption test (FTA-abs test)
• Treponemal enzyme-linked immunosorbent assay (ELISA).

ttt: Antibiotics (penicillin**, tetracycline and erythromycin)

 6

žThrush
-
Neonatal thrush
feature

2
Adult thrush
Bad oral hygiene

Clinically
Pathology
management
3
 !
✅

-
·jo
ž Thrush
Neonatal
Results from:
thrush
• Immaturity of the immune response.
• Infection during normal delivery
(passage through the birth canal)

Adult thrush Is

If NO apparent cause —> HIV infection.

> soft, friable and creamy (white) coloured plaques

wiped off
Clinically E

Pathology 7

management intercellular effect

Not intra
rinsing lozenges --

↓ Is (1) Topical antibiotic treatment (nystatin or amphotericin lozenges).

- I
(2) Systemic: Fluconazole or itraconazole, associated with a low CD4 count & poor prognosis.
↓ Is

- I
ji
 ⬆

Caused by leakage of candida-infected saliva (eg. Thrush) at

- the angles of the mouth.
·jo
ž Angular cheilitis Furrows at the angles of the mouth are made deeper by:
• Loss of vertical dimension
• Loss of support to the upper lip by resorption of the
Co-infection ‘closed bite’ underlying bone.
• Candida
• S. aureus

ttt:
• Correct vertical dimension and thickness of labial flange of the upper denture
• Plastic surgery (patient anxious)
• Anti-fungal & If co-infection with S. aureus, local application of fusidic acid cream (antibacterial drug).
 -
I
-

·jo

Common in upper jaw

°s?s

2-3 week," s
-

nystatio
It’s NOT ‘allergy’ to denture base material (Methylmethacrylate monomerh)
⑤jis, I wis

Porosity —> reservoir of C. albicans

ttt: take 1–2 weeks -

. -d's

• Elimination of C. albicans by soaking the denture in 0.1% hypochlorite or dilute chlorhexidine overnight.
• Coat the fitting surface with miconazole gel or varnish while it is being worn.
• Removed and clean & miconazole re-applied three times a day.
• Antifungal drugs, but topical agents such as nystatin or amphotericin can only gain access to the palate if the patient leaves out the denture while the tablets are allowed to dissolve in the mouth.
-
·jo

follow overuse or topical oral use of antibiotics, especially tetracycline (broad spectrum)

suppressing normal, competing oral flora. ttt:

• Stop antibiotic
• accelerated by topical
antifungal treatment.
 !

NO apparent cause —> HIV infection.

-
·jo

Patchy red mucosal macules due to C. albicans infection in HIV-positive patients.

Favoured sites, in order of frequency, are

ttt: itraconazole
• Hard palate
• Dorsum of the tongue
• Soft palate.