Viral, Bacterial and Mycotic

Infections of the Mouth

 Viral, Bacterial and Mycotic Infections
Viral infection
• Herpetic infections
• Acute herpetic Gingivostomatitis (primary)
• Herpes labialis - Recurrent herpetic infection (Secondary)
• Herpangina
• Hand foot and mouth disease
• Other viral infections
• Chickenpox
• Mumps
• Measles
• Glandular fever
Bacterial infections
Necrotising ulcerative gingivitis/ periodontitis
Mycotic infections
Candidosis (candidiasis)
 Acute Herpetic Gingivostomatitis

o Acute herpetic gingivostomatitis is caused by the herpes simplex virus.

o Occurs most frequently in pre-school children (1 – 4 years) but adults may also be
affected.

Signs and Symptoms:

o Within about 24 hours, the mouth is very sore, the temperature is raised, and
cervical lymph nodes are enlarged and tender. Vesicles about 3 or 4 mm in
diameter form on the gingiva and oral mucosa, particularly on the dorsum of the
tongue and on the hard and soft palate; the vesicles soon burst and leave
shallow, painful ulcers. The gingiva is diffusely inflamed.

o The lesions heal spontaneously within about 10 days.

Differential Diagnosis:
 Drug eruptions, erythema multiforme, aphthous ulcers, hand, foot and mouth
disease etc.
 Treatment
 Reassure the parents that the disease is self-limiting.
 Recommend a cold soft diet, a high fluid intake and rest.

Drug therapy:
Systemic
• The antiviral drug Acyclovir (Zovirax, Acelex) can be given
in tablet or elixir form five times a day for 5 days. Especially
used in immunosuppressed patients.

• Prescribe antipyretic for raised temperature, e.g; Brufen

(ibuprofen)or Calpol (Paracetamol).

• If the child cannot sleep, prescribe a hypnotic drug.

Topical
Regular topical applications very difficult in young children.

a. Carboxymethylcellulose Gelatin Paste (Orabase): A

paste that adheres to mucus membranes, and by
covering the ulcers, provides some relief from pain.

b. Choline Salicylate Dental Paste (Bonjela): Contains an

anti-inflammatory and analgesic substance in a base that
adheres to the oral mucosa.

c. Chlorhexidine Gel: Contains 1% chlorhexidine gluconate.

d. Mouthwash:
i. Tetracycline Mouth-bath (Tetracycline Mixture):
Contains 125 mg tetracycline hydrochloride in 5ml.

ii. Chlorhexidine Mouthwash: Contains 0.2 %

chlorhexidine gluconate. Prevent secondary
infection.
 Herpes labialis

• Secondary lesions appear when the balance created after first

attack is disturbed by common cold,fever or other factors.

• Small clusters of vesicles appear around the vermillion

borders of the lips which heal within about 10 days.
 Treatment

• Lesions heal spontaneously.

• Acyclovir application at the start of the lesion(redness and

prickly sensation) prevents the appearance of vesicles.

• If applied after the vesicles start to form, healing period may

be halved.
 Herpangina

• Caused by coxsackie group A virus.

• Affects infants and young children .

• Fever and sore throat and the child is unwell for 3-5 days.

• Vesicles similar to primary herpes ,but distributed to throat

and soft palate only.

• Gingiva is not affected.

• Healing occurs with in 3-4 days.

 Treatment

• Reassurance to parents that the condition is self limiting.

• Soft diet with adequate fluid intake.

• Analgesics and antipyretics.

 Hand foot and mouth disease

• Caused by coxsackie group A virus.

• Affects school age children.

• Main complaint is rash on the hands and feet with ulcers on

the oral mucosa ,no vesicle.

• Gingiva is not affected.

• The rash and oral ulcers disappear with in about one week.
 Treatment

• No treatment required.

• Carboxy-methylcellulose gelatin paste or

choline salicylate paste for painful ulcers.
 Other viral infections

Chickenpox:
Oral lesions of chickenpox accompany the skin lesions in the
form of vesicles which burst and leave small ulcers.

Treatment:
Cold and soft diet and symptomatic treatment.
 Glandular fever
• Also known as infectious mononucleosis, caused by the
Epstein-Barr virus (EBV)
• There is fever, sore throat, fatigue, swollen lymph nodes and
glands.
• Glandular fever is accompanied by acute gingivitis and
stomatitis.
• Occur during early childhood and produce lifelong immunity.

• Treatment:
Symptomatic and maintenance of fluid intake.
 Mumps
 Bilateral painful swelling of the salivary glands
usually the parotid by myxovirus.
 There is firm, rubbery swelling frequently elevating the
ears.
 There is headache, vomiting and fever.
 The symptoms last for about a week.

Treatment:
 Adequate rest and fluid intake.
 Measles

• Caused by paramyxovirus.
• There is high fever, nasal stiffness, sneezing, sore throat and
photophobia.
• The oral lesions are koplik’s spots occurring on the buccal
mucosa. They usually precede the skin lesions.
Treatment:
• Self limiting ,rest, hydration, analgesics, antipyretics and
antibiotics if complications develop.
 Bacterial infections
Necrotising ulcerative gingivitis
Necrotizing ulcerative periodontitis
• Aetiology: Fusiform and spirochetes bacteria.
• Most common in young adults over 16 years of age and
young children in developing countries.
• Predisposing factors are local irritation from plaque,
calculus deposits, mental stress, lack of sleep, smoking,
malnutrition, viral infections (overburdened immune
system).
 Signs and symptoms

• Rapid destruction of interdental papillae with grey punched

out ulcer formation.

• May be localized to a single papilla or both free and attached

Gingiva may be affected(severe cases).

• Marked halitosis(charateristic of the disease).

 Treatment
• Removal of gross calculus and debris from the Gingival
margins (if possible) and irrigation with Hydrogen peroxide
sol.

• Metronidazole (flagyl) tablets three times a day for 3-5 days

and broad spectrum antibiotic.

• Thorough scaling after one week.

• Balanced diet and adequate rest.

• Oral hygiene instructions to prevent recurrence.

 Mycotic infections
Candidosis or candidiasis
• Causative agents :candida albicans.
• Types: two main types.
1. Acute pseudomembranous candidosis (thrush):
• Common in newborn and weak undernourished infants.
• A baby may become infected during delivery.
• During first few days after birth (myeloperoxidase
enzyme absent).
• Prolong use of antibiotics or steroids.
• Compromised immune system.
• Diabetes.
• Xerostomia
 Signs and symptoms

• Soft elevated creamy-white patches covering small or

large areas of oral mucosa.

• Patches can be rubbed off leaving raw bleeding

surfaces.
 Treatment
1. Antifungal drugs:
• Topical miconazole gel applied over the affected area.
• Systemic miconazole 250 mg tablet sucked slowly 4
times for 10 days.
• Nystatin suspension 1ml after food 3-4 times daily.
• Nystatin pastilles: One pastille sucked slowly 4 times
daily for 7-14 days.
2. Cleaning of infant feeding utensils:
• Wash infant’s feeding utensils after each meal and
keep them in an antiseptic sol.
 2. Chronic Atrophic Candidosis
(denture stomatitis)
• This type affects the palatal mucosa under the denture or
orthodontic appliance which provide favourable condition for
multiplication of Candida Albicans.

• Local irritation from rough or ill fitting appliance may also be a

factor.

• The affected mucosa is inflamed, bright red and spongy.

 Treatment
1. Apply Daktarin oral gel to the affected area and fitting
surface of the appliance.
2. Smooth sharp edges of the appliance if any.
3. Give oral hygiene instructions(rinsing and brushing of
appliance after meals).
4. Not to wear the denture until healing has occurred while in
case of orthodontic appliance not to wear at night only for 2-
3 weeks.
Thank You