INFECTIOUS DISEASES OF THE ORAL REGION

Anatomy of the Mouth

General Information
• ORAL CAVITY (mouth) - a complex ecosysytem suitable for growth and interrelationships of many types of microorganisms

immunoglobulins (IgA). .contains enzymes ( including lysozyme). & buffers to control the near neutral pH & continually flushed microbes & food particles thru the mouth.secreted by the salivary and mucous glands help control the growth of opportunistic oral flora.saliva . .

diet. presence of decayed teeth.000 – 10. oral hygiene. systemic disease. eruption of teeth.000.000. anatomic relationship. cancer therapy . antibiotic therapy.• The Normal Flora – Oral cavity provides an environment favorable to microorganism growth – Flora of children is similar to adults – Bacterial counts range 10.000.000 organisms/ml of saliva – Modifies microbial population – Age.

tonsillitis) • Staph.• NOT all residents of oral flora are pathogens • Progression of initiating infection (by oral streptococci)  predominance of oral anaerobes occurs • Periodontal infections are polymicrobial • Infections from nonodontegenic causes (facial trauma.aureus • Streptococcus spp. surgical manipulation. • Infections originating solely from dental periapical tissues • Anareobic .

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Herpes Labialis . Fever Blisters.Viral Infections of the Oral Region • Cold sores.

• HSV1 commonly manifests as herpetic gingivostomatitis • direct contact with people who have draining lesions • asymptomatic carriers • ↑ incidence: 2-4 yrs.old • infants protected by maternal antibodies .

pharynx Healing: 1-2 wks Gradual crusting Re-epithelization . oral mucosa.Incubation period: 6 days Small vesicles Coalesce to form larger lesions Severe cases: lip. gingivae.

thereby transmit the disease .• Latency: – Continue throughout life – Reactivation triggered by • Actinic radiation • Emotional/physical stress • Recurrent disease: – Vesicles along mucocutanoeus border – Painfuly for 2 days  crusting & complete healing in 7-8 days – Up to 50% adults suffer • Unaware of recurrent cold sores.

• Odontogenic infection of primary molars • Superficial spread of cellulitis that follows the platysma muscles  cheek  neck  anterior chest wall • Group A streptococci .

or itching before bursting and crusting over. . Herpes Labialis -A small sore situated on the face or in the mouth that causes pain. chin or cheeks and in the nostrils. Fever Blisters.crust & heal w/n a few days . burning.Cold sores.reactivation may be caused by: > trauma > fever > physiologic changes or disease . Less frequented sites are the gums or roof of the mouth (the palate). The favorite locations are on the lips.

caused by herpes simplex virus type 1 ( HSV 1) or herpes simplex type 2 ( HSV 2) . Herpes Labialis . Fever Blisters.Cold sores.the infection may be severe & extensive in immunosupressed individuals .

these may also infect genital tract.are DNA viruses in the Family Herpesviridae .also known as human herpesvirus 1 and human herpesvirus 2. .HSV 1 & HSV 2 . although genital herpes infections are usually caused by HSV 2. .

Bacterial Infections of the Oral Cavity • Dental Caries • Gingivitis • Periodontitis .

starts when external surface ( the enamel) of a tooth is dissolved by organic acids. Mutans .Dental Caries .commonly caused by S. which are produced by masses of microorganisms attached to the tooth ( dental plaque) .tooth decay or cavities .

• Pattern of tooth decay affecting mainly the primary upper incisors and frequently the upper and lower primary molars .

softdrink) • Can destroys entire primary dentition as it erupts .• Practice of putting the child to bed with a nursing bottle filled with sugar-containing drink (milk. juice.

• Extension of microorganism throuroot apex leads to formation of abscess • Radiographic evidence of bone destruction ≅ 7-14 days .

• Indications that tooth has become abscessed: – Sensitivity to heat stimulus (relieved by cold) – Sensitivity to percussion – Tenderness to finger pressure on the alveolar process • Chronic abscess – Looseness of tooth – Suppuration from draining sinus tracks or gingival crevice – Radiolucency on radiographs • cellulitis  swollen face. pain. fever and malaise .

•Prevalent in all ages • Severe in diabetics. compromised hosts •Poor oral hygiene .

inflammation of the gingiva ( gums ) and abnormal loss of bone that surrounds the teeth and holds them in place .Gingivitis . .caused by toxins secreted by bacteria in "plaque" that accumulate over time along the gum line.

inflammation of the periodontium ( tissues that surround and support the teeth. including the gingiva & supporting bone) .Periodontitis .

• Severe infection • Progresses years before recognition – Hypertrophied gingivae – purulent discharge – Painless  Localized periodontal hygiene  Meticulous oral hygiene .

in otherwise healthy children • Etiology: gram negative anaerobe A.actinomycetemcomitan s  Tetracyline + periodontal surgery .• Localized to the molar & incisor regions • Deep gingival pocketing & severe bone resorption.

• Trench mouth. Vincent’s infection • Caused by fusiform bacilli and spirochetes • Frank ulceration at tips of interdental papillae  (+) spontaneous bleeding .

.• Impaction of microorganism & debris under the soft tissue overlying the crown of a tooth (often mandibular 3rd molar) • Polymicrobial • Prevotella. Streptococcus milleri) . Treponema denticola. Porphyromonas spp.

hospitalization (in presence of fever and trismus) Resolution expected < 7days .Lower 3rd molars lie in proximity to the pterygomandibular space ( a portion of the masticator space) Infection spreads to masticator space Trismus Deep parapharyngeal space involvement Therapy: local I&D. extraction of offending tooth Penicillin.

. Formation of dextran ( a polysaccharide ) from sugars by streptococci 2. Deposition of calculus by Actinomyces species 4. Acid formation of lactobacilli 3. Secretion of inflammatory substances ( endotoxin) by Bacteroides species.Four Microbial Activities 1.

5% hydrogen peroxide or 0. occasional fever • Therapy: – Penicillin – Localized gingival curettage – oral rinse with 0. thick ropy saliva.• Pseudomembranous necrotic exudate along marginal gingivae & interdental papillae • Pain.12% Chlorhexidine . malaise. foul breath & taste.

bleeding gums and tonsils. .causes extremely bad breath.Acute Necrotizing Ulcerative Gingivitis ( ANUG ). Vincent’s Angina.involves painful.originated in World War 1. erosion of gum tissue & swollen lymph nodes beneath the jaw. . physical or emotional stress. where soldiers developed the infection while fighting in trenches.usually the result a combination of poor oral hygiene. Trench Mouth Disease Characteristics: “ trench mouth” . and poorm diet.noncontagious . . .

Prevotella intermedius and Prevotella melaninogenica.Acute Necrotizing Ulcerative Gingivitis ( ANUG ). Prevention and Control.other commonly involved anaerobic Gramnegative bacilli are Bacteroides spp.most commonly involved bacteria are Fusobacterium nucleatum ( an anaerobic. . .can be prevented thru good oral hygiene . Vincent’s Angina. Trench Mouth Pathogens: .Trench mouth is a synergistic infection involving 2 or more species of anaerobic bacteria of the indigenous oral microflora.. Gramnegative bacillus) and Treponema vincentii ( a spyrochete) .

FUNGAL INFECTIONS OF THE ORAL CAVITY • Thrush .

Clotrimazole. white plaque that is rubbed off easily  exposed reddened surface mucosa • Therapy: • Nystatin. Amphothericin B . Fluconazole.• Pseudomembranous type • Creamy.

can be a manifestation of disseminated Candida infection ( candidiasis ) . .white.Disease Characteristics: .a yeast infectionof the oral cavity. creamy patches occur on tongue. elderly patients.common in infants. . and immunosupressed individuals. mucous membranes. and the corners of the mouth .

and pseudohyphae ( stringa of elongated buds) in microscopic examination of wet mounts. and other related species Diagnosis: Observation of yeast cells.Thrush Pathogens: the yeast. . and culture confirmation. Candida albicans.

AIDS patients may also present with Kaposi sarcoma tumors in the oral cavity. Candida dubliniensis.• AIDS patients suffer an intractable form of oral thrush. caused by a newly-described species. This organism is more resistant to antifungal therapy than Candida albicans. .

Ma. Leeanel Marielle . Clancy Anne G.Prepared by: Naval. Iroland Contreras. Aloha Regina Dominguez. Carmelottes.

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