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Bacterial infection of the oral cavity (khaled sadeq)
 Bacteria count a large
domain of prokaryotic
microorganisms.
 Different shapes, ranging
from spheres to rods and
spirals.
 They lack true nucleus.
 Can be classified to Gram +ve
& Gram –ve Bacteria
 Many of the bacteria have
Flagellae & Pili
 Healthy people may carry:
 Defention:
A Bacterial infection is the
invasion of body tissues by a
disease-causing Bacteria , and
their multiplication and the
reaction of body tissues to
these microorganisms and
toxins.
Bacterial infection of the oral cavity (khaled sadeq)
1. Scarlet Fever
2. Syphilis
3. Gonorrhea
4. T.P
5. Actinomycosis
6. Necrotizing ulcerative gingivitis (NUG)
7. Noma
8. leprosy
9. Tetanus
 systemic infection Causative agent :
1. ß hemolytic streptococci
2. S. pyogenes
 Produces pyrogenic / erythrogenic/
scarlet fever toxin
 Highly contagious
 Common in children
 enters into body through pharynx
 Incubation period is 3- 5days
 Causes:
1. severe pharyngitis, tonsilitis
2. Headache, fever, chills, vomiting
3. Cervical lymphadenopathy
 Clinical featers:
 2nd/3rd day - diffuse, bright red scarlet skin
rash appears
 Rash first appears on upper trunk
 Spreads to extremities
 Spares palms & soles
 Colour of rash varies from scarlet to dusky
red
 Small papules of normal colour erupt
through the rash….(sand paper feel to skin)
 Rash is prominent in areas of skin folds…
PASTA LINES
 Rash subsides after 6 to 7 days followed by
desquamation of palms & soles
 Palatal mucosa:
1. congested
2. Petechiae scattered on soft palate
3. Palate, throat – fiery red
 Tonsils ;
1. swollen
2. Often covered by pseudomembrane
 Tongue :
1. white coating
2. Fungiform papilla becomes edematous,
hyperemic
3. Projects above the surface (strawberry
tongue)
differential diagnosis
 Measles
 Rubella
 Meningococ cemia Y.
 Drug of choice is
PENICILLIN.
 250 mg
2-3x 10 days 27 kg
 500 mg > 27kgs
 ERYTHROMYCIN
 Clarithromycin
 Azithromycin x 5days
 STD Disease
 Caused by Treponema
Pallidum
 Two Types:
 Acquired syphilis is
subdivided into:
 Primary Syphilis
 Secondary Syphilis
 Tertiary syphilis
 Congenital
 Primary Syphilis:
 Incubation period is 3-4
weeks
 Characterized by the
appearance of
 Chancre: a chronic ulcer at
site of infection or site where
bacteria enter the body.
 Male and female genitalia
 Upper lips in male, lower lip in
females
 Tongue-lateral surface, anterior two
third, Palate, gingiva.
 on examination are:
1. firm nodule in which the surface breaks
up in a few days leaving a round hard
ulcer
2. Solitary
3. Elevated
4. painless
5. with serous exudates
6. Regional lymphadenopathy
7. edema of the surrounding tissues is
usually present.
8. with a rubbery consistency
9. Highly infectious
10. heals spontaneously in 3-8 weeks
 Secondary Syphilis :
 Develops in 1 to 4 months of
initial infection.
 It Causes:
 Mild Fever
 Sore Throat
 Headache
 Macular /papular patches as
ulcers which are painless
 coin like lesions-face
 Oral manifestations
 White grey plaque on the
tongue , gingiva , palate
and buccal mucosa covers
the ucerated surface.
 The Ulcer Discharge
contains many
spirochetes(Treponema
Pallidum ).
 Generalized
lymphadenopathy .
 Muscle Pain.
Bacterial infection of the oral cavity (khaled sadeq)
 Tertiary syphilis
 Non infectious as tissue damage is
due to delayed type of hypersenstivity
reaction between host &
treponemes/their break down products.
 Presented as:
 Mucous membrane gumma
 Begins as;
1. Small
2. Pale
3. Raised
4. Ulcerated
 Atrophic Glossitis :
 smooth shiny tongue,
 Almost exclsively in males.
 wrinkled lingual surface
 atrophy of filliform, fugiform papilla
 fibrosis of tongue musculature
 Hyperkeratosis frequently occurs
 May undergo carcinomatous
transformation
 Gumma : At the tongue , palate ,
tonsils , begins as swelling that
ulcerate and destroy the underlying
tissue that may cause perforation of
the palate.
Palatal perforation occurs due to;
1-sloughing of necroti mass
2-vigorous antibiotic therapy
 SYPHILITIC OSTEOMYELITIS
 Mandible > maxilla
 Gummatous involvement of bone
 Extensive necrosis
 Characterised by:
1. pain,
2. Swelling
3. Suppuration
4. sequestration
 Clinically & radiographically
resembles pyogenic osteomyelitis
 If the lesion ossifies radiographic
appearance is similar to osteogenic
sarcoma
 T.p – has ability to cross placental
barrier
 Fetus infected during 2nd,3rd trimester
 Disease manifest as:
 Latent : no symptoms but +ve serology
 Frontal bossing
 Saddle nose
 short maxilla
 relative protruberance of mandible
 Higoumenakis’s Sign : irregular
thickening of sternoclavicular portion of
clavicle bone.
Hutchinson’s
notched incisors
mulberry-shaped
molar
Saber shin Corneal
Keratitis
late manifestations Occurs 2 yrs after
birth
 Drug of choice for all stages is
Penicillin.
 Treponema Pallidum is
sensitive to antibiotics such
as:
1. Penicillin
2. Erythromycin
3. Tetracycline
 Doxycycline or erythromycin
can be used in patients who
are sensitive to penicillin.
 Most common sexually transmitted
bacterial infections
 Short incubation period of less than 7
days
 Caused by gram -ve diplococcus
Neisseria gonorrhea
 Absence of symptoms in many
individuals, especially females
 Age : 15-29 years
 Transmission from an infected patient to
dental personnel is regarded as highly
unlikely
 Requires break in skin or mucosa to
establish an infection
Protection
is by:
 No specific clinical signs
have been consistently
associated with oral
gonorrhea.
 Multiple ulcerations
 Generalized erythema
 Cervical
lymphadenopathy
 Chief complaint may be
sore throat
 Burning / itching sensation
 Dry hot feeling in mouth which
in 24-48 hrs turns to acute pain
 Foul oral taste
 stinking breath
 Enlarged, tender sub
mandibular lymphnodes
 Severe infection – fever occurs
 Gingiva : erythematous
with/without necrosis
 Lips : acute painful ulcers leading to
limitation of movement
 Tongue :
 red
 dry
 Ulcerations
 Become glazed
 Swollen
 painful Pseudomembrane –
(White,yellow,gray) in colour –
Easily scrappable – Bleeding
surfaces
 Pharyngitis and tonsillitis – Vesicles
and ulcers with pseudomembrane
 Gonococcal parotitis – Ascending
Bacterial infection of the oral cavity (khaled sadeq)
 Majority of gonococci
Resistant to b-lactam drug
so we use third generation
cephalosporin's
 Uncomplicated gonorrhea
responds to single dose of
appropriately selected
antibiotic( 125mg-
ceftriaxone oraly)
 Or complecated
Inj ceftriaxone-I.M. 400mg
 Infects about 1/3 of world’s population
 Kills approximately 3 million people
per year
 Second leading cause of death in the
world
 caused by aerobic, non-spore forming
bacillus Mycobacterium Tuberculosis
 It has :
 Thick , Waxy coat
 Doesn’t react with Gram Stains
 Mode of transmission :
1. Inhalation of organism
2. Ingestion of organism
3. Inoculation of organism
4. Transplacental route
 It can be spread through
small airborne droplets
 The organism will be carried
to the Pulmonary air spaces.
 Pathogenesis;
Bacterial infection of the oral cavity (khaled sadeq)
 Primary Tuberculosis:
 Occurs in previously
unexposed people.
 Almost always involves the
lungs.
 Most infections are the
result of direct person - to
– person spread.
 Results only in a localized ,
fibrocalcified nodule .
 Secondary Tuberculosis
( Active Disease ):
 Develops later in life from a
reactivation of organisms.
 associated with compromised
host defenses;
 Immunosuppressive medication
Or HIV Patients
 Diabetes
 Old age
 Primary T.B : Usually
asymptomatic.
 Secondary T.B :
1. Low grade fever
2. Malaise
3. Night sweats and
weight loss
4. With progression ,
hemoptysis and chest
pain.
 Primary
Tuberculosis:
 Secondary
Tuberculosis
bilateral hilar adenopathy of
primary pulmonary TB
discrete round nodule(s) with round
edges without calcification
 Primary infections
Effects;
 Gingiva
 Mucobuccal fold
 tooth extraction
sockets.(area of
inflanmation)
 Secondary infection (
more common )
 Tongue
 Palate
 Lips
 alveolar mucosa & jaw
bones
 Typical lesion:
1. Indurate
2. Chronic
3. Nonhealing Ulcer That
Is Usually Painful
4. Bony involvement of
maxilla and mandible
produces tuberculosis
osteomyelitis
 tongue ulcer of T.p
1. Site :
lateral borderant,
Dorsum, base of
tongue
1. Painful
2. grayish-yellow
3. firm well demarcated
 Mucosa
1. Irregular
2. Ragged
3. undermined edges
4. minimal induration
5. with yellowish
granular base
 Palate
1. Small granulomas
2. or ulcerations
Bacterial infection of the oral cavity (khaled sadeq)
 Bone involvmeint:
 difficulty in eating
 Trismus
 paraesthesia of lower lip
 lymphadenopathy
 Loosening of teeth
 Involvement of major salivary
glands:
 Parotid gland followed by
submandibular and sublingual
glands
1. Tuberculin skin test
2. Biopsy (with special
stains)
3. Polymerase chain
reaction (PCR) for
bacterial DNA detects
the disease.
 First line drugs include:
1. ISONIAZID
2. RIFAMPIN
3. PYRAZINAMIDE
4. EXAMBUTHOL
 Drug combinations are
often used in 6, 9, or 12
month treatment regimens.
 (BCG) vaccine is effective
in controlling childhood TB
 Hansen’s disease
 chronic infectious disease
 caused by;
acid-fast bacillus, Mycobacterium
leprae
 moderately contagious
 transmission of disease requires;
 frequent direct contact with an
infected individual for a long period
 inoculation through respiratory tract
is also believed to be a potential
mode of transmission
 Clinical Features
 there is clinical spectrum of
disease that ranges from a
limited form (tuberculoid
leprosy) to a generalized form
(lepromatous leprosy) latter has
a more seriously damaging
course
 skin + peripheral nerves are
affected
 cutaneous lesions appear as;
 erythematous plaques or
nodules
represents granulomatous
Signs of leprosy
 Oral manifestation
 similar lesions may
occur intraorally or
intranasally
 in time, severe
maxillofacial deformaties
can appear producing
classic destruction of
anterior maxilla
 (facies leprosa)
 chemotherapeutic
approach;
several drugs are used
for long period, typically
years
 commonly used drugs:
• dapsone
• rifampin
• clofazimine
• minocycline •
 is a suppurative and granulomatous
chronic infectious disease.
 Caused by
 Gr +ve anaerobic Actinomyces Israeli
 living as commensal organisms in the
human oral cavity and respiratory and
digestive tracts.
 Becoming invasive ;
 through a mucosal lesion, they gain
access to the subcutaneous tissue.
 55% occur in cervicofacial region
 Not regarded as contagious (always
endogenous)
 Usually appears after Trauma , Surgery
and previous infection( most common )
1. chronic
2. fluctuant mass
3. Located at the border of the
mandible
4. pain is rare
5. slight fever
6. sensation of superficial tension
around the mass.
 Initially; the mass may be
surrounded by induration or
erythema
 later; become tender to palpation,
on account of a central necrosis
process
 Later;
1. Mass breaks down and
abscess, sinuses are formed
2. Discharging pus contain
typical (yellow sulphur
granules )
3. Skin overlying abscess is
Purplish,Red
Indurated
has appearance of wood.
 Infection may extend into
adjoining soft tissue as well as
bone Leads actinomycotic
osteomyelitis
1. positive culture
2. macroscopic presence
of the classic sulfur
granules in tissue
specimens .
3. Surgery plays an
important role both in
the diagnosis and
treatment of
actinomycosis.
 Drainage of abscess
 surgical excison of sinus
tracts but recurrence
following surgery alone is
very common so??
1. 2-4 weeks IV penicillin
followed by oral penicillin
2. 3-6 months high-dose
penicillin
 Is an opportunistic infection that
occurs on a background of
impaired local or systemic host
defenses.
 severe necrosis of the free
gingival margin,the crest of the
gingiva and the interdental
papilla
 When NUG cause loss of
epithelial attachment and
spreads into the deeper tissues
of periodontium, it is known as
necrotizing ulcerative
Periodontitis
 caused by ;
a mixed bacterial infection that
includes anaerobes such as P.
intermedia and Fusobacteriu as
well as spirochetes such
as Treponema
 associated with;
diseases in which the immune
system is compromised,
including HIV/AIDS
 predisposing factors;
smoking, psychological
 Signs and symptoms;
1. necrosis
2. crater-like, punched-out ulceration
of the interdental papillae
3. sudden onset which may also
involve the gingival margins .
4. Sever pain.
5. The ulcers are covered with a
greyish-green pseudo membrane
demarcated from the surrounding
mucosa by a linear erythema.
6. gingival bleeding, either
spontaneously or on minor trauma
7. marked halitosis, bad taste
8. Malaise, cervical
lymphadenopathy,fever may be
 includes irrigation
and debridement of necrotic
areas
 oral hygiene instruction and the
uses of mouth rinses
 pain medication
 oral antibiotics may be given,
such as metronidazole.
 As these diseases are often
associated with systemic
medical issues, proper
management of the systemic
disorders is appropriate.
Untreated, the infection may
lead to rapid destruction of
the periodontium and can
spread, as:
necrotizing stomatitis or
noma,
 also known as gangrenous
stomatitis
 Occurs mostly as a secondary
complication of systemic
disease rather than a primary
disease
 devastating disease of
malnourished children
 destructive process of orofacial
tissues
 results from oral infaction
particularly Fusobacterium
necrophorum
these opportunistic pathogens invade
oral tissues whose defense are
weakened by:
1)malnutrition
2)acute necrotizing gingivitis
3) Trauma
4)other oral mucosal ulcers
 Clinical Features
 initial lesion is a painful
ulceration
 usually gingiva or buccal
mucosa
 spreads rapidly +
eventually becomes
necrotic
 Involvement of bone may
follow
 leading to necrosis +
sequestration
*blackening of skin
*Large masses of tissue may slough,
leaving jaw exposed
*Foul odour arise from these tissue
*have high temp
*Suffer secondary infection
* pt. May die from toxemia or pneumonia
teeth in affected area may become loose
+ exfoliate
 fluids
 Electrolytes
 general nutrition are restored
 along with antibiotics as clindamycin
• piperacillin • gentamicin
 debridement of necrotic tissue may
also be beneficial if destruction is
extensive
 And surgical correction of the
distracted area
 A Neurological disease
 characterised by; increased muscle tone & spasms.
 most common type the spasms begin in the jaw and
then progresses to the rest of the body last a few
minutes each time and occur frequently for (3-4)
weeks
 incubation period is approximately eight days.
 Caused by;
CLOSTRIDIUM TETANI
 Anaerobic , motile, gram +ve rod
 spore forming, Drumstick Shapefarther the injury site is from the central
nervous system, the longer the incubation
period, and the less severe are the symptoms
experienced.
 Mode of Transmission:
 contaminated wounds
 Tissue injury
 PATHOGENESI
 Germination & toxin
production
1.
Tetanospasmin(neurotoxi
n)
 Mechanism of Infection
 C. tetani usually enter the body
through an open wound, leading to
spore germination under anaerobic
conditions.
 Once spore germination has
occurred, toxins are released into
the bloodstream and lymphatic
system.
 These toxins act at several
locations within the central nervous
system, interfering with
neurotransmitter release and
blocking inhibitor impulses.
 lead to uncontrollable muscle
contractions.
Bacterial infection of the oral cavity (khaled sadeq)
 Risus Sardonicus :
 Spasm of facial muscles
( frontalis & angle of
mouth muscles )
 producing grinning
facies
 Corners of mouth are
drawn back
 lips protruded
 forehead is wrinkled
 Oral considerations
1. Tonic rigidity of muscles
of mastication
2. Stiffness of face
3. Difficulty in chewing
4. Dysphagia
5. Edentulous pts- inability
to insert dentures
6. Truisms, lock jaw
 NEUTRALIZE TOXIN :
1. Inj.Human Tetanus Immunoglobulin
2. 3000 – 6000 units IM, usually in divided doses
as volume is large.
 ANTIBIOTIC THERAPY :
1. IV Penicillin 10 -12 million units daily for 10
days
2. IV Metronidazole 500mg Q 6 hrly / 1gm Q 12
hrly
3. Allergic to Penicillin : consider Clindamycin &
Erythromycin
 Passive immunization
 3 doses in 1st yr of life
 Booster dose at school entry
Bacterial infection of the oral cavity (khaled sadeq)
is inflammation of the soft tissues
surrounding the crown of a partially
erupted tooth.
 including the;
 gingiva (gums)
 dental follicle
 The soft tissue covering a partially
erupted tooth is known as
an operculum, an area which can be
difficult to access with normal oral
hygiene methods
 and technically refers to
inflammation of the operculum alone.
 often occurring at the age of
wisdom tooth eruption (15-24)
caused by :
 accumulation of bacteria
(Streptococci and particularly
various anaerobic species) and
debris beneath the operculum
 mechanical trauma
 food impaction causing
periodontal pain
 Pulpitis from dental caries
 acute myofascial
pain in temporomandibular joint
disorder.
 depend upon the severity;
 Pain:
 gets worse and becomes more severe
 throbbing and radiate to the ear, temporomandibular joint, posterior
submandibular region
 Tenderness
 Erythema (redness)
 Edema (swelling) of the tissues around the involved tooth
 Halitosis resulting from volatile sulfur compounds
 Bad taste
 Trismus resulting from inflammation/infection of the muscles of mastication.
 Dysphagia (difficulty swallowing).
 Cervical lymphadenitis (inflammation and swelling of the lymph nodes in the
neck), especially of the submandibular nodes.
 Facial swelling, and rubor often of the cheek that overlies the angle of the jaw.
 Pyrexia (fever).
 Leukocytosis (increased white blood cell count).
 Malaise
 presence of dental plaque or
infection beneath an inflamed
operculum without other obvious
causes of pain will often lead to a
pericoronitis diagnosis.
 Radiographs can be used to rule out
other causes of pain and to properly
assess the prognosis for further
eruption of the affected tooth.
 Sometimes a "migratory abscess" of
the buccal sulcus occurs, pus from
the lower third molar region tracks
forwards to be spontaneously
discharge via an intra-oral sinus
located over the mandibular second
or first molar, or even the second
premolar.
 which can occur in conjunction
with pericoronitis may include:
 Dental caries (periapical
abscess)
 Food can also become stuck
between the wisdom tooth and
the tooth in front, termed food
packing and cause acute
inflammation in a periodontal
pocket.
 Pain associated
with temporomandibular joint
disorder and myofascial pain
easily missed diagnoses in the
presence of mild and chronic
Acute
 Pain(sudden onset and short lived, but
significant, symptoms)
 Truisms
 Dysphagia
 Pus discharge
 halitosis
 Systemic complications
 extra oral swelling
 malaise
 disturb sleeping
 lymphadenitis involve the cervical lymph node
 Chronic
Dull aching low grade pain
typically last only 1_2 days
Signs include;
 palpable non_tender
submandibular
lymphnodes
 radiographic appearance
of the local bone can
become more radiopaque
in chronic pericoronitis
 Operculectomy (the surgical re
moval of operculum, a flap of
tissue over partially erupted
tooth especially the third
molar)
 Typically operculectomy is
done with a surgical
scalpel, electrocautery ,with
lasers[ or, historically, with
caustic agents (trichloracetic
acid)
 Extraction and oral hygiene
maintenance

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Bacterial infection of the oral cavity (khaled sadeq)

  • 2.  Bacteria count a large domain of prokaryotic microorganisms.  Different shapes, ranging from spheres to rods and spirals.  They lack true nucleus.
  • 3.  Can be classified to Gram +ve & Gram –ve Bacteria  Many of the bacteria have Flagellae & Pili  Healthy people may carry:
  • 4.  Defention: A Bacterial infection is the invasion of body tissues by a disease-causing Bacteria , and their multiplication and the reaction of body tissues to these microorganisms and toxins.
  • 6. 1. Scarlet Fever 2. Syphilis 3. Gonorrhea 4. T.P 5. Actinomycosis 6. Necrotizing ulcerative gingivitis (NUG) 7. Noma 8. leprosy 9. Tetanus
  • 7.  systemic infection Causative agent : 1. ß hemolytic streptococci 2. S. pyogenes  Produces pyrogenic / erythrogenic/ scarlet fever toxin  Highly contagious  Common in children  enters into body through pharynx  Incubation period is 3- 5days  Causes: 1. severe pharyngitis, tonsilitis 2. Headache, fever, chills, vomiting 3. Cervical lymphadenopathy
  • 8.  Clinical featers:  2nd/3rd day - diffuse, bright red scarlet skin rash appears  Rash first appears on upper trunk  Spreads to extremities  Spares palms & soles  Colour of rash varies from scarlet to dusky red  Small papules of normal colour erupt through the rash….(sand paper feel to skin)  Rash is prominent in areas of skin folds… PASTA LINES  Rash subsides after 6 to 7 days followed by desquamation of palms & soles
  • 9.  Palatal mucosa: 1. congested 2. Petechiae scattered on soft palate 3. Palate, throat – fiery red  Tonsils ; 1. swollen 2. Often covered by pseudomembrane  Tongue : 1. white coating 2. Fungiform papilla becomes edematous, hyperemic 3. Projects above the surface (strawberry tongue)
  • 10. differential diagnosis  Measles  Rubella  Meningococ cemia Y.
  • 11.  Drug of choice is PENICILLIN.  250 mg 2-3x 10 days 27 kg  500 mg > 27kgs  ERYTHROMYCIN  Clarithromycin  Azithromycin x 5days
  • 12.  STD Disease  Caused by Treponema Pallidum  Two Types:  Acquired syphilis is subdivided into:  Primary Syphilis  Secondary Syphilis  Tertiary syphilis  Congenital
  • 13.  Primary Syphilis:  Incubation period is 3-4 weeks  Characterized by the appearance of  Chancre: a chronic ulcer at site of infection or site where bacteria enter the body.  Male and female genitalia  Upper lips in male, lower lip in females  Tongue-lateral surface, anterior two third, Palate, gingiva.
  • 14.  on examination are: 1. firm nodule in which the surface breaks up in a few days leaving a round hard ulcer 2. Solitary 3. Elevated 4. painless 5. with serous exudates 6. Regional lymphadenopathy 7. edema of the surrounding tissues is usually present. 8. with a rubbery consistency 9. Highly infectious 10. heals spontaneously in 3-8 weeks
  • 15.  Secondary Syphilis :  Develops in 1 to 4 months of initial infection.  It Causes:  Mild Fever  Sore Throat  Headache  Macular /papular patches as ulcers which are painless  coin like lesions-face
  • 16.  Oral manifestations  White grey plaque on the tongue , gingiva , palate and buccal mucosa covers the ucerated surface.  The Ulcer Discharge contains many spirochetes(Treponema Pallidum ).  Generalized lymphadenopathy .  Muscle Pain.
  • 18.  Tertiary syphilis  Non infectious as tissue damage is due to delayed type of hypersenstivity reaction between host & treponemes/their break down products.  Presented as:  Mucous membrane gumma  Begins as; 1. Small 2. Pale 3. Raised 4. Ulcerated
  • 19.  Atrophic Glossitis :  smooth shiny tongue,  Almost exclsively in males.  wrinkled lingual surface  atrophy of filliform, fugiform papilla  fibrosis of tongue musculature  Hyperkeratosis frequently occurs  May undergo carcinomatous transformation  Gumma : At the tongue , palate , tonsils , begins as swelling that ulcerate and destroy the underlying tissue that may cause perforation of the palate.
  • 20. Palatal perforation occurs due to; 1-sloughing of necroti mass 2-vigorous antibiotic therapy
  • 21.  SYPHILITIC OSTEOMYELITIS  Mandible > maxilla  Gummatous involvement of bone  Extensive necrosis  Characterised by: 1. pain, 2. Swelling 3. Suppuration 4. sequestration  Clinically & radiographically resembles pyogenic osteomyelitis  If the lesion ossifies radiographic appearance is similar to osteogenic sarcoma
  • 22.  T.p – has ability to cross placental barrier  Fetus infected during 2nd,3rd trimester  Disease manifest as:  Latent : no symptoms but +ve serology  Frontal bossing  Saddle nose  short maxilla  relative protruberance of mandible  Higoumenakis’s Sign : irregular thickening of sternoclavicular portion of clavicle bone.
  • 23. Hutchinson’s notched incisors mulberry-shaped molar Saber shin Corneal Keratitis late manifestations Occurs 2 yrs after birth
  • 24.  Drug of choice for all stages is Penicillin.  Treponema Pallidum is sensitive to antibiotics such as: 1. Penicillin 2. Erythromycin 3. Tetracycline  Doxycycline or erythromycin can be used in patients who are sensitive to penicillin.
  • 25.  Most common sexually transmitted bacterial infections  Short incubation period of less than 7 days  Caused by gram -ve diplococcus Neisseria gonorrhea  Absence of symptoms in many individuals, especially females  Age : 15-29 years  Transmission from an infected patient to dental personnel is regarded as highly unlikely  Requires break in skin or mucosa to establish an infection Protection is by:
  • 26.  No specific clinical signs have been consistently associated with oral gonorrhea.  Multiple ulcerations  Generalized erythema  Cervical lymphadenopathy  Chief complaint may be sore throat
  • 27.  Burning / itching sensation  Dry hot feeling in mouth which in 24-48 hrs turns to acute pain  Foul oral taste  stinking breath  Enlarged, tender sub mandibular lymphnodes  Severe infection – fever occurs  Gingiva : erythematous with/without necrosis
  • 28.  Lips : acute painful ulcers leading to limitation of movement  Tongue :  red  dry  Ulcerations  Become glazed  Swollen  painful Pseudomembrane – (White,yellow,gray) in colour – Easily scrappable – Bleeding surfaces  Pharyngitis and tonsillitis – Vesicles and ulcers with pseudomembrane  Gonococcal parotitis – Ascending
  • 30.  Majority of gonococci Resistant to b-lactam drug so we use third generation cephalosporin's  Uncomplicated gonorrhea responds to single dose of appropriately selected antibiotic( 125mg- ceftriaxone oraly)  Or complecated Inj ceftriaxone-I.M. 400mg
  • 31.  Infects about 1/3 of world’s population  Kills approximately 3 million people per year  Second leading cause of death in the world  caused by aerobic, non-spore forming bacillus Mycobacterium Tuberculosis  It has :  Thick , Waxy coat  Doesn’t react with Gram Stains
  • 32.  Mode of transmission : 1. Inhalation of organism 2. Ingestion of organism 3. Inoculation of organism 4. Transplacental route  It can be spread through small airborne droplets  The organism will be carried to the Pulmonary air spaces.  Pathogenesis;
  • 34.  Primary Tuberculosis:  Occurs in previously unexposed people.  Almost always involves the lungs.  Most infections are the result of direct person - to – person spread.  Results only in a localized , fibrocalcified nodule .  Secondary Tuberculosis ( Active Disease ):  Develops later in life from a reactivation of organisms.  associated with compromised host defenses;  Immunosuppressive medication Or HIV Patients  Diabetes  Old age
  • 35.  Primary T.B : Usually asymptomatic.  Secondary T.B : 1. Low grade fever 2. Malaise 3. Night sweats and weight loss 4. With progression , hemoptysis and chest pain.
  • 36.  Primary Tuberculosis:  Secondary Tuberculosis bilateral hilar adenopathy of primary pulmonary TB discrete round nodule(s) with round edges without calcification
  • 37.  Primary infections Effects;  Gingiva  Mucobuccal fold  tooth extraction sockets.(area of inflanmation)  Secondary infection ( more common )  Tongue  Palate  Lips  alveolar mucosa & jaw bones
  • 38.  Typical lesion: 1. Indurate 2. Chronic 3. Nonhealing Ulcer That Is Usually Painful 4. Bony involvement of maxilla and mandible produces tuberculosis osteomyelitis
  • 39.  tongue ulcer of T.p 1. Site : lateral borderant, Dorsum, base of tongue 1. Painful 2. grayish-yellow 3. firm well demarcated
  • 40.  Mucosa 1. Irregular 2. Ragged 3. undermined edges 4. minimal induration 5. with yellowish granular base
  • 41.  Palate 1. Small granulomas 2. or ulcerations
  • 43.  Bone involvmeint:  difficulty in eating  Trismus  paraesthesia of lower lip  lymphadenopathy  Loosening of teeth  Involvement of major salivary glands:  Parotid gland followed by submandibular and sublingual glands
  • 44. 1. Tuberculin skin test 2. Biopsy (with special stains) 3. Polymerase chain reaction (PCR) for bacterial DNA detects the disease.
  • 45.  First line drugs include: 1. ISONIAZID 2. RIFAMPIN 3. PYRAZINAMIDE 4. EXAMBUTHOL  Drug combinations are often used in 6, 9, or 12 month treatment regimens.  (BCG) vaccine is effective in controlling childhood TB
  • 46.  Hansen’s disease  chronic infectious disease  caused by; acid-fast bacillus, Mycobacterium leprae  moderately contagious  transmission of disease requires;  frequent direct contact with an infected individual for a long period  inoculation through respiratory tract is also believed to be a potential mode of transmission
  • 47.  Clinical Features  there is clinical spectrum of disease that ranges from a limited form (tuberculoid leprosy) to a generalized form (lepromatous leprosy) latter has a more seriously damaging course  skin + peripheral nerves are affected  cutaneous lesions appear as;  erythematous plaques or nodules represents granulomatous Signs of leprosy
  • 48.  Oral manifestation  similar lesions may occur intraorally or intranasally  in time, severe maxillofacial deformaties can appear producing classic destruction of anterior maxilla  (facies leprosa)
  • 49.  chemotherapeutic approach; several drugs are used for long period, typically years  commonly used drugs: • dapsone • rifampin • clofazimine • minocycline •
  • 50.  is a suppurative and granulomatous chronic infectious disease.  Caused by  Gr +ve anaerobic Actinomyces Israeli  living as commensal organisms in the human oral cavity and respiratory and digestive tracts.  Becoming invasive ;  through a mucosal lesion, they gain access to the subcutaneous tissue.  55% occur in cervicofacial region  Not regarded as contagious (always endogenous)  Usually appears after Trauma , Surgery and previous infection( most common )
  • 51. 1. chronic 2. fluctuant mass 3. Located at the border of the mandible 4. pain is rare 5. slight fever 6. sensation of superficial tension around the mass.  Initially; the mass may be surrounded by induration or erythema  later; become tender to palpation, on account of a central necrosis process
  • 52.  Later; 1. Mass breaks down and abscess, sinuses are formed 2. Discharging pus contain typical (yellow sulphur granules ) 3. Skin overlying abscess is Purplish,Red Indurated has appearance of wood.  Infection may extend into adjoining soft tissue as well as bone Leads actinomycotic osteomyelitis
  • 53. 1. positive culture 2. macroscopic presence of the classic sulfur granules in tissue specimens . 3. Surgery plays an important role both in the diagnosis and treatment of actinomycosis.
  • 54.  Drainage of abscess  surgical excison of sinus tracts but recurrence following surgery alone is very common so?? 1. 2-4 weeks IV penicillin followed by oral penicillin 2. 3-6 months high-dose penicillin
  • 55.  Is an opportunistic infection that occurs on a background of impaired local or systemic host defenses.  severe necrosis of the free gingival margin,the crest of the gingiva and the interdental papilla  When NUG cause loss of epithelial attachment and spreads into the deeper tissues of periodontium, it is known as necrotizing ulcerative Periodontitis
  • 56.  caused by ; a mixed bacterial infection that includes anaerobes such as P. intermedia and Fusobacteriu as well as spirochetes such as Treponema  associated with; diseases in which the immune system is compromised, including HIV/AIDS  predisposing factors; smoking, psychological
  • 57.  Signs and symptoms; 1. necrosis 2. crater-like, punched-out ulceration of the interdental papillae 3. sudden onset which may also involve the gingival margins . 4. Sever pain. 5. The ulcers are covered with a greyish-green pseudo membrane demarcated from the surrounding mucosa by a linear erythema. 6. gingival bleeding, either spontaneously or on minor trauma 7. marked halitosis, bad taste 8. Malaise, cervical lymphadenopathy,fever may be
  • 58.  includes irrigation and debridement of necrotic areas  oral hygiene instruction and the uses of mouth rinses  pain medication  oral antibiotics may be given, such as metronidazole.  As these diseases are often associated with systemic medical issues, proper management of the systemic disorders is appropriate.
  • 59. Untreated, the infection may lead to rapid destruction of the periodontium and can spread, as: necrotizing stomatitis or noma,
  • 60.  also known as gangrenous stomatitis  Occurs mostly as a secondary complication of systemic disease rather than a primary disease  devastating disease of malnourished children  destructive process of orofacial tissues  results from oral infaction particularly Fusobacterium necrophorum these opportunistic pathogens invade oral tissues whose defense are weakened by: 1)malnutrition 2)acute necrotizing gingivitis 3) Trauma 4)other oral mucosal ulcers
  • 61.  Clinical Features  initial lesion is a painful ulceration  usually gingiva or buccal mucosa  spreads rapidly + eventually becomes necrotic  Involvement of bone may follow  leading to necrosis + sequestration *blackening of skin *Large masses of tissue may slough, leaving jaw exposed *Foul odour arise from these tissue *have high temp *Suffer secondary infection * pt. May die from toxemia or pneumonia teeth in affected area may become loose + exfoliate
  • 62.  fluids  Electrolytes  general nutrition are restored  along with antibiotics as clindamycin • piperacillin • gentamicin  debridement of necrotic tissue may also be beneficial if destruction is extensive  And surgical correction of the distracted area
  • 63.  A Neurological disease  characterised by; increased muscle tone & spasms.  most common type the spasms begin in the jaw and then progresses to the rest of the body last a few minutes each time and occur frequently for (3-4) weeks  incubation period is approximately eight days.  Caused by; CLOSTRIDIUM TETANI  Anaerobic , motile, gram +ve rod  spore forming, Drumstick Shapefarther the injury site is from the central nervous system, the longer the incubation period, and the less severe are the symptoms experienced.
  • 64.  Mode of Transmission:  contaminated wounds  Tissue injury  PATHOGENESI  Germination & toxin production 1. Tetanospasmin(neurotoxi n)
  • 65.  Mechanism of Infection  C. tetani usually enter the body through an open wound, leading to spore germination under anaerobic conditions.  Once spore germination has occurred, toxins are released into the bloodstream and lymphatic system.  These toxins act at several locations within the central nervous system, interfering with neurotransmitter release and blocking inhibitor impulses.  lead to uncontrollable muscle contractions.
  • 67.  Risus Sardonicus :  Spasm of facial muscles ( frontalis & angle of mouth muscles )  producing grinning facies  Corners of mouth are drawn back  lips protruded  forehead is wrinkled
  • 68.  Oral considerations 1. Tonic rigidity of muscles of mastication 2. Stiffness of face 3. Difficulty in chewing 4. Dysphagia 5. Edentulous pts- inability to insert dentures 6. Truisms, lock jaw
  • 69.  NEUTRALIZE TOXIN : 1. Inj.Human Tetanus Immunoglobulin 2. 3000 – 6000 units IM, usually in divided doses as volume is large.  ANTIBIOTIC THERAPY : 1. IV Penicillin 10 -12 million units daily for 10 days 2. IV Metronidazole 500mg Q 6 hrly / 1gm Q 12 hrly 3. Allergic to Penicillin : consider Clindamycin & Erythromycin  Passive immunization  3 doses in 1st yr of life  Booster dose at school entry
  • 71. is inflammation of the soft tissues surrounding the crown of a partially erupted tooth.  including the;  gingiva (gums)  dental follicle  The soft tissue covering a partially erupted tooth is known as an operculum, an area which can be difficult to access with normal oral hygiene methods  and technically refers to inflammation of the operculum alone.  often occurring at the age of wisdom tooth eruption (15-24)
  • 72. caused by :  accumulation of bacteria (Streptococci and particularly various anaerobic species) and debris beneath the operculum  mechanical trauma  food impaction causing periodontal pain  Pulpitis from dental caries  acute myofascial pain in temporomandibular joint disorder.
  • 73.  depend upon the severity;  Pain:  gets worse and becomes more severe  throbbing and radiate to the ear, temporomandibular joint, posterior submandibular region  Tenderness  Erythema (redness)  Edema (swelling) of the tissues around the involved tooth  Halitosis resulting from volatile sulfur compounds  Bad taste  Trismus resulting from inflammation/infection of the muscles of mastication.  Dysphagia (difficulty swallowing).  Cervical lymphadenitis (inflammation and swelling of the lymph nodes in the neck), especially of the submandibular nodes.  Facial swelling, and rubor often of the cheek that overlies the angle of the jaw.  Pyrexia (fever).  Leukocytosis (increased white blood cell count).  Malaise
  • 74.  presence of dental plaque or infection beneath an inflamed operculum without other obvious causes of pain will often lead to a pericoronitis diagnosis.  Radiographs can be used to rule out other causes of pain and to properly assess the prognosis for further eruption of the affected tooth.  Sometimes a "migratory abscess" of the buccal sulcus occurs, pus from the lower third molar region tracks forwards to be spontaneously discharge via an intra-oral sinus located over the mandibular second or first molar, or even the second premolar.
  • 75.  which can occur in conjunction with pericoronitis may include:  Dental caries (periapical abscess)  Food can also become stuck between the wisdom tooth and the tooth in front, termed food packing and cause acute inflammation in a periodontal pocket.  Pain associated with temporomandibular joint disorder and myofascial pain easily missed diagnoses in the presence of mild and chronic
  • 76. Acute  Pain(sudden onset and short lived, but significant, symptoms)  Truisms  Dysphagia  Pus discharge  halitosis  Systemic complications  extra oral swelling  malaise  disturb sleeping  lymphadenitis involve the cervical lymph node
  • 77.  Chronic Dull aching low grade pain typically last only 1_2 days Signs include;  palpable non_tender submandibular lymphnodes  radiographic appearance of the local bone can become more radiopaque in chronic pericoronitis
  • 78.  Operculectomy (the surgical re moval of operculum, a flap of tissue over partially erupted tooth especially the third molar)  Typically operculectomy is done with a surgical scalpel, electrocautery ,with lasers[ or, historically, with caustic agents (trichloracetic acid)  Extraction and oral hygiene maintenance