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

saliva

- secreted by the salivary and mucous glands help control the growth of opportunistic oral flora.

- contains enzymes ( including lysozyme), immunoglobulins (IgA), & buffers to control the near neutral pH & continually flushed microbes & food particles thru the mouth.

• 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 –

10,000,000,000 organisms/ml of saliva– Modifies microbial population

– Age, anatomic relationship, eruption of teeth, presence of decayed teeth, diet, oral hygiene, antibiotic therapy, systemic disease, cancer therapy

• 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, surgical manipulation, tonsillitis)

• Staph.aureus• Streptococcus spp.

• Infections originating solely from dental periapical tissues

• Anareobic

Viral Infections of the Oral Region

• Cold sores, Fever Blisters, Herpes Labialis

• 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

Incubation period: 6 days

Small vesicles

Coalesce to form larger lesionsSevere cases: lip, gingivae, oral mucosa, pharynx

Healing: 1-2 wksGradual crustingRe-epithelization

• 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, thereby transmit the disease

• Odontogenic infection of primary molars

• Superficial spread of cellulitis that follows the platysma muscles cheek neck anterior chest wall

• Group A streptococci

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

> trauma> fever

> physiologic changes or disease

Cold sores, Fever Blisters, Herpes Labialis

- the infection may be severe & extensive in immunosupressed individuals

- caused by herpes simplex virus type 1 ( HSV 1) or herpes simplex type 2 ( HSV 2)

HSV 1 & HSV 2

- also known as human herpesvirus 1 and human herpesvirus 2.

- are DNA viruses in the Family Herpesviridae

- these may also infect genital tract, although genital herpes infections are usually caused by HSV 2.

Bacterial Infections of the Oral Cavity

• Dental Caries• Gingivitis• Periodontitis

Dental Caries

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

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

• Practice of putting the child to bed with a nursing bottle filled with sugar-containing drink (milk, juice, softdrink)

• Can destroys entire primary dentition as it erupts

• 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

Gingivitis

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

Periodontitis

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

• Severe infection• Progresses years

before recognition– Hypertrophied gingivae– purulent discharge– Painless

Localized periodontal hygiene

Meticulous oral hygiene

• Localized to the molar & incisor regions

• Deep gingival pocketing & severe bone resorption, in otherwise healthy children

• Etiology: gram negative anaerobe A.actinomycetemcomitans

Tetracyline + periodontal surgery

• 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,

Porphyromonas spp., Treponema denticola, Streptococcus milleri)

Lower 3rd molars lie in proximity to the pterygomandibular space ( a portion of the masticator space)

Trismus

Deep parapharyngeal space involvement

Therapy: local I&D, extraction of offending tooth Penicillin, hospitalization (in presence of fever and trismus)

Resolution expected < 7days

Infection spreads to masticator space

Four Microbial Activities1. Formation of dextran ( a polysaccharide )

from sugars by streptococci2. Acid formation of lactobacilli3. Deposition of calculus by Actinomyces

species4. Secretion of inflammatory substances

( endotoxin) by Bacteroides species.

• Pseudomembranous necrotic exudate along marginal gingivae & interdental papillae

• Pain, foul breath & taste, thick ropy saliva, malaise, occasional fever

• Therapy: – Penicillin– Localized gingival curettage– oral rinse with 0.5% hydrogen peroxide or 0.12%

Chlorhexidine

Acute Necrotizing Ulcerative Gingivitis ( ANUG ), Vincent’s Angina, Trench Mouth

Disease Characteristics: “ trench mouth”

- originated in World War 1, where soldiers developed the infection while fighting in trenches.

- usually the result a combination of poor oral hygiene, physical or emotional stress, and poorm diet.

- involves painful, bleeding gums and tonsils, erosion of gum tissue & swollen lymph nodes beneath the jaw.

- causes extremely bad breath.- noncontagious

Acute Necrotizing Ulcerative Gingivitis ( ANUG ), Vincent’s Angina, Trench MouthPathogens:

- Trench mouth is a synergistic infection involving 2 or more species of anaerobic bacteria of the indigenous oral microflora.

- most commonly involved bacteria are Fusobacterium nucleatum ( an anaerobic, Gram-negative bacillus) and Treponema vincentii ( a spyrochete)

- other commonly involved anaerobic Gram-negative bacilli are Bacteroides spp., Prevotella intermedius and Prevotella melaninogenica.

Prevention and Control. - can be prevented thru good oral hygiene

FUNGAL INFECTIONS OF THE ORAL CAVITY

• Thrush

• Pseudomembranous type• Creamy, white plaque that

is rubbed off easily exposed reddened surface mucosa

• Therapy:• Nystatin, Clotrimazole,

Fluconazole, Amphothericin B

Thrush

Disease Characteristics: - a yeast infectionof the

oral cavity.- common in infants,

elderly patients, and immunosupressed individuals.

- white, creamy patches occur on tongue, mucous membranes, and the corners of the mouth

- can be a manifestation of disseminated Candida infection

( candidiasis )

Thrush Pathogens: the yeast, Candida albicans, and

other related species

Diagnosis: Observation of yeast cells, and pseudohyphae ( stringa of elongated buds) in microscopic examination of wet mounts, and culture confirmation.

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

Prepared by:

Naval, Clancy Anne G.Carmelottes, IrolandContreras, Ma. Aloha ReginaDominguez, Leeanel Marielle