Oral path Ch 4

  1. Defense mechanism include:
    • Intact skin and mucosal surfaces
    • Antimicrobial secretory products on the skin and mucosa.
    • Saliva
    • Normal microflora
    • Inflammatory response
    • immune response
  2. Humoral immunity:
    (antibodies) is an effective defense against some microorganisms
  3. Cell-mediated immunity (T-cell lymphocytes)
    is an effective defense against others, such as intracellular bacteria, viruses, and fungi
  4. Most common infectious diseases that affect the oral cavity:
    • Bacterial infections
    • Fungal infections
    • viral infections
    • **protozoan and helminthic infections, although extremely rare, have been reported.***
  5. Microorganisms that initially invade the oral tissues can cause:
    • local infection
    • systemic infection
    • or both, local and systemic
  6. Opportunistic infections:
    • Changes such as the following affect the oral microflora so that organisms that are usually nonpathogenic are able to cause disease:
    • Decrease in salivary flow
    • Antibiotic administration
    • Immune system alterations
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    • A bacterial skin infection
    • Caused by Streptococcus pyogenes and Staphylococcus aureus
    • Usually seen in young children
    • Requires nonintact skin for infection (most common on face or extremities)
    • Vesicles that rapture, resulting in thick amber-colored crusts, or as longer-lasting bullae.
    • May be itchy (pruritis) and lymphadecnopathy may be present.
    • No fever or malaise
    • Infectious
    • may look like fingernail scratches.
    • Treatment: Topical or systemic antibiotics
  8. Tonsillitis and Pharyngitis:
    • Inflammatory conditions of the tonsils and pharyngeal mucosa.
    • Many different organisms cause them, including streptococci, adenoviruses, influenza viruses, and Epstein-Barr virus (EBV).
    • Spread by contact with infectious nasal or oral secretions.
    • Group A β-hemolytic streptococci: Scarlet fever and rheumatic fever
    • Clinical features may include sore throat, fever, tonsillar hyperplasia, and erythema of the oropharyngeal mucosa and tonsils
  9. Scarlet fever:
    • Usually occurs in children
    • Generalized red skin rash caused by a toxin released by the bacteria
    • Oral manifestations in addition to streptococcal tonsillitis and pharyngitis include:
    • Petechiae on the soft palate
    • Strawberry tongue: Fungiform papillae are red and prominent, with the dorsal surface of the tongue exhibiting either a white coating or erythema
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  11. Rheumatic fever:
    • A childhood disease that follows a group A β-hemolytic streptococcal infection
    • Characterized by an inflammatory reaction involving the heart, joints, and central nervous system
    • Permanent heart valve damage may occur
    • This may require that the patient be premedicated before dental hygiene treatment
  12. Tuberculosis:
    • Usually caused by the organism Mycobacterium tuberculosis
    • Rare oral ulcerations
    • Lesions mainly occur when the organism is carries from the lungs to the mouth through sputum
    • Tongue and palate most common site for oral lesions
    • The chief form of the disease is a primary infection of the lung.
    • Fever, chills, fatigue and malaise, weight loss,and persistant cough.
    • Oral lessions occur but are rare; they appear as painful, nonhealing, slowly enlarging ulcers that can be superficial or deep.
  13. Miliary tuberculosis
    • Involvement of organs: kidneys and liver
    • Widespread
  14. Scrofula or tuberculous lymphadenitis
    • Submandibular and cervical lymph nodes
    • Usually caused by ingestion of nonpasteurized milk
    • Can happen at any age, usually gets walled off in the lungs, heals by calcification or fibrosis, can reactivate usually when an individual becomes immuno compromised
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    • Oral lesions: Biopsy
    • Chronic granulomatous lesions with areas of necrosis surrounded by macrophages, multinucleated giant cells, and lymphocytes
    • When the skin test is performed, an antigen called purified protein derivative (PPD) is injected under the top layer of the skin. A type IV delayed-hypersensitivity rxn occurs if the person has been exposed to the antigen M. tuberculosis, a positive rxn occurs then
    • Chest radiographs are taken if skin test is positive
    • Effective drug treatment became available in the 1940s.
  16. Treatment for tuberculosis:
    • Combination medications, including isoniazid (INH), rifampin, and rifapentine
    • Treatment can last up to 2 years, but patient usually become noninfectious months after treatment beginThe patient’s physician should be consulted to determine whether the patient is infectious
    • Oral lesions resolve with treatment of the patient’s primary (usually pulmonary) disease
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    • An infection caused by a filamentous bacterium: Actinomyces israelii
    • Draining abscesses
    • Treatment: Long-term, high doses of antibiotics. These organisms were at one time thought to be fungi. That is why the “mycosis” term in the name
    • In general, the clinician makes a diagnosis of actinomycosis by identifying the colonies in the tissue from the lesion. Microscopic examination to determine
    • The organisms are commonly found in the oral cavity, it is not known why they cause disease in some individuals
    • The infection is ofter preceded by tooth extraction or mucosal abrasion
  18. Image Upload 6 Image Upload 7 Syphilis:
    • 3 Stages
    •  Caused by a spirochete: Treponema pallidum (spirochete is a corkscrewlike bacterium).
    • Organisms die when exposed to air and changes in temperature
    • Transmitted by:
    • Direct contact
    • Sexual contact
    • Transfusion of infected blood to a fetus from an infected mother
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    Primary stage of Syphilis:
    • Primary is called chancre.
    • Highly infectios and forms at site at which the spirochette enters the body.
  20. Secondary stage of syphilis:
    • Occurs about 6 weeks after the primary lesion appears.
    • After remission the disease may remain latent for years
    • Def of latent lying dormant or hidden until circumstances are suitable for development or manifestation.Diffuse eruptions occur on skin and mucous membranes
    • Mucous patches
    • Oral lesions that appear as multiple, painless, grayish-white plaques covering ulcerated mucosa
    • These lesions are the most infectious
    • They undergo spontaneous remission but may recur for months or years
  21. The tertiary lesions of Syphilis:
    • Occur years after the initial infection if the infection has not been removed.
    • Chiefly involves the cardiovascular system and the nervous system
    • Gumma-a localized lesion
    • A firm mass that eventually becomes an ulcer.
    • Noninfectious
    • A destructive lesion that can result in perforation of the palatal bone Gumma most commonly found on the tongue and palate
  22. Congenital Syphilis:
    • Treponema pallidum can cross the placenta and enter the fetal circulation
    • Causes serious, irreversible damage to the child, including facial and dental abnormalities
  23. Diagnosis and Treatment of Syphilis
    • Lesions on skin may be identified by dark-field microscopy to identify the spirochete
    • Blood tests include Venereal Disease Research Laboratory (VDRL) test and fluorescent treponemal antibody absorption (FTA-ABS) test
    • Treatment:
    • Penicillin
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    Necrotizing Ulcerative Gingivitis (NUG)
    • A painful, erythematous gingivitis with necrosis of interdental papillae
    • Most likely caused by both a fusiform bacillus and a spirochete (Borrelia vincentii)
    • Associated with decreased resistance to infection
    • Is more chronic than acute.
    • Used to be called ANUG, acute necrotizing ulcerative gingivitis
  25. Diagnosis and treatment of NUG
    • Diagnosis
    • Necrosis results in cratering of the interdental papillae
    • Sloughing of necrotic tissue causes a pseudomembrane to form over the tissue
    • Treatment
    • Gentle debridement
    • Antibiotics if fever is present
    • Treatment can also consist of rinsing with chlorhexidine or diluted hydrogen peroxide
    • Metronidazole can be prescribed also for tx
  26. Pericoronitis:
    • Inflammation around the crown of a partially erupted, impacted tooth
    • Most commonly a lower third molar
    • Trauma from an opposing molar and impacted food under the soft tissue flap (operculum) may precipitate
    • Infection is caused by bacteria part of the normal microflora, usually a compromised host defenses is needed for this infection
    • Treatment:
    • Mechanical debridement
    • Irrigation of the pocket
    • Systemic antibiotics
    • Often the long-term solution is removal of the offending tooth
  27. Acute Osteomyelitis:
    • Acute inflammation of the bone and bone marrow
    • Most commonly the result of a periapical abscess
    • Pain and lymphadenopathy sig features
    • May follow fracture of a bone
    • May result from a bacteremia
    • Diagnosis
    • Early radiographic changes are evident in 2 to 3 weeks.
    • Bone loss is rapid
    • Microscopically you can see nonviable bone, necrotic debris.
    • Acute inflammation
    • Bacterial colonies in marrow spaces
    • Treatment
    • Drainage of purulent exudate
    • Antibiotics
    • Surgical debridement of the area also may be necessary
  28. Chronic Osteomyelitis:
    • A long-standing inflammation of bone
    • The involved bone is painful and swollen
    • Radiographs reveal a diffuse and irregular radiolucency that can eventually become opaque known as chronic sclerosing osteomyelitis when radiopacity develops
    • Diagnosis:
    • Based on duration, biopsy results,& microscopic examination, which shows chronic inflamation of bone and marrow.
    • Treatment:
    • Debridement
    • Administration of systemic antibiotics
    • Some patients may require hyperbaric treatment.
  29. Lesson 4:2
  30. Candidiasis (Fungal)
    AKA candidosis, moniliasis, and thrush
    • The outcome of an overgrowth of Candida albicans
    • This can result from many different conditions: Antibiotics, cancer chemotherapy, corticosteroid therapy, dentures, diabetes mellitus, HIV infection, hypoparathyroidism, infancy, multiple myeloma, primary T-cell deficiency, xerostomia
    • Pregnant women often have Candida vaginitis because they are somewhat immunosuppressed in order to maintain the fetus.
    • Most common oral fungal infection
    • Associated with use of Abs, inhalers C. albicans
    • Systemic and topical corticosteriods, diabetes and cell-mediated immune system deficiency are factors that allow overgrowth of this normal flora
    • Affects the superficial layers of the epithelium
    • Mucosal smear-scrapping off the surface to see these organisms microscopically
  31. Types of Candidiasis
    • Types of oral candidiasis
    • Pseudomembranous candidiasis
    • Erythematous candidiasis
    • Denture stomatitis
    • Chronic hyperplastic candidiasis
    • Angular cheilitis
  32. Pseudomembranous Candidiasis:
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    • A white curdlike material is present on the mucosal surface
    • The mucosa is erythematous underneath
    • The patient may complain of a burning sensation and/or a metallic taste
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    Erythematous Candidiasis
    • The presenting complaint is of an erythematous, often painful mucosa
    • May be localized to one area of oral mucosa or be more generalized
  34. Denture Stomatitis (Chronic Atrophic Candidiasis)
    • The most common type of candidiasis
    • The mucosa is erythematous, but the change is limited to the mucosa covered by a full or partial denture
    • Most common on the palate and maxillary alveolar ridge
    • Usually asymptomatic
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  35. Chronic Hyperplastic Candidiasis (Candidal Leukoplakia
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    • A white lesion that does not wipe off the mucosa
    • It will respond to antifungal medication
    • A lesion that does not respond to antifungal medication should be biopsied
  36. Angular Cheilitis
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    • Erythema or fissuring at the labial commissures
    • Most commonly from Candida, but may be caused by other factors such as nutritional deficiency
    • Frequently accompanies intraoral candidiasis.
    • Maybe one or both sides of the lips
  37. Chronic Mucocutaneous Candidiasis
    • A severe form that usually occurs in patients who are severely immunocompromised
    • The patient has chronic oral and genital mucosal candidiasis as well as skin lesions
    • Oral involvement may appear as pseudomembranous (having a false membrane), erythematous, or hyperplastic candidiasis, and angular cheilitis is common.
    • Usually involves nails and skinfolds
  38. Median Rhomboid Glossitis
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    • An erythematous, often rhomboid-shaped, flat to raised area on the midline of the posterior dorsal tongue
    • Candida has been identified in some lesions, and some lesions disappear with antifungal treatment
    • Several studies have reported an association between median rhomboid glossitis and candidiasis.
    • AKA central papillary atrophy
    • Associated with candidiasis
    • A culture may identify candidiasis but that doesn’t mean that is what is causing the infection, remember it is part of the normal flora
  39. Diagnosis and Treatment of Median Rhomboid Glossitis
    ˜Diagnosis and treatment

    • A mucosal smear is obtained and sent to the laboratory for staining and examination
    • In some patients, candidiasis is persistent and recurrent
    • It may be a sign of a severe underlying medical problem
  40. Deep Fungal Infections
    • Oral lesions may be caused by deep fungal infections such as histoplasmosis, coccidioidomycosis, blastomycosis, and cryptococcosis
    • They all primarily involve the lungs
    • There is a regional distribution of these lesions
    • Infections caused by these organisms are more common in certain areas of the United States than others
    • Diagnosis:
    • Made by biopsy and microscopic examination
    • Oral lesions are preceded by involvement of the lungs
    • Oral lesions are chronic, nonhealing ulcers that can resemble squamous cell carcinoma
    • Treatment:
    • Systemic antifungal medications such as amphotericin B, ketoconazole, or itraconazole
    • Latent infections may remain after treatment and reappear if the immune system becomes deficient
  41. Mucormycosis (Phycomycosis)
    • Rare fungal infection
    • The organism is commonly found in soil and usually is nonpathogenic
    • Infection may occur with diabetic and debilitated patients
    • The disease can present as a proliferating or destructive mass in the maxilla
    • Disease often involves the nasal cavity, maxillary sinus, and hard palate.
    • Diagnosis is made by biopsy and identification of the organisms in the tissue.
  42. Human Papillomavirus Infection
    • More than 130 types of human papillomavirus (HPV) have been identified
    • Verruca vulgaris
    • Condyloma acuminatum
    • Focal epithelial hyperplasia
    • Also implicated in neoplasia
    • About 35 different types of HPV have been identified in oral mucosa.
    • A recent study that examined both high-risk and low-risk types of HPV in the oral cavity found the overall prevalence of HPV in the oral cavity to be 6.9%.
    • Examples of low-risk types associated with these lesions include HPV types 2, 6, 11, 13, 27, 32, and 57.
  43. Verruca Vulgaris (Common Wart)
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    • A papillary oral lesion caused by a papillomavirus
    • Usually transmitted from skin to oral mucosa
    • Autoinoculation usually occurs through finger sucking or fingernail biting
    • Usually a white, papillary, exophytic lesion that closely resembles a papilloma
    • Oral lesions are less common than skin lesions, but they do occur
  44. Condyloma Acuminatum
    • A benign papillary lesion caused by a papillomavirus
    • Generally transmitted by sexual contact
    • May be transmitted to the oral cavity through oral-genital contact or self-inoculation
    • Papillary, bulbous pink masses that can occur anywhere in the oral mucosa
    • Multiple lesions may be present
    • Treatment
    • Conservative surgical excision
    • Recurrence is common
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    • HPV types 6 and 1 are the most common types associated with condyloma acuminatum.
    • in a child is strongly suggestive of sexual abuse
  45. Multifocal Epithelial Hyperplasia (Heck Disease)Image Upload 18
    • Characterized by the presence of multiple whitish to pale pink nodules distributed throughout the oral mucosa
    • Most common in children
    • Lesions are generally asymptomatic and do not require treatment
    • Resolve spontaneously within a few weeks
    • Cells in the epithelium that have clear cytoplasm, consistent with koilocytes, may also be seen in the lesions.
  46. Herpes Simplex Infection
    • There are two major forms of herpes simplex viruses: Type 1 and type 2
    • Oral infections are caused mostly by type 1 and genital infections are most commonly caused by type 2
    • Herpes simplex is one of a group of viruses called human herpesviruses (HHVs)
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    • Oral infection with the herpes simplex virus occurs in an initial (primary) form and a recurrent (secondary) form.
  47. Primary Herpetic Gingivostomatitis
    • Initial infection with herpes simplex virus
    • Painful, erythematous, and swollen gingiva and multiple tiny vesicles on perioral skin, vermilion border of lips, and oral mucosa may be seen
    • The vesicles progress to form ulcers
    • The patient may have systemic symptoms such as fever, malaise, and cervical lymphadenopathy
    • Most commonly occurs in children ages 6 months and 6 years
    • The majority of infections are thought to be subclinical
    • The disease is usually self-limited; the lesions heal spontaneously in 1 to 2 weeks.
  48. Recurrent Herpes Simplex Infection
    • The virus tends to persist in a latent state
    • Usually in nerve tissue of the trigeminal ganglion
    • It is estimated that one third to one half of the population in the United States experiences recurrent herpes simplex infection
    • The most common type of recurrent oral herpes simplex infection occurs on the vermilion border of the lips and is called herpes labialis.
  49. Recurrent Herpes Simplex Infection (Cold Sore or Fever Blister)Image Upload 20
    • The most common location for recurrent infection is on the lips: Herpes labialis
    • Recurrent infections caused by certain stimuli
    • Stress
    • Sunlight
    • Menstruation
    • Fatigue
    • Fever
    • The lesions heal without scarring in 1 to 2 weeks.
  50. Recurrent Herpes Simplex Infection (intraoral)
    • Occurs intraorally on keratinized mucosa that is attached to bone
    • The patient may have a prodrome with symptoms such as pain, burning, or tingling
    • Highest amount of virus is in the vesicle stage
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    • Episodes of recurrence vary from once a month in some individuals to once a year in others.
  51. Recurrent Herpes Simplex Infection : herpatic eye infection
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    • Transmitted by direct contact with an infected individual
    • Can cause an eye infection
    • The primary infection occurs at the site of inoculation
  52. Recurrent Herpes Simplex Infection: herpatic whitlow
    • Herpetic whitlow
    • A painful infection of the fingers caused by a primary or secondary infection
    • Before the routine use of gloves during dental treatment, herpetic whitlow was an occupational hazard for dentists and dental hygienists.
  53. Recurrent Herpes Simplex Infection:
    Diagnosis and treatment
    • Diagnosis: Based on clinical appearance
    • Changes in epithelial cells can be seen microscopically
    • Treatment: Antiviral drugs when appropriate
    • These drugs have not been shown to be consistently effective in treating lesions except in immunocompromised patients
    • Smears of herpes simplex ulceration have been reported to be positive for virally altered cells only about 50% of the time.
    • Topical application of antiviral drugs may prevent or decrease the duration of herpes labialis when they are administered very early in the development of the lesion
  54. Varicella-Zoster Virus
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    • Causes both chickenpox (varicella) and shingles (herpes zoster)
    • Respiratory aerosols and contact with secretions from skin lesions transmit the virus
    • Both chickenpox and herpes zoster are highly contagious.
    • The incubation period of chickenpox is about 2 weeks; recovery generally occurs in 2 to 3 weeks.
    • Contagious
  55. Herpes Zoster: Shingles
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    • Secondary chickenpox in an adult
    • Characterized by a unilateral, painful eruption of vesicles along the distribution of a sensory nerve
    • Whether or not the varicella-zoster virus is harbored in the sensory ganglia during the interval between chickenpox and herpes zoster in a manner similar to that of the herpes simplex virus is not clear.
  56. Herpes Zoster: Shingles
    • Any branch of the trigeminal nerve may be involved if lesions affect the faceVesicles are often preceded by pain, burning, or paresthesia
    • The disease usually lasts for several weeks
    • Neuralgia may take months to resolve
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    • Oral lesions occur when the maxillary and/or mandibular branches are affected.The disease usually lasts for several weeks
  57. Treatment of Varicella-Zoster
    • Varicella generally is treated with supportive care
    • Antiviral drugs may be used for immunocompromised patients and for patients with herpes zoster
    • In some patients corticosteroids have been used in an attempt to prevent the pain of postherpetic neuralgia.
  58. Epstein-Barr Virus Infection
    • Infectious mononucleosis
    •  Nasopharyngeal carcinoma
    •  Burkitt lymphoma
    •  Hairy leukoplakia
    • The Epstein-Barr virus (EBV) has been implicated in several diseases that occur in the oral region, including infectious mononucleosis, nasopharyngeal carcinoma, Burkitt lymphoma, and hairy leukoplakia.
  59. Epstein-Barr Virus: Infectious Mononucleosis
    • Characterized by:
    •  Sore throat
    •  Fever
    •  Generalized lymphadenopathy
    •  Enlarged spleen
    •  Malaise
    •  Fatigue
    •  Petechiae may appear on the palate
    • In the United States, infectious mononucleosis occurs primarily among adolescents and young adults
    • Often transmitted by kissing
    • The mechanism for the development of the petechiae is unknown.
    • In most cases, infectious mononucleosis is a benign, self-limited disease that resolves within 4 to 6 weeks.
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    Epstein-Barr Virus: Infectious Mononucleosis
  61. Epstein-Barr Virus: Hairy Leukoplakia
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    • An irregular, corrugated, white lesion most commonly occurring on the lateral border of the tongue
    • It occurs most commonly in patients infected with HIV
  62. Coxsackievirus Infections
    • Transmitted by:
    • Fecal-oral contamination
    • Saliva
    • Respiratory droplets
    • Three distinctive oral lesions
    • Herpangina
    • Hand-foot-and-mouth disease
    • Acute lymphonodular pharyngitis
    • oxsackieviruses are named for the town in New York State where the virus was first discovered.
  63. Coxsackievirus Infection: Herpangina
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    • Characterized by:
    • Fever
    • Malaise
    • Sore throat
    • Difficulty in swallowing (dysphagia)
    • Vesicles on the soft palate
    • Erythematous pharyngitis
    • Resolves in less than 1 week without treatment
  64. Coxsackievirus Infection: Hand-Foot-and-Mouth Disease
    • Usually occurs in epidemics in children younger than 5 years of age
    • Multiple macules or papules occur on the skin, typically on the feet, toes, hands, and fingers
    • Oral lesions are painful vesicles that can occur anywhere in the mouth
    • Resolves within 2 weeks
  65. Coxsackievirus Infection: Acute Lymphonodular Pharyngitis
    • Characterized by fever, sore throat, and mild headache
    • Hyperplastic lymphoid tissue of the soft palate or tonsillar pillars appears as yellowish or dark pink nodules
    • Lasts several days to 2 weeks and does not usually require treatment
  66. Other Viral Infections That May Have Oral Manifestations
    • Measles
    • Caused by a type of virus called a paramyxovirus
    • A highly contagious disease causing systemic symptoms and a skin rashKoplik spots, small erythematous macules, may occur in the oral cavity
    • Mumps
    • A viral infection of the salivary glands
    • Most commonly causes bilateral swelling of the parotid glands
    • Measles and mumps most commonly occur in childhood.
  67. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)
    • By sexual contact with an infected person
    • By contact with infected blood and blood products
    • From infected mothers to their infants
    • The virus infects cells of the immune system, particularly CD4 T-helper lymphocytes
    • This type of lymphocyte participates in cell-mediated immunity and in regulating the immune response
    • The virus associated with AIDS was identified in 1983; in 1986 it was designated as human immunodeficiency virus (HIV).
  68. The Spectrum of HIV
    • Many individuals experience an acute disease shortly after infection with HIV, but others are asymptomatic
    • Infected individuals may not have any signs or symptoms of disease for some time, but in most patients a progressive immunodeficiency develops
    • As the immune system becomes deficient, life-threatening opportunistic infections and cancers occur
  69. The Spectrum of HIV (Cont.)
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  70. Diagnosing AIDS
    • The current definition of AIDS includes HIV infection with severe CD4 lymphocyte depletion
    • Fewer than 200 CD4 lymphocytes per microliter of blood
    • The normal level is between 550 and 1000
  71. HIV Testing
    • Two antibody tests are used to determine whether a person is infected
    • ELISA (enzyme-linked immunosorbent assay) is used first
    • When result of this test is positive twice, it is followed by the Western blot test
    • To be considered seropositive for HIV, a person must have two positive ELISA results followed by a positive Western blot test result
  72. Clinical Manifestations of AIDS
    • An initial infection may be asymptomatic
    • Some people may develop lymphadenopathy
    • Others may develop an acute illness resembling mononucleosis
    • After an acute illness, some individuals may have persistent lymphadenopathy
    • Many become completely asymptomatic
    • In some individuals lymphadenopathy may develop; in others an acute illness resembling infectious mononucleosis and lasting 8 to 14 days can occur
    • The virus infects cells of the immune system
    • In time, the immune system becomes deficient
    • AIDS-related complex is the occurrence of several signs and symptoms together
    • Oral candidiasis
    • Fatigue
    • Weight loss
    • Lymphadenopathy
    • The virus infects cells of the immune system; as a result, this system stops protecting the individual against certain infections and tumors.
  73. Clinical Manifestations of AIDS
    • Antibodies to HIV usually begin to become detectable about 6 weeks after infection
    • In some people, antibodies may not be detectable for 6 months or up to a year or longer
    • This is called the “window of infectivity”
    • HIV can also infect cells of the nervous system, resulting in dementia in some patients.
    • The spectrum of HIV infection includes everything from an asymptomatic infection to “full-blown” AIDS
    • HIV
    • Human immunodeficiency virus
    • AIDS
    • Acquired immunodeficiency syndrome
    • It is not yet known how many of the persons who become infected with HIV go on to experience immunodeficiency, opportunistic diseases, or dementia.
  74. Medical Management of AIDS
    • Tests such as polymerase chain reaction (PCR) are used to measure the amount of HIV circulating in serum
    • The measured amount is called the viral load
    • Measurement of the viral load along with the CD4 lymphocyte count is used to assess HIV infection
    • Managed with combinations of antiretroviral drugs and drugs used to treat opportunistic infections
  75. Oral Manifestations of AIDS
    • Many oral lesions are associated with HIV infection and AIDS
    • Some lesions indicate developing immunodeficiency and predict AIDS in patients who are HIV positive
    • Oral lesions develop because of deficiency in cell-mediated immunity and depletion of T-helper cells
    • Oral lesions include opportunistic infections, tumors, and autoimmune-like diseases
  76. Oral Manifestations of AIDS
    • Gingival and periodontal disease
    • Spontaneous gingival bleeding
    • Aphthous ulcers
    • Salivary gland disease
    • Mucosal melanin pigmentation
    • Gingival and periodontal disease
    • Spontaneous gingival bleeding
    • Aphthous ulcers
    • Salivary gland disease
    • Mucosal melanin pigmentation
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    Oral Candidiasis (Thrush) in HIV patient
    • Treatment: Antifungal medications
    • Recurrence is common
    • In HIV-positive patients, it generally signals the beginning of progressively severe immunodeficiency
    • In persons who are known to be infected with HIV, the development of oral candidiasis is worrisome because it generally signals the beginning of a progressively severe immunodeficiency
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    HIV patient with Herpes Simplex Infection
    An ulceration resulting from herpes simplex that has been present for more than 1 month “meets the criteria for the diagnosis of AIDS”
  79. HIV patient - Herpes Zoster
    • Generally follows the usual pattern when it occurs in a person who is HIV positive
    • In the facial and oral area, the lesions follow branches of the trigeminal nerve
    • It is a sign of developing immunodeficiency
    • The development of herpes zoster in a person infected with HIV is a sign of developing immunodeficiency.
  80. Hairy Leukoplakia
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    • Caused by Epstein-Barr virus
    • A predictor of AIDS in HIV-positive individuals
    • Chronic tongue chewing and hyperplastic candidiasis can produce a similar lesion
    • Other white lesions, such as those resulting from chronic tongue chewing and hyperplastic candidiasis, can resemble hairy leukoplakia clinically.
    • Treatment: None
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    Human Papillomavirus Infection
    • Associated with HIV infection
    • May have normal color or be erythematous
    • May be associated with antiretroviral treatment
    • Lesions may be persistent and may occur in multiple oral mucosal locations.
  82. Kaposi Sarcoma- AIDS patient
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    • An opportunistic neoplasm that may occur in patients with HIV infection
    • Most commonly located on the palate and gingiva
    • Diagnosis
    • Biopsy
    • Treatment
    • Surgical excision
    • Radiation treatment
    • Chemotherapy
    • Kaposi sarcoma is one of the intraoral lesions that may fulfill the criteria for the diagnosis of AIDS.
  83. Lymphoma
    • A malignant tumor that may occur in association with HIV infection
    • Appears as a nonulcerated, necrotic, or ulcerated mass
    • May be surfaced by ulcerated or normal-colored erythematous mucosa
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    • Epstein-Barr virus has been associated with this neoplasm.
    • Diagnosis
    • Biopsy and histologic examination
    • Treatment
    • Chemotherapeutic drugs
    • Oral lymphoma is another oral lesion that may meet the criteria for the diagnosis of AIDS.
  84. Gingival and Periodontal Disease -AIDS patient
    • Unusual forms of gingival and periodontal disease may develop in patients with HIV
    • Linear gingival erythema (LGE)
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    • Necrotizing ulcerative periodontitis (NUP)
  85. Linear Gingival Erythema (LGE)
    • Three characteristic features include:
    • Spontaneous bleeding
    • Punctate or petechiae-like lesions on attached gingiva and alveolar mucosa
    • A bandlike erythema of the gingiva that does not respond to therapy
    • LGE occurs independently of oral hygiene status
    • LGE is different from typical gingivitis in that gingivitis is generally not characterized by spontaneous bleeding, and the erythema of typical gingivitis responds within a few days to 1 week to scaling, root planing, and improvement of oral hygiene.
  86. Necrotizing Ulcerative Periodontitis (NUP)
    • Characterized by intense erythema and extremely rapid bone loss
    • Necrotizing stomatitis
    • Extensive focal areas of bone loss along with features of NUP
    • The specific causes of these atypical gingival and periodontal diseases remain unclear.
  87. Gingival and Periodontal Disease
    • Treatment
    •  Scaling
    •  Root planing
    •  Soft tissue curettage
    •  Intrasulcular lavage
    •  Chlorhexidine mouth rinse
    •  Systemic metronidazole
    • Good oral hygiene, including the use of smaller toothbrushes and interproximal cleaning devices, has been a component of management.
  88. Spontaneous Gingival Bleeding
    • A decrease in platelets may occasionally be seen in patients with HIV
    • It may be due to an autoimmune type of thrombocytopenic purpura
    • In these patients, a platelet count and bleeding time should be considered before deep scaling procedures
    • Gingival bleeding not related to thrombocytopenia has been described in linear gingival erythema and necrotizing ulcerative periodontitis
  89. Aphthous Ulcers - HIV patient
    • There appears to be an increase in the number of these ulcers in patients with HIV infection
    • Ulcers resembling major aphthous ulcers appear as deep, persistent, painful ulcers
    • They respond to steroids
  90. Salivary Gland Disease
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    • Bilateral parotid gland enlargement may occur in patients who are HIV positive
    • May be related to medication or salivary gland disease
    • The microscopic appearance is reported to be that of a benign lymphoepithelial lesion, often with a prominent cystic component.
    • The cause is not clear.
Card Set
Oral path Ch 4
oral path