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A - BDS4 Oral Medicine > Infectious diseases of the oral mucosa > Flashcards

Infectious diseases of the oral mucosa Flashcards

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1
Q

Gives examples of infectious diseases found in the oral mucosa

A

fungal - caniddia
viral
bacterial

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2
Q

Give examples of viral infections which can affect the oral cavity

A

Herpes simplex
Varicella Zoster
HIV
Hep C
Coxsackie virus

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3
Q

examples of bacterial infections which can affect oral cavity

A

sti’s
- syphillis
- gonorrhoea
- chlamydia
- tuberculosis

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4
Q

oral candidosis - define

A

infection of mucosa caused by candida species

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5
Q

Candida - features

A

can harmlessly colonise mucocutaneous surfaces

can invade deeper tissues and cause infection if conditions are right
- opportunistic infection

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6
Q

Local oral defences against disease

A

oral mucosa
- physical barrier
- innate immunity - lysozyme, T cells, phagocytes
oral microbiome
- competition and inhibition
saliva
- mechanical cleansing
- antimicrobial peptides - muffins, defensives, histamines
- IgA antibodies

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7
Q

systemic defences against disease

A

immune system
- adaptive immunity

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8
Q

oral candidosis local risk factors

A

xerostomia
poor oral hygiene
dentures
smoking
mouth piercings
irradiation to the mouth or salivary glands
inhaled/topical corticosteroids e.g. asthmatics

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9
Q

systemic risk factors for oral candidosis

A

extremes of age
- neonates, elderly
malnutrition
diabetes
HIV/AIDS
Haematinic deficiency
broad-spectrum antibodies
chemotherapy
haematological malignancy

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10
Q

candida infections - management

A

investigate and manage predisposing factors
- systemic disease
- smoking
- dry mouth
- steroid inhaler
- denture hygiene
oral hygiene
- toothbrushing
- dentire hygiene
topical antifungals
- miconazole oral gel
- nystatin oral mouthwash
systemic antifungals
- fluconazole capsules

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11
Q

Miconazole oral gel contraindications (same as fluconazole capsules)

A

warfarin
- increases anti-coagulant effect
stations
- risk of rhabdomylosis and myopathy with some statins

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12
Q

oral candida infections that appear white

A
  • acute pseudomembranous candidosis
  • chronic hyperplastic candidosis
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13
Q

oral candida infections that appear red

A

denture-related stomatitis
acute erythematous candidosis
median rhomboid glossitis
angular chelitis

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14
Q

Acute pseudomembranous candidosis features

A

‘thrush’
- white flecks resemble breast of thrush bird
commonly seen in neonates
in adults - “disease of the diseased”

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15
Q

acute pseudomembranous candidosis appearance

A

white slough on mucosa surface
- easily wiped off
underlying erythematous base

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16
Q

acute pseudomembranous candidosis diagnosis

A

usually clinical
- over diagnosed?
microbiology investigations
- oral rinse or swab

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17
Q

acute pseudomembranous candidosis (oral thrush) management

A

predisposing factors need to be investigated and dealt with
oral hygiene
topical
- miconazole oral gel
- nystatin oral mouthwash
systemic if topical ineffective or infection is extensive or severe
- fluconazole capsules

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18
Q

chronic hyperplastic candidosis features

A

candidal leukoplakia
potentially malignant disorder
- up to 12.1%

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19
Q

chronic hyperplastic candidosis clinical signs (candidal leukoplakia(

A

usually occur on buccal mucosa
- at labial commissure/corner of the mouth
often bilaterally
white or speckled red/white appearance
can occur on tongue - less common

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20
Q

chronic hyperplastic candidosis diagnosis

A

incisional biopsy with PAS stain
- is there dysplasia?

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21
Q

Why would you give fluconazole before a biopsy for a patient with chronic hyperplastic candidosis?

A

to allow pathologist to see potential dysplasia more clearly
fungal-related inflammation can give false positives for dysplasia

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22
Q

chronic hyperplastic candidosis management

A

predisposing factors - treat
systemic antifungal
stop smoking
careful clinical follow up in oral med clinic or GDP
- management of dysplasia as required

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23
Q

denture-related stomatitis features

A

candida infection of mucosa beneath a dental appliance
common in patients in care facilities
- elderly, dry mouth, high sucrose diet, poor OH
common upper complete denture
- micro-environment

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24
Q

Denture-related stomatitis - how does this occur?

A

candida in 90% of cases
- mixed infections occur - staph, strep
acrylic resin and soft liners = good habitat for candidal adherence
denture trauma potentiates infection
overnight denture wear cultivates biofilm

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25
denture-related stomatitis - diagnosis
clinical diagnosis - but if not resolving, investigate pre-disposing factors
26
denture related stomatitis clinical signs and symptoms
pain or discomfort bad breath dryness burning sensation in mouth redness
27
denture related stomatitis - classification
Newtons's classification 1 - localised inflammation (pinpoint) 2 - generalised erythema covering denture-bearing area 3 - granular type
28
denture-related stomatitis management
denture hygiene - remove dentures at night - gentle daily brushing - before and after soaking, after meals with denture cleaning solution (not toothpaste) - chlorhexidine immersion (for 20 minutes) - dilute hypochlorite immersion - microwave disnfection - alkaline peroxide re-make if required brushing palate antifungals - if other measures fail - miconazole gel can be applied to fitting surface before denture insertion -
29
acute erythematous candidosis clinical features
aka atrophic candidosis most commonly presents with associated 'burning' palate most commonly affected
30
acute erythematous candidosis predisposing factors
recent broad spectrum antibiotics corticosteroids diabetes HIV nutritional factors
31
acute erythematous candisosis diagnosis and management
diagnosis - clinical - oral rinse or swab management - medical referral - topical antifungal - systemic antifungal
32
median rhomboid glossitis features
posterior aspect, midline of tongue dorsal sometimes a kissing lesion on the palate depapillation in a regular shape
33
median rhomboid glossitis risk factors
smoking steroid inhaler
34
median rhomboid glossitis diagnosis and management
diagnosis - clinical management - predisposing factors - oral/denture hygiene - topical or systemic antifungal
35
what is angular chelitis?
infection of mucocunatneous region around corners of the mouth - often associated with dermatitis mixed infection - candida - staph and streptococcus often have associated intra-oral infection - denture induced stomatitis
36
angular chelitis signs and symptoms
soreness erythema fissuring crusting bleeding at corners of mouth
37
the role of mechanical factors in angular chelitis
ageing edentulous dentures lacking vertical height all encourage saliva pooling
38
angular chelitis diagnosis
usually clinical diagnosis swab for microbiology (culture and sensitivity)
39
angular chelitis management
predisposing factors - may require new dentures - underlying disease or deficiency? denture hygiene OHI topical antifingal - miconazole cream - effective against fungus and some bacteria topical antibacterial - sodium fusidate ointment - when clearly bacterial in nature e.g. non-denture wearer
40
Angular chelitis management -if there is significant associated dermatitis
combined miconazole and hydrocortisone cream/ointment - cream if wet surface - ointment if dry surface
41
human herpes virus features
family of DNA viruses transmitted in saliva, respiratory secretions, direct contact often encountered early in life characterised by latency and re-activation, when immunity drops
42
HSV1. and HS2 infection features and stages
herpes simples 1 - oral 2 - anogenital primary infection - lesions mouth, oropharynx, anogenital regions latency reactivation during relative immunosuppression
43
primary herpetic gingivostomatitis symptoms
fever malaise red, fiery oedamatous gingiva grey vesicles which break down to form ulcers
44
primary herpetic gingivostomatitis is caused by...
initial infection of HSV1 or HSV2
45
primary herpetic gingivostomatitis diagnosis
diagnosis - clinical and history - viral swab for PCR if uncertain (compliance)
46
primary herpetic gingivostomatitis management
largely supportive - fluids - soft diet - chlorhexidine to prevent secondary infection of oral lesions - difflam mouthwash - paracetamol
47
When would urgent specialist care with systemic antivirals be indicated for primary herpetic gingivostomatitis patients?
in pregnant women and neonates
48
recurrent herpes simplex virus features
15% population usually lips - herpes labials - cold sore - but can occur intraorally
49
Factors which can cause reactivation of HSV
sunlight - UV radiation unwell - fever tissue injury stress immunosuppression hormones - menstrual cycle
50
recurrent herpes simplex virus stages
prodromal period - pain, burning, tingling, itching - up to 48 hours before herpes labialis and/or intra-oral hepres typically crops of of ulcers - painful - scab within 72 hours - resolution by 10 days
51
recurent herpes simplex virus diagnosis
mostly clinical
52
recurrent herpes simplex virus management
avoidance of triggers antivirals in prodrome period - acyclovir 5% cream every 2 hour (herpes labialis) - acyclovir 200mg tablets 5x per day for 5 days (intra-oral herpes) immunocompromised - specialist referral
53
recurrent HSV potential complications
disseminated herpes infection - if immunocompromised Bell's palsy erythema multiforme herpetic whitlow - fingers eye disease - herpetic keratoconjuctivitis
54
Varicella-zoster virus features
varicella = chicken pox - primary infection in children latency - in dorsal root ganglion zoster = shingles - reactivation - usually adults
55
varicella signs and symptoms
mainly children - complication risk in adults highly contagious - via respiratory droplets or lesion fever malaise truncal rash - itch, papules, vesicles, scabs oral ulcers
56
varicella management
supportive referral to specialist care in pregnant women, neonates and immunocompromised patients
57
zoster features
zoster = belt recurrence of varicella zoster virus classically in one sensory dermatome - trigeminal divisions = face and oral cavity usually in elderly and immunocompromised
58
zoster - signs and symptoms
rash in one dermatome - scabs pain before, during and after lesions vesicles and ulcers intra-orally
59
what is a dermatome?
a specific area of skin connected to a single spinal nerve root
60
zoster diagnosis
clinical
61
zoster management
acyclovir 800mg tablets - within 72 hours of onset - can help healing and minimise post-herpetic neuralgia refer all patients to GP immunocompromised = refer to specialist
62
zoster potential complications
post herpetic neuralgia - persisting >6 months after mucocutanous healing burning pain - treat with gabapentin, amitriptyline or carbamazepine Ramsay Hunt syndrome - reactivation within geniculate ganglion - facial nerve palsy and vesicular rash around ear - oral vesicles
63
Epstein Barr virus features
90-95% of population have been infected transmission in saliva - "the kissing disease" establishes latency in lymphoid tissue - primarily B cells
64
diseases linked to Epstein bar virus
oral hairy leukoplakia burkitt's lymphoma nasopharyngeal cancer
65
Oral hairy leukoplakia features
Associated with HIV patients when CD4 cell count drops - also seen in chemotherapy and leukaemia patients affects lateral aspect of tongue - warty ridged or smooth white plaques
66
HIV features
human immonodeficiency virus RNA virus - blood borne - sexual transmission, needle stick injuries, splashes, vertical transmission enters and destroy CD4 T helper cells increasingly immunocompromised as disease progresses AIDS - acquired immunodeficiency syndrome - end stage of untreated disease
67
HIV treatment
very effective ART - antiretroviral therapy - halt HIV replication - normal CD4 count and undetectable viral load - can cause oral hyperpigmentation PrEP PEP
68
HHV 8 diagnosis and management
diagnosis - incisional biopsy management - excision - treat underlying immonosupression - cryotherapy - chemotherapy
69
oral AIDS defining illnesses
oral candidosis acute necrotising ulcerative gingivitis kaposi sarcoma oral hairy laukoplakia non-hodgkin's lymphoma aphthous-like ulcers
70
hepatitis C virus features
RNA virus - infects liver - chronic infection spread by blood and body fluids no vaccine available curable - with antiviral medications 8-12 weeks
71
hepatitis C complications
liver cirrhosis - dental implications hepatocellular carcinoma
72
Coxsackie virus features and oral presentations
family of RNA viruses spread faecal-oral route and saliva oral presentation - hand, foot and mouth disease - herpangina
73
Hand foot and mouth disease features and symptoms/signs
common - young children mainly nursery - clusters 7-10 days systemic - fever - reduced appetite - malaise hand - vesicles/blisters on palms feet - vesicles/blisters on soles mouth - vesicles/uclers on labial, buccal and tongue mucosa
74
herpangina clinical signs
numerous vesicles and ulcers - soft palate - uvula - fauces/throat
75
coxsackie virus diagnosis and management
clinical diagnosis management - supportive - fluids - paracetamol, ibrupforen - soft diet - chlorhexidine to aid oral hygiene - difflam/benzydamine mouthwash
76
oral Bacterial infections origins
odontogenic or salivary - periapical - periodontal - pericoronal - bacterial sialadentis - STI's - syphillis, gonorrhoea, chlamydia - Tuberculosis
77
Sexually transmission infections - management
refer/signpost - sexual health clinic - GP
78
STI risk factors
previous sti under 25 years of age a new sexual partner more than one sexual partner in the last year no condom use paying for sex socioeconomic deprivation Chemsex
79
syphillis features
multi-system disease - aphthous stomatitis, traumatic ulceration, oral cancer, vesiculobullous disorders primary, secondary and tertiary
80
primary syphilis features and signs
chancre at site of inoculation painless ulcer usually genital but can be oral self limiting - heals by 8 weeks associated lymphadenopathy in 80% if untreated, infection spreads lymphoedema's-vascular
81
secondary syphilis features and signs
4-6 weeks after initial infection non specific symptoms - lethargy - malaise - fever - rash - musculoskeletal pain mucosal white patches 'snail track' ulcers
82
tertiary syphilis signs and features
progression from untreated infection presents 1-30 years after inoculation granulomatous inflammation neurosyphilis - dementia - cranial nerve palsies cardiovascular syphilis - aortic aneurysms
83
syphilis diagnosis
incisional biopsy blood test - high false positives
84
syphilis management
by sexual health specialist screening for other STI's contact tracing STAT dose of IM benzylpenicillin
85
gonorrhoea and chlamydia features and symptoms
sexually transmitted infections primarily affected urethra, endocervix, rectum and pharynx - can be asymptomatic male - urethral discharge, pain or burning sensation when urinating (dysuria) female - altered vaginal discharge, dysuria
86
Gonorrhoea and chlamydia oral presentation
non specific uncommonly reported pharyngitis
87
Gonorrhoea and chlamydia diagnosis
clinical - oral specialist - vulvoanginal or urethral swabs
88
gonorrhoea and chlamydia management
by sexual health clinic gonorrhoea - STAT dose of IM ceftriaxone chlamydia - 8 days oral doxycycline screening for other STI's contact tracing
89
bacteria responsible for tuberculosis
mycobacterium tuberculosis
90
Tuberculosis - how it infects people
transmission through respiratory secretions infects macrophages in lung - can disseminate via bloodstream to almost any organ
91
tuberculosis signs and symptoms
fever weight loss night sweats cough haemoptysis - coughing up blood
92
tuberculosis risk factors
close contact with TB patient born in high-prevalence regions - india, pakistan, somalia, eritrea, Romania HIV diabetes leukaemia alcohol excess socio-economic deprivation homelessness
93
tuberculosis oral manifestations
ulceration lip swelling granulomatous inflammation - also seen in Crohn's and orofacial granulomatosis
94
tuberculosis diagnosis (oral)
incisional biopsy - H and E staining - Ziehl - Neelsen stain
95
tuberculosis management
specialist - combination antibiotics for 3-6 months
96
possible investigations for infectious oral mucosal diseases
Blood - FBC - Haematinics - HbA1c glucose - blood borne virus screen imaging - clinical photographs saliva - unstimulated saliva flow rate microbiology - swab of lesion - oral rinse biopsy - H and E staining - PAS staining - candida - Ziehl-Neelssen stain - TB

A - BDS4 Oral Medicine (15 decks)

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