30th AP State Dental Conference – Hyderabad – Guest Lecture 1

The AP State dental conference at Panineeya Institute of Dental Sciences, Hyderabad on the dates 31st Oct. and 1st Nov. 2009.

The first guest lecture is delivered by
Dr. K.S. Nagesh,
Principal, Prof and Head,
Dept. of Oral MEdicine and Radiology,
D.A. Pandu Memorial R.V. Dental College, Bangalore

Topic – Oral and Maxillofacial Infections

The time has came to close the book on infectious diseases.
4 primary
Diarrhea, Pneumonia, Tuberculosis, Malaria
Upto 1/3rd of the world population has Tuberculosis.

Oral and Maxillofacial infections –

• Bacterial infections
• Viral
• Fungal
• Rareities
• Odontogenic
• Non-Odontogenic
• Opportunistic

Bacterial infections –

• Necrotising Ulcerative Gingivitis/Periodontitis
• Tuberculosis
• Bacterial sialadenitis

Acute Necrotizing Ulcerative Gingivitis/ Acute Necrotizing Ulcerative Periodontitis –
Smokers and Immunocompromised patients, particularly in those with HIV infections.
ANUG exact cause not known
Proliferation of spirochaetes and fusiform bacteria
Soreness and bleeding of gingiva. Crater like ulcers, marked halitosus.
Management – Identify the predisposing factor, supragingival plaque control, gentle debridement of the gingival tissues, instruct to use the chlorhexidine mouth wash, and gentle toothbrushing.
Metronidazole drug of choice 200 m.g.

Tuberculosis –
M. tuberculosis and M. bovis
Worldwide endemix – upto 1/3rd world population
Resurgence of respiratory pulmonary disease
Immunodeficiency, malnutrition, non-compliance with drug regimes, AIDS-related phenomenon.
Primary oral involvement, secondarily sputum
Irregular painful lesion with undermined borders and covered by grey slough.
Commonly affects tongue, but other areas of oral mucosa, particularly towards the posterior parts of the mouth
May also present as white patches or granulating lesions.
Histopathology – Non-caseating granulomata. No. of acid fast bacilli on ZN staining. Culture of Mycobacteria seen.
Management – Look for pulmonary lesions. Referral to a chest physician too for lesions outside the field of oral medicine.

Bacterial sialadenitis –
Ascending Sialadenitis
Recurrent parotitis of childhood
Usually a secondary consequence of either a localized or systemic cause of reduced salivary flow
Also affect minor salivary gland.
Glang painful, tender, swollen, pain radiating to ear and temporal area.
Intraorally, duct may be swollen, reddened and duct papilla enlarged
Management – Penicillin group of drugs are antimicrobials of choice, adequate fluid intake, chewing saliva stimulants.

Odontogenic infections –

Causes – Dental caries, infected periapical pathologies – Dentoalveolar abscesses, periapical granuloma

Complications –
Ludwig’s angina
Infections in danger areas of face – Intracranial complications, brain abscess, sinus thrombosis, thrombophlebitis

Fungal infections of the oral cavity –

• Candidiasis
• Mucormycosis
• Histoplasmosis

Candidiasis –
Infections of skin, nails, mucous membrane, internal organs
Occurs as both primary and opportunistic infections
80% of HIV patients develop this disease
Complications – Palatal perforations, orofacial fistulas, secondary carcinomas.
Treatment –
Topica; – Clotrimazole 1% mouth paint, Ketoconazole 2% ointment for 5 mins, 4 times per day for 14 days
Systemic antifungal agents –
Ketoconazole tab 200 mg 4 times a day for 14 days
Fluconazole

Denture hygiene – Clean the denture thoroughly and regularly, and left out of mouth in Sodium hypochlorite soln.

Viral infections –

• Herpes simplex
• Varicella zoster
• Mumps
• Coxsaxckie virus
• Human papilloma virus
• Human immuno virus

Herpes Simplex Virus –
Herpes simplex type-1 oral mucosa, pharynx, skin
Herpes simplex type-2
Clinical features – Malaise with tiredness, generalized muscle aches and sometimes sore throat
Prodromal phase – 1-2 days followed by oral lesions
Complications – Post herpetic neuralgia. Anesthesia, paraesthesia, trigeminal neuralgia-like pains and persist for years, also reappear for prolonged absence, and fail to respond to any form of medical treatment.
Ramsay Hunt syndrome – Facial nerve involvement, during an episode of zoster reactivation. Facial weakness, loss of taste sensation, dizziness. Vesicular lesions in this conditions seen most on palate and around the external auditory meatus. Most cases, self-limiting condition that resolves with restoration of function, there may be permanent facial weakness in some cases.

Varicella Zoster Virus –
DNA virus, morphologically similar to HSV. Chicken pox and Herpes zoster
Vesicular eruption in an area of distribution of sensory nerve, and when it affects the trigemical nerve, the facial skin and oral mucosa in the sensory area may be affected.
Initial symptom – Prodromal pain severe and misdiagnosed as toothache lasting for 203 days Vesicles in a rash. Unilateral distribution of oral lesions.
Complications – Ophthalmic division of trigeminal nerve involved

Coxsackie virus –
Hand, foot and mouth disease –
Intraoral vesicles, ulcers. Macular rah with vesiculation seen

Mumps – Bilateral swelling of the parotid glands, although unilateral glandular swelling can occur.
Incubation period – 14-21 days
Transmission – Respiratory secretions and saliva
Ducts appear red, and inflamed.
Complications – Pancreatitis, Encephalitis, Orchitis, Oopedesis

Human Papillomavirus infections –
100 difference viruses which cause warty lesions on the skin and mucous membrane. Cauliflower like lesions on the lip are seen.

Investigations –
Cytology – Scraping from base of lesions, stained with Giesma, Wright’s stains.
Fluorescent staining
Isolation – tissue culture

Treatment – Antiviral drugs, within 72 hours
Decreased days of fever, pain, lesionsm and viral