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Non-Plaque Induced Gingival Diseases

These diseases are not caused by plaque These diseases do not disappear after plaque removal Non-Plaque Induced Gingival Diseases
Caused by Treponema pallidum Syphilis
The organism is transmitted usually by direct contact This organism looks for a break in the skin in which to enter the tissues Syphilis
Usually transmitted through sexual contact with skin or mucous membranes but may be transmitted through blood transfusion, or transplacental from mother to fetus Syphilis
-highly infectious, heal in a few weeks, then latent Syphilis Chancre
-appear about six weeks after chancre appeared, diffuse gray white eruptions of skin and membranes, resemble snail tracts, most infectious, may take months to heal, then long latent period Syphilis mucous patches
-may take years to appear, primarily affect CNS and cardiovascular system, may appear on tongue or palate as soft mass than may ulcerate and then perforate, non infectious Syphilis gumma
Occurs as a result of the yeastlike fungus, Candida Albicans Candida Albicans is part of our normal flora -most common oral fungal infection Seen often in immunocompromised patients (diabetes, HIV/AIDS) and patients with xerostomia Candidiasis
Can result from the following: Antibiotic therapy Chemotherapy Glucocorticoid therapy- Ex: Prednisone Dentures/Partials Diabetes mellitus HIV infection Xerostomia Candidiasis
Newborn infants are particularly susceptible because they do not have an established oral flora and fully developed immune system Candidiasis
Pregnant women with Candida vaginitis can pass on the fungus to the infant as it passes through the birth canal Candidiasis
is one of the most common oral lesions associated with a weakened immune system Candidiasis
Usually affects the superficial layers of the epithelium Different Types are: Pseudomembranous Erythematous Chronic atrophic Chronic hyperplastic Angular cheilitis Candidiasis
fluconazole (Diflucan)- 100mg tabs Take 200 mg 1st day, then 100-200mg qd X 14 days Treatment of Candida
nystatin gel (Mycostatin): Apply topically tid to corners of mouth clotrimazole (Mycelex, Lotrimin) Treatment of Angular Cheilitis
Histoplasmosis (histoplasma capsulatum) Coccidioidomycosis (coccidiodes immitus) Blastomycosis (blastomyces dermatitidis Cryptococcosis (cryptococcus neoformans) Deep Fungal Infections Examples
-characterized by primary involvement of the lung- Persistent cough Oral involvement occurs when coughing carries the organism from the lungs to the oral mucosa Deep Fubgal Infections
Diagnosis involves lungs-primary lung involvement is involved in all of these conditions The oral lesions are chronic, nonhealing ulcers that can resemble squamous cell carcinoma Histology is needed to identify the pathogen Deep Fungal Infections
These lesions often get diagnosed as TB and antibiotics are given which worsens the disease Treatment: systemic antifungals like amphotericin B, and ketoconazole Deep Fungal Infections
Two major types are: Herpes Simplex Type I- the oral type Herpes Simplex Type II- the genital type Herpes Simplex
Approximately 80% of the adult population have oral herpes Approximately 20% have genital herpes Herpes Simplex
Transmission occurs by direct skin or mucocutaneous contact with infected secretions or viral shedding Herpes Simplex
This is the first outbreak to the herpes virus Affects children between 6 months and six years most often The outbreak usually follows a 3-10 day incubation period The patient will report fever, irritability, malaise(discomfort) Primary Herpetic Gingivostomatitis
Orally, focal areas of the marginal gingiva become fiery red and edematous These areas bleed easily with the least amount of trauma Widespread inflammation of the free and attached gingiva follows Primary Herpetic Gingivostomatitis
Small clusters of vesicles erupt rapidly throughout the mouth (not just keratinized gingiva) The vesicles burst forming yellow ulcers surrounded by a red halo of erythema These ulcers may coalesce to form larger ulcerations Primary Herpetic Gingivostomatitis
These ulcers can occur anywhere in the mouth Perioral(around the mouth) skin ulcers may occur Hemorrhagic crusts of the lip are common- remember Erythema Multiforme/Stevens Johnson syndrome, and Leukemia Primary Herpetic Gingivostomatitis
The disease is contagious It resolves in 12- 20 days without scarring The patient has to be very careful not to self inoculate other parts of the body such as the eyes or genital areas Primary Herpetic Gingivostomatitis
Herpes remains in an inactive or latent state in the nerve tissue of the trigeminal ganglion—until an outbreak occurs Once exposed, there is a 40% chance that you will have ___. The most common type of recurrence is on the lips as a fever blister Recurrent Herpes Simplex(Secondary Herpes)
Recurrences seem to be brought on by stress, sunlight, fever, menstruation, immunosuppression The above things seem to start the viral replication stage- prodromal stage Recurrent Herpes Simplex(Secondary Herpes)
During the prodrome, such symptoms as tingling, burning, itching and throbbing precede the formation of blisters by 24 hours The prodromal period is the ideal time to treat herpes Recurrent Herpes Simplex(Secondary Herpes)
Most intraoral recurrences are limited to keratinized tissues (attached gingiva and hard palate) However, in immunocompromised patients, recurrences may involve the buccal mucosa and the tongue Recurrent Herpes Simplex(Secondary Herpes)
When Herpes is transmitted to a finger, the herpetic lesion is referred to as _____. Herpes Whitlow
Drugs such as acyclovir(Zovirax),famciclovir(Famvir), penciclovir(Denavir), valacyclovir(Valtrex) These drugs are most effective if they are administered during the prodromal period Tx of Herpes
Sunscreen, Vitamin C, and lysine, may help For pain: 2 % Viscous Xylocaine- 100ml The lesions will self heal normally in 7-10 days Primary herpetic gingivostomatitis may take up to 20 days Tx of Herpes
-causes both chickenpox and shingles The disease is transmitted primarily through skin contact Both chickenpox and shingles are contagious, particularly when lesions are weeping Varicella- Zoster Virus
The primary disease is ___. The secondary disease is the recurrent form of the disease which is called _____. Varicella(Chicken Pox)/Herpes Zoster (Shingles)
-vesicular rash that occurs after 2 week incubation period- also associated with headache, fever, malaise, heals in 2 to 3 weeks Chicken Pox
The normal age for this disease is 50 or over but it may occur in young adults or children It is related to the aging process or immunosuppression Before eruption, prodromal signs of itching, tingling, burning, pain, or paresthesia occur Shingles – Herpes Zoster
Lesions are painful, vesicular eruptions of the skin and mucosa Lesions are unilaterally distributed along nerve pathways and stop abruptly at the midline Shingles – Herpes Zoster
The most common locations are the trunk area and along the ophthalmic division of the trigeminal nerve After the vesicles burst, crust formation occurs within 7-10 days Pain may be intense Shingles – Herpes Zoster
Herpes Zoster skin lesions usually heal in about 3 weeks The pain, however, may persist for 6-12 months Treatment is the antiviral agent famciclovir(Famvir) or valacyclovir (Valtrex) For pain: Lyrica, Lidoderm Treatment of Shingles
Has been implicated in several oral diseases such as: Infectious mononucleosis Burkitt lymphoma-is a rare malignant disease Hairy leukoplakia Epstein-Barr Virus
Caused by the Epstein-Barr virus Characterized by sore throat, fever, lymphadenopathy, enlarged spleen, malaise Palatal petechiae(junction of hard and soft palate) that turn brown as they heal Infectious Mononucleosis
Occurs in late teens and early adulthood The disease is of low contagiousness Lasts about 2 weeks and then starts resolving May be transmitted by saliva or aerosols Infectious Mononucleosis
A raised, poorly demarcated, corrugated, white lesion most commonly occurring on the lateral border of the tongue The lesions are asymptomatic and cannot be rubbed off Caused by the Epstein-Barr Virus, associated with immunosuppression (HIV/AIDS) Hairy Leukoplakia
Treatment is antiviral agents Hairy Leukoplakia
A form of malignant lymphoma Causes bone destruction of the maxilla and mandible The lesion was first observed in central Africa Most common form of childhood cancer in Africa Burkitt Lymphoma
results in a proliferation of the B lymphocyte Clinically there is an enlargement of the lymph nodes that are involved Treatment is chemotherapy and radiation therapy Burkitt Lymphoma
usually appear on the palate and gingiva- These lesions appear as soft tissue masses that are often hemorrhagic Burkitt Lymphoma
HIV is the virus responsible for AIDS AIDS= Acquired Immunodeficiency Syndrome Was first reported by the Centers for Disease Control and Prevention in 1981 Human Immunodeficiency Virus-HIV
Transmitted by sexual contact with an infected person Transmitted by infected blood and blood products Transmitted to infants by infected mothers Human Immunodeficiency Virus-HIV
AIDS is HIV infection with severe +CD4 helper T cell depletion(less than 200/microliter of blood) The normal CD4 count is between 550-1000/microliter of blood Candida, hairy leukoplakia, TB, and Kaposi sarcoma, are also common in AIDS patients Diagnosing AIDS
White corrugated lesions on the lateral borders of the tongue that don’t wipe off, caused by Epstein Barr Virus Hairy Leukoplakia
-red-purplish macule that may become raised and ulcerate- seen on palate, gingiva, buccal mucosa or skin
Associated with HIV/AIDS Has 3 characteristic features 1. Spontaneous bleeding of gingiva 2. Petechiae on attached gingiva and alveolar mucosa 3. Bandlike band of erythema on gingiva that does not respond to therapy Linear Gingival Erythema
also called connective tissue diseases, the body loses its ability to differentiate between foreign substances and its own cells The immune system recognizes certain of its own cells as foreign, and then attacks them with autoantibodies Autoimmune Diseases
canker sores; Painful ulcerations 20% of population - more common in females and young adults Etiology is thought to be autoimmune; Etiology include: Trauma (#1), menstruation, stress, food allergies as well as types of foods(citrus) Aphthous Ulcers
Found on movable mucosa such as the buccal and labial mucosa Rarely seen on heavily keratinized tissues: hard palate and gingiva The ulcers are usually from 3-10 mm but can be larger They have a grey- white center, surrounded by a red border Aphthous Ulcers
It is a disease characterized by vesicle and bullae formation on the skin and mucous membranes Very rapid onset Often associated with reactions to drugs Occurs at any age, but most often affects young men Erythema Multiforme
Skin lesions develop on the hands, arms, legs, and face The lesions begin as small red circular macules The macules enlarge and become fluid filled vesicles or bulla These vesicles or bullae rupture forming ulcerations Erythema Multiforme
Orally: multiple ulcerations, commonly on lateral borders of tongue and lips Dark red-brown hemorrhagic crusts are normally present on the lips- this is the biggy Erythema Multiforme
Erythema Multiforme
The most severe form of Erythema Multiforme is Stevens-Johnson syndrome Stevens Johnson normally affects children and young adults- mostly males Orally it is similar to Erythema Multiforme but more severe lesions and patient is very sick Stevens Johnson Syndrome
The classic triad consists of eye lesions, oral lesions, and genital lesions The thing to remember is the “Target” or “Bullseye” Lesion Stevens Johnson Syndrome
Healing with this form of Erythema Multiforme takes about 6 weeks Stevens Johnson Syndrome
Etiology suspected to be autoimmune Seen normally in nervous, high strung individuals Most patients are women over 40 Lichen Planus
The disease has periods of remission and exacerbation There are 2 forms of Lichen Planus: Reticular and Erosive Lichen Planus
Most commonly seen on the buccal mucosa but may appear anywhere in the mouth The condition has a characteristic appearance of lacy-white interconnecting lines called Wickham striae Lichen Planus(Reticular Form)
The lesion is composed of Wickham striae along with white plaques that don’t wipe off Lichen Planus(Reticular Form)
The epithelium separates from the connective tissue beneath it leaving exposed connective tissue hemidesmosomes have been destroyed Erosive Lichen Planus
The tissue damage occurs because the immune system treats the person’s own cells and tissues as antigens or foreign Individuals with one autoimmune disease stand at risk for developing another autoimmune disease Autoimmune Diseases
An autoimmune disease that affects the salivary and lacrimal glands This results in decrease in saliva and tears Xerostomia-dry mouth Xerophthalmia- dry eyes Parotid Gland is primarily affected 80% of patients are women between 35-50 years old Sjögren Syndrome
Oral manifestations are dry mouth which leads to erythematous mucosa Lack of saliva makes the mouth feel sticky Generalized loss of filiform and fungiform papilla Sjögren Syndrome
These patients have high risk for caries, periodontal disease, oral candidiasis Bilateral enlargement of the parotid occurs in 50% of cases Sjögren Syndrome
– only involves the skin and mucous membranes- the milder form of lupus Discoid Lupus
– involves multiple organs, skin, mucous membranes, and joints Systemic Lupus
lesions on the face, scalp, external ears, and mucosa are present.  New skin lesions are red plaques with a thick adherent scale that occludes hair follicles.  Long standing lesions-hypopigmented areas with red raised borders that may be present for years Discoid Lupus
-just involves skin and mucous membranes Discoid Lupus
-involves skin, mucous membranes, organs and joints Systemic Lupus
Both types may have malar or butterfly rash (50% of patients have the malar rash) Affects women more than men and black women more than white women Lupus
Tx: hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex, Trexall) Treatment of Lupus
intraepithelial blisters that rupture quickly Pemphigus Vulgaris
Pemphigus vulgaris seems to have a genetic component for Jews and people of Mediterranean descent About 50% of cases of Pemphigus begin with mouth ulcers Pemphigus Vulgaris
Occurs most commonly in 4th and 5th decade of life Because the vesicles and bullae are so fragile, they rupture soon after they form, and are rarely seen Patients will have Positive Nikolsky Sign Pemphigus Vulgaris
Involves the oral cavity in 90% of patients More common than Pemphigus Vulgaris Sometimes called Benign Mucous Membrane Pemphigoid Cicatricial Pemphigoid
Occurs usually in women over 50 Chronic autoimmune disease that affects the oral mucosa, conjunctiva, genital mucosa, and skin This condition is not as severe as pemphigus Cicatricial Pemphigoid
Autoantibodies attack the hemidesmosomes that attach the basal cells of epithelium to the basement membrane This results in a separation(desquamation) of the epithelium from the connective tissue Cicatricial Pemphigoid
The most common site is the gingiva Patients will have Positive Nikolsky Sign Cicatricial Pemphigoid
A ____ sign may be produced by rubbing the gingiva + Nikolsky sign
Named after a Turkish physician (Hulusi Behcet) More prevalent in males between 20-30 Behcet Syndrome
Autoimmune disease consisting primarily of oral ulcers, genital ulcers, and ocular inflammation The oral lesions resemble aphthous ulcers and are painful Behcet Syndrome
Created by: jenn_m_2003