VIRUS. Viral infection causing, or associated with diseases of the oral mucosa : Herpes Simpleks 1 & 2

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1 VIRUS Viral infection causing, or associated with diseases of the oral mucosa : VIRUS Herpes Simpleks 1 & 2 Varicella - Zoster Coxsakie A PENYAKIT Primary Gingivostomatitis Herpetica Herpes Labialis Recurrent Herpes Intra Oral Recurrent Herpetic Whitlow Chickenpox Herpes Zoster Herpangina Hand, foot and mouth disease

2 Viral infection causing, or associated with diseases of the oral mucosa : VIRUS PENYAKIT Cytomegalovirus Salivary gland disease Epstein Barr Virus Paramyxovirus Papilomavirus H I V Hairy leukoplakia Measles Viral warts Manifestasi oral HIV

3 HERPES SIMPLEX VIRUS INFECTION Family herpesviridae Herpes simplex virus 1 Herpes simplex virus 2 Cytomegalovirus Varicella-zoster virus Epstein Barr virus Human herpes virus-6 Human herpes virus-7 Human herpes virus-8

4 Herpes Simplex virus 1 perioral, eyes Herpes Simplex virus 2 genitals TRANSMISSION : 1. Airbone droplets 2. Intimate contact

5 HERPES SIMPLEX VIRUS INFECTION PRIMARY INFECTION RECURRENT INFECTION

6 PRIMARY HSV-1 INFECTION : - Seronegative for HSV - Children, young adult - Does not imply clinical signs & symptoms subclinical - Incubation periode : several days 2 weeks - Primary Gingivostomatitis Herpetica Herpetic Whitlow

7 PRIMARY GINGIVOSTOMATITIS HERPETICA. CLINICAL APPEARANCES : - Prodromal symptoms : fever, malaise, nausea, headache, lymphadenopathy. - Vesicle rupture round/oval ulcers, shallow, grey-white pseudomembrane, surrounded by erythema area. - Ulcers can coalescent large ulcers. - Pain, disorders of swallowing, eating, secondarily infected. - Location: any intra oral. - Acute gingivitis marginalis gingiva are swollen with red edges that bleed easily. - Heal : days self limiting disease, without scar.

8 Treatment : Goals : 1. To shorten the current attack. 2. To prevent recurrences. Medications : Analgesics. Vitamin. Anaesthetic topical. Antivirus.

9 RECURRENT HSV INFECTION : - Affect 20 40% 0f adult population. - Antibody for HSV was present. - Reactivation of latent virus by trigger factors. - Recurrent Herpes Labialis Recurent Herpes Intra Oral Herpetic Whitlow.

10 RECURRENT HERPES LABIALIS. CLINICAL APPEARANCES : - Prodromal symptoms : mild fever, tingling, burning or pain in which lesions will appear. - Vesicles on the vermillion border of lip rupture shallow ulcer. - Yellow crust formation. - Problems : pain, cosmetic disfigurement, psychosocial effect. - Heal : 1 2 weeks without scar. - Recurrences is variable.

11 RECURRENT HERPES INTRAORAL. CLINICAL APPEARANCES : - Prodromal symptoms mild. - Vesicles rupture ulcers. - Intraorally. Recurrent Herpes Labialis maybe seen concurently with the intraoral lesions or they occur alone.

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13 Varicella zoster virus PRIMARY INFECTION RECURRENT INFECTION CHICKENPOX / VARISELA HERPES ZOSTER / SHINGLES

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21 TREATMENT : - Bed rest. - Local applications of heat. - Topical anesthetic. - Antiviral. - Analgesics. - tranquilizers.

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23 ORAL CANDIDIASIS A SUPERFICIAL INFECTION OF ORAL MUCOUS CAUSED BY THE YEASTLIKE FUNGUS CANDIDA ALBICANS

24 FACTORS PREDISPOSING TO ORAL CANDIDIASIS : LOCAL FACTORS SYSTEMIC FACTORS Denture wearing Saliva Xerostomia, low ph Commensal flora High-carbohydrate diet Smoking tobacco Physiological Old age, infancy, pregnancy Endocrine disorders Diabetes Melitus Nutritional deficiencies Iron, folate, vit.b 12 Malignancies Leukemia Immune defects HIV / AIDS Drugs / medication Broad spectrum antibiotics Corticosteroids Cytotoxic drugs

25 CLASSIFICATION OF ORAL CANDIDIASIS : T Y P E CLINICAL ACUTE : ACUTE PSEUDOMEMBRANOUS CANDIDIASIS = ORAL TRUSH Creamy / white patches on the surface of oral mucous; forming confluent; curd-like pseudomembranes. Pseudomembranes can be scraped off to reveal raw, erythematous base. ACUTE ATROPHIC CANDIDIASIS = ANTIBIOTIC SORE TONGUE Small lesions, usually on the tongue, with reddening / inflammation of surrounding tissue

26 T Y P E CHRONIC : Chronic Atrophic Candidiasis = Denture Stomatitis CLINICAL Chronic erythema and edema of upper palate localized to occluded / traumatized tissue Chronic hyperplastic White patch adherent to mucous on Candidiasis an erythematous base which is not = Candida Leukoplakia removable by digital pressure. Usually on the anterior buccak mucous Angular cheilitis =Perleche Erythema, fissure and encrustations at corners of mouth.

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36 DIAGNOSIS : CLINICAL APPEARANCES + LABORATORIUM EXAMINATIONS : * Culture * Cytologic * Serology

37 TREATMENT : To correct predisposing factors To correct sources of infection Antifungal drugs

38 ANTIFUNGAL DRUGS POLYENE AZOLES A. AMFOTERICIN B B. NYSTATIN A.IMIDIAZOLE : - Clotrimazole - Ketoconazole - Miconazole B. TRIAZOLE : - Fluconazole - Itraconazole

39 Tuberculosis Tuberculosis is a widespread infectious disease caused by Mycobacterium Tuberculosis that affects humans, animal and birds Predisposing factors - Poor nutrition - General debilitating diseases - Iatrogenic immunosuppression - Overcrowded living conditions - Certain respiratory diseases

40 Symptoms - Weight loss - Mild cough --- Persistent cough accompanied by bloody sputum - Anorexia - Fatigability - Afternoon rise in temperature - Night sweats - Cavitary pneumonia in chest radiograph

41 Oral Manifestations Pulmonary Tuberculosis Oral Contact of the oral tissues with infected sputum Sites : - lips, buccal mucosa, tongue, palate, corner of the mouth - Periapikal dental granulomata - Salivary gland - Tuberculosis periostitis

42 Lips : small tubercle ulcer Cheeks : irregular undermined border Tongue : most common lateral margin site of irritant deep central ulcer base thick mucous material

43 Diagnosis - Tuberculin test positive - Chest radiography - Systemic symptom - Smear sputum Differential Diagnosis - Chancre - Gumma - Carcinoma - Traumatic ulcer - Infection ulcer

44 Medical and Dental management Patients at high risk are highly contagious Dental procedure should be deferred Patient referred to their physician for further evaluation and management

45 GONORRHEA Gonorrhea is an almost exclusively sexually Gonorrhea is an almost exclusively sexually transmitted infection caused by a gram negative intracellulary located diplococcus Neisseria gonorrhoeae

46 Clinical Feature -Most common site is urethra - Incubation period 2-8 day - Most frequently seen in patients years old - High risk : military personnel, migrant group, homosexual men, prostitutes - Profuse purulent urethral discharge in male - In female more mild. asymptomatic

47 Asymptomatic Lesions occur within a week of genital contact Similar to Acute Necritizing Ulcerative Ginggivitis (ANUG) Gonococcal stomatitis Diffuse areas of mucosal erythema Oral Findings

48 Medical and Dental management - Referred to the physician for definitive treatment - Routine dental care should be postponed until treatment is completed