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2 Days to E3!

and i’m not trash-posting at all

according to oxford handbook of clinical dentistry 

Herpes Simplex

Herpes simplex viruses are ubiquitous, host-adapted pathogens that cause a wide variety of disease states. Two types exist: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Both are closely related but differ in epidemiology. HSV-1 is traditionally associated with orofacial disease (see the image below), while HSV-2 is traditionally associated with genital disease; however, lesion location is not necessarily indicative of viral type.

Pathophysiology:

HSV (both types 1 and 2) belongs to the family Herpesviridae and to the subfamily Alphaherpesvirinae. It is a double-stranded DNA virus characterized by the following unique biological properties:

Neurovirulence: the capacity to invade and replicate in the nervous system.

Latency: the establishment and maintenance of latent infection in nerve cell ganglia proximal to the site of infection, In orofacial HSV infections, the trigeminal ganglia are most commonly involved, while, in genital HSV infection, the sacral nerve root ganglia (S2-S5) are involved.

Reactivation: The reactivation and replication of latent HSV, always in the area supplied by the ganglia in which latency was established, can be induced by various stimuli (eg, fever, trauma, emotional stress, sunlight, menstruation), resulting in overt or covert recurrent infection and shedding of HSV. In immunocompetent persons who are at an equal risk of acquiring HSV-1 and HSV-2 both orally and genitally, HSV-1 reactivates more frequently in the oral rather than the genital region. Similarly, HSV-2 reactivates 8-10 times more commonly in the genital region than in the orolabial regions. Reactivation is more common and severe in immunocompromised individuals. 

The herpes simplex virus is a contagious virus that can be passed from person to person through direct contact. Children will often contract HSV-1 from early contact with an infected adult. They then carry the virus with them for the rest of their life. Infection with HSV-1 can happen from general interactions such as eating from the same utensils, sharing lip balm, or kissing. HSV-2 is contracted through forms of sexual contact with a person who has HSV-2.

Primary HSV:

Varies widely in severity (increase with age); often subclinical, asymptomatic in 80%. In infancy is often mistakenly attributed to ‘teething’. Presents with a single episode of widespread stomatitis and unstable mucosa with vesicles which break down to form shallow painful ulcers, enlarged, tender cervical lymph nodes, halitosis, coated tongue, fever and a general malaise for 10–14 days.Although generally self-limiting, rare complications include herpetic encephalitis and meningitis. diagnosis:  based on the clinical features and history, although the virus can be grown in cell culture.Microscopically ballooning degeneration of epithelial cells with intranuclear viral inclusions ‘Lipshutz bodies’ are seen.

treatment:

bed rest, topical and systemic analgesia, a soft or liquid diet with extra fluid intake, and prevention of secondry infection (chlorhexidine mouthwash) is usually adequate in healthy patients. Severely ill or immunocompromised patients should receive systemic aciclovir.

Recurrent HSV infections:

affecting mucocutaneous junction of the lips (herpes labialis, cold sore) is a reactivation of the primary infection which is believed to lie dormant in dorsal root, and autonomic or cranial nerve ganglia (trigeminal or geniculate).

Even if a virus is dormant, an outbreak can be triggered by certain stimuli, such as:

stress.

trauma.

menstrual periods.

fever or illness.

sun exposure or sunburn.

Prodromal phase (burning/tingling) over 24h is followed by vesiculation and pain. Lesions may respond to 1% penciclovir or aciclovir 5% cream if used in the prodromal stage. Should consider systemic aciclovir in the immunosuppressed or frequent recurrences.

Varicella Zoster

(human herpesvirus 3) is neurogenic DNA virus which causes chickenpox as a primary infection (varicella) and shingles as a reactivation (zoster).

Varicella-zoster virus (VZV) causes chickenpox and herpes zoster (shingles). Chickenpox follows initial exposure to the virus and is typically a relatively mild, self-limited childhood illness with a characteristic exanthema, but can become disseminated in immunocompromised children. Reactivation of the dormant virus results in the characteristic painful dermatomal rash of herpes zoster, which is often followed by pain in the distribution of the rash (postherpetic neuralgia).

Chickenpox

Classically an itchy, vesicular, cutaneous, centripetal rash affects children with peak age 5–9yrs, rarely affecting the oral mucosa. Patients are contagious from 1–2 days before the rash, until all lesions crusted.

Shingles

more commons in the immunocompromised, alcoholic, and elderly.Is confined to the distribution of a nerve, the virus staying either in the dorsal root ganglion of a peripheral nerve or the trigeminal ganglion.unilateral lesion never crossing the midline.Facial or oral lesions may arise in the area supplied by the branches of the trigeminal nerve. 

diagnosis: pre-eruption pain, followed by development of painful vesicles on skin or oral mucosa, which rupture to give ulcers or crusting skin wounds.These usually clear in 2–4 weeks, with scarring and pigmentations and is often followed by severe post-herpetic neuralgia which may continue for years.

treatment: symptomatic relief for chickenpox.There is some evidence to suggest that aggressive early treatment of shingles with aciclovir (within 3 days of first vesicle) decreasing the incidence and severity of post-herpetic neuralgia in immunocompromised patients.

Herpangina

causative agent: Coxsackie A virus

confined to children and presents with widespread small ulcers on the oral mucosa with fever and general upset. Clinically it resembles herpetic stomatitis, but site pathognomic affecting uvula, palate, and fauces with no gingivitis. May be preceded by sore throat and conjunctivitis. Can also be mistaken as ‘teething’.Self-limiting in 10–14 days. Spread by faeco-oral route.

Hand, foot, and mouth disease

Caused by Coxsackie virus is similar to herpangina but the lesions are present throughout the oral cavity. A papular, vesicular rash appears on the hands and feet in conjunction with nasal congestion and

oral mucosal vesicles. These break down, leaving painful superficial ulcers,

particularly on the palate. The gingivae are rarely involved. It is self-limiting

in 10–14 days. treatment bed rest, topical and systemic analgesia, a soft or liquid diet with extra fluid intake.

Human papilloma virus

HPV virus infects at least 50% of all people who have sex at some time in their lives. Often, people don't have any symptoms and the HPV infection goes away on its own. Some types of HPV can lead to cervical cancer or cancer of the anus or penis.

has been associated with squamous cell papilloma condyloma acuminatum, focal epithelial hyperplasia, and verruca vulgaris.

treatment: local surgery and possibly interferon for benign growths.

Measles

Measles, or rubeola, is a viral infection of the respiratory system. Measles is a very contagious disease that can spread through contact with infected mucus and saliva. An infected person can release the infection into the air when they cough or sneeze.

The prodromal phase of measles may be marked by small white spots with an erythematous margin on the buccal mucosa, known as Koplik spots. A few days later the maculo-papular rash of measles appears, usually behind the ears, then spreading to the face and trunk. Complications include pneumonia and encephalitis which may lead to neurological deficits in 40% and has a 15% mortality.

Glandular fever (infectious mononucleosis)

seen mostly in children and young adults and spread by infected saliva. It varies widely in severity and presents with sore throat, generalized lymphadenopathy,

fever, headaches, general malaise, and often a maculo-papular rash. There may be hepatosplenomegaly. Oral manifestations may mimic primary herpetic gingivostomatitis, with widespread oral ulceration, and in addition petechial hemorrhage, especially at the junction of hard and soft palate (pathognomonic) and bruising may be present. The cause is usually Epstein–Barr virus (EBV) and less commonly, cytomegalovirus (CMV). Toxoplasmosis can give a similar picture.diagnosis: initially monospot test, Paul–Bunnell test to exclude EBV and acute and convalescent titres for CMV and toxoplasmosis.Be aware that early HIV infection can mimic this condition. treatment: symptomatic as for primary herpes, except toxoplasmosis, which may respond to sulfa drugs; seek expert advice.  Ampicillin should not be given to patients with a sore throat who may have glandular fever as it inevitably produces an unwanted response, ranging from a rash to anaphylaxis.Opportunistic infection on the tongue mucosa by EBV is thought to be the pathological mechanism behind ‘hairy leucoplakia’, which is found intransplant and HIV positive patients.

Reiter syndrome

(reactive arthritis)

Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex. Pregnant women with the disease can spread it to their baby. This disease, called congenital syphilis, can cause abnormalities or even death to the child.

Syphilis is caused by the bacteria Treponema pallidum.

Syphilis was once a major public health threat, commonly causing serious long-term health problems such as arthritis, brain damage, and blindness. It defied effective treatment until the late 1940s, when the antibiotic penicillin was first developed.

Syphilis infection occurs in three distinct stages:

Early or primary syphilis:

People with primary syphilis will develop one or more sores called a chancre. chancre is painless, but it’s highly infectious.The sores are usually small painless ulcers. They occur on the genitals or in or around the mouth somewhere between 10-90 days (average three weeks) after exposure. Even without treatment they heal without a scar within six weeks.

The secondary stage

may last one to three months and begins within six weeks to six months after exposure. People with secondary syphilis experience a rosy “copper penny” rash typically on the palms of the hands and soles of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. They may also experience moist warts in the groin, white patches on the inside of the mouth, swollen lymph glands, fever, and weight loss. Like primary syphilis, secondary syphilis will resolve without treatment.

Other symptoms of secondary syphilis may include:

headaches.

swollen lymph glands.

fatigue.

fever.

weight loss.

hair loss.

aching joints.

Latent syphilis:

This is where the infection lies dormant (inactive) without causing symptoms.

Tertiary syphilis:

If the infection isn’t treated, it may then progress to a stage characterized by severe problems with the heart, brain, and nerves that can result in paralysis, blindness, dementia, deafness, impotence, and even death if it’s not treated.Some other potential outcomes of tertiary syphilis include:

blindness.

deafness. 

mental illness. 

memory loss. 

destruction of soft tissue and bone. 

neurological disorders, such as stroke or meningitis. 

heart disease.

neurosyphilis, which is an infection of the brain or spinal cord.

Syphilis can be easily diagnosed with a quick and inexpensive blood test given at your doctor’s office or at a public health clinic.

Syphilis can be diagnosed by testing samples of:

Blood. Blood tests can confirm the presence of antibodies that the body produces to fight infection. The antibodies to the bacteria that cause syphilis remain in your body for years, so the test can be used to determine a current or past infection.

Cerebral spinal fluid. If it’s suspected that you have nervous system complications of syphilis, it is suggested to collecting a sample of cerebrospinal fluid through a procedure called a lumbar puncture (spinal tap).

A single injection of penicillin can stop the disease from progressing if you’ve been infected for less than a year. If you’ve had syphilis for longer than a year, you may need additional doses Benzathine penicillin G (2.4 million units administered intramuscularly).

Penicillin is the only recommended treatment for pregnant women with syphilis.

For those allergic to penicillin, tetracycline, doxycycline or another antibiotic can be given instead.

Congenital syphilis

Congenital syphilis is a severe, disabling, and often life-threatening infection seen in infants. A pregnant mother who has syphilis can spread the disease through the placenta to the unborn infant.

classical appearance:

saddle nose.

frontal bossing.

sensorineural deafness.

Hutchinson incisors (peg-shaped with notch).

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What is Candidiasis ?

Candidiasis is a fungal infection caused by yeasts that belong to the genus Candida. There are over 20 species of Candida yeasts that can cause infection in humans, the most common of which is Candida Albans. Candida yeasts normally reside in the intestinal tract and can be found on mucous membranes and skin without causing infection; however, overgrowth of these organisms can cause symptoms to develop.

in the oral cavity of normal individuals, candida species are present in lower concentration ( less than 200 cells per millimeter of saliva).

Candidiasis of the mouth and throat, also known as “thrush" or oropharyngeal candidiasis, is a fungal infection that occurs when there is overgrowth of a yeast called Candida.

What Causes It?

Candidiasis occurs when there is an overgrowth of Candida. Causes may include: 

Physiological factors: such as age and genetic factors. 

Hormonal factors: such as hypoparathyroidism, diabetes mellitus and addison’s disease.

Iatrogenic factors: such as long-term use of broad spectrum antibiotics, cancer chemotherapy, radiotherapy and immunosuppressive therapy.

Systemic factors: such as carcinoma, rheumatoid arthritis, lupus erythematosus, iron deficiency, pernicious anemia, lichen planus, AIDS, hereditary disorders associated with impaired immune response.

Local factors: such a suse of denture, angular chelitis, over closure of mouth, leukoplakia.

What are the Signs and Symptoms of Candidiasis?

creamy white bumps on the tongue, inner cheeks, gums, or tonsils.

slight bleeding when the bumps are scraped.

pain at the site of the bumps.

dry, cracked skin at the corners of the mouth.

difficulty swallowing.

How  Oral Candidiasis Can be Prevented?

Good oral hygiene practices may help to prevent oral thrush in people with weakened immune systems. Some studies have shown that chlorhexidine (CHX) mouthwash can help to prevent oral candidiasis in people undergoing cancer treatment. People who use inhaled corticosteroids may be able to reduce the risk of developing thrush by washing out the mouth with water or mouthwash after using an inhaler.

How  Oral Candidiasis Can be diagnosed?