manifestation of bacterial and viral diseases in oral cavity 6dm i

Manifestation of Manifestation of bacterial and viral bacterial and viral diseases in oral diseases in oral cavitycavity

6DM 6DM

I.

Common childhood Common childhood affections in oral affections in oral cavitycavity Viral –Viral – primary herpetic gingivostomatitis, primary herpetic gingivostomatitis,

secondary herpes labialis, herpangina, secondary herpes labialis, herpangina, chickenpox, mumps, measles, gladular fever, chickenpox, mumps, measles, gladular fever, HIVHIV

Bacterial –Bacterial – impetigo, streptococcal impetigo, streptococcal stomatitis, acute ulcerative gingivitis (rare stomatitis, acute ulcerative gingivitis (rare under 16)under 16)

Fungal -Fungal - candidacandida

Miscellaneous –Miscellaneous – aphtous ulcerationaphtous ulceration

InfluenzaInfluenza

CAUSE:CAUSE: influenza viruses, Orthomyxoviridae, RNA influenza viruses, Orthomyxoviridae, RNA TRANSMISION:TRANSMISION: airborne dropletsairborne dropletsSYMPTOMS:SYMPTOMS: chills and fever, sore throat, muscle pains, chills and fever, sore throat, muscle pains,

severe headache, coughing, weakness and general severe headache, coughing, weakness and general discomfort.discomfort.

I.O.: dry mouth, coated tongue +hyperemia and edema, I.O.: dry mouth, coated tongue +hyperemia and edema, sometimes vivid red color, rarely enanthema bucally, sometimes vivid red color, rarely enanthema bucally, later vesicles, erosionslater vesicles, erosions

Little papulae on the mucosa of hard palate, dry lips, Little papulae on the mucosa of hard palate, dry lips, rhagaderhagade

DIAGNOSIS:DIAGNOSIS: Diagnostic tests available for influenza Diagnostic tests available for influenza include viral culture, serology, rapid antigen testing, include viral culture, serology, rapid antigen testing, polymerase chain reaction (PCR), and polymerase chain reaction (PCR), and immunofluorescence assaysimmunofluorescence assays

TREATMENT:TREATMENT: symptomaticsymptomatic COMPLICATIONS:COMPLICATIONS: pneumoniapneumonia

Measles - Measles - MorbilliMorbilli

most fremost freqquent of childuent of child’s diseases’s diseases CAUSE:CAUSE: paramyxovirus of the genus paramyxovirus of the genus

MorbillivirusMorbillivirus SYMPTOMS:SYMPTOMS: high fever, high fever, ccough, ough,

ccoryza(runny nose), oryza(runny nose), cconjunctivitis and a onjunctivitis and a generalized maculopapular, erythematous generalized maculopapular, erythematous rash (exanthema)rash (exanthema)

TRANSMISSION:TRANSMISSION: through respiration, highly through respiration, highly contagiouscontagious

INCUBATION PERIOD:INCUBATION PERIOD: 10–14 days (during 10–14 days (during which there are no symptoms). Infected which there are no symptoms). Infected kids remain contagious from the kids remain contagious from the appearance of the first symptoms until 3–5 appearance of the first symptoms until 3–5 days after the rash appears.days after the rash appears.


CL.CL.picpic.:.: Koplik spots seen in prodromal stage Koplik spots seen in prodromal stage

inside the mouthinside the mouth,, are are pathognomonic (diagnostic) for pathognomonic (diagnostic) for measles but are not often seen, measles but are not often seen, even in real cases of measles, even in real cases of measles, because they are transient and may because they are transient and may disappear within a day of arising. disappear within a day of arising.

Small white spots with an erythematous margin on the bucal, palatal and palatal arches mucosa, size of a pinhead. The characteristic measles rash is classically described as a generalized, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the head, spreads behind ears, on the neck, body and extremities, often causing itching.Tongue is coated, hyperemia and hypetrophy of papilae,


DIAGNOSIS:DIAGNOSIS: Clinical diagnosis - a history of fever of at least Clinical diagnosis - a history of fever of at least

three days together with at least one of the three days together with at least one of the three C. Observation of Koplik's spots is also three C. Observation of Koplik's spots is also diagnostic of measles.diagnostic of measles.

Alternatively, laboratory diagnosis of measles Alternatively, laboratory diagnosis of measles can be done with confirmation of positive can be done with confirmation of positive measles IgM antibodies or isolation of measles IgM antibodies or isolation of measles virus RNA from respiratory measles virus RNA from respiratory specimens. specimens.

DIF.DG.:DIF.DG.: gsh, stomatitis catarrhalis, gsh, stomatitis catarrhalis, candidosiscandidosis

TREATMENT:TREATMENT: symptomaticsymptomatic


COMPLICATIONS:COMPLICATIONS: mild diarrhea, pneumonia mild diarrhea, pneumonia and encephalitis (subacute sclerosing and encephalitis (subacute sclerosing panencephalitis), corneal ulceration leading panencephalitis), corneal ulceration leading to corneal scarring. Complications are usually to corneal scarring. Complications are usually more severe amongst adults who catch the more severe amongst adults who catch the virus.virus.

MMR vaccine (measles, mumps, rubella), MMR vaccine (measles, mumps, rubella), the the routine administration of MMR vaccine at routine administration of MMR vaccine at ages 12-15 months and at 4-6 yearsages 12-15 months and at 4-6 years

after diseaseafter disease life-long immunity life-long immunity

Inflammation and Infection: Inflammation and Infection: Hand – Foot – Mouth diseaseHand – Foot – Mouth disease

A rash with blisters affects the A rash with blisters affects the throat, tonsils, hands and feetthroat, tonsils, hands and feet. . Ulcers on oral mucosa and Ulcers on oral mucosa and gingiva. gingiva. The illness is usually mild The illness is usually mild and the rash heals in 7 days. and the rash heals in 7 days.

Cause Cause Coxsackie virus, Coxsackie virus, enterovirus. enterovirus.

Incubation period:Incubation period: 3-7days 3-7days

IncidenceIncidence The infection The infection commonly affects young children commonly affects young children from 2 weeks to 3 years old. from 2 weeks to 3 years old.


Symptoms Symptoms prodromal: fever, sore throat, prodromal: fever, sore throat,

headache, cough and loss of headache, cough and loss of appetite, enlarged LN. Blisters appetite, enlarged LN. Blisters or ulcers form in the throat or ulcers form in the throat and mouth (buccal, palate, and mouth (buccal, palate, tongue). tongue).

A rash (exanthema) with A rash (exanthema) with blisters forms on the hands, blisters forms on the hands, feet and diaper area, feet and diaper area, periungual localisation. periungual localisation.

Recovery is usually complete Recovery is usually complete in 5 to 7 days. in 5 to 7 days.


Prevention Prevention a avoid contact with those who void contact with those who are thought to be are thought to be infected. infected.

DiagnosisDiagnosis is made on physical examination is made on physical examination and history of recent illness. Histology – and history of recent illness. Histology – intraepitelial vesicleintraepitelial vesicle

Dif.dg.:Dif.dg.: herpangina, g.s.hherpangina, g.s.h


TreatmentTreatment symptomatic. symptomatic. - s- salt water mouth rinses can be soothing. An alt water mouth rinses can be soothing. An

adequate fluid intake is important. Rivanol, adequate fluid intake is important. Rivanol, vit.B,C, liquid powder, ATB, Zoviraxvit.B,C, liquid powder, ATB, Zovirax

Complications Complications - - possible convulsions with high fever (febrile possible convulsions with high fever (febrile

seizures). seizures). - - viral meningitis.viral meningitis.

Gingivostomatitis herpetica

HSV

-The most common viral stomatitis, primary infection

-Occurrence: in children 1-6 years adolescents and adults up to 35 year

-Transmission: droplet infection and direct contact

-Incubation period: 5-7 days

-Clinically: prodromal stage with uncharacteristic symptoms, sore throat, enlarged lymph nodes. After 1-4 days, the general symptoms subside and intraoral appear. A typical small intraepithelial vesicles the reddened oral mucosa, including gingiva

GSH AFTA

Lesion multiple solitary

Locality Hard palate, gingiva, tongue, possible extraoral localisation

Floor of the mouth, vestibular gingiva

Size < 1 mm 2mm - cm

MMumps - Parotitis umps - Parotitis epidemica epidemica

CAUSE:CAUSE: Mumps virus, Mumps virus, ParamyxoviridaeParamyxoviridae

TRANSMISSION:TRANSMISSION: direct contact with direct contact with droplets of salivadroplets of saliva

INCUBATION PERIOD:INCUBATION PERIOD: 18-22 days18-22 days SYMPTOMS:SYMPTOMS: sudden onset of fever (38sudden onset of fever (38

C,C, lasting 3-7days), pain and parotid lasting 3-7days), pain and parotid swelling, elevated earlobeswelling, elevated earlobe

Parotid inflammation (or parotitis) - Parotid inflammation (or parotitis) - causes swelling and local pain, causes swelling and local pain, particularly when chewing. Classically particularly when chewing. Classically on one side first (unilateral), later on one side first (unilateral), later bilateral swelling. Hard and painful bilateral swelling. Hard and painful mouth opening, mild trismus, difficult mouth opening, mild trismus, difficult swallowingswallowing


Orchitis, referring to painful Orchitis, referring to painful inflammation of the testicle. inflammation of the testicle. Males past puberty who develop Males past puberty who develop mumps have a 30 percent risk of mumps have a 30 percent risk of orchitis.orchitis.

I.O.: enanthem on bucal mucosa, I.O.: enanthem on bucal mucosa, Inflamated red swollen d. Inflamated red swollen d. Stenoni, normal or Stenoni, normal or hyposalivation,hyposalivation,

MMumps - Parotitis umps - Parotitis epidemica epidemica Sometimes submandibular gland is affected Sometimes submandibular gland is affected

as well, but sublingual very rarelyas well, but sublingual very rarely Other symptoms of mumps can include sore Other symptoms of mumps can include sore

face and/or ears and occasionally in more face and/or ears and occasionally in more serious cases, loss of voice.serious cases, loss of voice.

DIAGNOSIS:DIAGNOSIS:.. based on clinical picture and no based on clinical picture and no confirmatory laboratory testing is needed, or confirmatory laboratory testing is needed, or PCR if uncertain in specific casesPCR if uncertain in specific cases

DIF.DG.:DIF.DG.: other types of parotid inflammationother types of parotid inflammation


TREATMENT:TREATMENT: symptomatic - symptomatic - bed rest, bed rest, Paracetamol for pain relief. Warm salt water Paracetamol for pain relief. Warm salt water gargles, soft foods, and extra fluids, avoid gargles, soft foods, and extra fluids, avoid fruit juice or any acidic foodsfruit juice or any acidic foods

COMPLICATIONS:COMPLICATIONS: orchitis, mastitis, orchitis, mastitis, pancreatitis, meningoencephalitis, hearing pancreatitis, meningoencephalitis, hearing lossloss

MMR vaccine (measles, mumps, rubella), MMR vaccine (measles, mumps, rubella), life-life-long immunitylong immunity

RubeRubelllala – German – German measlesmeasles

CAUSE:CAUSE: Rubella virus, RNA virus, genus Rubivirus, Rubella virus, RNA virus, genus Rubivirus, TogaviridaeTogaviridae

TRANSMISION:TRANSMISION: via airborne droplet emissionvia airborne droplet emission INCUBATION PERIOD:INCUBATION PERIOD: 14-21 days14-21 days SYMPTOMS:SYMPTOMS:

- - often mild, often mild,

- - rash (exanthema) on the face which spreads to the rash (exanthema) on the face which spreads to the trunk and limbs, trunk and limbs,

- - low grade fever, low grade fever,

- - swollen glands (post cervical lymphadenopathy), swollen glands (post cervical lymphadenopathy),

- - joint pains (transient arthropathy), headache, joint pains (transient arthropathy), headache, conjunctivitis conjunctivitis

RubeRubelllala – German – German measlesmeasles

I.O.: small, red papules on the area of the soft I.O.: small, red papules on the area of the soft palate, tongue non-spalate, tongue non-sppecific, as in morbilliecific, as in morbilli

DIAGNOSIS:. the presence of these antibodies (Rubella virus specific IgM antibodies) along with, or a short time after, the characteristic rash confirms the diagnosis.

DIF.DG.: morbilli, scarlatina TREATMENT: symptomatic

COMPLICATIONS: congenital rubella syndrome - comprises cardiac, cerebral, ophthalmic and auditory defects. The risk of major defects or organogenesis is highest for infection in the first trimester. MMR vaccine (measles, mumps, rubella), life-long immunity

MononucleosisMononucleosis – – Glandular feverGlandular fever "the kissing disease""the kissing disease" CAUSE:CAUSE: Epstein-Barr virus (EBV), which infects Epstein-Barr virus (EBV), which infects

B cells (B-lymphocytes), less commonly CMVB cells (B-lymphocytes), less commonly CMV TRANSMISION:TRANSMISION: infected salivainfected saliva INCUBATION PERIOD:INCUBATION PERIOD: 4-14 days4-14 days SYMPTOMS:SYMPTOMS: vary widely in severity (acute, vary widely in severity (acute,

subacute, chronic form) - sore throat, subacute, chronic form) - sore throat, generalized lymphadenopathy, fever, generalized lymphadenopathy, fever, headache, malaise, maculo-papular rash, headache, malaise, maculo-papular rash, hepatosplenomegalyhepatosplenomegaly

I.O.: may mimic g.s.h., widespread oral I.O.: may mimic g.s.h., widespread oral ulcerations, petechiae, bruisingulcerations, petechiae, bruising

DIAGNOSIS:DIAGNOSIS: clinical picture, lymphocytosis, Paul-clinical picture, lymphocytosis, Paul-Bunnell test to exclude EBV, abnormal liver Bunnell test to exclude EBV, abnormal liver function testsfunction testsDIF.DG.:DIF.DG.: DiphtheriaDiphtheria, tularemia, leukemia, , tularemia, leukemia, infectious hepatitisinfectious hepatitisTREATMENT: symptomatic, Penicillin or other antibiotics should be administered to treat the strep throat, rest, liver dietAmpicillin, amoxicillin should not be given to patients with sore throat – rashCOMPLICATIONS: subacute form - several moths: fatigue, hepatopathy,

lifelong imunity

MononucleosisMononucleosis – – Glandular feverGlandular fever

ACUTE FORM:ACUTE FORM: Sudden onset, high fever, Sudden onset, high fever,

petechiae on soft palate, edema petechiae on soft palate, edema of eyelids, malaise, headache, of eyelids, malaise, headache, abdominal pain, vomiting, abdominal pain, vomiting, anorexia, diarrhea. Fever 39-anorexia, diarrhea. Fever 39-40st.C, 4-5 days, within 3 days 40st.C, 4-5 days, within 3 days sore throat, tonsils coated, sore throat, tonsils coated, enlarged, LN submandibular, enlarged, LN submandibular, cervical, auricular enlarged cervical, auricular enlarged (check LN in axilla and inguina)(check LN in axilla and inguina)

Chickenpox - Chickenpox - VaricellaVaricella

CAUSE:CAUSE: VCV varicella-zoster virus, Herpesviridae, VCV varicella-zoster virus, Herpesviridae, primary infection – chickenpox, reactivation - primary infection – chickenpox, reactivation - shinglesshingles

TRANSMISION:TRANSMISION: spread easily through aerosolized spread easily through aerosolized droplets or through direct contact with secretions droplets or through direct contact with secretions from the rash.from the rash.

INCUBATION PERIOD:INCUBATION PERIOD: 10-21 days, a person with 10-21 days, a person with chickenpox is contagious from one to five days chickenpox is contagious from one to five days before the rash appears and until all vesicules have before the rash appears and until all vesicules have formed crust (5 to 10 days)formed crust (5 to 10 days)

SYMPTOMS:SYMPTOMS: start as a two to four millimeter red start as a two to four millimeter red papule which develops an irregular outline (a rose papule which develops an irregular outline (a rose petal), later vesicle, breaks leaving a crust, which petal), later vesicle, breaks leaving a crust, which falls off after seven days, may leave a crater-like falls off after seven days, may leave a crater-like scarscar


DIAGNOSIS:DIAGNOSIS: clinical, typical clinical, typical prodromal symptoms, prodromal symptoms, vvesicle fluid examinesicle fluid examinationation, , or direct fluorescent or direct fluorescent antibodyantibody

TREATMENT:TREATMENT: symptomatic, symptomatic, sodium bicarbonate baths sodium bicarbonate baths or antihistamine or antihistamine medication ease itching, medication ease itching, paracetamolparacetamol , liquid talc , liquid talc with mentholwith menthol


COMPLICATIONS:COMPLICATIONS: congenital varicella congenital varicella syndromesyndrome/neonatal /neonatal varicella, conjunctivitis, varicella, conjunctivitis, stomatitisstomatitis

I.O.:I.O.: pustula pinhead size, pustula pinhead size, rupture, maceration, rupture, maceration, aphta/ulcer-like lesionsaphta/ulcer-like lesions

Localisation: bucal, hard Localisation: bucal, hard palate, tongue, lipspalate, tongue, lips

Smallpox - Smallpox - VariolaVariola

The global eradication of smallpox was The global eradication of smallpox was certified, based on intense verification certified, based on intense verification activities in countries, by a commission of activities in countries, by a commission of eminent scientists on 9 December 1979 and eminent scientists on 9 December 1979 and subsequently endorsed by the World Health subsequently endorsed by the World Health Assembly on 8 May 1980Assembly on 8 May 1980

Any surgery is contraindicatedAny surgery is contraindicated

ATB to prevent secondary infectionATB to prevent secondary infection

Scarlet fever - Scarlet fever - ScarlatinaScarlatina CAUSE:CAUSE: exotoxin released by exotoxin released by ββ-haemolytic -haemolytic

streptococci streptococci TRANSMISIONTRANSMISION: : airborne droplet emisionairborne droplet emision INCUBATION PERIODINCUBATION PERIOD: : 1-7 days1-7 days SYMPTOMS:SYMPTOMS: very painfulvery painful sore throat – sore throat –

tonsillitis, pharyngitis, malaise, headache, tonsillitis, pharyngitis, malaise, headache, high fever (40st.C), vomiting,high fever (40st.C), vomiting,

skin rash - fine sandpaper rash over the skin rash - fine sandpaper rash over the upper body, begins to fade three to four upper body, begins to fade three to four days after onset and desquamation days after onset and desquamation (peeling) begins.(peeling) begins.

No rash circumorally – “white mustache” – No rash circumorally – “white mustache” – Filatov’s signFilatov’s sign

Scarlet fever - Scarlet fever - ScarlatinaScarlatina

I.O.: I.O.: strawberry tongue,strawberry tongue, enanthema especially soft enanthema especially soft palate tonsils and bucal areaspalate tonsils and bucal areas

DIAGNOSIS:DIAGNOSIS: clinical, if blood clinical, if blood test - leukocytosis with test - leukocytosis with neutrophilia, high erythrocyte neutrophilia, high erythrocyte sedimentation rate (ESR) and sedimentation rate (ESR) and C-reactive protein (CRP),C-reactive protein (CRP),

DIF.DG.:DIF.DG.: morbilli, rubella, morbilli, rubella, toxoallergic drug exanthematoxoallergic drug exanthema

Enathema, yellowish coating, edema, teeth impression on the sides of tongue, keratinisation disorders, hyperkeratosis of papillae, the tip and sides of tongue vivid red colour

Rarely vesicles-necrosis-glossitis necrotisans

strawberry tongue

TREATMENT: ATB (PNC, clindamycin or erythromycin)- agrimony tea irrigation, intensive oral hygieneCOMPLICATIONS: septic complications due to spread of streptococcus in blood

DiphtheriaDiphtheria

upper respiratory tract illness characterized by upper respiratory tract illness characterized by sore throat, low fever, and an adherent sore throat, low fever, and an adherent membrane (a pseudomembrane) on the membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavitytonsils, pharynx, and/or nasal cavity

eradicated in developed nations through eradicated in developed nations through widespread vaccination widespread vaccination

DPT (Diphtheria–Pertussis–Tetanus) vaccineDPT (Diphtheria–Pertussis–Tetanus) vaccine CAUSE:CAUSE: Corynebacterium diphtheriae, G+Corynebacterium diphtheriae, G+ TRANSMISION:TRANSMISION: direct physical contact or direct physical contact or

breathing the aerosolized secretions of breathing the aerosolized secretions of infected individualsinfected individuals

INCUBATION PERIOD:INCUBATION PERIOD: 1-7 days1-7 days

Bull’s neck

DiphtheriaDiphtheria

SYMPTOMS:SYMPTOMS: The onset of disease is usually The onset of disease is usually gradual. Symptoms include fatigue, fever, a gradual. Symptoms include fatigue, fever, a mild sore throat and problems swallowing. mild sore throat and problems swallowing. Later tonsils and oropharynx vivid red color, Later tonsils and oropharynx vivid red color, whitegray / yellow pseudomembranes, whitegray / yellow pseudomembranes, adherent, cannot be wiped off, stomatitis adherent, cannot be wiped off, stomatitis diphterica, coated tongue, foetor ex ore diphterica, coated tongue, foetor ex ore

Sore throat, vomiting, fever, enlargement of Sore throat, vomiting, fever, enlargement of cervical LN, slightly painfulcervical LN, slightly painful

DIAGNOSISDIAGNOSIS::. . iisolation of Corynebacterium solation of Corynebacterium diphtheriae from a clinical specimen, diphtheriae from a clinical specimen, histopathologyhistopathology

Bull’s neck

TREATMENT:- diphtheria anti-toxin- antibiotics do not help healing of local infection, used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others- Erythromycin, Procaine penicillin, Rifampin or Clindamycin- Local - mouthwashes, intensive oral hygiene

PertussisPertussis – whooping – whooping coughcough CAUSE:CAUSE: Bordetella pertusisBordetella pertusis TRANSMISION:TRANSMISION: contact with airborne contact with airborne

discharges from the mucous membranes of discharges from the mucous membranes of infected peopleinfected people

INCUBATION PERIOD:INCUBATION PERIOD: 7–21 day7–21 day SYMPTOMS:SYMPTOMS: initially by mild respiratory initially by mild respiratory

infection symptoms such as coughing, infection symptoms such as coughing, sneezing, and runny nose (catarrhal stage). sneezing, and runny nose (catarrhal stage). After one to two weeks, the cough changes After one to two weeks, the cough changes character, with an increase of coughing character, with an increase of coughing followed by an inspiratory "barking" sound followed by an inspiratory "barking" sound (paroxysmal stage). (paroxysmal stage).

I.O.: catarrhal stage – non-specific stomatitisI.O.: catarrhal stage – non-specific stomatitis paroxysmal stage – paroxysmal stage – ulcus frenuli linguaeulcus frenuli linguae, , trauma by lower teeth during coughing, edema trauma by lower teeth during coughing, edema of face and eyof face and eyeelids (dif.dg. Periostitis)lids (dif.dg. Periostitis)DIAGNOSIS: culturing of nasopharyngeal swabs, polymerase chain reaction (PCR), serology

TREATMENT: antibiotic (erythromycin or azithromycin)COMPLICATIONS: pneumonia, encephalitis, pulmonary hypertension, and secondary bacterial superinfection

Impetigo is a highly contagious bacterial skin infection most common among pre-school children. People who play close contact sports such as rugby, American football and wrestling are also susceptible,regardless of age. Impetigo is not as common in adults. The name derives from the Latin impetere It is also known as school sores.

Impetigo contagiosaThis common form of impetigo, also called nonbullous impetigo, most often begins as a red sore near the nose or mouth which soon breaksleaking pus or fluid, and forms a honey-colored scab followed bya red mark which heals without leaving a scar.Sores are not painful but may be itchy.LN in the affected area may be swollen, but fever is rare. Touching or scratching the sores may easily spread the infection to other parts of the body.[3]

Impetigo contagiosaThis common form of impetigo, also called nonbullous impetigo, most often begins as a red sore nearthe nose or mouth which soon breaks leaking pusor fluid, and forms a honey-colored scab followed bya red mark which heals without leaving a scar.Sores are not painful but may be itchy.LN in the affected area may be swollen, but fever is rare. Touching or scratching the sores may easily spread the infection to other parts of the body.

CausesIt is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes.TransmissionThe infection is spread by direct contact with lesions or with nasal carriers. The incubation period is 1–3 days. Dried streptococci in the air are not infectious to intact skin. Scratching may spread the lesions.DiagnosisImpetigo generally appears as honey-colored scabs formed from dried serum, and is often found on the arms, legs, or face.

TreatmentFor generations, the disease was treated with an application of the antiseptic gentian violet.Today, topical or oral antibiotics are usually prescribed.Mild cases may be treated with bactericidal ointment, more severe cases require oral antibiotics, such as dicloxacillin, flucloxacillin or erytromycin.

Inflammation and Infection: Inflammation and Infection: Candidiasis Candidiasis (Oral Thrush)(Oral Thrush)

Causes Causes Candida albicans is a normal commensal of the Candida albicans is a normal commensal of the

mouth.mouth. Its growth is normally kept under control by Its growth is normally kept under control by

the other normal micro-organisms of the mouth. the other normal micro-organisms of the mouth. Overgrowth of Candida can be caused by factors Overgrowth of Candida can be caused by factors

which reduce the individuals natural resistance. which reduce the individuals natural resistance. These factors include stress, long term use of These factors include stress, long term use of corticosteroids or drugs, which suppress the corticosteroids or drugs, which suppress the immune system, and AIDS. Other conditions can immune system, and AIDS. Other conditions can upset the balance of normal micro-organisms in upset the balance of normal micro-organisms in the mouth allowing the Candida to proliferate. the mouth allowing the Candida to proliferate. This is commonly associated with antibiotics, DM, This is commonly associated with antibiotics, DM, and hormonal changes occurring in pregnancy. and hormonal changes occurring in pregnancy.

• Incidence - Candidiasis is most common in: Infants and toddlers – undernourished, prolonged atb or steroids th

• Individuals whose immune responses have been suppressed by disease or drugs. • Long term use of antibiotics, corticosteroids and anti-cancer drugs.

• Symptoms • Ulcers form in the mouth, usually on the tongue or inner cheeks.The lesions are painful, slightly raised, and creamy white in appearance.

PreventionPrevention Good oral hygiene is important. Those at risk Good oral hygiene is important. Those at risk

can be given prophylactic antifungal can be given prophylactic antifungal medication. medication.

Tests Tests Removal of the white lesions reveals a red, Removal of the white lesions reveals a red,

tender area which may bleed.tender area which may bleed. A microscopic A microscopic examination of tissue from the lesion will examination of tissue from the lesion will confirm Candida. confirm Candida.

Treatment Treatment It is important to treat any underlying condition. It is important to treat any underlying condition. Antifungal medications such as nystatin, Antifungal medications such as nystatin,

miconazole or clotrimazole can be given to treat miconazole or clotrimazole can be given to treat the infection. the infection.

Good oral hygiene helps the healing process. Good oral hygiene helps the healing process. Especially in denture induced candidal infections.Especially in denture induced candidal infections.

Complications These include insufficient nutrition, as the oral

thrush can be very painful. The Candida may spread to the GIT, lungs or other areas.

manifestation of bacterial and viral diseases in oral cavity 6dm i

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