Transcript Development of Occlusion

Oral Manifestations of
Infectious Diseases in
Children
Reference:
Pinkham, Chapter 4
Common Oral Conditions
 Acquired
 Developmental
 Congenital
Acquired Oral Conditions
Infections:
Viral
Bacterial
Candida
Autoimmune lesions
Glossitis
Discolored teeth
INFECTIOUS DISEASES
 DIAGNOSTIC
 Obtain
CRITERIA
medical history
 Obtain dental history
 Conduct complete clinical examination
 Obtain necessary laboratory and
radiographic studies.
HERPETIC GINGIVOSTOMATITIS
 Causative Agent:
Herpes Simplex Virus (HSV) Type I

Clinical Evaluation:

Viral infection S/S (malaise, fever..etc)
 Clinical:
- Vesicle develop on the lips, tongue, gingival, palate
- Vesicles rupture to form large painful ulcers
- Gingiva: Edematous, bleeds easily
HERPETIC GINGIVOSTOMATITIS
 Diagnosis:



Age: Young patients History
First exposure to HSV
Viral culture, serum antibody
Vesicle develop on the lips, tongue, gingival, palate
HERPETIC GINGIVOSTOMATITIS
 Treatment:
 SELF-LIMITING
(7-10 DAYS)
 Palliative mouthrinses.
 Orabase, or petroleum jelly, as a protective
barrier
 Dehydration is a concern
 Patient is contagious
 Antibodies and steroids are contraindicated
RECURRENT HERPES SIMPLEX
(HERPES LABIALIS)

Causative Agent: HSV – I (reactivation of the
virus lying in the trigeminal ganglion).

Clinical Presentation:
- Hx of similar lesion
- Small ulcers in the lip at:
- mucocutaneous junction or
- at the corner of the mouth, or
- beneath the nose
RECURRENT HERPES SIMPLEX
(HERPES LABIALIS)

Diagnosis:

Subjective findings:
- Itching before ulcer development.
- Mild flu like symptoms.

Objective findings:
- Vesicles (2-4 mm), rupture and
crust over 36-48 hrs.
- Healing in 7-10 days.
RECURRENT HERPES SIMPLEX
(HERPES LABIALIS)
 Treatment:
 Self-limiting.
 Different
Tx. modalities proposed:
Lesion should be well lubricated
 Prophylactic or oral acyclovir:



for suppression of herpes labialis: No evidence of
effectiveness
reduce the frequency – best success if lesion >
1/month.
 Healing
without scar.
HERPES ZOSTER
(CHICKEN POX)

Causative Agent:
Varicilla-Zoster Virus (reactivation of the virus
months or years after chicken pox can occur)

Evaluation:




Exposure to infected person
More common in winter and spring time
Most patients develop life-long immunity
Children who are infected early in life or experience a
particularly mild or sub-clinical case may become reinfected again.
HERPES ZOSTER
(CHICKEN POX)

Diagnosis:

Subjective: Fever, malaise, chills

Objective: Vesicles starts on trunk, spread to extremities and
face. Lesions crust and heal.

Oral: Vesicles that rupture leaving small ulcers with red
margins. These lesions are not very painful.
HERPES ZOSTER
(CHICKEN POX)
 Treatment:
Self-limiting (7-10 days)
- Contagious
- Palliative treatment:
-
-
Bed rest, antipyretics and analgesics.
- Nails
HERPENGINA

Causative Agent:
Coxsakie A Virus (types 2,3,4,5,6,8,10).

Evaluation:



Common in young children (< 4 yrs)
Recent exposure to infected person (epidemic)
More common during summer and fall.
HERPENGINA
 Diagnosis:
 Subjective:
Viral infection S/S (fever, malaise
..etc)
 Objective:



Multiple vesicles on soft palate and tonsillar area.
Vesicles ulcerate leaving gray area with erythematous
base. Ulcers are painful.
Lesions do not involve anterior 2/3 of the mouth.
HERPENGINA
 Treatment:
- Self-limiting: Acute symptoms persists for 3
days
- Oral lesions heal in 7 to 10 days without
scarring
- Contagious ( isolation of the patient)
- Palliative treatment:
-
Bed rest, antipyretics and analgesics
Oral Fluid (dehydration)
HAND, FOOT, AND MOUTH
DISEASE

Causative Agent
Coxsakie A Virus (A-16)
Tend to occur in epidemics

Incubation period:
 Incidence:
 Symptoms:
2-6 days
Children 1-10 years
Low grade fever and malaise
HAND, FOOT, AND MOUTH
DISEASE
 Signs





Maculopapular rash: 2-10 mm
Appears on palms and soles
and ventral surface of fingers
and toes
Become vesicular in 1-2 days
Persists for 1-2 weeks
Vesicles rupture and form
painful aphthous like
ulceration
HAND, FOOT, AND MOUTH
DISEASE
 Oral
Manifestation:
 Multiple
scattered
superficial ulcers in the:
tongue, buccal mucosa,
 less frequently in palate,
gingiva, and lips

HAND, FOOT, AND MOUTH
DISEASE
 Healing:
 Oral lesions:
 Skin lesions:
5-10 days
1-2 weeks
 Treatment:
 Palliative treatment
IMPETIGO
 Causative Agent:
 Two
Types:
Bullous caused by staphylococci
 Non-bullous caused by streptococci

 Evaluation:

Gram stain good for bullous type only because
non-bullous type can be secondarily infected by
staphylococci.

Throat and skin cultures for family members.
IMPETIGO- Diagnosis
 Subjective:
 Hx of insect bites, exposure to infected person.
 Lesions are asymptomatic
 Objective:

Non-Bullous:



Thick, adherent-yellowish-brown crusted lesions
(coalesce to form large lesion).
Found in face and extremities.
Bullous:


Flaccid large bullae (anywhere),
rupture in 2-3 days to form discrete round lesion
(polycyclic area)
IMPETIGO - Treatment
 Non-bullous:

Minimal type:

Moderate or excessive type:
- Water soaks to remove crust
- Topical antiseptic cleaner
- Topical antibiotics 2-3/day
- If no healing, systemic antibiotics.
- Antibiotics: Penicillin G or erythromycine
 Bullous:

Penicillinase-resistant penicillin (dicloxacillin)
SCARLET FEVER

Causative Agent:
ß hemolytic streptococci

Clinical Presentation:



Incubation period: 3-5 days
Symptoms: pharyngitis, headache, fever, nausea,
vomiting, cervical lymphadenopathy
Within 2-3 days: Skin rash develops as bright red
papular skin rash
SCARLET FEVER
 Oral




Manifestation:
Strawberry tongue (white coating with the
papillae being erythematous and
prominent)
The coating is lost leaving an erythematous
smooth surface.
congestion of oral mucosa and palate
A grayish-white exudates may cover the
tonsils and facial pillars.
 Treatment:



Penicillin for 10 days
Mouthrinse (debridement of infected
area)
Paracetamol (Pain relief)
CANDIDIASIS

Causative Agent:



Candida albicans
Infection is established if normal oral normal
flora is altered ( patient takes steroids,
antibiotics for long time)
Evaluation:

It is important to identify the underlying cause
CANDIDIASIS: Diagnosis:
 Subjective



Sore throat
Burning sensation
Or Asymptomatic
 Objective



Findings:
Pseudomembranous form:


Findings:
Raised-white-curdy plaque
Scaping leave a raw bleeding
surface
Erythrematous form: Red surface
mostly on the tongue and palate
Lesions may occur on any mucosal
surface
CANDIDIASIS
 Treatment:
 Mild:

Topical antifungal agents (Nystatin)
 Moderate:

Systemic antifungal agents (Ketoconazole)
 Severe:

Systemic antifungal agents (Amphotericin B).
INFECTIOUS DISEASES

DIAGNOSTIC CRITERIA




Obtain medical and dental history
Conduct complete and thorough clinical
examination
Obtain necessary laboratory and radiographic
studies.
TYPES



VIRAL
BACTERIAL
Fungal
VIRAL INFECTIONS

Primary herpes
 Recurrent herpes
 Herpes zoster (chicken pox)
 Cat Scratch Disease
 Herpangina
 Hand, foot, and mouth disease
 Rubeolla measels
 Rubella (German measles)
 Infectious mononucleosis
PEDIATRIC HIV INFECTION
 Causative Agent
 Clinical
Presentation
PEDIATRIC HIV INFECTION
 Diagnosis:
 Treatment: