DR.LINDA MAHER

INFECTION AND INFLAMMATION INFECTION Infection is disease caused by a specific invading microorganism (virus, bacteria,, parasite, etc.). INFLAMMATION Inflammation is the body's response to an irritation which may be infection, chemical or autoimmune

DIAGNOSIS OF ORAL INFECTIONS 1\clinical manifestations 2\detailed history 3\biopsy of the lesion and histopathological investigations 4\serological antibody test

VIRUS A virus is a small infectious agent that replicates only inside the living cells of other organisms. COMMON VIRUSES AFFECTING ORAL MUCOSA: HIV HERPES SEMPLEX VIRUS(HSV) EPESTIN BARR VIRUS(EBV) HUMAN PAPILLOMA VIRUS(HPV) COXSACKIE VIRUS INFECTIOUS MONONUCLEOSIS

DIFFERENCE BETWEEN VIRUS AND BACTERIA VIRUS BACTERIA Non living organism which needs a living host to survive viral infections are systemic. This means they involve many different parts of the body or more than one body system at the same time.(mostly causes fever, malaise,and fatigue) more difficult to kill Can not be treated with antibiotics Living microorganism bacterial infection are localized (causes redness, heat, swelling and pain in specific part of the body) Can be treated with antibiotics

MANAGEMENT OF VIRAL INFECTIONS TREATMENT OF VIRAL INFECTIONS DEPENDS ON: 1\strength of the individual’s immune system 2\ their overall health status 3\ age 4\the severity of the condition 5\ type of viruses involved.

GENERAL RULES IN MANAGEMENT : 1\viral infections usually only require symptomatic treatment(analgesics to decrease pain-antipyretic for fever) 2\supportive therapy(to improve the overall body health and immunity) -eating foods rich in vitamins -drinking plenty of fluids -bed rest 3\in severe cases antiviral drugs may be indicated

1\HERPES SEMPLEX VIRUS(HSV) TRANSMISSION: By direct contact After treatment of primary infection the virus become latent and can be activated again by certain triggering factors to cause secondary infection PRIMARY INFECTION: Causes acute herpetic stomatitis SECONDARY INFECTION: Causes herpes labialis(cold sore or fever blister)

1\PRIMARY ACUTE HERPETIC STOMATITIS;

CLINICAL FEATURES : Most of primary infections with HSV are subclinical(no clinical manifestations) The lesions are vesicles which can affect any part of the oral mucosa but mostly the hard palate and the dorsum of the tongue. The vesicles are 2-3 mm in diameter. they rupture leaving circular,sharply defined,shallow ulcers with yellowish or grayish floor and red margins Ulcers are painful and may interfere with eating

Systemic manifestations: Regional lymph node enlargement Fever, malaise and systemic upset DIAGNOSIS: 1\mainly clinical 2\biopsy 3\antibody titer(level of antibodies against HSV in the blood) TREATMENT: Aciclovir(topical) Bed rest, fluid intake,soft diet USUALLY prolong herpetic ulcerations that persist for more than a month not responding to acyclovir is an AIDS-defining illness

2\HERPES LABIALIS:

After the primary infection,the latent virus can be reactivated in % of patient to cause herpes labialis or cold sores(fever blisters) TRIGGERING FACTORS: common cold - other febrile infections emotional upset - strong sunshine menstruation -any local irritation such as dental treatment

CLINICAL FEATURES: 1\Prodromal paresthesia or burning sensation in the lip 2\then, erythema at the site of the attack 3\vesicles form after an hour or two, usually in clusters along the mucocutaneous junction of the lip, but can extend onto the adjacent skin. 4\the vesicles enlarge, coalesce and weep exudates. after two or three days they rupture and crust over. The whole cycle may take up to 10 days

TREATMENT: Aciclovir cream Penciclovir 2hourly is more effective.

2\VERICELLA ZOOSTER VIRUS(VSV) Can cause primary or secondary infection After the primary exposure the virus remains latent in nerve ganglion e.g. trigeminal ganglion When reactivated, the secondary lesion well affect the dermatome corresponding to the affected ganglion 1\PRIMARY INFECTION: Causes chickenpox mainly in children 2\SECONDARY REACTIVATION: Causes zoster mainly in elderly

1\chickenpox

2\RECURRENT HERPES ZOSTER(shingles) :

CLINICAL FEATURE: 1\pain and irritation in the dermatome corresponding to the trigeminal ganglion(along the distribution of the trigeminal nerve) 2\then vesicles are formed on one side of the face and mouth up to the midline. 3\regional lymph nodes are enlarged and tender 4\fever and malaise 5\the acute phase usually lasts about a week.

MANAGEMENT: 1\Aciclovir 800 mg 5 times per day for 7 days 2\analgesics 3\in very severe cases prednisolone(steroid) may be indicated

3\COXSACKIE A VIRUS CAUSES HAND FOOT AND MOUTH DISEASE This is a common,mild viral infection which is highly infectious and often causes minor epidemics among school children. CLINICAL FEATURES: IT is characterized by ulcerations in the mouth and a vesicular rash in the extremities. 1\ORALY: the small scattered oral ulcers causes little pain –gingivitis is not a feature.

2\regional lymph nodes are not usually enlarged. 3\systemic upset is typically mild or absent. 4\the rash consist of vesicles mainly seen around the base of fingers or toes

TREATMENT: No specific treatment is needed and the disease typically resolves within a week

4\EPSTEIN BARR VIRUS CAUSES INFECTIOUS MONO NUCLEOSIS Acute,self limited infectious disease primarily affects young adolescents. CLINICAL FEATURES: 1\fever,malaise,headache,sore throat and fatigue 2\The oral manifestations are early and common, and consist of palatal petechiae, uvular edema, tonsillar exudates, gingivitis, and rarely ulcers Generalized lymphadenopathy, hepatosplenomegaly, maculopapular skin rash are common.

Palatal petechiae

TREATMENT: Symptomatic non specific treatment

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