1. Dr Mohammed Malik Afroz

2. BACTERIAL INFECTIONS – 1 1. Scarlet Fever 2. Diptheria 3. Tuberculosis 4. Tetanus 5. Actinomycosis BACTERIAL INFECTIONS – 2 1. Syphilis 2. ANUG/Noma 3. Cat scratch disease 4. Gonorrhea

3.  Caused by treponema pallidum which is a spirochete.  Classification : 1. Acquired : mainly transmitted as venereal disease 2. Congenital : from mother to the child  Manifests in three stages :  1. primary  2. secondary  3. tertiary

4.  Develops at site of inoculation (entry) in 3 to 90 days.  It is an elevated ulcerated nodule showing local induration, painless and producing regional lymphadenitis.  May have scanty serous secretion.  Most commonly occurs at the penis in male or cervix in the female

5.  Develop on the tongue, palate, gingiva and tonsils.  Intra oral chancre is ulcerated, indurated which may be painful due to secondary infection  The chancre heals spontaneously in 3 wks to 2 months

6.  Commences 6 weeks after primary.  Characterized by diffuse eruptions of skin and mucous membrane.  The oral lesions are multiple, painless, greyish white plaques overlying ulcerated surface  The oral lesions occur mostly on the tongue, gingiva, buccal mucosa and are surrounded by erythematous margin.

7.  It is an explosive wide spread form of secondary syphilis characterized by fever headache, muscle pain followed by necrotic ulcerations involving the face and scalp seen in immuno compromised patients.

8.  It is non infectious stage and involves cvs and cns.  The lesions are due to hypersensitivity reaction between the host and treponemes or their break down products.  Sites- skin, mucous membrane mostly.  Also occur in liver, testis and bone.  Intraoral gumma involves the tongue and palate.  In syphilitic glossitis, the tongue becomes fissured, fibrosed and hyperkeratosis occurs.

9.  It is transmitted to the offspring only by infected mother and is not inherited.  Frontal bossing  Irregular thickening of sterno clavicular portion of clavicle  Hutchinson’s Teeth  High arched palate  Mulberry molars  Saddle nose.  Other Findings – short maxilla, high protruberance of mandible.

10.  Investigations –  Ground field microscopy  VDRL  Direct Florescent antibody  Treatment –  2.4 million units of IV pencillin once weekly or thrice weekly depending on the stage  Facial defects can be surgically corrected  Recurrence – no recurrence on complete treatment

11.  ETIOLOGY:  It is caused by specific bacteria namely fusiform bacillus and spirochaetal organisms.  To confirm the presence of the bacteria involved necessary immunological titres of the IgG and IgM antibodies is necessary.  PREDISPOSING FACTORS: 1. Local factors – unhygoenic conditions 2. Systemic factors – underlying diseases 3. Debilitating disease – AIDS, Venereal diseases 4. Psychological factors – Acts as aggravating factor not primary cause

12.  Sudden in onset sometime may be followed by episodic debilitating disease or acute respiratory tract infections  Long hours of working without adequate rest and psychological stress are also frequent feature in the history of ANUG.  INTA ORAL SIGNS AND SYMPTOMS:  SIGNS:  Punched out,crater like depression at the crest of the interdental papilla subsequently involving the marginal gingiva and the attached gingiva.  Craters are covered by greyish pseudo membranous slough  LINEAR ERYTHEMA suggests the demarcation between normal and diseased gingiva  Gingival hemorrhage  Fetid (soaked blood) odour and increased salivation

13.  Local lymphadenopathy  Slightly elevated temperature  In severe cases, marked systemic complications such as high fever,increased pulse rate,leucocytosis,loss of appetite,general lassitude  In rare cases noma or gangrenous stomatitis

14.  This is based on the clinical findings –  Pain  Ulceration and  Bleeding  A bacterial smear is not necessary or definite because the bacterial pictures is same as in other gingival lesions  Differential Diagnosis –  Gonococcal stomatitis  Agranulocytosis  Vincent”s angina  Desquamative gingivitis

15.  Initial stages should be debridement with irrigation and periodontal curettage  Local factors should be removed  Also careful homecare instruction to the patient  Patient should be made aware of the significance of such factors as poor oral hygiene, smoking and stress  Including the Hydrogen peroxide mouth rinses for three days and chlorexidine 12% rinses  Antibiotics prescribed for extensive gingival inflammation,lymphadenopathy,other systemic signs and symptoms other than the gingiva involved

16.  Penicillin regime of 500mg thrice a day  If Allergic to penicillin,erythromycin  Metronidazole of 200mg or 400mg twice a day for 7 days  After the disease is resolved the patient should return for a complete periodontal evaluation because the ANUG may return to severe form of periodontitis.

17.  Rapidly spreading gangrene of the oral & facial tissues in debility & nutritional disturbances.  May be secondary to diphtheria, dysentery, measles, pneumonia, scarlet fever, syphilis, Tuberculosis, blood dyscrasias & anemia. Clinical Features:  Usually starts as a small ulcer of the gingival mucosa. Spreads & involves the surrounding tissues of the jaws, lips & cheeks by gangrenous necrosis.

18.  Overlying skin inflamed, edematous & necrotic with a line of demarcation between sloughing tissue & normal.  Jaw may be exposed- skin turns black in color.  Subcutaneous & buccal pad of fat undergoes necrosis.  Foul smell, high fever.  The patient may die from secondary infection, toxemia & pneumonia.

19.  It is a venereal disease affecting the male and female genital urinary tract  It is caused by neisseria gonorrhea(gram negative)  CLINICAL FEATURES:  Males –urethritis, dysuria, urethal; discharge of purulent nature  Females_cervicitis with candidal or trichomonal vaginitis. Vaginal discharge, dysuria may be present

20.  Lips, gingiva, tongue, palate and buccal mucosa may be invovled  Gonococcal pharyngitis and tonsillitis may be present  The lesions appears as vesicles, ulcers with a grey or white pseudo- membrane  There may be associated fever and lymphadenopathy

21. TRAETMENT:- IM/IV – Pencillin of 2.4million units once daily for 5 days Metronidazole – 400mg IV

22.  Any Questions????