1. Oral Manifestations of Systemic Diseases
Reference: Pinkham, Chapter 4

2. HERPETIC GINGIVOSTOMATITIS
Causative Agent:
Herpes Simplex Virus (HSV) Type I
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

3. HERPETIC GINGIVOSTOMATITIS
Diagnosis:
Age: Young patients
History : First exposure to HSV
Viral culture, serum antibody
Treatment:
SELF-LIMITING (7-10 DAYS)
Palliative: Bed rest, fluids…etc.

4. 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

5. 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 hrs.
- Healing in 7-10 days.
Treatment:
Self-limiting. Healing without scar.

6. HERPES ZOSTER (CHICKEN POX)
Causative Agent:
Varicilla-Zoster Virus (reactivation)
Evaluation:
Exposure to infected person
More common in winter and spring time
Most patients develop life-immunity

7. HERPES ZOSTER (CHICKEN POX)
Diagnosis:
Subjective: Fever, malaise, chills
Objective: Vesicles starts on trunk, spread to extremities. Lesions crust and heal.
Oral: Vesicles that rupture leaving small ulcers with red margins.
Treatment:
- Self-limiting - Contagious
- Palliative treatment - Nails

8. 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.

9. HERPENGINA Diagnosis: Treatment:
Subjective: Viral infection S/S (fever, malaise ..etc)
Objective: Multiple vesicles on soft palate and tonsillar area. Vesicles ulcerate (gray with erythematous base). Ulcers are painful.
Treatment:
- Self-limiting - Contagious
- Palliative treatment - Fluid (dehydration)

10. HAND, FOOT, AND MOUTH DISEASE
Causative Agent
Coxsakie A Virus (A-16)
Evaluation:
Epidemics, more common in children

11. HAND, FOOT, AND MOUTH DISEASE
Diagnosis:
Subjective: Incubation (2-6 days) followed by viral S/S.
Objective: Painful vesicles that ulcerate.
Oral: Hard palate, tongue and buccal mucosa
Palms and soles
Treatment:
Self-limiting (7-10 days), healing without scaring
Palliative treatment

12. IMPETIGO Causative Agent: Evaluation: Two Types:
Bullous caused by staphylococci
Non-bullous caused by streptococci
Evaluation:
Gram stain good for bullous type
Throat cluture

13. IMPETIGO
Diagnosis:
Subjective: Hx of insect bites, exposure to infected person. Lesions are asymptomatic
Objective:
Non-Bullous: Lesion: Thick, adherent-yellowish-brown crust (coalesce to form large lesion). Found in face and extremities.
Bullous: Flaccid large bullae (anywhere)
2-3 days rupture discrete round lesion
plycyclic area
Treatment:

14. SCARLET FEVER
Causative Agent
Clinical Presentation

15. SCARLET FEVER
Diagnosis:
Treatment:

16. CANDIDIASIS
Causative Agent
Clinical Presentation

17. CANDIDIASIS
Diagnosis:
Treatment:

18. DIABETES MELLITS
Causative Agent
Clinical Presentation

19. DIABETES MELLITS
Diagnosis:
Treatment:

20. ACUTE LYMPHOBLASTIC LEUKEMIA
Causative Agent
Clinical Presentation

21. ACUTE LYMPHOBLASTIC LEUKEMIA
Diagnosis:
Treatment:

22. SICKLE CELL ANEMIA
Causative Agent
Clinical Presentation

23. SICKLE CELL ANEMIA
Diagnosis:
Treatment:

24. HISTIOCYTOSES (HISTOCYTOSIS X)
Causative Agent
Clinical Presentation

25. HISTIOCYTOSES (HISTOCYTOSIS X)
Diagnosis:
Treatment:

26. HEMOPHILIA (HEMOPHILIA A; FACTOR VIII DEFICINENCY)
Causative Agent
Clinical Presentation

27. HEMOPHILIA (HEMOPHILIA A; FACTOR VIII DEFICINENCY)
Diagnosis:
Treatment:

28. PEDIATRIC HUMAN IMMUNO-DEFICNEINCY VIRUS INFECTION
Causative Agent
Clinical Presentation

29. PEDIATRIC HUMAN IMMUNO-DEFICNEINCY VIRUS INFECTION
Diagnosis:
Treatment:

30. QUESTIONS