1. Oral Manifestations of Infectious Diseases in Children
Reference:
Pinkham, Chapter 4

2. Common Oral Conditions
Acquired
Developmental
Congenital

3. Acquired Oral Conditions
Infections:
Viral
Bacterial
Candida
Autoimmune lesions
Glossitis
Discolored teeth

4. INFECTIOUS DISEASES DIAGNOSTIC CRITERIA Obtain medical history
Obtain dental history
Conduct complete clinical examination
Obtain necessary laboratory and radiographic studies.

5. 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

6. HERPETIC GINGIVOSTOMATITIS
Diagnosis:
Age: Young patients History
First exposure to HSV
Viral culture, serum antibody
Vesicle develop on the lips, tongue, gingival, palate

7. 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

8. 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

9. 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.

10. 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.

11. 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 re-infected again.

12. 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.

13. HERPES ZOSTER (CHICKEN POX)
Treatment:
Self-limiting (7-10 days)
- Contagious
Palliative treatment:
Bed rest, antipyretics and analgesics.
- Nails

14. 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.

15. 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.

16. 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)

17. HAND, FOOT, AND MOUTH DISEASE
Causative Agent
Coxsakie A Virus (A-16)
Tend to occur in epidemics
Incubation period: 2-6 days
Incidence: Children 1-10 years
Symptoms: Low grade fever and malaise

18. 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

19. HAND, FOOT, AND MOUTH DISEASE
Oral Manifestation:
Multiple scattered superficial ulcers in the:
tongue, buccal mucosa,
less frequently in palate, gingiva, and lips

20. HAND, FOOT, AND MOUTH DISEASE
Healing:
Oral lesions: days
Skin lesions: 1-2 weeks
Treatment:
Palliative treatment

22. IMPETIGO Causative Agent: Bullous caused by staphylococci
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.

23. IMPETIGO- Diagnosis Subjective: Objective: Non-Bullous: Bullous:
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)

24. IMPETIGO - Treatment Non-bullous: Bullous:
Minimal type: - Water soaks to remove crust
- Topical antiseptic cleaner
- Topical antibiotics 2-3/day
- If no healing, systemic antibiotics.
Moderate or excessive type:
- Antibiotics: Penicillin G or erythromycine
Bullous:
Penicillinase-resistant penicillin (dicloxacillin)

25. 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

26. SCARLET FEVER Oral Manifestation: Treatment: Penicillin for 10 days
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)

27. CANDIDIASIS Causative Agent: Evaluation: 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

28. CANDIDIASIS: Diagnosis:
Subjective Findings:
Sore throat
Burning sensation
Or Asymptomatic
Objective Findings:
Pseudomembranous form:
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

29. CANDIDIASIS Treatment: Mild: Moderate: Severe:
Topical antifungal agents (Nystatin)
Moderate:
Systemic antifungal agents (Ketoconazole)
Severe:
Systemic antifungal agents (Amphotericin B).

31. INFECTIOUS DISEASES DIAGNOSTIC CRITERIA TYPES
Obtain medical and dental history
Conduct complete and thorough clinical examination
Obtain necessary laboratory and radiographic studies.
TYPES
VIRAL
BACTERIAL
Fungal

32. 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

35. PEDIATRIC HIV INFECTION
Causative Agent
Clinical Presentation

36. PEDIATRIC HIV INFECTION
Diagnosis:
Treatment: