1. Pediatric Dentistry
“Features of the structure and function of oral mucosa (mucous membrane) in children. Viral mucous membrane lesions: clinical features, diagnosis, treatment and prevention.”
Lecturer: Dr. Katrin Duda

2. Oral Mucosa
The oral cavity is lined by a mucous membrane that consists of:
mucosa
Epithelium
Lamina propria
A submucosa, which is not always present

3. Oral Mucosa
There is considerable variabilty in the type of epithelium present, as well as in the characteristics of the connective tissue. As a consequence, several regions are usually distinguished from one another:
Lining mucosa
Masticatory mucosa (mucoperiosteum)
Specialized mucosa
A transitional zone (vermilion zone)

4. Lining Mucosa
The epithelium of lining mucosa is a non-keratinized stratified squamous epithelium, which has a:
A basal layer
An intermediate layer (similar to spinous layer)
A superficial layer
The thickness of the epithelium is variable. For example, in the buccal mucosa the the epithelium is relative thick, whereas on the floor of the mouth it is quite thin.

5. Lining Mucosa
As in the skin,"immigrant" cells (Langerhans cells, Merkel cells and melanocytes) are also present within the basal and suprabasal layers of the mucosal epithelium. Recall that Langerhans cells are derived from bone marrow an have an immune function, Merkel cells are associated with intraeipthelial nerve endings and and melanocytes (neural crest origin) synthesize melanin pigment.

6. Lining Mucosa
The underlying connective tissue (lamina propria) is separated from the epithelium by a basement membrane. The lamina propria is similar in structure and composition to the dermis of the skin. In the papillary layer there are connective tissue papillae and epithlial ridges. However, the interface between the mucosal epithelium and connective tissue is fairly "flat" compared to that in either skin or masticatory mucosa. The deeper submucosa is analagous to the hypodermis or subcutus of the skin, and it contains glands and adipose tissue.

7. Lining Mucosa
As with other connective tissues, the most common cell type in both the lamina propria and the submucosa is the fibroblast. Other cells, particularly macrophages and mast cells, are also present, and under conditions of inflammation, neutrophils, lymphocytes and plasma cells may also be seen. Collagen type I is the predominant fiber component of the extracellular matrix. Both collagen type III and elastic fibers are found in the lamina propria and submucosa, but their proportions vary depending on the region. Clinically, the relatively "loose" nature of the connective tissue in lining mucosa allows for the easy and relatively painless injection of local anesthetic solutions.

8. Masticatory Mucosa
In contrast to lining mucosa, masticatory mucosa has a keratinized stratified squamous epithelium:
Basal layer
Spinous layer
Granular layer
Cornified layer
Orthokeratinized -- no nuclei present
Parakeratinized -- pyknotic nuclei retained
The epithelial ridges and connective tissue papillae are long and numerous.

9. Masticatory Mucosa
In addition to a keratinized epithelium and the complex epithelial-connective tissue junction, the lamina propria of masticatory mucosa is often directly attached to the periosteum of the underlying alveolar or palatal bone, i.e. there is no submucosa. This arrangement is also called a "mucoperiosteum". There are exceptions to this eneralization, however. In the posterior lateral region of the hard palate, for example, there is a submucosa containing adipose tissue and numerous minor salivary glands.

10. Specific Regional Variation
Differences in both the epithelium and the underlying connective tissue contribute to regional variation within the oral cavity. One of the most important functional aspects of this regional variation is the effects on permeability. The oral mucosa acts as a permeability barrier, much like the lining of the intestine. However, in certain areas (floor of the mouth, ventral surface of the tongue) both the epithelium and the underlying connective tissue are thin, and there is an extensive capillary network in the lamina propria. Transmucosal adsorption of drugs, for example, occurs rapidly across these surfaces.

11. The Mucogingival and Mucocutaneous Junctions
The boundaries between lining mucosa and masticatory mucosa, as well as between the skin and labial mucosa, are relatively sharply defined. The mucogingival junction is the border between the alveolar mucosa and the gingiva. The mucocutaneous junction is found at the vermilion zone where the skin is continuous with the labial mucosa. The line separating the skin from the red vermilion zone is sometimes called the vermilion border.

12. Epithelial differentiation: Metaplasia and Dysplasia
The differentiation of epithelium in the oral cavity is regulated by growth factors and retinoids, as in the skin. In addition, the underlying connective tissue plays a significant role in epithelial differentiation. Following wounding, epithelium at the edges of the wound proliferate to reepithelkialize the surface. The phenotype of the epithelium (keratinized versus non-keratinized) is determined largely by the connective tissue. Thus, gingiva regains keratinized epithelium, and alveolar mucosa will have its non-keratinized epithelium restored. This is of considerable clinical significance when doing gingival and other grafts within the oral cavity.

13. Epithelial differentiation: Metaplasia and Dysplasia
Epithelial differentiation can also be influenced by functional stresses and other factors (e.g. smoking). The linea alba, for example, is a region of lining mucosa that changes to a keratinizing phenotype. This is an example of metaplasia. In metaplasia, the terminal differentiation of the epithelium is altered, but the basic architecture of is maintained. In "premalignant lesions", however, you start to see mitotic activity in the suprabasal layers, and there may be considerable variability in nuclear morphology. This is referred to as dysplasia.

14. Herpes simplex
Oral herpes is an infection of the lips, mouth, or gums due to the herpes simplex virus.

15. Herpes simplex
Oral herpes is an infection caused by the herpes simplex virus. The virus causes painful sores on the lips, gums, tongue, roof of the mouth and inside the cheeks. It also can cause symptoms such as fever and muscle aches.
The herpes simplex virus only affects humans. Mouth sores most commonly occur in children aged 1-2 years, but they can affect people at any age and any time of the year.

16. Herpes simplex
People contract herpes by touching infected saliva, mucous membranes, or skin. Because the virus is highly contagious, most people have been infected by at least one herpes subtype before adulthood.

17. Herpes simplex Three stages:
Primary infection: The virus enters your skin or mucous membrane and reproduces. During this stage, oral sores and other symptoms, such as fever, may develop. The virus may not cause any sores and symptoms. This is called asymptomatic infection. Asymptomatic infections occur twice as often as the disease with symptoms.
Latency: From the infected site, the virus moves to a mass of nervous tissue in spine called the dorsal root ganglion. There, the virus reproduces again and becomes inactive.
Recurrence: When experience certain emotional or physical stresses, the virus may reactivate and cause new sores and symptoms.

18. Oral herpes causes
Herpes simplex is a DNA virus that causes sores in and around mouth. Two herpes subtypes may cause these sores.
Herpes simplex virus type 1, or herpes-1, which causes around 80% of cases of oral herpes infections
Herpes simplex virus type 2, or herpes-2, which causes the rest.

19. Oral herpes symptoms
Incubation period: For oral herpes, the amount of time between contact with the virus and the appearance of symptoms, called the incubation period, is 2-12 days. The average is about four days.
Duration of illness: Signs and symptoms will last two to three weeks. In addition to below symptoms, fever, tiredness, muscle aches and irritability may occur.

20. Oral herpes symptoms
Pain, burning, tingling or itching occur at the infection site before the sores appear. Then clusters of blister erupt. These blisters break down rapidly and, when seen, appear as tiny, shallow, grey ulcers on a red base. A few days later, they become crusted or scabbed and appear drier and more yellow.
Neck lymph nodes often swell up and become painful
The gums may become mildly swollen and red and may bleed.

21. Oral herpes symptoms
Oral sores: The most intense pain caused by these sores is felt when they first appear, and can make eating and drinking difficult. The sores may occur on the lips, the gums, the front of the tongue, the inside of the cheeks, the throat and the roof of the mouth. They may also extend down the chin and neck.
In people in their teens and 20s, herpes may cause a painful throat with shallow ulcers and a greyish coating on the tonsils.

22. Exams and Tests
Doctor can diagnose oral herpes by looking at your mouth area. Sometimes, a sample of the sore is taken and sent to a laboratory for closer examination. Tests may include:
Viral culture
Viral DNA test
Tzanck test to check for HSV

23. Treatment Acyclovir Famciclovir Valacyclovir
Symptoms may go away on their own without treatment in 1 to 2 weeks.
Acyclovir
Famciclovir
Valacyclovir

24. The following steps can make better:
Apply ice or a warm washcloth to the sores to help ease pain.
Wash the blister gently with germ-fighting (antiseptic) soap and water. This helps prevent spreading the virus to other body areas.
Avoid hot beverages, spicy and salty foods, and citrus.
Gargle with cool water.
Rinse with salt water.
Take a pain reliever such as acetaminophen (Tylenol).

25. Prognosis
Oral herpes usually goes away by itself in 1 to 2 weeks. However, it may come back.
Herpes infection may be severe and dangerous if:
It occurs in or near the eye
You have a weakened immune system due to certain diseases and medications

26. Prevention
Apply sunblock or lip balm containing zinc oxide to your lips before you go outside.
A moisturizing balm to prevent the lips from becoming too dry may also help.
Avoid direct contact with herpes sores.
Wash items such as towels and linens in boiling hot water after each use.
Do not share utensils, straws, glasses, or other items if someone has oral herpes.

27. Varicella
Varicella (Chickenpox) results from primary infection. Intra-oral vesicles of varicella, when present, are seen on the tongue, buccal mucosa, gingival, palate and oropharynx. They generally are not very painful.

28. Varicella

29. Varicella
The varicella-zoster virus may be spread through the air or by direct contact with the blisters (lesions) of someone infected with chickenpox or shingles.
Once someone is infected, the virus usually incubates for 14 to 16 days before a rash appears, although incubation can last from 10 days to 21 days. There are no symptoms during incubation and a person is contagious from 1 to 2 days before symptoms appear. The person remains contagious until all the blisters have dried and scabs have formed.

30. Symptoms and Complications of Varicella
Flu-like symptoms start to develop a day or two before an itchy red rash appears. Fatigue, mild headache, fever, chills, and muscle or joint aches are typical. The rash emerges as raised red bumps that turn to teardrop-shaped blisters that are extremely itchy.
These blisters may appear anywhere on the body, usually starting on the scalp, spreading to the trunk or torso, and then to the arms, legs, and face. In some cases, the rash may even spread across your entire body, including areas such as the throat, mouth.

31. Symptoms and Complications of Varicella
The blisters come in waves, with new crops developing as old ones burst. New blisters stop forming within about 5 days. By the sixth day, most blisters will have burst, dried, and crusted over. 2 weeks after that, most of the scabs will have disappeared.
Children usually have a much milder infection and recover faster than adults. Babies, adults, and those with weakened immune systems tend to have more severe and longer-lasting symptoms. They are at higher risk of developing complications.

32. Symptoms and Complications of Varicella
Skin infection from bacteria is by far the most common complication in children. It may leave scarring, especially if the child scratches the lesions. Necrotizing fasciitis ("flesh-eating disease") in children, though extremely rare, can occur as a complication of infection entering through the chickenpox lesions. An awkward problem occurs when chickenpox blisters appear in the mouth, throat. Lesions in these places are very uncomfortable.

33. Treating and Preventing Varicella
In most cases, treatment is directed at relieving symptoms until the illness goes away on its own. Non-medical therapy includes:
keeping the body cool, as heat and sweat aggravate itchiness
applying cool-water compresses to the affected skin areas to reduce itchiness
keeping nails cut short and hands clean, as bacteria found under fingernails can infect open skin lesions
taking daily baths with soap and water, which can prevent bacterial infection.

34. Thank you for attention