Staph aureus (more common)

Strep pyogenes

Honey colored crusts!

(impetigenous means honey colored)

70% have red flat areas

What etiologic agents cause impetiginized angular chelitis?

What are treatment options?

Staph aureus and Strep pyogenes

impetiginized means honey colored

2% mupirocin ointment (bactroban) 3X daily for

1 week

Group A Beta-hemolytic strep (GABS)

Tonsillitis or pharyngitis

Fever and rash appear 7 days later.

Enanthem:  Petechiae, mucousal sloughing

Strawberry Tongue -->Rasperry Tongue

Exanthem:  Rash (sunburn with goose pimples)

Epithelial desquamation (IN FLAKES!)

Skin peels off in chunks for 3-8 weeks...OUCH!

Throat culture with rapid detection GAS (Group A Strep)

Administer penicillin or erythromycin

Excellent prognosis

glomerulonephritis

rheumatic fever

inflammation of heart muscle

(problems with replacement valves)

Commonly called strep throat

-passed by aerosol droplets

Sore throat, huge tonsils, red mouth and throat, petechiae, and cervial lymphadenopathy.

Yellow ooze from tonsils...YUMMY

What etiologic agent causes Strep Throat?

How is it diagnosed and what is treatment?

Group A Strep

Rapid throat culture

Antibiotics (Pen VK and Azithromycin)

Only 24 Hours

Just because I'm not contagious doesn't mean I'm going back to SCHOOL!  Get me a popsicle!

odontogenic infection of maxillary teeth!

Also dental trauma (extraction, implants, etc)

strep pneumonia

H. influenza

Odontogenic sources: peptostrep, fusobacterium, porphymonas gingivalis

1.  Treat causitive periapical disease

2.  Treat with antibiotics (usually amoxicillin)

3.  Enlarge ostea (endoscopic or Caldwell-Luc)

Pain

Abscess

Ulceration (Bacteria eat your tonsils)

Difficulty Swallowing (huge tonsils, duh)

Nasty ass breath (Halitosis)

Mechanical enucleation (Q-Tip)

Irrigation (Water-Pik)

Antibiotics (if you're a wuss)

Tonsillectomy (if you're a hardass)

Laser Cryptolysis (If your a Star Wars Fan)

Treponema pallidum

2-3 weeks after exposure

Indianapolis!

Marion County

It's so awesome to win something

Primary:  Chancre 1-12 weeks

NASTY

Secondary:  Oral Mucous Patches

Rash 1-3 months after infection

Tertiary:  33% of untreated cases get thoracic aneursm, gummas (necrotic type IV), go CRAZY

Oral:  erythema, mucous patches, ulcerations

Fever, malaise, headache, sore throat, rash!

Kind of looks like Rocky Mountain Spotted Fever!

It is associated with Congenital Syphilis

Signs and symptoms: 

1.  Hutchinson's Teeth

(Notched incisors and mulberry molars)

2.  Interstital kerititis

3.  Eight nerve deafness

VDRL (Venereal Dsease Research Laboratory)

RPR (Rapid Plasma reagin)

Specifically:  FTA-HBS and TPHA

2-5 days of incubation of Neisseria gonorrhoeae

Gram NEGATIVE!

Usually in young, sexually active people

10% of men and 50% of women asymptomatic

20% Oral (more common in homosexual men)

Many! (Some resistant strains)

Cefixime (See-fix-me)

Ceftriaxone

Ciprofloxacin

Ofloxacin

Levofloxacin

Azithromycin

Doxycycline

SILVER NITRATE!

Also erythromycin and tetracycline

Mycobacterium tuberculosis

There can be primary infection (active 5-10%)

Secondary:  Reactivation in old, poor, crowded

Miliary:  Hematologic dissemination

Low grade fever

Malaise

Weight loss

Cough

Lupus Vulgaris (huge pimple)

SCROFULA! (Enlarged lymph node on neck)

Ziehl-Neelson

(Like Le-Ziehl-y Neelson)

Isoniazide and Rifamide for 9 months.

Isoniazide, Rifamide, and pyrinamide for 2 months

Then back to isoniazide and rifampin for another 4 months!

Chimp and mangabey monkey

ARMADILLO in LA and TX

Hansen's Disease

MMM-BOP!

What are two types of Leprosy?

How are clinical features different?

1.  Tuberculoid paucibacillary (BODY CONTROLS)

-High Immune Reaction

-Localized Disease

-2-5 year incubation

2.  Lepromatous multibacillary (No Body Control)

-No cell mediated response!

-Micro ory present in skin test

-incubation 8-12 years

Diagnose with biopsy and FITE stain

Treat with rifampin (same as TB)

-Also use Dapsone

Paucibacillary for 6 mo but Multi needs 2 yrs!

Cancrum Oris, Gangrenous Stomatitis, Necrotizing Stomatitis.

Caused by oportunistic bacteria:

Borrelia vincetii, Staph aureus, Prevotella intermedia.

Malnutrition

Dehydration

Poor Oral Hygiene

Recent Illness

Malignancy

Immunosupression

Why is necrotizing stomatitis associated with HIV?

What are the common etiologic agents?

HIV obviously has immunosupression

-also antiviral therapy

-Emotional Stress

-Periodontal Disease

Caused by:  PSEUDOMONAS AERUGINOSA

-40% Mortality

Treponema species, Prevotella intermedia, Fusobacterium, Staph Aureus, Selenomonas

Wound Debridement with penicillin/metronidazole

Proper nutrition and fluid levels

10% morbidity with antibiotics

-severe deformity

Actinomycosis!

It's actually a gram positive, filamentous bacteria!

All gram positive filamentous bacteria!

israelii, naeslundii, viscosus, odontoyticus, meyeri, and bovis

Acute or chronic "WOODY" fibrosis

Sulfur granules in the PUS!

Lumpy Jaw

Soft Tissue trauma (periodontal, salivary gland)

You treat RAY FUNGUS (actually gram positive bacteria) by:

 -debridement

-long-term antibiotics 5-12 weeks. (Penicillin/tetracycline)

Bartonella henaselae

A gram-negative Bacteria

Caught from cat scratches (40% carriers!)

Lympadenopathy

Malaise and Fever

Tender Nodes

Skin Red and nodular

MOSTLY Younger individuals (<21)

1.  Negative for other lympadenopathy diseases

2.  Warthin Starry stain (Silver)

3.  Indirect fluorescent-antibody

They don't get Cat Scratch Fever!

They get Bacillary angiomatosis!

(Can see histo with Warthin Starry)

Treat with Doxycycline!

What is the etiologic factor for histoplasmosis?

Where is it found, both geographically and in the environment?

Histoplasma capsulatum

Endemic to the Ohio Valley and Mississippi River Valley.

Mold from soil or bat shit is inhaled, while yeast in tissue= consumed

Histoplasma capsulatum

HISTOPLASMOSIS!

T-cell mediated infection in the lungs

Granulomatous

1% acute (elderly, immunosuppressed)

Extra Pulmonary (HIV pts mostly)

-Oral associated with HIV patients

amphotericin B. ketoconazole, and itraconazole

Chronic w/o treatment= death in 20%

Disseminated even with treatment=death in 20%

This fungus is found in moist soil in the Eastern United States, Northern Wisconsin, and Canada.

Usually affects males

Acute pneumonia (fever, cough, night sweats, chest pain)

Chronic is more common (same as above...lesser)

Chest radiographs:  diffuse infiltrates

Disseminated- oral and skin (looks like malignant)

Blastomycosis is diagnosed using:

Examinatin of tissues

KOH

Culture of sputum

DNA probe

Cause-Coccidioides immitis  (as in immigrants)

Also Called:

"San Joaquin Valley Fever"

"Valley Fever"

"Desert Fever"

More prevalent in Blacks and Filipinos!

Disseminates in immunocompromised

People that live in San Joaquin Valley...

Tissue specimen, cytology, and culture

Treated with normal ketoconazole/fluconazole

-maybe amphotericin B

What is the etiologic factor for Cryptococcosis?

Where is it found?

Cryptococcus neoformans

Found in soil SPREAD BY PIGEONS!

Cryptococcus=pigeon poop!

 Cryptococcosis (pigeon poop)

Usually asymptomatic in healthy pts

Immunosupressed: skin, oral, meninges, bones

Many different fungi (its a broad term for fungal infections)

Affects immunocompromised patients

-spores inhaled

-affects nasal, sinuses, meninges, orbitals

Radiographically has opacities, destruction of bone, and looks like malignancy!

Syphillis (Treponema pallidum) 

Zygomycosis

Aspergillosis

Surgical debridement and antifungals (amphotericin B)

Prognosis is POOR!

There are many...anything in the genus Aspergillus.

The most medically important are:  A. flavus and A. fumigatus

Remember Flavorful Fumey Gas after you eat Asparagus

FUNGUS BALL!

(aspergilloma)

Sinusitis, ulcers, able to disseminate

esp. with immunocompromised/corticosteroids

Usually antifungals:  Amphotericin B

Prognosis:  If disseminated, only 30-40% survive

What is the most common etiology for Candidiasis?

What are some clinical classifications?

Candida albicans

Pseudomembranous

Angular Cheilitis

Acute erythematous

Chronic erythematous

Inflammatory Papllary hyperplasia

Leukoplakia

Antibiotics

Corticosteroids

Xerostomia

Diabetes Mellitus

Pregnancy

Poor Oral Hygiene

Immunosupression

Usual distribution:

20% Candida albicans

60% Mix of Staph aureas and C. albicans

20% It's just S. aureus

Median Rhomboid Glossitis

(diffuse oral candidiasis)

Toxoplasmosis

(Protozoa Toxoplasma gondii)

IgM=primary infection defense

(M-got it from your MOM as a kid)

IgG=Latent infection defense

(G- got it from your girlfriend...you man-whore)

Acyclovir terminates viral DNA replication

Penciclovir and Famciclovir are competitive inhibitors of one of 4 nucleotides for DNA synthesis

80% take place on the maxilla!

(61% on the hard palate alone!)

Valcyclovir

-take two 1 gram tablets with prodrome and 2 more 12 hours later

Famciclovir (Valtrex)

-take three 500mg tabs with prodrome

Life long infection with 30-40% recurrence

Complications include

-scarring

-erythema

-encephalitis

Primary:  Chicken Pox

Recurrent:  Shingles (dermatome distribution)

It is a form of HVZV

It affects facial, external auditory canal, facial paralysis, hearing deficits, vertigo.

May result in pulpal necrosis.

Rarely causes bone loss of associated teeth

Painful perioral area with trigeminal herpetic neuralgia.

Infectious Mononucleosis (MONO)

Oral hairy leukoplakia

Burkitt's lymphoma

Nasopharyngeal carninoma

Gatric-smooth muscle tumors

Infectious mononucleosis!

Epstein-Barr Virus

Severe fatigue, low grade fever, eye pain, swelling of eyelids, lymphadenopathy.

skin:  maculopapular rash, uticaria, petechiae

Mucosal:  acute gingivitis, ANUG, palatal petechiae

Monospot and Monosticon

Multiple lymphocytes AND atypical lyphocytes!

-nuclei are huge

The EBV in immunocompromised patients

OR

Healthy people that use corticosteroids

It is caused by the human herpes virus type 5

aka salivary gland virus!

Remember: Megaman is awesome 5 is fav #

Multiple shallow ulcers

-lips, tongue, pharynx

Infected neonates will have enamel hypoplasia

Histologically:  OWL EYE CELL!

Herpangina (Coxsakie A and B)

Hand, foot, and mouth disease (Cox A)

Lymphonodular pharyngitis (Cox A10)

1.  Caused by Coxsakie A and B, CONTAGIOUS

2.  Mostly in kids

3.  Vesicles usually on soft palate and tonsils

4.  Fever, malaise, enlarged tonsils, headache

1.  Caused by Group A Coxsakie virus, mildly contagious.

2.  Vesicles on hands, mouth, feet (DUH!)

-actually anthing below knees and elbows

3-6 weeks after exposure

-Seroconversion

-Fever, rash

Oral- erythema, erosions, ulcerations, candidiasis.

CD4 Lymphocytes deplete

Loss of Langrehan's cells

Impaired cell-mediated immunity

Phagocytic cell defects

The loss of CD4!

CD4 (cluster of differentiation 4) is a glycoprotein expressed on the surface of T helper cells, regulatory T cells, monocytes, macrophages, and dendritic cells.  CD4 is a co-receptor that assists the T cell receptor (TCR) to activate its T cell following an interaction with an antigen presenting cell.

Parotid Lymphoepitheilia Cysts

Sjogren's Syndrom-like illness

Diffuse infiltrative lymphocytosis syndrome (DILS)

Sialadenopathey (HUGE SALIVARY GLANDS!)

Kaposi's sarcoma

Non-Hodgkin lymphoma

Melanoma

Oral squamous cell carcinoma

Viral Antibodies, antigens, RNA/DNA

EIA (Enzyme Immunoassay)

ELISA (Enzyme Linked Immunosorbent Assay)

Treated with Cocktail of 3-Drugs!

-Nucleoside Reverse Transcriptase Inhibitors

HAART (Highly Active AntiRetroviral Therapy)

Chronic Infectious Disease

Not all progresses to AIDS

The higher the CD4, the lower risk for AIDS

What are the etiological factors for German Measles?

What is prognosis?

The Rubella Virus (Togavirus Family)

Remember MMR and TOGA, TOGA, TOGA!

Excellent for child with mild disease

Terrible for kid with congenital Rubella Syndrome!

Part of MMR Vaccine!

First shot 12-15 months

Second dose 4-6 years

1.  Paramyxovirus, Rubulavirus

2.  CHIPMUNK CHEEKS!

3.  MMR Vaccine for prevention

-Palliative treatment

Antipyretics (fever reducers)

Analgesics

Bedrest

Good Prognosis!

1.  Mechanical Injury

2.  Thermal Injury

3.  Chemical Irritation

4.  Bacterial effects

Probably age related

1.  Denticles

2.  Pulp Stones

3.  Diffuse Linear calcifications

May lead to obstruction of canal!

Periapical granuloma

Apical periodontal cyst

Parulis

Focal sclerosing osteomyelitis

Periapical Granuloma

Tooth is almost always non-vital

(Unless limited to one root on multi-root tooth)

Radiolucency, root resorption, loss of lamina dura

Granulation surround by wall of fibrous tissue

-Eosinophilic globs of gamma globulins

-Russel Bodies (blanched plasma cells)

Cyst at apex of non-vital tooth!

May arise from:  Epithelial cell rests of Malassez

(part of PDL or Herwigs (HERS))

Sinus lining

TOOTH IS NON-VITAL!

Root resorption with displaced adjacent teeth

Strong male predominance

Usually in the mandible

Acute osteomyelitis may produce dead bone

-sequestrum

Acute is less than 1 month, chronic is more

Both have swelling, pain, purulence

Acute has fever involved

Chonic has dead bone space bacteria reservoir

Acute

- Antibiotics and drainage

Chronic

- Walled off infected areas

-Surgical intervention mandatory

-Curretage down to good bleeding area

-Antibiotic impregnated products

GARRE'S OSTEOMYELITIS!

Caused by caries with periapical disease

-Forms multiple layers of reactive vital bone

ONION PEEL LOOK!

aka Proliferative periostitis

(ONION PEEL BONE)

Remove source of infection

-Onion peel bone will remodel in 6-12 mths

What is another name for alveolar osteitis?

Its causes?

DRY SOCKET! 

OUCH!

Destruction of initial blood clot after tooth extraction.

Change of plasminogen to plasma-clot destroyed!

Its a white line on the buccal mucosa

Caused by: Pressure, friction, sucking trauma

What is the fancy word for Cheek biting?

What are some of its causes and clinical signs?

MORSICATIO BUCCARUM!

Bilateral, thickened white areas on cheeks

Twice as common in females, esp. after age 35!

Thought to be stress induced

Acute or chronic

Most often seen on tongue, lips, buccal mucousa

Either red ring with removable cental yellow membrane

OR

Rolled up white border or hyperkeratosis.

CRAZY Babies!  1 week to 1 year

Affects dorsal tongue/ventral tongue

Traumatic Granulomas

What is the common cause of electrical oral burns?

Thermal?

Biting or chewing into a live wire.

Thermal comes from ingestions of hot foods/beverages.  (Microwave)

PIZZA BURN!

Pt. is usually under 4

Lips and commissure (corners of mouth) common sites

Can result in sever microstomia!

Silver nitrate, ASA, cavity varnish, and acid-etch

Hydrogen Peroxide (Tooth whiteners)

Viadent

(The old version that had sanguinaria)

Accumulates in vestibules (where salivary flow is lowest)

Mucousitis and Hemorrhage

ALSO

1.  xerostomia

2.  loss of taste

3.  osteoradionecrosis

4.  trismus

5.  chronic dermatitis

6.  developmental abnormalities

Permanent damage to the osteocytes and microvasculature.

Mandible is the most frequently affected due to reduced blood flow.

Questionable teeth should be dealt with BEFORE radiation!

Difficulty opening the mouth due to radiation effects on muscles of mastication.

Dental treatment problemas

It is caused by the action of bacterial H₂S on lead.

Associated with Water pipes and lead paint

SMOKING!

Smoker's Melanosis

21.5% of smokers have it vs 3% Non-smokers

Correlation btwn amount smoked and shade

More common in women

-probable synergy between sex hormones and smoke.

1.  Smoking

2.  Drug induced (minocycline)

Women are more affected in both cases!

It is a cyst of the sinus

Commonly found in floor of maxillary sinus

Inflammatory exudate (probably odontogenic infection)

Accumulations of mucin, completely encased by epithelium.

Caused by trauma or surgery to sinus

Obstruction of sinus ostium

VERY SERIOUS

-enlarge in intraluminal pressure

-Distends walls and erodes bone

It is by the rejection of a topical antibiotic in a petroleum base, used after surgery.

Collection of spherules resmble a "BAG OF MARBLES" in a "BLACK GREASY TAR"