Oral Inflammation and Ulceration Lesions

ULCERATIVE AND INFLAMMATORY
LESIONS
dr. Juliana Lina, Sp.PA

Medan - 2023
SCARLET FEVER:
• Scarlet fever is mainly a disease of children, caused by several strains of
β-hemolytic streptococci (Streptococcus pyogenes).
• Damage to vascular endothelium by the erythrogenic toxin results in a
rash on the skin and oral mucosa.
• The tongue acquires a white coating, through which the hyperemic
fungiform papillae project as small red knobs (“strawberry tongue”).
• Untreated scarlet fever can lead to glomerulonephritis and heart disease
ACUTE NECROTIZING ULCERATIVE GINGIVITIS (VINCENT
ANGINA): “Fusospirochetosis”
• Vincent angina is an acute necrotizing ulcerative gingivitis caused by infection
with two symbiotic organisms, a fusiform bacillus and a spirochete (Borrelia
vincentii).
• These organisms are found in the mouths of many healthy people, suggesting
that other factors are involved, particularly decreased resistance to infection due
to inadequate nutrition, immunodeficiency or poor oral hygiene.
• Vincent angina is characterized by punched-out erosions of the interdental
papillae. The process tends to spread and eventually involves all gingival
margins, which become covered by a necrotic pseudomembrane.
• “Oma (cancrum oris)” is severe infection.
LUDWIG ANGINA:
• Ludwig angina is a rapidly spreading cellulitis originating in the submaxillary
or sublingual space but extending to involve both.
• A potentially life-threatening inflammatory process.
• It is uncommon in developed countries except in patients with chronic illnesses
associated with immunosuppression.
• Most often related to dental extraction or trauma to the floor of the mouth. After
extraction of a tooth, hairline fractures may occur in the lingual cortex of the
mandible, providing microorganisms ready access to the submaxillary space.
• May cause massive hemorrhage. The inflammation may also dissect into the
superior mediastinum to involve the pleural space and pericardium
DIPHTHERIA:
• Infection with Corynebacterium diphtheriae is characterized by a patchy
pseudomembrane, which often begins on the tonsils and pharynx but may also
involve the soft palate, gingiva or buccal mucosa.
TUBERCULOSIS:
• Primary tuberculosis of the oral mucosa is rare.
• Most lesions spread from the lung, with bacilli carried in sputum and entering
small breaks in the mucosa.
• Produce irregular, painful ulcers, mostly on the tongue. Caseating
granulomatous inflammation is typical.
SYPHILIS:
• Primary syphilitic chancres may form on the lips, tongue or oropharyngeal
mucosa after contact with an infectious lesion.
• Regional lymphadenitis follows and heals by itself in a few weeks. A
diffuse mucocutaneous eruption of the secondary stage follows. Syphilitic
lesions in the oral mucosa are multiple gray-white patches overlying
ulcerated surfaces. They may remit and also recur spontaneously.
• Gummas on the palate and tongue may appear years after initial infection
as firm nodular masses that ulcerate and may cause palatal perforation.
ACTINOMYCOSIS:
• Actinomycetes are common denizens of the oral cavity in healthy people.
• Invasive actinomycosis is most often caused by Actinomyces bovis, but
Actinomyces israelii is sometimes seen.
• The organisms produce chronic granulomatous inflammation and
abscesses that drain by fistula formation, with suppurative infection
containing characteristic yellow “sulfur granules.”
• In cervicofacial actinomycosis, soft tissue infection may extend to
adjacent bones, most often to the mandible.
HUMAN PAPILLOMAVIRUS (HPV)–RELATED DISEASES:
• The HPV family of viruses causes epithelial proliferations including
papillomas (e.g., sinonasal, Schneiderian papillomas and other papillomas
of upper aerodigestive tract sites).
• “High-risk” HPV, mainly types 16 and 18, as well as 31, 33 and 35, is
strongly associated with oropharyngeal squamous cell carcinoma.
HUMAN HERPES VIRUS 8 (HHV8):
• HHV8 is associated with Kaposi sarcoma (KS). This tumor occurs most
often in the skin but can also involve, among other places, the tongue and
oral cavity. These tumors resemble their cutaneous counterparts.
Immunosuppressed patients (e.g., transplant recipients or patients infected
with HIV-1) are at very high risk for this disease. It is also seen in
OTHER VIRAL INFECTIONS:

• Coxsackievirus causes herpangina, an acute vesicular oropharyngitis.
• Cytomegalovirus (CMV) infection typically presents with surface ulceration.
• Include measles, rubella, chickenpox and herpes zoster.
Aphthous Ulcers (Canker Sores)
• Common, often recurrent, and painful.
• The causes are not known, tend to be familial, may be associated with immunologic
disorders.
• The lesions appear as single or multiple, shallow, hyperemic, superficial mucosal
ulcerations covered by a thin exudate and rimmed by a narrow zone of erythema.
• The underlying inflammatory infiltrate is initially mononuclear but becomes neutrophil-
rich upon secondary bacterial infection.
• Lesions typically resolve spontaneously in 7 to 10 days but sometimes persist for weeks,
particularly in immunocompromised patients.
Herpes Simplex Virus Infections
• Herpes simplex virus causes a self-limited primary infection that can be reactivated
when there is a compromise in host resistance.
• Oral herpes usually presents as gingivostomatitis in children, pharyngitis in adults, and
chronic mucocutaneous infection in immunocompromised individuals.
• Most orofacial herpetic infections are caused by herpes simplex virus type 1 (HSV-1),
but oral HSV-2 (genital herpes) infections do occur.
• In children, primary infections are most common between 2 and 4 years of age.
• These are often asymptomatic but may present as acute herpetic gingivostomatitis,
with abrupt onset of vesicles and ulcerations of the oral mucosa, in up to 20% of cases.
• These lesions can be accompanied by lymphadenopathy, fever, and anorexia.
• Most adults harbor latent HSV-1, and the virus can be reactivated,
resulting in a so-called “cold sore” or recurrent herpetic stomatitis.
• Factors associated with HSV reactivation include trauma, allergies,
exposure to ultraviolet light and extremes of temperature, upper-
respiratory tract infections, pregnancy, menstruation, and
immunosuppression.
• The lips (herpes labialis), nasal orifices, buccal mucosa, gingiva, and hard
palate are the most common locations.
• Although lesions typically resolve within 7 to 10 days, they can persist in
immunocompromised patients, who may require systemic anti-viral
therapy
Oral Candidiasis Also called thrush or moniliasis
• Candida albicans is a normal component of the oral flora in approximately 50%
of the population and is the most common fungal infection of the oral cavity.
• Oral candidiasis can be pseudomembranous, erythematous, or hyperplastic. The
pseudomembranous form, thrush, is characterized by a superficial, gray to white
inflammatory membrane composed of matted organisms enmeshed in a
fibrinosuppurative exudate that can be readily scraped off to reveal an underlying
erythematous inflammatory base.
• Deep in immunosuppression, individuals with organ or bone marrow transplants,
neutropenia, chemotherapy-induced immunosuppression, AIDS, or diabetes.
• Broad-spectrum antibiotics that eliminate or alter the normal bacterial flora of the
mouth can also promote thrush.
EPIDEMIOLOGY
• 30-40% Kandida albikan pada rongga mulut orang dewasa sehat
• 45% pada neonatus,
• 45-65% pada anak-anak sehat,
• 50-65% pada pasien yang memakai gigi palsu lepasan,
• 65-88% pada orang yang mengkonsumsi obat-obatan jangka panjang,
• 90% pada pasien leukemia akut yang menjalani kemoterapi,
• 95% pada pasien HIV/AIDS
Faktor resiko
• Gangguan fungsi kel ludahproduksi menurunmuncul jamur
• Radioterapi kepala leher
• Obat yang dapat menurunkan produksi saliva
• Pemakai gigi tiruan
• Penyakit sistemik : DM, HIV
• Px kemoterapi, px leukemia
• Px terapi kortikosteroid jangka waktu lama
Deep Fungal Infections
• Including histoplasmosis, blastomycosis, coccidioidomycosis,
cryptococcosis, zygomycosis, and aspergillosis, have a predilection for the
oral cavity, head, and neck.
• The incidence of oral fungal infections has grown along with increasing
numbers immunocompromised patients as a result of diseases such as
AIDS, therapies for cancer, and organ transplantation.
SUMMARY
• Aphthous ulcers are painful superficial ulcers of unknown etiology that
may in some cases be associated with systemic diseases.
• Herpes simplex virus causes a self-limited infection that presents with
vesicles (cold sores, fever blisters) that rupture and heal, without scarring,
and often leave latent virus in nerve ganglia. Reactivation can occur.
• Oral candidiasis may occur when the oral microbiota is altered (e.g., after
antibiotic use). Invasive disease may occur in immunosuppressed
individuals.

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ULCERATIVE AND INFLAMMATORY

dr. Juliana Lina, Sp.PA

OTHER VIRAL INFECTIONS:

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