OM Sheet #4 By Aseel Hattar

by **Sura** 17/10/2012, 2:39 am

http://www.4shared.com/office/tJ_7h_Mn/aseel_hattar_OM_4.html

by **Shadi Jarrar** 15/11/2012, 6:42 pm

Oral infections

Primary herpes simplex :

*Primary herpes simplex or herpetic gingivostomatitis is a combination of gingivitis and stomatitis caused by herpes simplex virus HSV 1 and to a less degree HSV 2 .*Mainly type 1 affects oral cavity and type 2 affects genital area .

*It’s a vesiculobollus disease but usually we don’t see the vesicles bcz it rupture quickly due to trauma ,that’s why we only see the ulcers .

* It affects the gingival and the buccal mucosa and it generally affects children but if it affects adults its more sever.

*In HSV the ulcers should always affect the gingival ,if there is no ulcers on the gingival then its not HSV . *there might be a crusted bleeding lips in HSV ,but mainly it affects the free and attached gingival .

*Sometimes a generalized marginal gingivitis may precede oral ulcers.

* the transmission of the infection is by droplets from another infected person .

*80% of herpes simplex infections are asymptomatic..

*the first symptoms usually appears within 5-10 days after contact with an infected person . there are a prodromal symptoms (fever , malaise, irritability , headache, vomiting and lymphadenopathy ) 1-2 days prior to oral lesions .

*its highly contagious 1 week to 10 days before the onset of symptoms to 5 days during the symptom phase.

Diagnosis:

*Immunodot glycoprotein G-specific (IgG) HSV test detects the presence or absence of past infection,but we depend mostly on the symptoms to detect the HSV .

Treatment:

1)supporative (soft diet and adequate fluid intake , analgesics and antipyretics and chlorohixidine mouth wash.

2)systemic acyclovir is recommended to trat oral herps only in immunocompromised patients ,bcz the infection is life threatening in those pt's.

3) pt's should be cautioned to avoid touching the herpitic lesions and then touching the eyes ,genitals or other areas bcz of the possibility of self inoculation .

Recurrent herps simplex

*After the initial or primary infection ,herps simplex virus becomes latent in the sensory root gangilion of the trigeminal nerve .

*In adolescence or adulthood if the immune system weakens due to any disease ,stress or sunlight ,the virus brake out and reactivates ,and it causes recurrent cold sores or fever blisters that are usually in the same area.

*mostly it affects the mucocutanous junction ,and is confined to a localized area of skin or mucous membrane *affect more the upper and the lower lips ,the recurrent infection thus often called herpes labialis .

*Symptoms typically begin with tingling and reddening of the skin around the infected site . within 24 h fluid filled blesters form, which ruptures within a further 48 h to leave an erosive area of epihilium which subsequently crusts over and heals.

*The lesion usually disappears spontaneously in 1-2 weeks . infection may be sever and dangerous if it occurs in or near the eye, or if it occurs in immunocompromised pt's . rarely ,reinfection occurs inside the mouth (intra oral herpes simplex stomatitis ),usually affecting the hard palate and gingival ,possibly accompanied by herps labialis ,as a small crop of painful ulcers which heals within 1-2 weeks.

*the infected pt's remain contagious until the vesicles rupture.

*we call it herpes labialis if it affectes the lips , and recurrent herpes simplex if it affects another area.

Diagnosis:

it is made by history and clinical examination .

treatment:

1)application of sunscreen (SPF15 or higher ) to lips 1 hour before sun exposure and every hour .

2)constant or intermittent application of ice to the area for 90 min. during the prodromal phase may result in abortion of the lesion .

3)acyclovir cream workes best when applied early to the affected area at the first sign of pain and tingiling 6 times/day only when the visecles are intact ,if not we use dactacort (antibac. And cortisone )

4)zinc oxide cream .

5)oral acyclovir given therapeutically and prophylactically ,when frequent recurrent herpitic episodes interfere with daily function and the nutrition of the pt. .

Herpitic whitlow :

*Aherptic whitlow is a painful infection that typically affects the fingers or thumbs or toes.

*HSV1 whitlow is most commonly contracted by dental or medical workers exposed to oral secretions .it is also observed in thumb sucking children with primary HSV 1 oral infection (autoinoculation ) .

Aetiology:

Herpitic whitlow can be caused by infection with HSV1 or 2 .

diagnosis:

it is made by history and clinical examination .*

*presented clinically by lymph node enlargement ,fever fatigue ,malaise ,reddening and swelling and vesicles around the nail bed ,and its very painful .

treatment :

1)to prevent this infection ,gloves should be used when examining the pt's.

2)acyclovire cream 5 times /day.,

3)lancing or surgically debriding the lesion may make it worse by causing a superinfection or encephalitis .

4) pain killers .

***steriodes is contraindicated.

Chickenpox (varicella ):

*Affects children 2-8 years caused by varicella zoster virus (vzv)it is sever in adults. Its epidemic affects lots of children at the same time ,around once every 3 years .

*There is a prodromal phase first (fever fatigue malaise) then mainly cause ulcers on the oropharynx area (soft palate ,tonsilis ) , skin rash and vesicles .

*The contagious period continues until all blisters crust over forming scabs which may take 5-10 days .

Diagnosis:

Clinically by seeing skin rash ,vesicles . if we are not sure we take a sample from the vesicles fluid or a blood sample and do a serology (IgG ,IgM) against HSV.

Treatment:

1)mouth wash

2)Topical application of calamine lotion containing zinc oxide to skin rash is one of the most commonly used interventions to ease itching.

3)if the itching is untolerable we give antihistamine.

4)oral acyclovir in adults .

Herpes zoster (shingles or zona )

*caused by varicella zoster virus (VSV)

*once an episode of chickenpox has resolved ,the virus is not eliminated from the body but sometimes latent in dorsal root ganglia without causing any symptoms until the pt reaches 40's it reactivates due to impaired immune response.

*Usually it affects the thorasic area ,very painfull ,preceded by staplike pain ,burning ,itching then it becomes (belt-like rash) .

* it affects a dermatom either left or right side ,it never crosses the midline .

*30% of herpes zoster lesions affects the trigeminal N. (ophthalmic or max. or mand. Branches)

*most common and not welcomed branch to be involved is the ophthalmic .

When it affects the max. or mand. Branches it may cause a vesicles intraorally (rare)

Diagnosis:

IgG indicates a past infection

IgM indicates a present infection .

*we should exclude malignancy and immune defects if there are a recurrences .

Treatment:

1)topical application of calamine lotion containing zinc oxide to skin rash or blisters is commonly use to ease ithching .

2)in sever pain we give topical lidocaine or morphine

3) only in herpes zoster we give acyclovir ,valacyclovir or famacyclovir.

**valacyclovir is better in herpes zoster we give 200 mg 5 times /day for 1 week.

**we give oral acyclovir to reduce the chance of post herpitic neuralgia.

** if the ophthalmic N. involves we consult an ophthalmologist to give him eye drops bcz it leaves a scars in the eys.

Herpes zosrter oticus:

Read it from the book plz page 37

Hand foot and mouth disease:

It affects children mainly.*

*Oral ulcers affects the tongue and buccal mucosa. And visecles on the palm of the hands and soles of the feet.

*Fever and malaise.

*Clinically diagnosed .

*Supporative treatment (antipyretics ,analgisices)

Herpangina :

Aetiology :

coxsackie virus A &B .

*Herpangina &chickenpox à the ulcers appears on the oropharynx (soft palate and tonsils )

*the rest of the viral infections à the ulcers appears on the buccal m. and anterior part of the oral cavity.

Treatment:

supporative bcz its self limited .

Oropharynx	Herpangina
Oropharynx and skin rash	Chickenpox
Hands feet ,anterior part of oral cavity	Hand foot mouth disease
Never crosses the midline	Zoster

Focal epithelial hyperplasia(heck's disease) :

*One of the most contagious oral papillary lesions.

*In some isolated populations up to 40 % of children have been affected ,and it can affect numerous populations and ethinic groups .

Aetiolgy :

Human papilloma virus (HPV 13 &32)

* This lesion never transformes into malignancy .

*Clinically , presented in oral cavity on labial buccal and lingual mucosa.

*lesions are frequently papillary in nature ,but are relatively smooth –surfaced and flat-topped.

*The lack of pronounced surface projections easily differentiates it from squamous papilloma ,verruca vulgaris, and condyloma ,but they frequently cluster so closely together that the entire mucosa takes on a cobblestone or fissured appearance.

Treatment:

1)If the lesion occurs on the lips we can remove it by surgery or by laser due to esthetic reasons

2)imiquimod cream (immune response modulator or inhancer)

Infectious mononucleosis( kissing disease or mono or glandular fever) :

Affects mainly teenagers 15 -17 ,its common but mainly its subclinical (no symptoms).

Aeitiolgy:

EBV

*Clinically there is ulcers from the biggining of the disease and no vesicles precedes these ulcers.

*Patachial hemorrhages at the junction of hard and soft palate ,spongy gums that bleedes easily ,posterior cervical adenopathy ,axillary adenopathy , inguinal adenopathy ,spleenomegaly ,high fever.

**if those pt's took amoxicillin or ampicillin it will cause non allergic skin rash .

Diagnosis:

They call it mononucleousis bcz they used to think that there is increase in the number of monocytes which is wrong , but what actually happening is an increase in the lymphocytes and bcz they are a typical with irregular large nucli they look like the monocytes .

*a positive heterophile test (paul-bunnel or monospot test)

*more sensitive tests have been developed such as the IgG and IgM tests. IgG ,when positive ,reflectes a past infection IgM reflects a current infection

*elevated hepatic transaminase level .

**this viruse is contagious in saliva up to 18 monthes and there is fatigue fot 6 monthes , so if the symptoms persist for more than 6 months we call it chronic EBV

Treatment :

1)supportive

2)valacyclovire

3)if there is a streptoccocul infection in the tonsils we give him penicillin not amoxicillin .

If he's sensitive to penicillin we give arythromycin .

4)avoid any heavy sports bcz there is spleenomegaly and elevated liver enzymes .

GOD BLESS U

Aseel hattar

O.M # 4

DR.samar

OM Sheet #4 By Aseel Hattar

OM Sheet #4 By Aseel Hattar

Re: OM Sheet #4 By Aseel Hattar