MUCOSAL – INFECTIONS
Oral infections are viral, bacterial, or fungal in nature. The most commonly encountered infections are viral, usually herpes simplex virus (HSV) infections.

Clinical presentation of viral infections depends on viral type: herpes causes mucosal ulceration (preceded by vesicles), human papillomavirus (HPV) typically induces a verruciform (warty) lesion, and Epstein-Barr virus (EBV) causes a white lesion (hairy leukoplakia).

Most bacterial and fungal infections manifest as chronic ulcers. The fungus Candida albicans can cause either white or red lesions.


VIRAL INFECTIONS

HERPES SIMPLEX VIRUS– stress /exam
PRIMARY
- Majority of primary herpetic infections are asymptomatic
- It affects pan-orally means anywhere in and around the mouth
- It is self-limiting- will go away on its own usually
- Common in childhood
- Treatment – palliative, painkillers usually

RECURRENT
- The HSV stays latent in trigeminal ganglion
- Triggered if body is highly stressed out. Or sunlight. Or is under immunosuppressives.
- Site – multiple ulcers 🡪 only on kertinized tissue ie. Attached gingiva, hard palate, vermillion border, etc – distinguishing factor from primary & secondary
- C/F – herpetic whitlow on finger tip of examined doc- so it is advised that dentist should not touch patient until it resides
- Herpes labialis 🡪 vermillion border
- Itching and vesicle appearance every year **
- Qn. Child came with pain and fatigue + multiple vesicles on hard palate (last year he had the same and went away after one week). – recurrent herpex simplex
- Rx - % acyclovir cream

VARICELLA ZOSTER – CHICKEN POX
- Chickenpox in childhood
- Itchy vescicles.
- Latent in trigeminal ganglion VZV
- Recurrent – HERPES ZOSTER / SHINGLES

SYNDROME RAMSY HUNT SYNDROME
- Herpes zoster reccurent inf In geniculate ganglion affecting cranial nerves 7 (facial) & 8 (vestibulopharyngeal) 🡪 facial paralysis, vertigo-dizziness, deafness-
- C/F : Herpes Zoster Rashes usually do not cross the midline, and is primarily in the thoracic region.
- Treatment - acyclovir

COCKSAKIE VIRUS – HERPANGINA
- Caused by COK SACKIE VIRUS
- Below 5 years children
- Hand-Foot-Mouth Disease
- Causes herpangina at Sites – post part of oral cavity 🡪 Soft palate, tonsil, uvula
- C/F – facial pallor, sore throat

MEASLES- Rubeola
- Viral infection – rubella virus
- Primary is self limiting
- mostly affecting children
- Koplik’s sign ***
- Bluish white spots on buccal mucosa
- Present before the onset of classical skin rash of measles as a sign
- Rx – Acyclovir

EPSTEIN BAR VIRUS EBV
- Oral hairy leukoplakia
- White patch on lateral tongue that does not wipe of
- Opportunistic infection
- Usually associated with HIV and the immunosuppression associated with that
EBV*** causes diseases like :
- Burkits lymophoma
- Nasopharyngeal carcinoma } cancers
- Infectious mononucleosis
- Oral hairy leaukoplakia } infection


Additional Notes:
HUMAN IMMUNODEFICIENCY VIRUS HIV – AIDS
- Slim disease
- Caused by retro virus(P24 antigen)
- Oral manifestationof HIV in a child – herpetic gingivostomatitis****
- Incubation period – 9-11 years***** (Hep B incubation period is 4 months)
- Most common cancer – Kapossi’s sarcoma

4 stages
Stage 1 — symptomatic
Stage 2 — asymptomatic
Stage 3 — T-cells damaged — thymus and lymphoid nodes affected ,Persistant generalised lymphadenopathy
Stage 4 — AIDS occurs — Body is completely weak and aquires infection


Scenario
Qn. A child born to an HIV +ve mother takes nystatin drop, diagnosis is candidiasis/oral thrush
- Prophylaxis if needle prick dentist
- Rx – 1 NRT + 2 NNRT for 4 weeks (for doctor)
Investigation
+ Screening test – ELISA
+ Confirmation — western Blot
+ Best investigation – PCR
+ Saliva in HIV is not contagious
+ Saliva in Hep B is contagious

HUMAN PAPILLOMA VIRUS
- Causes papilloma / wart
- Benign epithelial pedunculates/ sessile proliferation of skin or mucosa