Bacterial Infections of Oral Mucosa

1. BACTERIAL INFECTIONS OF
THE ORAL MUCOSA
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. OUTLINE
• Introduction
• Acute Necrotizing Ulcerative Gingivitis
• Actinomycosis
• Syphilis
• Tuberculosis
• Leprosy
• Gonorrhea
• References

3. INTRODUCTION
• More than 500 species of bacteria live in the oral cavity
• Yet bacterial infections – Aside from caries and Periodontal diseases – are rare to be
seen in the oral cavity due to:
• The barrier function of the oral epithelium
• The mechanical cleansing action
• The specific and non-specific antimicrobial substances in saliva
• The migration of phagocytic cells, predominantly neutrophils, into the gingival
crevice and oral cavity.

4. HOW BACTERIAL INFECTIONS HAPPEN?

5. ACUTE NECROTIZING ULCERATIVE GINGIVITIS
• Synonyms
• Relatively uncommon in industrialized countries, young adults and more common in
males.
• Polymicrobial
• Clinical picture:
1. Punched out crater-like necrosis in the interdental papilla
2. Pseudo-membrane formation
3. Bleeding
4. Marked Halitosis and bad metallic taste
5. Advanced cases: Cervical Lymphadenopathy, fever and Malaise.

6. • Risk factors:
1. Malnutrition
2. Poor Oral Hygiene
3. Smoking
4. Stress
5. Immunodeficiency
ACUTE NECROTIZING ULCERATIVE GINGIVITIS

7. TREATMENT OF ANUG
• Local Debridement
• OHI
• Oral Rinses [Types]
• Analgesics
• Antibiotics [When]
Metronidazole 200 mg TID for 7 days
• Modify Predisposing factors
• Follow-up

9. ACTINOMYCOSIS
• Chronic, Suppurative, Polymicrobial, non-contiguous infection.
• Cervico-Facial and Abdominal Actinomycosis
• Actinomyces Israelii, Actinomyces Nuslandii and Nocardia Asteroids
• Predisposing factors:
• Trauma.
• Surgery.
• Previous Infection.
• Suppressed immunity.

10. CLINICAL FEATURES OF ACTINOMYCOSIS
• Chronic indurated swelling in the submandibular area and neck
• Multiple foci of chronic suppuration.
• Multiple sinuses
• Sulfur Granules
• Osteomyelitis in Maxillary infections.

12. DIAGNOSIS OF ACTINOMYCOSIS
• Radiography.
• Biopsy: granulomatous and inflammatory response with central abscess
formation. The microbial colonies are seen in the center
• Smear and Light Microscopy.
• Microbiological Culture.

13. TREATMENT OF ACTINOMYCOSIS
• IV Penicillin: 10 – 20 million units/ day for 4 – 6 weeks
• Oral Penicillin: 4 – 6 gms/ day for 6 – 8 weeks
• Drainage
• Surgical Excision of scar and sinus tract

14. SYPHILIS
• Treponema Pallidum
• Modes of transmission:
1. Sexual
2. Blood transfusion
3. Trans-placental inoculation
• Dark Ground Microscopy
Disease
Latency
Disease
Latency
Disease

15. PRIMARY SYPHILIS
• Chancre:
• Local to the infection site
• 2 – 3 weeks after infection and disappears after another 2 weeks
• Painless indurated swelling, dark red in colour and with a glazed surface.
• Syphilitic Collar: Non-tender enlargement of the cervical lymph nodes.

17. SECONDARY SYPHILIS
• May last for many years
• Generalized Rash
• Snail track ulcers: grey-white ulcers covered by a thick slough

18. TERTIARY SYPHILIS
• Syphilitic Leukoplakia
• Gumma: Chronic Granuloma, common in palatal tissues causing a tissue defect due
to breakdown
• Widespread systemic involvement

19. CONGENITAL SYPHILIS
• Hutchinson’s Triad:
• Eighth Cranial Nerve Defect
• Dental Abnormalities: Hutchinson’s Incisors and Moon “Mulberry” Molars
• Interstitial Keratitis

21. DIAGNOSIS OF SYPHILIS
• Serological tests.
• Venereal Disease Reference Laboratory (VDRL) test: + in 75% of Primary Syphilis and
100% of secondary Syphilis patients.
• The Treponema pallidum hemagglutination assay (TPHA)
• The fluorescent Treponema antibody absorbed test (FTA): + in 90% of primary
Syphilis patients
• The Treponema pallidum immobilization (TPI) test

22. TREATMENT OF SYPHILIS
• High Doses of Antibiotics Penicillin or Erythromycin or Tetracycline
• In primary syphilis the course of antibiotics is up to 1 month
• In late (or latent) syphilis this is for up to 12 weeks.

23. TUBERCULOSIS
• Mycobacterium Tuberculosis
• Endemic with 1/3 of the world’s population being infected.
• Primarily a Respiratory disease with a Secondarily infected oral mucosa
• Clinical Features:
• The classical description of a tuberculous ulcer is of an irregular lesion with
undermined borders and covered by a grey slough
• The Tongue is most commonly affected but can affect other sites
• Tuberculosis Lymphadenopathy

24. DIAGNOSIS OF TUBERCULOSIS
• A tuberculous origin should be considered in the differential diagnosis of persistent
oral ulceration of unknown aetiology.
• Biopsy, with histopathological examination of Ziehl–Nielsen staining, or by
immunofluorescent techniques.
• Chest X-Ray
• Treatment:
• The most common medications used to treat tuberculosis include: Isoniazid,
Rifampin, Ethambutol and Streptomycin.

26. LEPROSY
• chronic, progressive bacterial infection caused by Mycobacterium leprae.
• It primarily affects the nerves of the extremities, the lining of the nose, and the
upper respiratory tract.
• Leprosy produces skin sores, nerve damage, and muscle weakness.

28. GONORRHEA
• Neisseria Gonorrhoea by direct mucosal contact.
• Clinical Features:
• Purulent gingivitis
• Diffuse erythema and ulcers
• Tonsillitis
• TMJ affection
• Gonorrhoea in the orofacial area is likely to be underdiagnosed
• Treatment: varying from a single, high-dose intramuscular injection of procaine
penicillin to oral Amoxicillin to short courses of oral tetracycline or co-Trimoxazole.

30. REITER’S SYNDROME
Polyarthritis
ConjunctivitisGeographic Tongue – like lesions

31. SCARLET FEVER
• Etiology: group A streptococci
• Clinical features:
• Children
• Incubation period
• Pharyngitis, tonsillitis, fever
• Lymphadenopathy, malaise, headache
• Red skin rash
• Flushed face and circumoral pallor
• Strawberry tongue - Raspberry tongue
• Subsides in few days time
• Complications:
• Rheumatic fever
• Glomeriolo-nephritis

32. REFERENCES
• Tyldesley’s Oral Medicine: Chapter 4: Infections of the gingivae and oral Mucosa
• Oral Pathology 4th edition: Chapter 11: Infections of the Oral Mucosa

33. THANK YOU