METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
Bacterial infection of the oral cavity (khaled sadeq)
1.
2. Bacteria count a large
domain of prokaryotic
microorganisms.
Different shapes, ranging
from spheres to rods and
spirals.
They lack true nucleus.
3. Can be classified to Gram +ve
& Gram –ve Bacteria
Many of the bacteria have
Flagellae & Pili
Healthy people may carry:
4. Defention:
A Bacterial infection is the
invasion of body tissues by a
disease-causing Bacteria , and
their multiplication and the
reaction of body tissues to
these microorganisms and
toxins.
7. systemic infection Causative agent :
1. ß hemolytic streptococci
2. S. pyogenes
Produces pyrogenic / erythrogenic/
scarlet fever toxin
Highly contagious
Common in children
enters into body through pharynx
Incubation period is 3- 5days
Causes:
1. severe pharyngitis, tonsilitis
2. Headache, fever, chills, vomiting
3. Cervical lymphadenopathy
8. Clinical featers:
2nd/3rd day - diffuse, bright red scarlet skin
rash appears
Rash first appears on upper trunk
Spreads to extremities
Spares palms & soles
Colour of rash varies from scarlet to dusky
red
Small papules of normal colour erupt
through the rash….(sand paper feel to skin)
Rash is prominent in areas of skin folds…
PASTA LINES
Rash subsides after 6 to 7 days followed by
desquamation of palms & soles
9. Palatal mucosa:
1. congested
2. Petechiae scattered on soft palate
3. Palate, throat – fiery red
Tonsils ;
1. swollen
2. Often covered by pseudomembrane
Tongue :
1. white coating
2. Fungiform papilla becomes edematous,
hyperemic
3. Projects above the surface (strawberry
tongue)
11. Drug of choice is
PENICILLIN.
250 mg
2-3x 10 days 27 kg
500 mg > 27kgs
ERYTHROMYCIN
Clarithromycin
Azithromycin x 5days
12. STD Disease
Caused by Treponema
Pallidum
Two Types:
Acquired syphilis is
subdivided into:
Primary Syphilis
Secondary Syphilis
Tertiary syphilis
Congenital
13. Primary Syphilis:
Incubation period is 3-4
weeks
Characterized by the
appearance of
Chancre: a chronic ulcer at
site of infection or site where
bacteria enter the body.
Male and female genitalia
Upper lips in male, lower lip in
females
Tongue-lateral surface, anterior two
third, Palate, gingiva.
14. on examination are:
1. firm nodule in which the surface breaks
up in a few days leaving a round hard
ulcer
2. Solitary
3. Elevated
4. painless
5. with serous exudates
6. Regional lymphadenopathy
7. edema of the surrounding tissues is
usually present.
8. with a rubbery consistency
9. Highly infectious
10. heals spontaneously in 3-8 weeks
15. Secondary Syphilis :
Develops in 1 to 4 months of
initial infection.
It Causes:
Mild Fever
Sore Throat
Headache
Macular /papular patches as
ulcers which are painless
coin like lesions-face
16. Oral manifestations
White grey plaque on the
tongue , gingiva , palate
and buccal mucosa covers
the ucerated surface.
The Ulcer Discharge
contains many
spirochetes(Treponema
Pallidum ).
Generalized
lymphadenopathy .
Muscle Pain.
17.
18. Tertiary syphilis
Non infectious as tissue damage is
due to delayed type of hypersenstivity
reaction between host &
treponemes/their break down products.
Presented as:
Mucous membrane gumma
Begins as;
1. Small
2. Pale
3. Raised
4. Ulcerated
19. Atrophic Glossitis :
smooth shiny tongue,
Almost exclsively in males.
wrinkled lingual surface
atrophy of filliform, fugiform papilla
fibrosis of tongue musculature
Hyperkeratosis frequently occurs
May undergo carcinomatous
transformation
Gumma : At the tongue , palate ,
tonsils , begins as swelling that
ulcerate and destroy the underlying
tissue that may cause perforation of
the palate.
24. Drug of choice for all stages is
Penicillin.
Treponema Pallidum is
sensitive to antibiotics such
as:
1. Penicillin
2. Erythromycin
3. Tetracycline
Doxycycline or erythromycin
can be used in patients who
are sensitive to penicillin.
25. Most common sexually transmitted
bacterial infections
Short incubation period of less than 7
days
Caused by gram -ve diplococcus
Neisseria gonorrhea
Absence of symptoms in many
individuals, especially females
Age : 15-29 years
Transmission from an infected patient to
dental personnel is regarded as highly
unlikely
Requires break in skin or mucosa to
establish an infection
Protection
is by:
26. No specific clinical signs
have been consistently
associated with oral
gonorrhea.
Multiple ulcerations
Generalized erythema
Cervical
lymphadenopathy
Chief complaint may be
sore throat
27. Burning / itching sensation
Dry hot feeling in mouth which
in 24-48 hrs turns to acute pain
Foul oral taste
stinking breath
Enlarged, tender sub
mandibular lymphnodes
Severe infection – fever occurs
Gingiva : erythematous
with/without necrosis
28. Lips : acute painful ulcers leading to
limitation of movement
Tongue :
red
dry
Ulcerations
Become glazed
Swollen
painful Pseudomembrane –
(White,yellow,gray) in colour –
Easily scrappable – Bleeding
surfaces
Pharyngitis and tonsillitis – Vesicles
and ulcers with pseudomembrane
Gonococcal parotitis – Ascending
29.
30. Majority of gonococci
Resistant to b-lactam drug
so we use third generation
cephalosporin's
Uncomplicated gonorrhea
responds to single dose of
appropriately selected
antibiotic( 125mg-
ceftriaxone oraly)
Or complecated
Inj ceftriaxone-I.M. 400mg
31. Infects about 1/3 of world’s population
Kills approximately 3 million people
per year
Second leading cause of death in the
world
caused by aerobic, non-spore forming
bacillus Mycobacterium Tuberculosis
It has :
Thick , Waxy coat
Doesn’t react with Gram Stains
32. Mode of transmission :
1. Inhalation of organism
2. Ingestion of organism
3. Inoculation of organism
4. Transplacental route
It can be spread through
small airborne droplets
The organism will be carried
to the Pulmonary air spaces.
Pathogenesis;
33.
34. Primary Tuberculosis:
Occurs in previously
unexposed people.
Almost always involves the
lungs.
Most infections are the
result of direct person - to
– person spread.
Results only in a localized ,
fibrocalcified nodule .
Secondary Tuberculosis
( Active Disease ):
Develops later in life from a
reactivation of organisms.
associated with compromised
host defenses;
Immunosuppressive medication
Or HIV Patients
Diabetes
Old age
35. Primary T.B : Usually
asymptomatic.
Secondary T.B :
1. Low grade fever
2. Malaise
3. Night sweats and
weight loss
4. With progression ,
hemoptysis and chest
pain.
38. Typical lesion:
1. Indurate
2. Chronic
3. Nonhealing Ulcer That
Is Usually Painful
4. Bony involvement of
maxilla and mandible
produces tuberculosis
osteomyelitis
39. tongue ulcer of T.p
1. Site :
lateral borderant,
Dorsum, base of
tongue
1. Painful
2. grayish-yellow
3. firm well demarcated
40. Mucosa
1. Irregular
2. Ragged
3. undermined edges
4. minimal induration
5. with yellowish
granular base
43. Bone involvmeint:
difficulty in eating
Trismus
paraesthesia of lower lip
lymphadenopathy
Loosening of teeth
Involvement of major salivary
glands:
Parotid gland followed by
submandibular and sublingual
glands
44. 1. Tuberculin skin test
2. Biopsy (with special
stains)
3. Polymerase chain
reaction (PCR) for
bacterial DNA detects
the disease.
45. First line drugs include:
1. ISONIAZID
2. RIFAMPIN
3. PYRAZINAMIDE
4. EXAMBUTHOL
Drug combinations are
often used in 6, 9, or 12
month treatment regimens.
(BCG) vaccine is effective
in controlling childhood TB
46. Hansen’s disease
chronic infectious disease
caused by;
acid-fast bacillus, Mycobacterium
leprae
moderately contagious
transmission of disease requires;
frequent direct contact with an
infected individual for a long period
inoculation through respiratory tract
is also believed to be a potential
mode of transmission
47. Clinical Features
there is clinical spectrum of
disease that ranges from a
limited form (tuberculoid
leprosy) to a generalized form
(lepromatous leprosy) latter has
a more seriously damaging
course
skin + peripheral nerves are
affected
cutaneous lesions appear as;
erythematous plaques or
nodules
represents granulomatous
Signs of leprosy
48. Oral manifestation
similar lesions may
occur intraorally or
intranasally
in time, severe
maxillofacial deformaties
can appear producing
classic destruction of
anterior maxilla
(facies leprosa)
50. is a suppurative and granulomatous
chronic infectious disease.
Caused by
Gr +ve anaerobic Actinomyces Israeli
living as commensal organisms in the
human oral cavity and respiratory and
digestive tracts.
Becoming invasive ;
through a mucosal lesion, they gain
access to the subcutaneous tissue.
55% occur in cervicofacial region
Not regarded as contagious (always
endogenous)
Usually appears after Trauma , Surgery
and previous infection( most common )
51. 1. chronic
2. fluctuant mass
3. Located at the border of the
mandible
4. pain is rare
5. slight fever
6. sensation of superficial tension
around the mass.
Initially; the mass may be
surrounded by induration or
erythema
later; become tender to palpation,
on account of a central necrosis
process
52. Later;
1. Mass breaks down and
abscess, sinuses are formed
2. Discharging pus contain
typical (yellow sulphur
granules )
3. Skin overlying abscess is
Purplish,Red
Indurated
has appearance of wood.
Infection may extend into
adjoining soft tissue as well as
bone Leads actinomycotic
osteomyelitis
53. 1. positive culture
2. macroscopic presence
of the classic sulfur
granules in tissue
specimens .
3. Surgery plays an
important role both in
the diagnosis and
treatment of
actinomycosis.
54. Drainage of abscess
surgical excison of sinus
tracts but recurrence
following surgery alone is
very common so??
1. 2-4 weeks IV penicillin
followed by oral penicillin
2. 3-6 months high-dose
penicillin
55. Is an opportunistic infection that
occurs on a background of
impaired local or systemic host
defenses.
severe necrosis of the free
gingival margin,the crest of the
gingiva and the interdental
papilla
When NUG cause loss of
epithelial attachment and
spreads into the deeper tissues
of periodontium, it is known as
necrotizing ulcerative
Periodontitis
56. caused by ;
a mixed bacterial infection that
includes anaerobes such as P.
intermedia and Fusobacteriu as
well as spirochetes such
as Treponema
associated with;
diseases in which the immune
system is compromised,
including HIV/AIDS
predisposing factors;
smoking, psychological
57. Signs and symptoms;
1. necrosis
2. crater-like, punched-out ulceration
of the interdental papillae
3. sudden onset which may also
involve the gingival margins .
4. Sever pain.
5. The ulcers are covered with a
greyish-green pseudo membrane
demarcated from the surrounding
mucosa by a linear erythema.
6. gingival bleeding, either
spontaneously or on minor trauma
7. marked halitosis, bad taste
8. Malaise, cervical
lymphadenopathy,fever may be
58. includes irrigation
and debridement of necrotic
areas
oral hygiene instruction and the
uses of mouth rinses
pain medication
oral antibiotics may be given,
such as metronidazole.
As these diseases are often
associated with systemic
medical issues, proper
management of the systemic
disorders is appropriate.
59. Untreated, the infection may
lead to rapid destruction of
the periodontium and can
spread, as:
necrotizing stomatitis or
noma,
60. also known as gangrenous
stomatitis
Occurs mostly as a secondary
complication of systemic
disease rather than a primary
disease
devastating disease of
malnourished children
destructive process of orofacial
tissues
results from oral infaction
particularly Fusobacterium
necrophorum
these opportunistic pathogens invade
oral tissues whose defense are
weakened by:
1)malnutrition
2)acute necrotizing gingivitis
3) Trauma
4)other oral mucosal ulcers
61. Clinical Features
initial lesion is a painful
ulceration
usually gingiva or buccal
mucosa
spreads rapidly +
eventually becomes
necrotic
Involvement of bone may
follow
leading to necrosis +
sequestration
*blackening of skin
*Large masses of tissue may slough,
leaving jaw exposed
*Foul odour arise from these tissue
*have high temp
*Suffer secondary infection
* pt. May die from toxemia or pneumonia
teeth in affected area may become loose
+ exfoliate
62. fluids
Electrolytes
general nutrition are restored
along with antibiotics as clindamycin
• piperacillin • gentamicin
debridement of necrotic tissue may
also be beneficial if destruction is
extensive
And surgical correction of the
distracted area
63. A Neurological disease
characterised by; increased muscle tone & spasms.
most common type the spasms begin in the jaw and
then progresses to the rest of the body last a few
minutes each time and occur frequently for (3-4)
weeks
incubation period is approximately eight days.
Caused by;
CLOSTRIDIUM TETANI
Anaerobic , motile, gram +ve rod
spore forming, Drumstick Shapefarther the injury site is from the central
nervous system, the longer the incubation
period, and the less severe are the symptoms
experienced.
65. Mechanism of Infection
C. tetani usually enter the body
through an open wound, leading to
spore germination under anaerobic
conditions.
Once spore germination has
occurred, toxins are released into
the bloodstream and lymphatic
system.
These toxins act at several
locations within the central nervous
system, interfering with
neurotransmitter release and
blocking inhibitor impulses.
lead to uncontrollable muscle
contractions.
66.
67. Risus Sardonicus :
Spasm of facial muscles
( frontalis & angle of
mouth muscles )
producing grinning
facies
Corners of mouth are
drawn back
lips protruded
forehead is wrinkled
68. Oral considerations
1. Tonic rigidity of muscles
of mastication
2. Stiffness of face
3. Difficulty in chewing
4. Dysphagia
5. Edentulous pts- inability
to insert dentures
6. Truisms, lock jaw
69. NEUTRALIZE TOXIN :
1. Inj.Human Tetanus Immunoglobulin
2. 3000 – 6000 units IM, usually in divided doses
as volume is large.
ANTIBIOTIC THERAPY :
1. IV Penicillin 10 -12 million units daily for 10
days
2. IV Metronidazole 500mg Q 6 hrly / 1gm Q 12
hrly
3. Allergic to Penicillin : consider Clindamycin &
Erythromycin
Passive immunization
3 doses in 1st yr of life
Booster dose at school entry
70.
71. is inflammation of the soft tissues
surrounding the crown of a partially
erupted tooth.
including the;
gingiva (gums)
dental follicle
The soft tissue covering a partially
erupted tooth is known as
an operculum, an area which can be
difficult to access with normal oral
hygiene methods
and technically refers to
inflammation of the operculum alone.
often occurring at the age of
wisdom tooth eruption (15-24)
72. caused by :
accumulation of bacteria
(Streptococci and particularly
various anaerobic species) and
debris beneath the operculum
mechanical trauma
food impaction causing
periodontal pain
Pulpitis from dental caries
acute myofascial
pain in temporomandibular joint
disorder.
73. depend upon the severity;
Pain:
gets worse and becomes more severe
throbbing and radiate to the ear, temporomandibular joint, posterior
submandibular region
Tenderness
Erythema (redness)
Edema (swelling) of the tissues around the involved tooth
Halitosis resulting from volatile sulfur compounds
Bad taste
Trismus resulting from inflammation/infection of the muscles of mastication.
Dysphagia (difficulty swallowing).
Cervical lymphadenitis (inflammation and swelling of the lymph nodes in the
neck), especially of the submandibular nodes.
Facial swelling, and rubor often of the cheek that overlies the angle of the jaw.
Pyrexia (fever).
Leukocytosis (increased white blood cell count).
Malaise
74. presence of dental plaque or
infection beneath an inflamed
operculum without other obvious
causes of pain will often lead to a
pericoronitis diagnosis.
Radiographs can be used to rule out
other causes of pain and to properly
assess the prognosis for further
eruption of the affected tooth.
Sometimes a "migratory abscess" of
the buccal sulcus occurs, pus from
the lower third molar region tracks
forwards to be spontaneously
discharge via an intra-oral sinus
located over the mandibular second
or first molar, or even the second
premolar.
75. which can occur in conjunction
with pericoronitis may include:
Dental caries (periapical
abscess)
Food can also become stuck
between the wisdom tooth and
the tooth in front, termed food
packing and cause acute
inflammation in a periodontal
pocket.
Pain associated
with temporomandibular joint
disorder and myofascial pain
easily missed diagnoses in the
presence of mild and chronic
76. Acute
Pain(sudden onset and short lived, but
significant, symptoms)
Truisms
Dysphagia
Pus discharge
halitosis
Systemic complications
extra oral swelling
malaise
disturb sleeping
lymphadenitis involve the cervical lymph node
77. Chronic
Dull aching low grade pain
typically last only 1_2 days
Signs include;
palpable non_tender
submandibular
lymphnodes
radiographic appearance
of the local bone can
become more radiopaque
in chronic pericoronitis
78. Operculectomy (the surgical re
moval of operculum, a flap of
tissue over partially erupted
tooth especially the third
molar)
Typically operculectomy is
done with a surgical
scalpel, electrocautery ,with
lasers[ or, historically, with
caustic agents (trichloracetic
acid)
Extraction and oral hygiene
maintenance