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Lecture xiii ju-oral pathology-lecture xiii-perio5


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Lecture xiii ju-oral pathology-lecture xiii-perio5

  1. 1. Oral Pathology Periodontal Diseases Sem IV- Lecture-XIII By Dr. Juma Alkhabuli (BDS, MDentSci, PhD) Associate Professor, Chair, Oral Biology Department
  2. 2. Non- Non-Plaque induced gingival lesions  Gingival diseases of specific bacterial origin  Gingival diseases of viral origin  Gingival diseases of fungal origin  Gingival diseases of genetic origin  Gingival manifestations of systemic conditions  Traumatic lesions  Foreign body reactions
  3. 3. 1. Gingival disease of specific bacteria origin  Streptococcal species Rare Usually starts as tonsolitis (A&B β-haemolytic streptococci)  Treponema pallidum (Syphilitic gingivitis) Extremely contagious Of 3 phases (2nd/mucous patch + skin rash)  Neisseria gonorrhea associated lesions
  4. 4. Cont’d Mucous patch Streptococcal infection
  5. 5. 2. Gingival diseases of viral origin A. Herpes virus infection:  Primary herpetic gingivostomatitis (HSV-1)  Recurrent herpes oral infection * 1/3 of the primary infected pt. are affected * Sunlight, trauma or stress may activate the virus and the new lesions are called herpes labialis (mucocutaneous) /cold sore  Varicella-zoster infection (V-Z-V; HHV-3) * cause chickenpox and herpes zoster B. Herpes papilloma virus (HPV)
  6. 6. Primary Herpetic Gingivostomatitis Recurrence
  7. 7. Cont’d Recurrent oral herpes on Recurrent herpes on palatal mucosa gingiva Note that oral recurrent herpes affects keratinised mucosa
  8. 8. Papilloma Condyloma Accuminatum
  9. 9. 3. Gingival diseases associated with fungal infections: infections: A. Candida-species infections:  Generalised gingival candidoses  Candida albicans (commensal organisms of 40% of population) * C. glabrata, C. tropicalis ,C. krusei, C. parapsilosis  Opportunistic pathogens  Common in immunocompromised and long-term broad spectrum antibiotic hosts
  10. 10. Cont’d A. Linear Gingival Erythema (HIV +ve) B. Histoplasmosis- systemic fungal disease caused by exposure to dust from animal dropping)
  11. 11. Cont’d Linear gingival Histoplasmosis erythema
  12. 12. 4. Gingival lesions of genetic origin  Hereditary Gingival Fibromatosis (rare hereditary condition)-  Generalised or localised enlargement  May be associated with hypertrichosis, epilepsy, mental retardation  Involves full width of the attached gingiva
  13. 13. Cont’d Gingival fibromatosis
  14. 14. 5. Gingival manifestations of systemic conditions A. Mucocutaneous disorders Lichen Planus (LP): Affects skin and oral mucous membranes Many forms; reticular, erosive, atrophic Immunologically mediated dermatoses Affects 0.1-4% of population, female>males Skin lesions present in1/3 of cases with oral LP Oral lesions present in 2/3 of cases with skin LP lesion infiltrate (CD8)
  15. 15. Cont’d Histologically, characterised by hyperkeratosis, base cell degeneration and sub-epithelial T- lymphocytic infiltrate (CD8)
  16. 16. Lichen planus Erosive
  17. 17. Cont’d Erosive lichen Planus Hyperkeratosis Subepithelial t-lymphocytic infiltrate Epithelium
  18. 18. Cont’d  Pemphigoid:  Vesiculobullous disease, slightly affects F>M  Twice as common as pemphigus  Formation of subepithelial bullous due to deposition of auto antibodies (C3+IgG) on hemidesmosomes and epithelial basement membrane  Involve skin and/or mucous membrane  Cicatricial pemphigoid = scar formation commonly affects moist mucosa [oral mucosa, nose, eye, throat, vagina]
  19. 19. Cont’d  Mucosa lesion= mucous membrane pemphigoid (cicatricial pemphigoid)  Skin lesion= bullous pemphigoid  On gingiva, it cause desquamative gingivitis
  20. 20. Cont’d Pemphigoid Complement 3 (C3) with/without IgG deposition at the basement membrane
  21. 21. Cont’d Adhesion- caused by Extensive scarring- pemphigoid pemphigoid
  22. 22. Cont’d Basement membrane components and sites of antibody deposition
  23. 23. Cont’d  Pemphigus vulgaris: Auto-antibodies target the inter-epithelial desmosomes More common in Jews 4 types; vulgais, vegetans (affects oral mucosa), erythematous and foliaceus Affects gingiva + other parts of oral mucosa and skin Oral ulcerations, erosion are common features
  24. 24. Cont’d Ocular lesion may be present (bilateral conjunctivitis) 50% of patients have oral lesions before skin eruptions positive Nikolsky sign [bulla can be induced on normal-appearing skin if firm lateral pressure is applied
  25. 25. Cont’d Pemphigus vulgaris
  26. 26. Cont’d  Erythema multiforme:  Immunopathologic vascular injuries lead to ischemic necrosis of skin and mucosa  Cause is unknown but allrgic to sulfonamides, and herpes simplex viral infection have been implicated  T "Target" lesions are characteristic  Oral lesions occur in 70% of cases may become hemorrhagic, life-threatening in the form of "Stevens-Johnson Syndrome“[oral mucosa+skin +(ocular /genital)]
  27. 27. Cont’d Target lesion Erythema multiforme
  28. 28. Cont’d  lupus erythematosis  It is immunologically mediate connective  Tissue disease, affecting oral mucosa+skin  3 types; systemic (SLE):  Cutaneous (chronic  CLE, also called discoid)  Sub-acute cutaneous (CLE)  B lymphocytes + abnormal function of T lymphocytes  Clinically appear similar to erosive LP
  29. 29. IgA desquamative gingivitis Lupus erythematosis Desqumative gingivitis Psoriasis
  30. 30. Cont’d B. Allergic reactions Dental restorative materials Mercury Nickel Acrylic Other
  31. 31. Cont’d  Ractions attributable to  Toothpastes/dentifrices  Mouthrinses/mouthwashes  Chewing gum additives  Foods and additives
  32. 32. Dentifrice/ reaction Mercury from amalgam
  33. 33. Con’d Allergic Gingivitis Plasma Cell Gingivitis (cinnamon) (hot peppers)
  34. 34. 6. Traumatic lesions  Chemical injury e.g. Aspirin burn, alcohol  Physical injury e.g. radiation  Thermal injury e.g. hot food
  35. 35. Con’d Alcohol Aspirin burn Radiation
  36. 36. Cocaine burn Pizza burn
  37. 37. Smokeless tobacco Bismuth-accumulation of metal sulfides Amalgam tattoo
  38. 38. 7. Other  Vascular neoplasm  Epithelial malignancy  Granulomatous diseases
  39. 39. Cont’d Cavernous Kaposi hemangioma sarcoma
  40. 40. Cont’d Epithelial carcinoma SCC
  41. 41. Cont’d Wegener's Crohn’s disease granulomatosis