fmd175 slide infection diseases of the oral mucosa

VIRUS

FUNGI

BACTERIA

DISEASE

The oral focal infection theory

• A concept generally negleted for several decades, is controversial yet has gained renewed interest with progress in clasification and identification of oral microorganisms.

• Additionally, recent evidence associating dental with artherosclerosis and other chronic disease has also helped resurrect

the focal infection theory

Pathways of infection arising from oral bacteria

The three pathway that may link oral bacteria to

secondary disease distant from the oral nidus

are :

1. Metastatic infection attributable to transient bacteria in

the blood

2. Metastatic immunologic injury

3. Metastatic toxic injury

The scientific evidence weak a it is best supports of first

pathway of transient bacteriemias of oral origin

Mechanical prosthetic

valve (arrow)

Odontogenic infection

Caries dental pulpitisCaries dental pulpitis

Necrosis of the pulp pulp polyp

Periapical abscess

Periodontal infection

Periodontal abscess

ANUGGingivitis

Salivary infection

Mucositis

Recurent Apthous Stomatitis

Minor

RAS Mayor

Penyakit Infeksi Bakteri Spesifik Penyakit Infeksi Bakteri Spesifik

di Rongga Mulut

Sifilis

Gonorrhea

Tuberkulosis

Lepra

SIFILIS

1.Sifilis acquired

Sifilis primer

Sifilis sekunder

Sifilis tertier

2.Sifilis kongenital

Penyebab: Treponema Pallidum

Patogenesis

Kontak seksual --- lesi primer ( chancre ) ---- hilang---

lesi sekunder -----hilang --- tertier

Transfusi darah --- lesi sekunder --- hilang --- tertier

Kongenital ----- plasenta ibu yang terinfeksi ----

tidak ada lesi primer

Sifilis Primer

- Berkembang pada tempat masuknya kuman, 3-4

minggu

- Lesi chancre -- plak keras, sedikit meninggi, ulserasi,

bulat,

indurasi dengan tepi bergulung, coklat berkrusta,

dimulaidimulai

dengan bercak atau papula --- ulser

- Diameter 5 mm - beberapa cm

- Tidak sakit

- Hilang spontan sesudah 10 hari

- Lesi dapat satu atau multiple.

- Pembesaran kelenjar limfe regional

Manifestasi di rongga mulut

- Lesi chancre

- Lokasi bibir, mukosa mulut, lidah, palatum lunak, tonsil

faring, jarang pada gusi

- Sedikit sakit karena infeksi sekunder

- Ulser ditutupi lapisan putih keabuan

- Pada ekstra oral bibir--- krusta coklat- Pada ekstra oral bibir--- krusta coklat

- Dapat multiple

Diagnosa

- Riwayat kontak dengan penderita

- Smear mulut tidak terlihat

- Pemeriksaan darah negatif

- Eksudat dengan darkfield microscope positif pada akhir

stadium primer

Diagnosa Banding

-Lesi herpes pada bibir

-Squamous cell carcinoma stadium awal

-Lesi trauma kronik

-Tuberkulosis

Sifilis SekunderTanda-tanda umum- Terjadi 3-6 minggu setelah lesi primer

- Lokasi tidak berhubungan dengan lesi primer

- Erupsi difus pada kulit dan mukosa

- Makula papula pada kulit

- Pada mukosa dan kulit yang lembab terjadi : mucous patch

split papula dan condyloma latumsplit papula dan condyloma latum

Mucous patch : area kecil, licin, eritematus atau erosi

superfisial, putih keabuan pada genital dan mulut, multiple dan

tidak sakit

Split papula : Lesi doble papula pada area intertrigenus

Condyloma latum : Papula besar, lembab, abu-abu, pada

mukokutan yang lembab


Mucous patch

- Lokasi pada lidah, mukosa bukal, tonsil, faring dan bibir

pada gusi jarang

- Lesi yang paling menular

- Plak berwarna putih keabuan, sedikit meninggi, permukaan

ulserasi, dasar eritematusulserasi, dasar eritematus

- Bentuk ovoid atau tidak teratur

- Multiple dan tidak sakit

- Pada lidah, papilla hilang diatas lesi berbatas jelas

- Trauma pada lesi dapat sakit dan berdarah

Split Papula

- Lokasi pada komisura bibir berupa fisur yang membagi dua

bibir atas dan bawah oleh papula

- Dapat terjadi pada dorsum lidah

- Tidak spesifik

Condyloma latum

- Jarang pada mulut- Jarang pada mulut

- Berwarna abu-abu silver, rata, seperti kutil, ulserasi

- Tidak sakit

Diagnosa Banding

Mucous patch

- Lesi herpes masa penyembuhan

- Lesi traumatik

- Eritema multiform

- Kandidiasis

- Proses alergi- Proses alergi

Split Papula

- Angular cheilitis karena defisiensi Vitamin atau kurangnya

ruang inter maksilar

Diagnosa : Tes serologis biasanya positif

Sifilis Tertier

Tanda-tanda umum- Asimtomatik atau simtom kompleks

- Lesi gumma pada kulit, mukosa, liver, testis, tulang

- Dapat melibatkan sistem kardiovaskular, CNS, jaringan dan

organ tertentu

- Neurosifilis ---- tabes dorsalis dan general paresis- Neurosifilis ---- tabes dorsalis dan general paresis

Tabes dorsalis --- colum, spinal cord, root ganglia posterior

General paresis ---- jaringan cerebral


- Lesi gumma , berupa massa nodular yang padat , ulserasi,

nekrose, pada palatum --- perforasi palatum

- Lokasi : palatum, lidah, kelenjar ludah, tulang rahang

- Pada lidah --- atropi papilla, lidah keras --- luetic bald tongue

- Tabes dorsales ---- rasa sakit kepala dan leher, kehilangan

rasa pengecapan, nekrosis spontan padarasa pengecapan, nekrosis spontan pada

prosessus alveolaris

- General paresis ---- paresis bibir, lidah, hidung, pipi

ulserasi tidak sakit pada palatum, septum

hidung, kematian pulpa spontan

- Atropik lidah ---- epidermoid carcinoma

Diagnosa Banding

- Gumma ---- Fraktur yang tidak sembuh-sembuh

Osteomielitis yang lama bertahan

Karsinoma

Tindakan dokter gigi

- Menghindari penularan ---- sifilis primer dan sekunder

- Sebagai case finder

-Mencegah bakterial endokarditis

PerawatanPerawatan- Sifilis primer, sekunder dan laten -- Benzathine penisilin G

- Bila alergi penisilin --- tetrasiklin atau eritromisin

Sifilis kongenital ( prenatal sifilis )

Tanda-tanda umum

- Manifestasi pada 2 tahun pertama kehidupan

- Tidak ada lesi primer

- Rinitis, hidung sumbat, kehilangan berat badan, tumit

berkerut dan bersisik

- Makula, papula, bula, vesikel, deskuamasi superfisial.- Makula, papula, bula, vesikel, deskuamasi superfisial.

- Kulit berkerut dan bersisik

- Petechie, mucous patch, condyloma latum

- Kepala bentuk empat segi, lobus frontal menonjol

- Manifestasi lanjutan sesudah 2 tahun, interstitial keratitis,

vaskularisasi kornea, ketulian, artopati

- Umur 10-12 tahun, saddle nose, deformiti tulang hidung

perforasi palatum

Umur 10-12 tahun

- Saddle nose, deformiti tulang hidung atau perforasi palatum

- Melibatkan tulang fasial dan gigi

- Dapat terjadi frontal bosse, maksila yang pendek, palatum

yang tinggi, mulberry molar.

Tanda khas- Triad Hutchinson : Hipoplasia Incisivus dan Molar- Triad Hutchinson : Hipoplasia Incisivus dan Molar

Ketulian syaraf 8

Keratitis interstitial


1. Post Rhagadic scarring pada mulut

- daerah linear merah tembaga ditutupi krusta lunak pada

bibir

- Bila sembuh seperti sikatrik

2. Perobahan pada gigi

- Perobahan bentuk, warna dan ukuran gigi- Perobahan bentuk, warna dan ukuran gigi

- Resorbsi akar yang berkurang pada gigi desidui

- Hipoplasia gigi pada I, C dan M satu permanen

bentuk obeng, runcing pada I, bud shaphe pada M

DD dengan terapi Tetrasiklin atau Riketsia

3. Perobahan dentofasial : malokklusi dan open bite

Diagnosa

- Riwayat dilahirkan

ibu penderita sifilis

- Lesi-lesi yang khas

Perawatan

Injeksi Penisilin

Fungal infection

• Are oral fungal infections common ?

• No, most are associated with an underlying

systemic condition immunosuppression

imunodeficiency syndrome cancer therapy

anemia

diabetes

uremia

leukemia

• Patients who have conditions that modify

the normal oral environment are at

increased risk of fungal infection

Among these individuals are patients withAmong these individuals are patients with

_ xerostomia

_ have taken broad spectrum antibiotics

Diagnosis of oral fungal infection based on :

• History

• Clinical appearance

• Culture

• Potassium hydroxide preparation• Potassium hydroxide preparation

• Biopsy

• What is the most common fungal infection to affect the mouth?

• Oral candidiasis caused by Candida Albicans

What is the typical clinical presentation of oral candidiasis ?

• Pseudomembranous candidiasis

• Hyperplastic candidiasis• Hyperplastic candidiasis

• Erythematous candidiasis

• Angular cheilitis

Pseudomembranous candidiasis ( Thrush )

• Most typical clinical presentation of the infection

• White, cottage cheesy-looking raised lesionslesions

• Most often of tongue or palate

• Can be scrapped off, leaving a painful, raw

bleeding base

Hyperplastic Candidiasis

• Less common

• As area leukoplakia at corners of the mouth or

the cheeks

• Unlike pseudomembranous forms, these lesions• Unlike pseudomembranous forms, these lesions

cannot be scraped off

Erythematous Candidiasis

• Most often present on the dorsal surface or edges tongue and palate

• The degree of mucosal erythema may be variablevariable

• Patients with this form of candidiasis often

complain of a burning mouth

Angular cheilitis

Viral infection

• Are viral infections of the mouth common or rare ?

Viral infections are among the most Viral infections are among the most common causes of oral lesions

Symptoms of acute viral infections that affects the mouth

• Vesicles or rupture small ulcers

• History suggesting viremia : fever, malaise, myalgia, upper respiratory symptoms, anorexiasymptoms, anorexia

• Pain associated lesions

Group of viruses for most oral infections:

• HS type 1,2

• Varicella-zoster virus

• The epstein-barr virus

• Cytomegalovirus• Cytomegalovirus

• Herpes virus 6,7,8 ( infectious in immunocompromisefd patient

HIV HAS BEEN ISOLATED FROM BODY FLUIDS :

� HUMAN BLOOD.

� SEMEN

� VAGINAL SECRETIONS.

� BREAST MILK.� BREAST MILK.

� TEARS.

� URINE.

� SALIVA.

� CEREBROSPINAL FLUID.

� AMNIOTIC FLUID.

DIAGNOSTIC TESTING FOR HIV :

1. Detection of serum antibody

ELISA.

2. Detection of viral antigen in patient’s

blood or tissue

WESTERN BLOT TEST.

PREVALENSI : 40 – 90%

HIV-related lesions have particular significancebecause :

- They are often the first sign of HIV disease.- They have prognostic value.- They have prognostic value.- They are a frequent cause a morbidity andmortality.

- Knowledge and proper treatment can addto the quality of life of HIV patients.

SAN FRANSISCO, AUG. 17, 1990 :

I. CANDIDIASIS.A. Pseudomembranous candidiasis.B. Erythematous candidiasis.C. Angular cheilitis.C. Angular cheilitis.

II. GINGIVITIS / PERIODONTITIS.A. HIV – associated gingivitis.B. HIV – associated periodontitis.

III. NECROTIZING STOMATITIS.

IV. HERPES SIMPLEX.A. Intra oral form.B. Perioral form.B. Perioral form.

V. CYTOMEGALOVIRUS.

VI. VARICELLA – ZOSTER VIRUS

VII. APHTHOUS ULCERATION.A. Minor.B. Mayor.B. Mayor.C. Herpetiform.

VIII. HAIRY LEUKOPLAKIA.

IX. HIV SALIVARY GLAND DISEASE.

X. ORAL KAPOSI SARCOMA.

XI. ORAL WARTS / PAPILOMA.A. Papilloma.B. Focal epithelial hyperplasia.

TREATMENT OF THE ORAL LESIONS ASSOCIATED WITH HIV INFECTION.

CONDITION THERAPY

I. Candidiasis Antifungal (topical and /I. Candidiasis Antifungal (topical and /or systemic).

II. HIV- associated Plaque removal, debri-gingivitis dement, chlorhexidine,

povidone iodine.

CONDITION THERAPY

HIV- associted Plaque removal, debri-

periodontitis dement, chlorhexidine,metronidazole.

Necrotizing sto- Debridement, chlorhe-matitis xidine, metronidazole.matitis xidine, metronidazole.

III. Herpes simplex If not self limiting, ifprolonged, if frequen-tly recurrent �� acyclo-

vir.

IV. Herpes zoster Oral Acyclovir.

CONDITION THERAPY

V. Aphthous ulcer Topically steroid

VI. Hairy leukoplakia Usually no treatment,severe �� acyclovir

VII. Kaposi sarcoma Excision, laser, radia-tion, chemotherapy

VIII. Oral wart Excisison, laser

IX. Xerostomia Salivary stimulation, artificial saliva.

HIV

• The main targets for the virus are cells expressing the

CD4 membrane reseptor, such as T4 helper lymphocyte,

macrophages and monocyte

• Viral replication occures within the CD4 cel, leading to its • Viral replication occures within the CD4 cel, leading to its

destruction and loss of function. As a result the number

of CD4 cell declines, and the patient become at high risk

for opportunistic infections.

Many medication used to treat HIV have side

effect

• Abacavir oral ulceration

• Flycotsine myelosuppression

• Foscarnet ou &m

• Ganciclovir m

• Hydroxyurea ou

• Interferon xerostomis,metallic

taste & mtaste & m

• Lopinavir u & x

• Pentamidine mt

• Rifampin salivary discoloration

• Ritonavir perioral paresthesia

• Saquinavir p, neutropenia, thrombocytopenia

• TMP/SMZP myelosup,ou, glositis

• Dideoxycytidine my & ou Zidovudine Neutropenia

VIRUS

VIRUS PENYAKIT

Herpes Simpleks 1 & 2

Primary Gingivostomatitis HerpeticaHerpes Labialis Recurrent

Viral infection causing, or associated with diseases

of the oral mucosa :

Herpes Labialis RecurrentHerpes Intra Oral RecurrentHerpetic Whitlow

Varicella - Zoster Chickenpox

Herpes Zoster

Coxsakie A Herpangina

Hand, foot and mouth disease

VIRUS PENYAKIT

Cytomegalovirus Salivary gland disease

Epstein Barr Virus

Hairy leukoplakia

Viral infection causing, or associated with diseases

of the oral mucosa :

Virus

Paramyxovirus Measles

Papilomavirus Viral warts

H I V Manifestasi oral HIV

HERPES SIMPLEX VIRUS INFECTION

Family herpesviridaeFamily herpesviridaeFamily herpesviridaeFamily herpesviridae

∗ Herpes simplex virus Herpes simplex virus Herpes simplex virus Herpes simplex virus –––– 1111∗ Herpes simplex virus Herpes simplex virus Herpes simplex virus Herpes simplex virus –––– 1111∗ Herpes simplex virus Herpes simplex virus Herpes simplex virus Herpes simplex virus –––– 2222∗ CytomegalovirusCytomegalovirusCytomegalovirusCytomegalovirus∗ VaricellaVaricellaVaricellaVaricella----zoster viruszoster viruszoster viruszoster virus∗ Epstein Barr virusEpstein Barr virusEpstein Barr virusEpstein Barr virus∗ Human herpes virusHuman herpes virusHuman herpes virusHuman herpes virus----6666∗ Human herpes virusHuman herpes virusHuman herpes virusHuman herpes virus----7777∗ Human herpes virusHuman herpes virusHuman herpes virusHuman herpes virus----8888

Herpes Simplex virus Herpes Simplex virus Herpes Simplex virus Herpes Simplex virus –––– 1111⇒⇒⇒⇒ perioral, eyesperioral, eyesperioral, eyesperioral, eyes

Herpes Simplex virus Herpes Simplex virus Herpes Simplex virus Herpes Simplex virus –––– 2222⇒⇒⇒⇒ genitalsgenitalsgenitalsgenitals

TRANSMISSION :TRANSMISSION :TRANSMISSION :TRANSMISSION :1. Airbone droplets1. Airbone droplets1. Airbone droplets1. Airbone droplets2. Intimate contact2. Intimate contact2. Intimate contact2. Intimate contact

HERPES SIMPLEX VIRUS HERPES SIMPLEX VIRUS HERPES SIMPLEX VIRUS HERPES SIMPLEX VIRUS INFECTIONINFECTIONINFECTIONINFECTION

PRIMARY PRIMARY PRIMARY PRIMARY INFECTIONINFECTIONINFECTIONINFECTION

RECURRENT RECURRENT RECURRENT RECURRENT INFECTIONINFECTIONINFECTIONINFECTION

CHARACTERISTIC PROPERTY OF HERPES CHARACTERISTIC PROPERTY OF HERPES CHARACTERISTIC PROPERTY OF HERPES CHARACTERISTIC PROPERTY OF HERPES VIRUS :VIRUS :VIRUS :VIRUS :

after “primary infection” after “primary infection” after “primary infection” after “primary infection” ⇒⇒⇒⇒ latent inlatent inlatent inlatent incell host cell host cell host cell host ⇒⇒⇒⇒ reactivated by variety factorsreactivated by variety factorsreactivated by variety factorsreactivated by variety factors⇒⇒⇒⇒ “recurrent infection”“recurrent infection”“recurrent infection”“recurrent infection”

Trigger factors :Trigger factors :Trigger factors :Trigger factors :Trigger factors :Trigger factors :Trigger factors :Trigger factors :---- FeverFeverFeverFever---- Emotional stressEmotional stressEmotional stressEmotional stress---- Ultraviolet radiationUltraviolet radiationUltraviolet radiationUltraviolet radiation---- MenstruationMenstruationMenstruationMenstruation---- HormonesHormonesHormonesHormones---- ImmunosuppressionImmunosuppressionImmunosuppressionImmunosuppression---- Ionizing radiationIonizing radiationIonizing radiationIonizing radiation

PATHOGENESIS OF HSV-1 INFECTIONS :

Host (seronegative)

Primary disease

orRecurrent infection or

HSV

or

Subclinical infection

Host (seropositive)

latent virus

ReactivationReactivationReactivationReactivation

Recurrent infection or

Shedding asymptomatic

ResolutionResolutionResolutionResolution

PRIMARY HSV-1 INFECTION :

---- Seronegative for HSVSeronegative for HSVSeronegative for HSVSeronegative for HSV---- Children, young adultChildren, young adultChildren, young adultChildren, young adult---- Does not imply clinical signs & symptomsDoes not imply clinical signs & symptomsDoes not imply clinical signs & symptomsDoes not imply clinical signs & symptoms---- Does not imply clinical signs & symptomsDoes not imply clinical signs & symptomsDoes not imply clinical signs & symptomsDoes not imply clinical signs & symptoms⇒⇒⇒⇒ subclinicalsubclinicalsubclinicalsubclinical

---- Incubation periode : several days Incubation periode : several days Incubation periode : several days Incubation periode : several days ––––2 weeks2 weeks2 weeks2 weeks

---- ⇒⇒⇒⇒ Primary Gingivostomatitis HerpeticaPrimary Gingivostomatitis HerpeticaPrimary Gingivostomatitis HerpeticaPrimary Gingivostomatitis Herpetica⇒⇒⇒⇒ Herpetic WhitlowHerpetic WhitlowHerpetic WhitlowHerpetic Whitlow

PRIMARY GINGIVOSTOMATITIS PRIMARY GINGIVOSTOMATITIS PRIMARY GINGIVOSTOMATITIS PRIMARY GINGIVOSTOMATITIS

HERPETICA.HERPETICA.HERPETICA.HERPETICA.

CLINICAL APPEARANCES :CLINICAL APPEARANCES :CLINICAL APPEARANCES :CLINICAL APPEARANCES :---- Prodromal symptoms : fever, malaise, nausea,Prodromal symptoms : fever, malaise, nausea,Prodromal symptoms : fever, malaise, nausea,Prodromal symptoms : fever, malaise, nausea,headache, lymphadenopathy.headache, lymphadenopathy.headache, lymphadenopathy.headache, lymphadenopathy.

---- Vesicle Vesicle Vesicle Vesicle →→→→ rupture rupture rupture rupture →→→→ round/oval ulcers,round/oval ulcers,round/oval ulcers,round/oval ulcers,shallow, greyshallow, greyshallow, greyshallow, grey----white pseudomembrane, surroundedwhite pseudomembrane, surroundedwhite pseudomembrane, surroundedwhite pseudomembrane, surroundedby erythema area.by erythema area.by erythema area.by erythema area.by erythema area.by erythema area.by erythema area.by erythema area.

---- Ulcers can coalescent Ulcers can coalescent Ulcers can coalescent Ulcers can coalescent →→→→ large ulcers.large ulcers.large ulcers.large ulcers.---- Pain, disorders of swallowing, eating, Pain, disorders of swallowing, eating, Pain, disorders of swallowing, eating, Pain, disorders of swallowing, eating, secondarily infected.secondarily infected.secondarily infected.secondarily infected.

---- Location: any intra oral.Location: any intra oral.Location: any intra oral.Location: any intra oral.---- Acute gingivitis marginalis Acute gingivitis marginalis Acute gingivitis marginalis Acute gingivitis marginalis →→→→ gingiva are gingiva are gingiva are gingiva are swollen with red edges that bleed easily.swollen with red edges that bleed easily.swollen with red edges that bleed easily.swollen with red edges that bleed easily.

---- Heal : 10 Heal : 10 Heal : 10 Heal : 10 –––– 12 days 12 days 12 days 12 days →→→→ self limiting disease,self limiting disease,self limiting disease,self limiting disease,without scar.without scar.without scar.without scar.

Treatment :Treatment :Treatment :Treatment :Goals :Goals :Goals :Goals :

1. To shorten the current attack.1. To shorten the current attack.1. To shorten the current attack.1. To shorten the current attack.2. To prevent recurrences.2. To prevent recurrences.2. To prevent recurrences.2. To prevent recurrences.

Medications :Medications :Medications :Medications :Medications :Medications :Medications :Medications :♥♥♥♥ Analgesics.Analgesics.Analgesics.Analgesics.♥♥♥♥ Vitamin.Vitamin.Vitamin.Vitamin.♥♥♥♥ Anaesthetic topical.Anaesthetic topical.Anaesthetic topical.Anaesthetic topical.♥♥♥♥ Antivirus.Antivirus.Antivirus.Antivirus.

RECURRENT HSV INFECTION :RECURRENT HSV INFECTION :RECURRENT HSV INFECTION :RECURRENT HSV INFECTION :

---- Affect 20 40% 0f adult population.Affect 20 40% 0f adult population.Affect 20 40% 0f adult population.Affect 20 40% 0f adult population.---- Antibody for HSV was present.Antibody for HSV was present.Antibody for HSV was present.Antibody for HSV was present.---- Reactivation of latent virus by triggerReactivation of latent virus by triggerReactivation of latent virus by triggerReactivation of latent virus by triggerfactors.factors.factors.factors.factors.factors.factors.factors.

---- ⇒⇒⇒⇒ Recurrent Herpes LabialisRecurrent Herpes LabialisRecurrent Herpes LabialisRecurrent Herpes Labialis⇒⇒⇒⇒ Recurent Herpes Intra OralRecurent Herpes Intra OralRecurent Herpes Intra OralRecurent Herpes Intra Oral⇒⇒⇒⇒ Herpetic Whitlow.Herpetic Whitlow.Herpetic Whitlow.Herpetic Whitlow.

RECURRENT HERPES LABIALIS.RECURRENT HERPES LABIALIS.RECURRENT HERPES LABIALIS.RECURRENT HERPES LABIALIS.

CLINICAL APPEARANCES :CLINICAL APPEARANCES :CLINICAL APPEARANCES :CLINICAL APPEARANCES :---- Prodromal symptoms : mild fever, tingling, Prodromal symptoms : mild fever, tingling, Prodromal symptoms : mild fever, tingling, Prodromal symptoms : mild fever, tingling, burning or pain in which lesions will appear.burning or pain in which lesions will appear.burning or pain in which lesions will appear.burning or pain in which lesions will appear.

---- Vesicles on the vermillion border of lip Vesicles on the vermillion border of lip Vesicles on the vermillion border of lip Vesicles on the vermillion border of lip →→→→---- Vesicles on the vermillion border of lip Vesicles on the vermillion border of lip Vesicles on the vermillion border of lip Vesicles on the vermillion border of lip →→→→rupture rupture rupture rupture →→→→ shallow ulcer.shallow ulcer.shallow ulcer.shallow ulcer.

---- Yellow crust formation.Yellow crust formation.Yellow crust formation.Yellow crust formation.---- Problems : pain, cosmetic disfigurement,Problems : pain, cosmetic disfigurement,Problems : pain, cosmetic disfigurement,Problems : pain, cosmetic disfigurement,psychosocial effect.psychosocial effect.psychosocial effect.psychosocial effect.

---- Heal : 1 Heal : 1 Heal : 1 Heal : 1 –––– 2 weeks without scar.2 weeks without scar.2 weeks without scar.2 weeks without scar.---- Recurrences is variable.Recurrences is variable.Recurrences is variable.Recurrences is variable.

RECURRENT HERPES INTRAORAL.RECURRENT HERPES INTRAORAL.RECURRENT HERPES INTRAORAL.RECURRENT HERPES INTRAORAL.

CLINICAL APPEARANCES :CLINICAL APPEARANCES :CLINICAL APPEARANCES :CLINICAL APPEARANCES :---- Prodromal symptoms Prodromal symptoms Prodromal symptoms Prodromal symptoms →→→→ mild.mild.mild.mild.---- Vesicles Vesicles Vesicles Vesicles →→→→ rupture rupture rupture rupture →→→→ ulcers.ulcers.ulcers.ulcers.---- Intraorally.Intraorally.Intraorally.Intraorally.---- Intraorally.Intraorally.Intraorally.Intraorally.

Recurrent Herpes Labialis maybe seen concurentlyRecurrent Herpes Labialis maybe seen concurentlyRecurrent Herpes Labialis maybe seen concurentlyRecurrent Herpes Labialis maybe seen concurentlywith the intraoral lesions or they occur alone.with the intraoral lesions or they occur alone.with the intraoral lesions or they occur alone.with the intraoral lesions or they occur alone.

HERPETIC WHITLOW :HERPETIC WHITLOW :HERPETIC WHITLOW :HERPETIC WHITLOW :

---- Primary or secondary HSV infection involvingPrimary or secondary HSV infection involvingPrimary or secondary HSV infection involvingPrimary or secondary HSV infection involvingthe finger.the finger.the finger.the finger.

---- Because of the physical contact with infected Because of the physical contact with infected Because of the physical contact with infected Because of the physical contact with infected individual.individual.individual.individual.

---- Fever, lymphadenopathy.Fever, lymphadenopathy.Fever, lymphadenopathy.Fever, lymphadenopathy.---- Fever, lymphadenopathy.Fever, lymphadenopathy.Fever, lymphadenopathy.Fever, lymphadenopathy.---- Pain, redness, swelling are prominent.Pain, redness, swelling are prominent.Pain, redness, swelling are prominent.Pain, redness, swelling are prominent.---- Duration : 4 Duration : 4 Duration : 4 Duration : 4 –––– 6 weeks.6 weeks.6 weeks.6 weeks.---- Locations : paronychial, eponychial orLocations : paronychial, eponychial orLocations : paronychial, eponychial orLocations : paronychial, eponychial orsubungal portions of the distal phalanges,subungal portions of the distal phalanges,subungal portions of the distal phalanges,subungal portions of the distal phalanges,other area of the fingerother area of the fingerother area of the fingerother area of the finger....

VARICELLA VARICELLA VARICELLA VARICELLA –––– ZOSTER ZOSTER ZOSTER ZOSTER VIRUSVIRUSVIRUSVIRUS

⇒ DNA untai gandaDNA untai gandaDNA untai gandaDNA untai ganda⇒ NeurotropicNeurotropicNeurotropicNeurotropic⇒ Penularan : kontak langsung,Penularan : kontak langsung,Penularan : kontak langsung,Penularan : kontak langsung,⇒ Penularan : kontak langsung,Penularan : kontak langsung,Penularan : kontak langsung,Penularan : kontak langsung,

infeksi droplet.infeksi droplet.infeksi droplet.infeksi droplet.⇒⇒⇒⇒ Infeksi primer dan rekurenInfeksi primer dan rekurenInfeksi primer dan rekurenInfeksi primer dan rekuren⇒⇒⇒⇒ bersifat latenbersifat latenbersifat latenbersifat laten

Varicella – zoster virus

PRIMARY INFECTION RECURRENT INFECTION

CHICKENPOX / CHICKENPOX / CHICKENPOX / CHICKENPOX / VARISELAVARISELAVARISELAVARISELA

HERPES ZOSTER / HERPES ZOSTER / HERPES ZOSTER / HERPES ZOSTER / SHINGLESSHINGLESSHINGLESSHINGLES

Hospes (seronegative)Hospes (seronegative)Hospes (seronegative)Hospes (seronegative)

Primary infectionPrimary infectionPrimary infectionPrimary infection( Chickenpox )( Chickenpox )( Chickenpox )( Chickenpox ) Recurrent infectionRecurrent infectionRecurrent infectionRecurrent infection

( Herpes zoster )( Herpes zoster )( Herpes zoster )( Herpes zoster )

Hospes (seropositive )Hospes (seropositive )Hospes (seropositive )Hospes (seropositive )Latency virusLatency virusLatency virusLatency virus

Reactivation :Reactivation :Reactivation :Reactivation :- ageageageage-Immunosupression, dllImmunosupression, dllImmunosupression, dllImmunosupression, dll

( Herpes zoster )( Herpes zoster )( Herpes zoster )( Herpes zoster )

VARICELLA ( CHICKENPOX ) :VARICELLA ( CHICKENPOX ) :VARICELLA ( CHICKENPOX ) :VARICELLA ( CHICKENPOX ) :

---- seronegative individual.seronegative individual.seronegative individual.seronegative individual.---- children.children.children.children.---- incubation periode : 2 incubation periode : 2 incubation periode : 2 incubation periode : 2 –––– 3 weeks.3 weeks.3 weeks.3 weeks.---- prodromal symptoms : fever, chills, malaise,prodromal symptoms : fever, chills, malaise,prodromal symptoms : fever, chills, malaise,prodromal symptoms : fever, chills, malaise,---- prodromal symptoms : fever, chills, malaise,prodromal symptoms : fever, chills, malaise,prodromal symptoms : fever, chills, malaise,prodromal symptoms : fever, chills, malaise,headache.headache.headache.headache.

---- rash rash rash rash →→→→ vesicles vesicles vesicles vesicles →→→→ pustula / ulcerations.pustula / ulcerations.pustula / ulcerations.pustula / ulcerations.---- heal : 2 weeks heal : 2 weeks heal : 2 weeks heal : 2 weeks →→→→ self limiting.self limiting.self limiting.self limiting.---- intra oral : not consistently involved.intra oral : not consistently involved.intra oral : not consistently involved.intra oral : not consistently involved.⇒⇒⇒⇒ discrete/scattered vesicles discrete/scattered vesicles discrete/scattered vesicles discrete/scattered vesicles →→→→ rupture rupture rupture rupture →→→→

shallow round ulcer surrounded by red halo.shallow round ulcer surrounded by red halo.shallow round ulcer surrounded by red halo.shallow round ulcer surrounded by red halo.

HERPES ZOSTER :HERPES ZOSTER :HERPES ZOSTER :HERPES ZOSTER :

Clinical appearancess :Clinical appearancess :Clinical appearancess :Clinical appearancess :- Gejala prodromal : parastesi, gatal, rasa terbakar,Gejala prodromal : parastesi, gatal, rasa terbakar,Gejala prodromal : parastesi, gatal, rasa terbakar,Gejala prodromal : parastesi, gatal, rasa terbakar,nyeri di daerah dermatom yg terlibat.nyeri di daerah dermatom yg terlibat.nyeri di daerah dermatom yg terlibat.nyeri di daerah dermatom yg terlibat.

- Dermatom yg terlibat : T5, C3, L1, L2, s. trigeminalDermatom yg terlibat : T5, C3, L1, L2, s. trigeminalDermatom yg terlibat : T5, C3, L1, L2, s. trigeminalDermatom yg terlibat : T5, C3, L1, L2, s. trigeminal---- Ruam makulopapular Ruam makulopapular Ruam makulopapular Ruam makulopapular →→→→ vesikel vesikel vesikel vesikel →→→→ ulser dengan dasarulser dengan dasarulser dengan dasarulser dengan dasareritematus eritematus eritematus eritematus →→→→ krusta.krusta.krusta.krusta.eritematus eritematus eritematus eritematus →→→→ krusta.krusta.krusta.krusta.

- Distribusi unilateral.Distribusi unilateral.Distribusi unilateral.Distribusi unilateral.- Intra oral : vesikel Intra oral : vesikel Intra oral : vesikel Intra oral : vesikel →→→→ ruptur ruptur ruptur ruptur →→→→ ulkus.ulkus.ulkus.ulkus.

∗∗∗∗ Cab. Maksilaris : palatum lunak, mukosa bibir atas,Cab. Maksilaris : palatum lunak, mukosa bibir atas,Cab. Maksilaris : palatum lunak, mukosa bibir atas,Cab. Maksilaris : palatum lunak, mukosa bibir atas,uvula mukosa pipi.uvula mukosa pipi.uvula mukosa pipi.uvula mukosa pipi.

∗∗∗∗ Cab. Mandibularis : lidah, gimngiva, mukosa bibirCab. Mandibularis : lidah, gimngiva, mukosa bibirCab. Mandibularis : lidah, gimngiva, mukosa bibirCab. Mandibularis : lidah, gimngiva, mukosa bibirbawah. bawah. bawah. bawah.

TREATMENT :TREATMENT :TREATMENT :TREATMENT :---- Bed rest.Bed rest.Bed rest.Bed rest.---- Local applications of heat.Local applications of heat.Local applications of heat.Local applications of heat.---- Topical anesthetic.Topical anesthetic.Topical anesthetic.Topical anesthetic.---- Topical anesthetic.Topical anesthetic.Topical anesthetic.Topical anesthetic.---- Antiviral.Antiviral.Antiviral.Antiviral.---- Analgesics.Analgesics.Analgesics.Analgesics.---- tranquilizers.tranquilizers.tranquilizers.tranquilizers.

LOCALIZED FUNGAL INFECTIONSLOCALIZED FUNGAL INFECTIONSLOCALIZED FUNGAL INFECTIONSLOCALIZED FUNGAL INFECTIONS∗∗∗∗ ORAL CANDIDIASISORAL CANDIDIASISORAL CANDIDIASISORAL CANDIDIASIS

DEEPDEEPDEEPDEEP----SEATED FUNGAL SEATED FUNGAL SEATED FUNGAL SEATED FUNGAL INFECTIONSINFECTIONSINFECTIONSINFECTIONS

∗∗∗∗ ASPERGILOSISASPERGILOSISASPERGILOSISASPERGILOSIS∗∗∗∗ CRYPTOCOCOSISCRYPTOCOCOSISCRYPTOCOCOSISCRYPTOCOCOSIS∗∗∗∗ HISTOPLASMOSISHISTOPLASMOSISHISTOPLASMOSISHISTOPLASMOSIS∗∗∗∗ GEOTRICHOSISGEOTRICHOSISGEOTRICHOSISGEOTRICHOSIS∗∗∗∗ BLASTOMYCOSISBLASTOMYCOSISBLASTOMYCOSISBLASTOMYCOSIS

⇒⇒⇒⇒ Rarely affect the oral cavityRarely affect the oral cavityRarely affect the oral cavityRarely affect the oral cavity

ORAL CANDIDIASISORAL CANDIDIASISORAL CANDIDIASISORAL CANDIDIASIS

A SUPERFICIAL INFECTION OF ORAL A SUPERFICIAL INFECTION OF ORAL A SUPERFICIAL INFECTION OF ORAL A SUPERFICIAL INFECTION OF ORAL MUCOUSMUCOUSMUCOUSMUCOUSCAUSED BY THE YEASTLIKE FUNGUS CAUSED BY THE YEASTLIKE FUNGUS CAUSED BY THE YEASTLIKE FUNGUS CAUSED BY THE YEASTLIKE FUNGUS CANDIDACANDIDACANDIDACANDIDAALBICANSALBICANSALBICANSALBICANSALBICANSALBICANSALBICANSALBICANS

FACTORS PREDISPOSING TO ORAL FACTORS PREDISPOSING TO ORAL FACTORS PREDISPOSING TO ORAL FACTORS PREDISPOSING TO ORAL CANDIDIASIS :CANDIDIASIS :CANDIDIASIS :CANDIDIASIS :LOCAL FACTORSLOCAL FACTORSLOCAL FACTORSLOCAL FACTORS SYSTEMIC FACTORSSYSTEMIC FACTORSSYSTEMIC FACTORSSYSTEMIC FACTORS

Denture wearingDenture wearingDenture wearingDenture wearing

SalivaSalivaSalivaSalivaXerostomia, low pH

Commensal floraCommensal floraCommensal floraCommensal flora

PhysiologicalPhysiologicalPhysiologicalPhysiologicalOld age, infancy, pregnancy

Endocrine disordersEndocrine disordersEndocrine disordersEndocrine disordersDiabetes Melitus

Nutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficienciesIron, folate, vit.B 12

HighHighHighHigh----carbohydrate dietcarbohydrate dietcarbohydrate dietcarbohydrate diet

Smoking tobaccoSmoking tobaccoSmoking tobaccoSmoking tobacco

Iron, folate, vit.B 12MalignanciesMalignanciesMalignanciesMalignancies

LeukemiaImmune defectsImmune defectsImmune defectsImmune defects

HIV / AIDSHIV / AIDSHIV / AIDSHIV / AIDSDrugs / medicationDrugs / medicationDrugs / medicationDrugs / medication

Broad spectrum antibioticsCorticosteroidsCytotoxic drugs

CLASSIFICATION OF ORAL CLASSIFICATION OF ORAL CLASSIFICATION OF ORAL CLASSIFICATION OF ORAL CANDIDIASIS :CANDIDIASIS :CANDIDIASIS :CANDIDIASIS :T Y P ET Y P ET Y P ET Y P E CLINICALCLINICALCLINICALCLINICAL

ACUTE :ACUTE :ACUTE :ACUTE :ACUTE ACUTE ACUTE ACUTE PSEUDOMEMBRANOUSPSEUDOMEMBRANOUSPSEUDOMEMBRANOUSPSEUDOMEMBRANOUSCANDIDIASISCANDIDIASISCANDIDIASISCANDIDIASIS= ORAL TRUSH= ORAL TRUSH= ORAL TRUSH= ORAL TRUSH

Creamy / white patches on the surface of Creamy / white patches on the surface of Creamy / white patches on the surface of Creamy / white patches on the surface of oral mucous; forming confluent; curdoral mucous; forming confluent; curdoral mucous; forming confluent; curdoral mucous; forming confluent; curd----like like like like pseudomembranes. Pseudomembranes pseudomembranes. Pseudomembranes pseudomembranes. Pseudomembranes pseudomembranes. Pseudomembranes can be scraped off to reveal raw, can be scraped off to reveal raw, can be scraped off to reveal raw, can be scraped off to reveal raw, erythematous base.erythematous base.erythematous base.erythematous base.= ORAL TRUSH= ORAL TRUSH= ORAL TRUSH= ORAL TRUSH erythematous base.erythematous base.erythematous base.erythematous base.

ACUTE ATROPHIC ACUTE ATROPHIC ACUTE ATROPHIC ACUTE ATROPHIC CANDIDIASISCANDIDIASISCANDIDIASISCANDIDIASIS= ANTIBIOTIC SORE TONGUE= ANTIBIOTIC SORE TONGUE= ANTIBIOTIC SORE TONGUE= ANTIBIOTIC SORE TONGUE

Small lesions, usually on the tongue, with Small lesions, usually on the tongue, with Small lesions, usually on the tongue, with Small lesions, usually on the tongue, with reddening / inflammation of surrounding reddening / inflammation of surrounding reddening / inflammation of surrounding reddening / inflammation of surrounding tissuetissuetissuetissue

T Y P ET Y P ET Y P ET Y P E CLINICALCLINICALCLINICALCLINICALCHRONIC :CHRONIC :CHRONIC :CHRONIC :Chronic Atrophic CandidiasisChronic Atrophic CandidiasisChronic Atrophic CandidiasisChronic Atrophic Candidiasis= Denture Stomatitis= Denture Stomatitis= Denture Stomatitis= Denture Stomatitis

Chronic erythema and edema of Chronic erythema and edema of Chronic erythema and edema of Chronic erythema and edema of upper palate localized to occluded / upper palate localized to occluded / upper palate localized to occluded / upper palate localized to occluded / traumatized tissuetraumatized tissuetraumatized tissuetraumatized tissue

Chronic hyperplastic Chronic hyperplastic Chronic hyperplastic Chronic hyperplastic CandidiasisCandidiasisCandidiasisCandidiasis

White patch adherent to mucous on White patch adherent to mucous on White patch adherent to mucous on White patch adherent to mucous on an erythematous base which is not an erythematous base which is not an erythematous base which is not an erythematous base which is not removable by digital pressure. removable by digital pressure. removable by digital pressure. removable by digital pressure. = Candida Leukoplakia= Candida Leukoplakia= Candida Leukoplakia= Candida Leukoplakia removable by digital pressure. removable by digital pressure. removable by digital pressure. removable by digital pressure. Usually on the anterior buccak Usually on the anterior buccak Usually on the anterior buccak Usually on the anterior buccak mucousmucousmucousmucous

Angular cheilitisAngular cheilitisAngular cheilitisAngular cheilitis=Perleche=Perleche=Perleche=Perleche

Erythema, fissure and encrustations Erythema, fissure and encrustations Erythema, fissure and encrustations Erythema, fissure and encrustations at corners of mouth.at corners of mouth.at corners of mouth.at corners of mouth.

DIAGNOSIS :DIAGNOSIS :DIAGNOSIS :DIAGNOSIS :

CLINICAL APPEARANCESCLINICAL APPEARANCESCLINICAL APPEARANCESCLINICAL APPEARANCES++++

LABORATORIUM LABORATORIUM LABORATORIUM LABORATORIUM EXAMINATIONS :EXAMINATIONS :EXAMINATIONS :EXAMINATIONS :LABORATORIUM LABORATORIUM LABORATORIUM LABORATORIUM EXAMINATIONS :EXAMINATIONS :EXAMINATIONS :EXAMINATIONS :

* Culture* Culture* Culture* Culture* Cytologic* Cytologic* Cytologic* Cytologic* Serology* Serology* Serology* Serology

TREATMENT :TREATMENT :TREATMENT :TREATMENT :

⇒⇒⇒⇒ To correct predisposing factorsTo correct predisposing factorsTo correct predisposing factorsTo correct predisposing factors⇒ To correct sources of infectionTo correct sources of infectionTo correct sources of infectionTo correct sources of infection⇒ Antifungal drugsAntifungal drugsAntifungal drugsAntifungal drugs

ANTIFUNGAL DRUGS

POLYENE AZOLES

A.IMIDIAZOLE :A.IMIDIAZOLE :

- Clotrimazole

- Ketoconazole

- Miconazole

B. TRIAZOLE :

- Fluconazole

- Itraconazole

A. AMFOTERICIN B

B. NYSTATIN

Penyakit Infeksi Bakteri Spesifik Penyakit Infeksi Bakteri Spesifik

di Rongga Mulut

Sifilis

Gonorrhea

Tuberkulosis

Lepra

SIFILIS

1.Sifilis acquired

Sifilis primer

Sifilis sekunder

Sifilis tertier

2.Sifilis kongenital

Penyebab: Treponema Pallidum

Patogenesis

Kontak seksual --- lesi primer ( chancre ) ---- hilang---

lesi sekunder -----hilang --- tertier

Transfusi darah --- lesi sekunder --- hilang --- tertier

Kongenital ----- plasenta ibu yang terinfeksi ----

tidak ada lesi primer

•Sifilis Primer

•- Berkembang pada tempat masuknya kuman, 3-4

minggu

•- Lesi chancre -- plak keras, sedikit meninggi, ulserasi,

bulat,

• indurasi dengan tepi bergulung, coklat berkrusta,

dimulaidimulai

• dengan bercak atau papula --- ulser

•- Diameter 5 mm - beberapa cm

•- Tidak sakit

•- Hilang spontan sesudah 10 hari

•- Lesi dapat satu atau multiple.

•- Pembesaran kelenjar limfe regional


- Lesi chancre

- Lokasi bibir, mukosa mulut, lidah, palatum lunak, tonsil

faring, jarang pada gusi

- Sedikit sakit karena infeksi sekunder

- Ulser ditutupi lapisan putih keabuan

- Pada ekstra oral bibir--- krusta coklat- Pada ekstra oral bibir--- krusta coklat

- Dapat multiple