Oral Diagnosis I Third Year

1. By
Dr . Wael Mohamed Swelam
1
Sunday, November 25, 2007
Sexually Transmitted Diseases

2. 2
َ‫ال‬َ‫و‬ َ‫ر‬َ‫خ‬‫ءا‬ ‫ا‬َ‫ه‬ٰ‫ـ‬َ‫ل‬ِ‫إ‬ ِ‫ه‬َّ‫ل‬‫ٱل‬ َ‫ع‬َ‫م‬ َ‫ن‬‫و‬ُ‫ع‬ْ‫د‬َ‫ي‬ َ‫ال‬ َ‫ن‬‫ي‬ِ‫ذ‬َّ‫ل‬‫ٱ‬َ‫و‬
ّ‫ق‬َ‫ح‬ْ‫ل‬‫ٱ‬ِ‫ب‬ َّ‫ال‬ِ‫إ‬ ُ‫ه‬َّ‫ل‬‫ٱل‬ َ‫م‬َّ‫ر‬َ‫ح‬ ‫ى‬ِ‫ت‬َّ‫ل‬‫ٱ‬ َ‫س‬ْ‫ف‬َّ‫ن‬‫ٱل‬ َ‫ن‬‫و‬ُ‫ل‬ُ‫ت‬ْ‫ق‬َ‫ي‬
ً‫ا‬‫ام‬َ‫ث‬َ‫أ‬ َ‫ق‬ْ‫ل‬َ‫ي‬ َ‫ك‬ِ‫ل‬ٰ‫ذ‬ ْ‫ل‬َ‫ع‬ْ‫ف‬َ‫ي‬ ‫ن‬َ‫م‬َ‫و‬ َ‫ن‬‫و‬ُ‫ن‬ْ‫ز‬َ‫ي‬ َ‫ال‬َ‫و‬
ْ‫د‬ُ‫ل‬ْ‫خ‬َ‫ي‬َ‫و‬ ِ‫ة‬َ‫ٰم‬‫ـ‬‫ي‬ِ‫ق‬ْ‫ل‬‫ٱ‬ َ‫م‬ْ‫و‬َ‫ي‬ ُ‫اب‬َ‫ذ‬َ‫ع‬ْ‫ل‬‫ٱ‬ ُ‫ه‬َ‫ل‬ ْ‫ف‬َ‫ع‬ٰ‫ـ‬ َ‫ض‬ُ‫ي‬
ً‫ال‬َ‫م‬َ‫ع‬ َ‫ل‬ِ‫م‬َ‫ع‬َ‫و‬ َ‫ن‬َ‫م‬‫ءا‬َ‫و‬ َ‫اب‬َ‫ت‬ ‫ن‬َ‫م‬ َّ‫ال‬ِ‫إ‬ ً‫ا‬‫ان‬َ‫ه‬ُ‫م‬ ِ‫يه‬ِ‫ف‬
ْ‫م‬ِ‫ه‬ِ‫ت‬‫ا‬َ‫ئ‬ّ‫ي‬ َ‫س‬ ُ‫ه‬َّ‫ل‬‫ٱل‬ ُ‫ل‬ّ‫د‬َ‫ب‬ُ‫ي‬ َ‫ك‬ِ‫ـئ‬َ‫ل‬ْ‫و‬ُ‫أ‬َ‫ف‬ ً‫ا‬‫ح‬ِ‫ٰل‬‫ـ‬ َ‫ص‬
‫ن‬َ‫م‬َ‫و‬ ً‫ا‬‫يم‬ِ‫ح‬َّ‫ر‬ ً‫ا‬‫ور‬ُ‫ف‬َ‫غ‬ ُ‫ه‬َّ‫ل‬‫ٱل‬ َ‫ن‬‫ا‬َ‫ك‬َ‫و‬ ٍ‫ٰت‬‫ـ‬َ‫ن‬ َ‫س‬َ‫ح‬
ِ‫ه‬َّ‫ل‬‫ٱل‬ ‫ى‬َ‫ل‬ِ‫إ‬ ُ‫وب‬ُ‫ت‬َ‫ي‬ ُ‫ه‬َّ‫ن‬ِ‫إ‬َ‫ف‬ ً‫ا‬‫ح‬ِ‫ٰل‬‫ـ‬ َ‫ص‬ َ‫ل‬ِ‫م‬َ‫ع‬َ‫و‬ َ‫اب‬َ‫ت‬

3. 3
Syphilis
An infectious systemic disease that may be either congenital
or acquired through sexual contact or contaminated needles.
High-risk groups
1. Sexually active teenagers
2. People infected with another sexually
transmitted disease (STD), including AIDS
3. Sexually abused children
4. Women of childbearing age
5. Prostitutes of either sex and their customers
6. Prisoners
7. Persons who abuse drugs or alcohol Motzart

4. TREPONEMA PALLIDUM
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Gram stainSilver stain
Electron Microscope

5. CHANCROID ULCERS
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1. This first stage of syphilis is called
primary syphilis characterized by
(Chancre)
a) contains a clear fluid that is full
of Treponema pallidum
b) patient highly contagious
c) chancre will heal even without
treatment within a few weeks
Chancre

6. SECONDARY SYPHILIS
1. Characterized by flu-like illness
2. The patient will be highly infectious
3. If the immune system does not destroy the microbes, a generalized
skin rash develops
4. Mucous patches
5. Moist, warty patches may develop on the genitalia or skin folds
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7. TERTIARY SYPHILIS “GUMMAS” AFTER 3-15 YEARS
LATENCY
1. Microorganism spread to other parts
of the body, in particular:
a) Mucous membranes,
b) Liver, Central nervous system (CNS)
c) Eyes, Joints, bones, muscles,
2. 50% proceed to Gumma stage, the
symptoms depend on what organs
have active pathogen replication;
a) Although they may be very destructive,
they respond rapidly to treatment
b) Start as a superficial nodule or as a
deeper lesion that breaks down to form
punchedout ulcers
c) Significant central nervous system
involvement resulting in paralysis and
death
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8. CONGENITAL SYPHILIS - MUCOUS PATCHES
8

9. CONDYLOMA ACCUMINATUM
Causative organism:
HPV-6, HPV-11, HPV-16, and HPV-18
!
Develops at a site of sexual contact or trauma
!
Age: Teenagers and young
!
Shape:
•Broad-based,
•Pink mass,
•Short, blunted projections

10. GONORRHEA
Gram stain of Neisseria gonorrhoeae
from urethral discharge
Nisseria G. can grow and multiply easily in the warm, moist areas
of the reproductive tract
Modes of transmission
1.The lining of the urethra (the opening at the tip of the penis);
2.The lining of the vagina or cervix;
3.The lining of the anus; or
4.Directly into the body through small cuts or open sores.

11. GONOCOCCAL INFECTIONS
11
Ophthalmia Disseminated G
skin lesion
Gonorrhea infections of the mouth and
throat are usually without symptoms. If
present, symptoms include soreness and
redness in the mouth or throat

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13. ORAL LESIONS ASSOCIATED WITH HIV
INFECTION
✓ RECOGNIZE ORAL LESIONS SEEN WITH
IMMUNOSUPPRESSION
!
✓ EFFECTS OF HAART ON PREVALENCE OF
THESE LESIONS

14. ▪ IMMUNOSUPPRESION
n. The inhibition of the normal immune response
because of disease.
▪ OPPORTUNISTIC INFECTION
adj. A microorganism causing disease only
under certain conditions, as when a
person’s immune system is impaired.
WHAT DO WE SEE IN HIV/AIDS?

15. WHAT ARE SOME OF THE FACTS
▪ Approximately 70 to 80 percent of people with
HIV/AIDS will experience an oral manifestation
▪ Treating routine problems as soon as possible
can prevent more serious infections
!
▪ Almost all of the infections we see, appear in
people who are not infected with HIV/AIDS, but
they appear more frequently and with more
severity in people who are infected

16. RECOMMENDATIONS FOR AN
ORAL EXAMINATION
•LIPS AND GUMS
!
•CHEEKS
!
•TONGUE
!
•FLOOR OF THE MOUTH
!
•ROOF OF THE MOUTH
!
•LYMPH NODES
!
!
!
!

17. !
▪ Recognition of the lesion
▪ History of the condition
▪ Observation
▪ Palpation
!
!
DIFFERENTIAL DIAGNOSIS
The process

18. CAUSES OF ORAL LESIONS
✓ FUNGAL
✓ VIRAL
✓ BACTERIAL
✓ ULCERATIVE
✓ NEOPLASTIC

19. FUNGAL
ANGULAR CHELITIS

20. ✓ Inflammation/irritation
✓ Cracking and fissuring
✓ Pain upon opening the mouth
✓ Susceptible to infection
ANGULAR CHELITIS
TREATMENT
• Antifungal medication
• Correct vertical dimension
FUNGAL

21. FUNGAL
PSEUDOMEMBRANOUS CANDIDIASIS

22. PSEUDOMEMBRANOUS CANDIDIASIS
✓ Multiple white to yellow soft plaques
✓ Plaques easily removed by gauze
✓ Areas may bleed and burn
✓ Taste alterations
✓ Xerostomia
TREATMENT
• Antifungal medication
FUNGAL

23. FUNGAL
ATROPHIC OR ERYTHEMATOUS
CANDIDIASIS

24. ATROPIC CANDIDIASIS
✓ Spotty appearance
✓ May look like pizza burn
✓ Mistaken for trauma, infections, radiation,
xerostomia
✓ Pain is less severe than pseudomembranous
candidiasis
TREATMENT
• Antifungal medications
FUNGAL

25. VIRAL
ORAL HAIRY LEUKOPLAKIA

26. ORAL HAIRY LEUKOPLAKIA
✓ Asymptomatic
✓ Predictive of disease progression
✓ Affects the lateral border and ventral tongue,
and buccal vestibule
✓ Can result from epithelial hyperplasia,
secondary to a reactivation of latent EBV
TREATMENT
• usually none
• occasionally antivirals
!
VIRAL

27. VIRAL
HERPES SIMPLEX VIRUS

28. HERPES SIMPLEX VIRUS
✓ Vesicles that coalesce into bullae and break
✓ Some report a tingling sensation
✓ Occur on fixed and keratinized tissue
✓ Painful
✓ May have systemic manifestations
TREATMENT
• Antivirals
• Palliative support
VIRAL

29. VIRAL
HUMAN PAPILLOMA VIRUS

30. HUMAN PAPILLOMA VIRUS (HPV)
✓ Some begin as a smooth-surface papule
✓ Rough fingerlike projections
✓ Occur mainly on keratinized mucosa
✓ Tend to reoccur
✓ May interfere with eating and swallowing
and may bleed
✓ Not painful
✓ Transmissible
VIRAL
TREATMENT
• Excision

31. PERIODONTAL DISEASE
BACTERIAL

32. ✓ Most common oral bacterial infection among
HIV infected persons
✓ Contributing factors include poor diet, poor
oral hygiene, and lack of saliva
✓ Mainly due to overgrowth of normal flora
PERIODONTAL DISEASE
BACTERIAL
TREATMENT
• Deep scaling and root planning
•Good home care
•Antimicrobial rinses

33. BACTERIAL
LINEAR GINGIVAL ERYTHEMA

34. LINEAR GINGIVAL ERYTHEMA (LGE)
✓ Inflammation
✓ Spontaneous bleeding
✓ Not always painful
✓ May occur without the presence of plaque
✓ Microbiologic profile of gingival fluids is
same as for Periodontal Disease
✓ Early manifestation of HIV
TREATMENT
• Periodontal scaling
• Peridex
BACTERIAL

35. ULCERATIVE
APTHOUS ULCER

36. APTHOUS ULCER
✓ Crater type sore on mucous membrane
✓ Pus formation
✓ Painful
✓ Interference with speech and swallowing
✓ Stress, Acidic Foods, Trauma, and Medication
✓ CMV (Cytomegalovirus) are clinically identical
TREATMENT
• Topical steroids mixed with
Orabase
ULCERATIVE

37. BACTERIAL
NECROTIZING ULCERATIVE
PERIODONTITIS (NUP)

38. NEOPLASM
KAPOSI’S SARCOMA (KS)

39. KAPOSI’S SARCOMA (KS)
NEOPLASM
✓ Lesions begin flat and painless and can
progress to painful papules and nodules
✓ It is mainly seen in men with AIDS
✓ Recent studies indicate that it may be caused
by a sexually transmitted herpes virus-HHV 8
TREATMENT
•Radiation therapy
•Chemotherapy
•Immuno-modulator drugs

40. NEOPLASM
NON-HODGKIN’S LYMPHOMA

41. NON-HOGKIN’S LYMPHOMA
NEOPLASM
✓ Second most common malignancy in AIDS
✓ Tumors present intraorally as soft tissue
masses
✓ Grows faster and spreads outside the lymph
system in those with AIDS
TREATMENT
•Radiation therapy
•Chemotherapy
•Immuno-modulator drugs

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‫سبح‬
‫انك‬
‫اللهم‬
‫وبح‬
‫مدك‬