2. Acute Pharyngitis
• Definition: This is a commonest variety of sore
throat & usually associated with cold. It is
common and important prodormal
manifestetion of Measles, Typoid, Influenza,
etc.
• Aetiology:
Viruses: Rhino-, Adenovirus, Influenza A & B viruses,
Enterovirus, etc.
Bacterial: Haemolytic, Streptococcus, Haemophilus
influenzae, Pneumococcus, etc.
5. Treatment:
- Symptomatic with bed rest, analgesics, plenty
of fluid, etc.
- If a significant bacterial complications has
occurred, antibiotics are indicated.
- In case of complications, treatment should be
directed accordingly.
6. Acute Diphtheritic Pharyngitis:
- A severe infection due to the gram +ve
bacillus (corynebacterium diphtheriac).
- Children are particularly affected, between 2-
5 years.
- Mode of transmission – droplet.
- Incubetion period: 2-7 days.
7. Clinical features:
- Onset is insidious.
- Sore throat.
- t: 99 – 101°f.
- Malase.
- Headache.
- False membrane on the tonsils, pillars, soft
palate, posterior ph. Wall.
- Colour of membrane, usually gray may be white
or dark brown.
8. Continued … ……
- Firmly attached to the mucosa.
- Leaves the bleeding surface when it is
removed, after which quickly reforms.
- It may spread to lkarynx, causing complete
obstruction, may need tracheostomy.
- Blood mixed nasal discharge.
- Cervical lymphnodes, tender.
17. Herpes Simplex Stomatitis
• HSV-1: Primary herpetic Gingivostomatitis
Recurrent herpes labialis
• HSV-2:
• Primary herpetic Gingivostomatitis:
-most frequent cause of acute stomatitis in
children
-varies in severity, many infections -subclinical
-misdiagnosed as “teething”
-malaise, anorexia, irritability, fever, anterior
cervical lymphadenopathy, diffuse, purple,
boggy gingivitis
-multiple vesicles scarred ulcers(1-3mm)
-occasionally in adults
18. • Diagnosis:
-clinically
-scrapping or smears from the lesion
-immunofluorescent staining
-exfoliative cytology- typical
multinucleated giant cells
• Treatment:
-symptomatic
-acyclovir (systemic)-severe cases
19. • Recurrent Intraoral Herpes Simplex Infection:
-may affect healthy individual
-persistent lesions in immunocompromised
-chronic ulcer, raised, white border
-esp. at sites of trauma
-acyclovir
20. Herpes zoster (Shingles)
• Reactivation of Varicella –Zoster virus
• Predisposing factor: Immunocompromised
status
• One dermatome affected (trigeminal nerve)
• Unilateral
• Ulcers in the distribution of dermatome
• Mandibular nerve: ulceration of one side of
tongue, floor of the mouth, lower labial &
buccal mucosa
• Maxillary nerve: one side of palate, the
upper gingiva, buccal sulcus
• Lesions persists for 2-3 wks
Lesions on lips and chin
21. • Herpes Zoster Oticus (Ramsay Hunt
Syndrome)
• Ophthalmic Herpes Zoster
• Post Herpetic Neuralgia
• Diagnosis: clinically
• Treatment:
-Analgesics
-Antivirals(within 72 hrs of onset of
the lesions):acyclovir, famciclovir,
valacyclovir, & gabapentin
22. Herpangina
• Common in children
• Coxsackie virus group A,
Enteroviruses(30 & 71)
• Self limiting vesicular eruptions in
the oropharynx eg. soft palate,
uvula, tonsillar pillars, posterior
pharyngeal wall
• Similar to herpes simplex except the
lesions more commonly in
oropharynx rather than oral cavity
• Diagnosis: Clinically
• Treatment: Supportive
23. Hand, Foot and Mouth Disease
• Enterovirus 71,Coxsackie viruses, some
untypeable enteroviruses
• Young children
• Vesicular eruption in the oral cavity &
oropharynx dysphagia, dehydration
• Vesicles on the hands & feet
• Pyrexia, malaise, vomiting
• Short lived(5-8 days)
• Diagnosis: clinically
• Treatment: supportive
33. Primary Syphilis
• Lips, tongue, buccal mucosa, & tonsils
• Site of inoculation- 3 weeks after the
infection, Papule, breaks down to form an
ulcer (chancre)
• Oral chancre: painless ulcer with a
smooth surface, raised borders, &
indurated margin
• Non tender cervical lymphadenopathy
• Spontaneous healing
35. • Hyperemia and inflammation of
pharynx & soft palate
• Snail Track ulcer :-
-Oral cavity & oropharnyx
-Ulcerated lesion covered with
grayish white membrane
which when scraped has pink base
with no bleeding
36. Syphilitic Pharyngitis
• May be congenital or acquired by
sexual intercourse
• Secondary stage most likely
• HIV positive patients
37. Tertiary Syphilis
• Tertiary syphilis - after a period of 4–7 years
• Typically painless
• No lymphadenopathy unless secondary infection
• Gumma:
-Characteristic lesion
-Hard palate, Nasal septum, Tonsil, PPW, or
Larynx
• VDRL may be negative
38. Congenital Syphilis
Early:
first 3 months of life, manifest as
snuffles nasal discharge purulent
Late:
Manifest at puberty
Gummatous lesion
• Oral lesions: high-arched palate, short
mandible, Hutchinson’s teeth, and
Moon’s or mulberry molars
39. Diagnosis:
1.Immunoflurorescence or dark field microscopy
2. Biopsy
3.Serology
Non-treponemal antibody tests:
-VDRL, RPR
-For screening and treatment follow up
Treponema specific antibody tests:
-FTA-ABS test, TPHA
-For confirmation
-Usually remains positive for life
Treatment: Penicillin( DOC)
Ceftriaxone, Erythromycin, or Doxycycline
40. Leprosy
• Mycobacterium Leprae
• Optimum temperature growth-less than body
temp preference for skin, mucosa &
superficial nerve
• Transmission- nasal discharge
• Both Humoral & cellular immune response
• Clinically- Chronic granulomatous disease
skin, peripheral nerve & nasal mucosa
51. Sjogren’s Syndrome
• Autoimmune
• Female
• Primary Sjogren’s Syndrome:
• Secondary Sjogren’s Syndrome: associated
with RA, SLE, Scleroderma, Polymyositis,
Polyarteritis Nodusa
• Presents with xerostomia & parotid
enlargement
• Oral findings:
-Due to decreased salivadysphagia,
disturbances in taste & speech, burning
pain of mouth & tongue, increased dental
caries, increased predisposition to
infection (candidiasis)
52. • Mucosal changes: dry, red & wrinkled mucosa
• Fissured tongue, atrophy of tongue papillae
and redness of tongue, cracked & ulcerated
lips
Diagnosis:
-Minor salivary gland biopsy (mucosa of lower
lip)
-Periductal lymphocytic infiltrate
-Serum: Autoantibodies (ANA, antilacrimal &
antithyroid antibodies, RA factor)
Treatment :
-Steroid & immunossuppresive drugs
-Artificial saliva
-Constant dental evaluation
53. Systemic Lupus Erythematosus(SLE)
• Approx. one quarter of SLEoral
lesions
• Oral lesions: superficial ulcers with
surrounding erythema
• Lips & all oral mucosal surfaces
• Periodontal diseases, xerostomia
54. Scleroderma
• Deposition of collagen in the tissues or
around nerves & vessels
• Difficulty in opening mouth(due to
fibrosis of masticatory muscles),
immobility of tongue, dysphagia,
xerostomia
• Telangiectasia: lips, oral mucosa
• Association with Sjogren’s Syndrome &
CREST Syndrome(Calcinosis, Raynaud’s
phenomena, Esophageal hypomotility,
& Sclerodactly)
55. Kawasaki disease
• Mucocutaneous lymph node syndrome
• Vasculitis- medium & large arteries
• Children <5 yrs of age
• High grade fever
• Cardiovascular complications
• Oral findings: swelling of papillae on the
surface of tongue(strawberry tongue),
erythema of the buccal mucosa & lips
Lips are cracked, cherry red, swollen &
hemorrhagic
56. Laboratory tests: polymorphonuclear leukocytosis,
thrombocytosis, raised ESR & CRP
Diagnosis: 4 out of 6 clinical features with evidence of coronary
dilatation
1.Fever persisting>5 days
2.Bilateral conjunctival congestion
3.Erythema of lips, buccal mucosa & tongue
4.Acute non-purulent cervical lymphadenopathy
5.Polymorphous exanthema
6.Erythema of palms & soles (edemadesquamation)
Treatment: Aspirin, IVIg
Steroid avoided- risk of worsening coronary artery dilatation
57. Wegener’s Granulomatosis
• Rare chronic granulomatous disease
• Immunological
• Clinical features: necrotizing
granulomatous lesions of the respiratory
tract, generalized focal necrotizing
vasculitis, and necrotizing glomerulitis
• Oral lesions: solitary or multiple irregular
ulcers, surrounded by an inflammatory
zone
• Tongue, palate, buccal mucosa & gingiva
• Laboratory tests: HPE, c-ANCA
• Treatment: Steroids, Azathioprine, &
Cyclophosphamide
65. Osler-Weber-Rendu Disease
(Hereditary Hemorrhagic Telangiectasia)
• Autosomal dominant
• Telangiectasia of dorsum of tongue,
oral cavity, buccal mucosa, lips, palate
& nasal mucosa
• Apparent at puberty
• Lung, liver, & GI tract arterio-venous
malformations
• Treatment: regular iron therapy,
laser therapy
66. Plummer Vinson Syndrome
(Patterson-Brown-Kelly Syndrome)
• Oral manifestations: Dysphagia, iron def.
anaemia, atrophic glossitis, angular
stomatitis, & koilonychia
• Female, in fourth decade
• Barium swallow: web in post-cricoid region
• Pre-malignant Post-cricoid carcinoma
• Treatment:
-Esophageal dilatation
(if symptoms from web)
-Follow up-developing carcinoma
67. Idiopathic Thrombocytopenic Purpura (ITP)
• Oral lesions may be the first
manifestation of this condition
• Petechiae, ecchymoses,
& haematoma anywhere on the oral
mucosa
• Spontaneous bleeding from the
gingiva
• Treatment:
-Systemic steroids, Splenectomy
68. Agranulocytosis
• Etiology: Drug or infection
• Clinical features:
Oral lesions -multiple necrotic ulcers covered
with dirty pseudomembrane
• Buccal mucosa, tongue, palate, & tonsillar
area
• Severe necrotizing gingivitis
• Laboratory tests: White blood count & bone-marrow
aspiration
• Treatment: Antibiotics, white blood cell
transfusions, granulocyte colony-stimulating
factor (G-CSF) or granulocyte-macrophage
colony-stimulating factor (GM-CSF)
70. Crohn’s Disease
• Diffuse nodular swelling in lips
(painless), angular cheilitis,
cobblestone appearance of buccal
mucosa or mucosal tag, Aphthous
ulcer
• May precede intestinal symptoms or
may be the only manifestations in
some cases
• Systemic steroids
71. Ulcerative Colitis
• Destructive oral ulceration due to
immune mediated vasculitis
• Polystomatitis Vegetans:
microabscess on lips, palate, ventral
tongue
• May manifests as aphthous ulcers
• Exacerbation & remission
75. Thyroid Diseases
• Hypothyroidism: Macroglossia
• Congenital Hypothyroidism: Macroglossia,
pronounced lips, & delayed tooth eruption with
malocclusion
• Hyperthyroidism:
Facial & skin manifestations: upper eyelid
retraction, exophthalmous, hyperpigmentation,
& skin erythema
Oral manifestations: early loss of primary teeth
with subsequent rapid eruption of permanent
teeth(young children)
lymphoid tissue hyperplasia- tonsillar &
oropharynx (Grave’s disease)
76. Cushing’s Syndrome
• Long term, high dose corticosteroid
administration
• Moon or round face, buffalo humps,
central obesity, osteoporosis, DM, HTN
• Oral symptoms:
-Increased susceptibility to oral
infections (candidiasis)
-Muscle weakness difficulty with
speaking, & swallowing
Dx: Dexamethasone suppression test
Rx: Depends on the cause
77. Addison’s Disease
• Primary adrenal insufficiency
• Destruction of adrenal cortex eg.
autoimmune, metastasis, infection,
haemorrhage
• Oral manifestations: diffuse or patchy
pigmentation of the skin & mucous
membranes (due to increased ACTH-cross
reacts with melanin receptors)
• Buccal mucosa, palate, lips, & gingiva
• Diagnosis: ACTH test
• Treatment: Replace steroid
(glucocorticoid/mineralocorticoid)
78. Renal Disease
(Uraemic Stomatitis)
• Painful plaques and crust on buccal mucosa,
dorsum of tongue, & floor of mouth covered
with gray pseudomembrane exudate, &
painful ulcers
• Bleeding diathesis: inhibited platelet
aggregation eg. petechiae, ecchymoses
• Irritation & chemical injury of mucosa-ammonium
compounds
• Xerostomia, unpleasant taste, burning mouth,
uriniferous breath odour
• A/W with acute rise in blood urea nitrogen
• Heal spontaneously after resolution of
uraemic state eg. after hemodialysis
89. Parkinson’s Disease
• Extrapyramidal symptoms
• Loss of facial expression
• Difficulty with mastication, slow
speech, & tremors of head, lips, &
tongue
• Esophageal dysmotility & dysphagia
• Impaired lip seal drooling fungal
infection of lip commissure (angular
cheilitis)
90. Alzheimer’s Disease
• Dementia
• Inability to perform self care (oral hygiene)- self
neglect & loss of cognitive and motor skills
• Poor oral hygiene- increased prevalence of dental
plaque, dental caries, & gingival bleeding
91. Multiple Sclerosis
• Demyelination of central nervous
system
• Remitting & exacerbating course
• Loss of muscle coordination, weakness
of the tongue, & loss of upper
extremity severely impairs
orodental hygiene
• Trigeminal neuralgia- also common
characterized by excruciating, unilateral
pain of the lips, gingiva, or chin
triggered by contact with certain areas
of the face, lips, or tongue
92. Bell’s Palsy
• Idiopathic unilateral lower motor neuron
palsy (7th cranial nerve)
• Lack of control of the muscles of facial
expressiondistortion of facial
appearance
• Loss of functional ability of cheek & lips
(affected side)poor oro-dental hygiene
93. Melkersson-Rosenthal Syndrome
• Characterized by -unilateral facial palsy, recurrent facial
swelling, & lingua plicata (fissured tongue)
95. • Vitamin A deficiency:
-Dyskeratotic changes of the skin & mucous
membranes
-Angular cheilitis
-Defects in the dentin & enamel of developing
teeth
• Vitamin B2 (Riboflavin) deficiency:
-Angular cheilitis
-Burning pain in the lips, mouth, & tongue
• Vitamin B3 (Niacin) deficiency (Pellagra):
-Dermatitis, dementia,& diarrhoea
-Oral manifestations: glossitis (red, swollen) &
stomatitis, burning tongue
96. • Vitamin B6 deficiency:
-Peripheral neuropathy
-Oral lesions-similar to pellagra
(i.e. glossitis & stomatitis)
• Vitamin C deficiency (Scurvy):
-Cofactor for collagen synthesis
-Weakened vessels are responsible for
petechiae, ecchymoses, delayed wound
healing
• Deficiency of Vitamin B12 & Folic acid:
-Megaloblastic anemia
-Oral findings: angular cheilitis, recurrent
aphthous ulcers, & glossitis
97. • Vitamin D deficiency & Calcium deficiency:
-Calcium metabolism
-Mandibular osteopenia/osteoporosis, enamel
hypoplasia
• Vitamin k deficiency:
-Haemorrhagic diathesis
-Oral haemorrhagic bullae
• Zinc deficiency:
-Taste changes
-Acrodermatitis Enteropathica: angular cheilitis, ulcers,
glossitis, crusting, scaling of the lips as well as ulcers,
erosions & fissures
98. Oral lesions associated with HIV
• Early recognition, diagnosis, & treatment of HIV
associated oral lesions - reduce morbidity
• Oral lesions-
-Early diagnostic indicator of HIV infection
-Stage of HIV infection
-Predictor of the progression of HIV disease
101. Hairy Leukoplakia
• Epstein Barr virus
• Common, characteristic lesion-HIV infection
• White, asymptomatic, raised, corrugated,
unremovable patch on lateral marigns of
tongue
• The surface is irregular and may have
prominent folds or projections, sometimes
markedly resembling hairs
• Lateral margins may spread to dorsum of
tongue
• Diagnosis: Biopsy
• Treatment:
-Usually asymptomatic-Rx not required
-Antiviral(Aciclovir/valaciclovir)
102. Kaposi’s Sarcoma
• Most common malignancy in HIV (+Ve)
• Human Herpes Virus-8(KSHV)
• Derived from capillary endothelial cells
• Occur intraorally, either alone or in a/w skin
& disseminated lesions (lymph nodes, salivary
gland)
• Intraorally- hard palate, buccal mucosa, &
gingiva
-bluish, purple or red patches or
papulesnodular, ulcerate & bleed
• Diagnosis: Biopsy
• Treatment:
-Low dose radiation & chemotherapy
(eg.Vinblastine)
-Surgical excision (eg.CO2 laser)
-Immunotherapy (Interferon)
103. Non-Hodgkin’s Lymphoma
• Etiology: Unknown, genetic &
environmental factors (viruses, radiation)
• Clinical features:
– Both sexes - any age
– Lymph nodes involved
– Oral lesions - part of a disseminated
disease, or the only sign
• Oral Lymphoma: diffuse, painless swelling,
which may or may not be ulcerated -soft
palate, the posterior part of the tongue,
the gingiva, & the tonsillar area
• HPE & Immunohistochemical examn
• Treatment: Radiotherapy & chemotherapy