1. Oral Pathology
Periodontal Diseases
Sem IV- Lecture-XIII
By
Dr. Juma Alkhabuli
(BDS, MDentSci, PhD)
Associate Professor, Chair, Oral Biology Department

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. 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. Cont’d
Mucous patch Streptococcal infection

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. Primary Herpetic Gingivostomatitis
Recurrence

7. Cont’d
Recurrent oral herpes on Recurrent herpes on
palatal mucosa gingiva
Note that oral recurrent herpes affects keratinised mucosa

8. Papilloma
Condyloma
Accuminatum

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. Cont’d
A. Linear Gingival Erythema (HIV +ve)
B. Histoplasmosis- systemic fungal disease
caused by exposure to dust from animal
dropping)

11. Cont’d
Linear gingival Histoplasmosis
erythema

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. Cont’d
Gingival fibromatosis

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. Cont’d
Histologically, characterised by
hyperkeratosis, base cell degeneration and
sub-epithelial T- lymphocytic infiltrate (CD8)

16. Lichen
planus
Erosive

17. Cont’d
Erosive lichen Planus
Hyperkeratosis
Subepithelial
t-lymphocytic
infiltrate
Epithelium

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. Cont’d
 Mucosa lesion= mucous membrane
pemphigoid (cicatricial pemphigoid)
 Skin lesion= bullous pemphigoid
 On gingiva, it cause desquamative gingivitis

20. Cont’d
Pemphigoid
Complement 3 (C3)
with/without IgG
deposition at the
basement membrane

21. Cont’d
Adhesion- caused by Extensive scarring-
pemphigoid pemphigoid

22. Cont’d
Basement membrane components and sites of antibody deposition

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. 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. Cont’d
Pemphigus vulgaris

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. Cont’d
Target lesion
Erythema
multiforme

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. IgA desquamative gingivitis Lupus erythematosis
Desqumative gingivitis Psoriasis

30. Cont’d
B. Allergic reactions
Dental restorative materials
Mercury
Nickel
Acrylic
Other

31. Cont’d
 Ractions attributable to
 Toothpastes/dentifrices
 Mouthrinses/mouthwashes
 Chewing gum additives
 Foods and additives

32. Dentifrice/ reaction
Mercury from amalgam

33. Con’d
Allergic Gingivitis Plasma Cell Gingivitis
(cinnamon) (hot peppers)

34. 6. Traumatic lesions
 Chemical injury e.g. Aspirin burn, alcohol
 Physical injury e.g. radiation
 Thermal injury e.g. hot food

35. Con’d Alcohol
Aspirin burn
Radiation

36. Cocaine burn Pizza burn

37. Smokeless tobacco
Bismuth-accumulation
of metal sulfides
Amalgam tattoo

38. 7. Other
 Vascular neoplasm
 Epithelial malignancy
 Granulomatous diseases

39. Cont’d
Cavernous Kaposi
hemangioma sarcoma

40. Cont’d
Epithelial carcinoma
SCC

41. Cont’d
Wegener's Crohn’s disease
granulomatosis