ANUG Infection

Acute Necrotizing Ulcerative Gingivitis (ANUG)

• Caused by fusiform bacilli, Bacteroides, and spirochetes, known as Vincent's organisms
• Normal oral flora, making ANUG an endogenous infection
• Predisposing factors: local (alcohol, tobacco, poor oral hygiene, pre-existing gingivitis), systemic (psychological stress, poor diet, immunocompromised status)
• Clinical features: necrotic punched-out or crater-like ulcerations on interdental papilla and marginal gingiva, grayish pseudo membrane, gingival bleeding, pain, foul odor, excessive salivation, bad metallic taste
• Systemic manifestations: fever, malaise, cervical lymphadenopathy
• Histopathological features: non-specific, necrosis of surface epithelium, acute inflammatory cells in connective tissue
• Treatment: removal of local irritating factors, antibiotics (penicillin and metronidazole)

Actinomycosis

• Definition: chronic suppurative granulomatous bacterial infection, usually occurs in the soft tissue of the angle of the mandible
• Causative organisms: endogenous bacteria, especially Actinomyces israeli and/or Actinomyces bovis
• Predisposing factors: local (poor oral hygiene, periodontal pocket, or after tooth extraction or jaw surgery), systemic (immunocompromised patients with malignancies, HIV, diabetes, or steroid use)
• Clinical features: two types of Actinomycosis can be distinguished
  • Peripheral Actinomycosis: lesion begins as asymptomatic firm (indurated) swelling, later breaks down forming sinuses and discharging pus with sulfur granules, characterized by formation of multiple abscesses and sinus tracts
  • Central Actinomycosis: occurs in the bones of the jaw, leading to chronic actinomycosis osteomyelitis
• Histopathological features: central abscess consists of colonies of microorganisms with radiating filaments, forming a rosette pattern, with neutrophils, multinucleated giant cells, and macrophages
• Treatment: incision and drainage, long-term penicillin-based antibiotics, antiseptic mouth rinse

Noma (Cancrum Oris)

• Definition: destructive, disfiguring, necrotizing disease affecting the orofacial tissues
• Most frequently affects children in developing countries, especially Sub-Saharan Africa, who are malnourished or debilitated by systemic conditions
• Histopathological and bacteriological features are similar to ANUG
• Noma is preceded by ANUG, so early diagnosis prevents the development of noma and death

Gonorrhea

• Definition: venereal disease transmitted by sexual intercourse, caused by Neisseria gonorrhea
• Oral manifestations: vary from asymptomatic to painful, including generalized erythematous stomatitis, ulceration, burning sensation, and difficulty swallowing
• Secondary stage of acquired syphilis: highly contagious, characterized by the formation of mucous patches and condyloma latum, with a typical snail-track appearance

Syphilis

• Definition: chronic, specific granulomatous bacterial infection, transmitted by direct contact, caused by Treponema pallidum
• Classification: acquired and congenital types
• Acquired syphilis: 3 stages
  • Primary stage: characterized by the formation of Chancre, a painless nodule that breaks down to form a round ulcer with raised, indurated, and rolled margins, with regional lymphadenopathy
  • Secondary stage: highly contagious, characterized by the formation of mucous patches and condyloma latum, with a typical snail-track appearance
  • Tertiary stage: appears 2-3 years, characterized by gumma, diffuse syphilitic glossitis, and diffuse syphilitic osteitis
• Histopathological features: central coagulation necrosis, surrounded by chronic inflammatory cells, with fibroblasts for the synthesis of fibrous tissue with endarteritis obliterans

Tuberculosis of the Oral Cavity

• Definition: chronic specific granulomatous bacterial infection, caused by Mycobacterium tuberculosis
• Clinical features: primary lesion of the oral mucosa is rare, usually associated with coughing-up of infected sputum from pulmonary tuberculosis, with a chronic, irregular, indurated, painful ulcer that slowly increases in size, affecting the tongue, buccal mucosa, palate, and lips
• Histopathological features: microscopic examination of T.B reveals granulomatous inflammation, with central caseous necrosis, collections of epithelioid histiocytes, lymphocytes, and multinucleated Langhans giant cells

Leprosy

• Definition: chronic infectious disease produced by Mycobacterium leprae, with two forms: tuberculoid leprosy (limited form with low-virulence bacilli) and lepromatous leprosy (generalized form with high-virulence bacilli)
• Clinical features: oral lesions in the form of multiple necrotic and ulcerated nodules with slow healing and atrophic scarring, affecting the palate, tongue, and gingiva, with cutaneous lesions, severe maxillofacial deformities, and damage to peripheral nerves
• Histopathological features: granulomatous inflammatory response with epithelioid histiocytes and multinucleated giant cells, with infiltration of nerves by mononuclear inflammatory cells, and acid-fast bacilli demonstrated with Fite-Faraco stain