Oral Soft Tissue Infections:

Diagnostic Methods for Oral Infections

• Aspirate samples are used for fluid-filled cavities like dental abscesses
• Broad-spectrum antibiotics (e.g., amoxicillin) are typically used empirically
• Paper points may be used by periodontists for lab testing
• Swabs are a common method, especially for clean mucosa
• Swabs may be moistened or dried based on the site characteristics
• Sensitivity tests with antimicrobial discs help determine appropriate antibiotics
• Oral Rinse is primarily used for diagnosing Candida infections
• Patients rinse with sterile saline, which is then analyzed in the lab

Candida Infections

• Oral infections caused by Candida species, typically Candida albicans

Acute Pseudomembranous Candidosis (Thrush)

• Creamy, soft, white plaques can be wiped off to reveal an erythematous, sore background
• Commonly seen in infants and women
• Often associated with angular cheilitis
• Management includes good oral hygiene and antifungal treatments like miconazole or nystatin; treat associated angular cheilitis

Chronic Pseudomembranous Candidosis

• Similar to the acute form but more painful
• Occurs in immunocompromised patients
• Management involves antifungal treatments and addressing underlying immunocompromised conditions

Acute Atrophic Candidosis

• Generalized desquamative areas appear as diffuse red patches without white plaque
• Management involves stopping causative antibiotics or steroids, improving oral hygiene, and using topical antifungal therapy

Chronic Atrophic Candidosis (Denture Stomatitis) or Erythematous Candidosis (Non-Denture)

• Red, velvet-like lesions appear under dentures or in non-denture wearers
• Management includes antifungals, good denture hygiene, removing dentures at night, and possibly replacing ill-fitting dentures

Chronic Hyperplastic Candidosis or Candida Leukoplakia

• Thick, white, painful plaques are difficult to remove
• Requires biopsy for diagnosis
• Management includes antifungal therapy and addressing contributing factors like smoking or iron deficiency

Median Rhomboid Glossitis

• Asymptomatic, erythematous, well-demarcated area is present on the midline of the dorsal tongue
• Management involves antifungals and addressing any contributing factors like corticosteroid use or smoking

Angular Cheilitis

• Cracking appears at the corners of the mouth, sometimes with Candida or bacterial infection
• Management involves an appropriate topical antifungal or antibiotic
• Consider underlying factors like denture fit or nutritional deficiencies

Chronic Mucocutaneous Candidosis Syndromes (CMC)

• Persistent Candida infections occur on the skin, nails, oral, and genital mucosa
• Management involves long-term antifungal therapy, possibly combined with treatments for associated disorders like immunoglobulin or stem cell transplantation

Viral Infections

• Infections caused by various viruses affecting the oral cavity and surrounding tissues

Herpes Simplex Virus (HSV)

• Types include acute herpetic gingivostomatitis and herpes labialis
• Acute Herpetic Gingivostomatitis: Severe oral soreness, fever, swollen lymph nodes
• Herpes Labialis: Cold sores with burning sensation before blistering
• Management: Antivirals like acyclovir during outbreaks, and supportive care, including hydration and pain management

Varicella Zoster Virus

• Types include chickenpox and shingles
• Chickenpox: Oral and body lesions
• Shingles: Painful rash along dermatomes, possibly involving the face
• Management: Acyclovir and possibly steroids for severe cases, pain management for post-herpetic neuralgia

Epstein-Barr Virus (EBV)

• Associated with infectious mononucleosis, oral hairy leukoplakia, nasopharyngeal carcinoma, and Burkitt lymphoma
• Infectious Mononucleosis: Sore throat, fever, swollen lymph nodes
• Oral Hairy Leukoplakia: White patches on the tongue that cannot be wiped away
• Management: Mostly supportive; antivirals may reduce symptoms but do not alter the course

Cytomegalovirus (CMV)

• Rare in healthy individuals, may cause mouth ulcers and retinitis
• Management: Antiviral treatments like ganciclovir

Bacterial Infections

• Infections caused by bacteria, leading to various oral and systemic manifestations

Necrotizing Ulcerative Gingivitis

• Painful, bleeding gums with necrotic patches
• Management: Improved oral hygiene and antibiotic therapy like metronidazole

Syphilis

• Primary Syphilis:
  • Painless chancre at the infection site
  • Management: Treated with penicillin to prevent progression
• Secondary Syphilis:
  • Rashes, especially on palms and soles, mucous patches, fever, and swollen lymph nodes
  • Management: Penicillin treatment continues; additional care for symptom relief may be necessary
• Tertiary Syphilis:
  • Gummas (painful ulcers), neurological, or cardiovascular symptoms
  • Management: Requires longer durations of antibiotic therapy, possibly including hospitalization for intensive care
• Congenital Syphilis:
  • Occurs in infants born to infected mothers, can cause multiple organ malformations
  • Management: Prevention is key via prenatal screening and treatment of the mother; infants need antibiotic therapy

Tuberculosis

• Oral manifestations are rare, but may include painful ulcers, nodules, or fissures
• Management: Antitubercular therapy in coordination with medical specialists, particularly if pulmonary TB is also present

Acute Bacterial Sialadenitis

• Painful swelling of the salivary glands, potentially with pus
• Management: Hydration, antibiotics, and possibly surgical intervention to remove blockages

Actinomycosis

• Rare oral infections are characterized by abscesses and sinus tract formation
• Management: Surgical drainage and prolonged antibiotic therapy, typically with amoxicillin or ceftriaxone

Impetigo

• Red sores that quickly rupture and form honey-colored crusts
• Management: Antibiotic creams or oral antibiotics, and hygiene measures to prevent spread

Gonorrhea

• May include a sore throat, redness in the throat, and fever; oral lesions are less common
• Management: Antibiotics, with confirmation of diagnosis by culture or smear to ensure appropriate treatment

Paramyxoviruses

• Viral infections caused by paramyxoviruses

Mumps

• Swelling of the parotid glands, sometimes accompanied by orchitis or meningoencephalitis
• Management: Supportive care, as there is no specific treatment for mumps

Measles

• Koplik spots inside the mouth, fever, conjunctivitis, and a characteristic red-brown rash
• Management: Supportive care, vitamin A supplements, and monitoring for complications

Human Papillomavirus (HPV)

• Viral infection that can cause several oral manifestations

Oral Manifestations

• Squamous Cell Papilloma: Warty growths due to HPV types 6 and 11
• Condyloma Acuminatum: Pink nodules with a cauliflower appearance
• Heck's Disease (Focal Epithelial Hyperplasia): Multiple painless papules, often in children and immunocompromised individuals
• Verruca Vulgaris: Common warts with a rough surface
• Management: Surgical excision of papillomas, monitoring for potential malignancy, especially with HPV types 16 and 18 related to oropharyngeal carcinoma

Human Immunodeficiency Virus (HIV) Related Infections

• Increased susceptibility to infections like candidiasis, herpes zoster, and oral hairy leukoplakia due to immunodeficiency
• Management: Highly active antiretroviral therapy (HAART) has significantly reduced the incidence of these infections, but supportive care and specific treatments for oral lesions are necessary

Coxsackie Infections

• Viral infections caused by Coxsackieviruses
• Coxsackieviruses are a group of enteroviruses that consist of RNA viruses
• Two notable diseases caused by different strains of Coxsackie A virus are Herpangina and Hand, Foot, and Mouth Disease (HFMD)
• Both conditions predominantly affect children and are transmitted primarily via the feco-oral route

Herpangina

• Caused by Coxsackievirus A, typically affecting children
• Transmission is via the oro-faecal route
• Symptoms: Sudden onset of mild illness with fever, anorexia, dysphagia, and sore throat
• Small vesicles develop into ulcers (1-2mm in diameter) located at the back of the mouth, including the tonsils, soft palate, and uvula, lesions typically last 2-3 days
• Can be difficult to distinguish from acute primary herpes, which usually involves the anterior oral regions, whereas herpangina affects more posterior areas of the mouth
• Management: Supportive care, including mouth rinses with topical analgesics along with antipyretic analgesics to manage fever

Hand, Foot, and Mouth Disease (HFMD)

• Caused by various types of Coxsackievirus A, often type 16
• Transmission is via close contact, common in children
• Symptoms: Small, scattered ulcers more anteriorly than herpangina, often presenting as shallow painful ulcers, and rarely intact vesicles and lesions typically appear on the palms of the hands and soles of the feet
• Management: Primarily supportive, resolving within 7 days
• This disease is not the same as the foot-and-mouth disease found in cattle