Oral Infections PDF

Yrd. Doç. Dr. Erim Tandoğdu INFECTIONS OF THE ORAL MUCOSA: A. Bacterial Infections ​ Acute necrotizing ulcerative gingivitis ​ Syphilis ​ Gonorrhea ​ Non-specific urethritis ​ Tuberculosis B. Fungal (yeast) Infections C. Viral Infections VIRAL INFECTIONS ​ Herpes...

Yrd. Doç. Dr. Erim Tandoğdu INFECTIONS OF THE ORAL MUCOSA: A. Bacterial Infections ​ Acute necrotizing ulcerative gingivitis ​ Syphilis ​ Gonorrhea ​ Non-specific urethritis ​ Tuberculosis B. Fungal (yeast) Infections C. Viral Infections VIRAL INFECTIONS ​ Herpes simplex virus infections ​ Varicella zoster virus infections ​ Epstein-Barr virus infections ​ Coxsackie virus infections ​ Paramyxovirus infections ​ Human papillomavirus infections ​ Human immunodeficiency virus and AIDS ACUTE NECROTIZING ULCERATIVE GINGIVITIS (ANUG): Although this disease has become more widespread recently, it is less common in developed countries. ANUG is frequently seen in smokers and those with immunodeficiencies, particularly AIDS patients. The exact cause is unknown. CLINICAL FINDINGS IN ANUG PATIENTS ​ Pain and bleeding in the gums ​ Necrosis in the gingival papillae ​ Crater-shaped ulcerations ANUG ​ Halitosis (bad breath) ​ Lateral spread of ulceration along the gingival margins ​ Some patients may experience fever, malaise, and lymphadenitis. Yrd. Doç. Dr. Erim Tandoğdu PREDISPOSING FACTORS: ​ Poor oral hygiene ​ Smoking and psychological stress ​ Reduced organism resistance or suppressed immune system EFFECTS OF NICOTINE: ​ Nicotine stimulates the adrenal glands, resulting in an excessive release of adrenaline. ​ This is followed by vasoconstriction in the blood vessels of the gingiva. ​ Consequently, the amount of blood flowing to the tissues decreases, leading to infection and tissue damage. EFFECTS OF NICOTINE: ​ It has been suggested that endotoxins released by gram-negative bacteria in nearby dental plaque also increase the vasoconstrictive effect. DIAGNOSIS OF ANUG: ​ Diagnosis is made by demonstrating fusospirochetes stained with Gram stain in a culture taken from a gingival smear. TREATMENT OF ANUG: ​ Supragingival plaque control should be performed at the onset of ANUG. ​ Systemic antibiotic therapy (combination of metronidazole and penicillin) ​ Smoking cessation ​ Careful gingival curettage ​ Chlorhexidine mouthwash is recommended. ​ The patient is advised to brush their teeth with a soft toothbrush. ​ The patient uses Metronidazole (Flagyl 500 mg) three times a day at 8-hour intervals for one week. ​ Penicillin (amoxicillin 500 mg or augmentin 1000 mg) is used twice a day at 12-hour intervals for one week. CAUTION IN THE USE OF METRONIDAZOLE: ​ The patient should avoid alcohol while using metronidazole as it can cause nausea and hypotension. ​ It should not be used during the early stages of pregnancy due to its teratogenic effects. SYPHILIS Yrd. Doç. Dr. Erim Tandoğdu ​ Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. SYPHILIS ​ Although rare today, its incidence is increasing in Russia and the Far East. ​ It destroys the cardiovascular and nervous systems. ​ If untreated, it is a fatal disease. CLINICAL PRESENTATION ​ A. Acquired (Primary, Secondary, Tertiary) ​ B. Congenital PRIMARY SYPHILIS ​ The characteristic lesion is a chancre. ​ Chancres are mostly seen on the vulva and glans penis, and around the anus in homosexuals. ​ It can also appear in the mouth of individuals engaging in oral sex, and on the fingers of healthcare personnel working without gloves. PRIMARY SYPHILIS ​ It can occur in the mouth through kissing, sharing utensils, or oral sex. ​ Oral lesions have a dark red, glassy surface. PRIMARY SYPHILIS ​ The image shows two chancres on the tongue. ​ Oral chancres are seen in about 5-10% of cases. PRIMARY SYPHILIS ​ Oral chancres appear as painless ulcers. ​ Regional lymphadenitis is seen at this stage. ​ The image shows a chancre on the lip. CHANCRE ​ Painless ​ Starts as a macule (spot) within three weeks of spirochete entry into the body, then becomes a papule and ulcerates. ​ The chancre is round or oval with a hard base. ​ Heals within 3-10 weeks, leaving a scar. Yrd. Doç. Dr. Erim Tandoğdu SECONDARY SYPHILIS SYMPTOMS ​ Widespread rash ​ Mucous plaque formation ​ Condylomata ​ Generalized lymphadenopathy ​ Headache ​ Malaise ​ Weight loss ​ Multiple arthralgia (joint pain) SECONDARY SYPHILIS (RASH) ​ Occurs 8 weeks to 2 years after infection. ​ Widespread rashes in syphilis may sometimes appear as large, dark red papules. SECONDARY SYPHILIS (RASH) ​ In a few patients, the rash forms pustules and crusts. ​ Different types of lesions may occur in the same patient. SYPHILIS RASH ​ In 70% of cases, the rash is widespread as seen in the image. ​ The rash is seen along with fever, headache, malaise, arthralgia (joint pain), and mucous plaque formation. SECONDARY SYPHILIS (RASH) ​ The rash may also appear on the soles of the feet. SECONDARY SYPHILIS (MUCOUS PLAQUE) ​ The image shows mucous plaques on the hard palate and gingiva. ​ Mucous plaques can occur anywhere on the oral mucosa. SECONDARY SYPHILIS (MUCOUS PLAQUE) ​ Differential diagnosis should be made with stomatitis from drugs, traumatic ulcers, and Behçet's disease. SECONDARY SYPHILIS (MUCOUS PLAQUE) ​ A mucous plaque under the tongue. ​ Mucous plaques are highly infectious. Healthcare providers and dentists examining Yrd. Doç. Dr. Erim Tandoğdu patients without gloves can contract the disease. SECONDARY SYPHILIS (CONDYLOMATA) ​ Condylomata, warty lesions more commonly seen on genital organs, can occur as secondary syphilis lesions. ​ The image shows a case of condylomata on the palate. TERTIARY SYPHILIS ​ Tertiary syphilis begins within four to seven years. ​ Characteristic lesions include syphilitic leukoplakia and gummas. TERTIARY SYPHILIS ​ Third-stage lesions of the disease are not seen in developed countries due to treatment. ​ The image shows a gumma on the tongue. CONGENITAL SYPHILIS CONGENITAL SYPHILIS ​ Syphilis can be transmitted from an untreated mother to her child within two years of infection. ​ During this period: ○​ Hutchinson's incisors ○​ Mulberry molars are seen. CONGENITAL SYPHILIS ​ Hutchinson's teeth are seen in 10-30% of children with congenital syphilis. ​ Upper central incisors are most affected. ​ Primary teeth are not affected. ​ The incisal edges of the incisors are narrower than the middle part of the crown. ​ These teeth resemble a screwdriver. MULBERRY AND PFÜLÜGER MOLARS ​ Mulberry molars have a narrower occlusal surface, a rough crown, and enamel hypoplasia. ​ Pfülüger molars have a similar appearance but no enamel hypoplasia. GONORRHEA Yrd. Doç. Dr. Erim Tandoğdu GONORRHEA (Gonorrhea) ​ The primary oral lesion of gonorrhea is rare. ​ It may result from direct mucosal contact with the organism (Neisseria gonorrhoeae). CLINICAL FINDINGS ​ Transmitted through sexual contact in adults. ​ In adults, it can appear as a localized infection in the urogenital tract, rectum, conjunctiva, and oropharynx; ​ As a general infection in the skin, joints, meninges, and endocardium. ORAL GONORRHEA CLINICAL FINDINGS ​ Diffuse, vesicular, erythematous, ulcerative oral lesions, ​ Purulent gingivitis, ​ Tonsillitis may be seen. ​ Additionally: ○​ Submandibular lymphadenopathy ○​ Infectious arthritis in the temporomandibular joint has been reported in some patients. DIAGNOSIS ​ Diagnosis is made by identifying gram-negative diplococci in cultures taken from oral lesions. TREATMENT ​ High doses of antibiotics are administered. ​ Procaine penicillin intramuscularly or oral amoxicillin can be given. ​ As with all sexually transmitted diseases, the patient may have multiple infections simultaneously. TUBERCULOSIS TUBERCULOSIS ​ The causative agent is Koch's bacillus (Mycobacterium tuberculosis). ​ The disease is transmitted to humans from animals or individuals with tuberculosis. ​ The disease is typically seen in the lungs but can also occur in the oral cavity. Yrd. Doç. Dr. Erim Tandoğdu TUBERCULOSIS These lesions are thought to occur in areas of minor trauma in the oral cavity exposed to infected sputum. The most common location is the back of the tongue, but it can also be seen on the palate, lips, gums, buccal mucosa, and jawbones. DIAGNOSIS (CLINICAL FINDINGS) ​ Chronic cough ​ Hemoptysis ​ Weight loss ​ Night sweats ​ Increased body temperature LYMPHADENITIC TUBERCULOSIS The image shows bilateral cervical tuberculosis lymphadenitis in a young child. This form of the disease is transmitted by drinking milk from tuberculous cows. The affected lymph nodes are initially hard, later soften, and eventually rupture, opening to the outside. LABORATORY FINDINGS ​ Sputum culture ​ Tuberculin test ​ Chest radiograph BONE TUBERCULOSIS Tuberculosis can also affect the bone. The image shows a tuberculosis lesion in the upper alveolar crest. CLINICAL FINDINGS OF ORAL TUBERCULOSIS Oral tuberculosis lesions appear as painful ulcers covered with gray-yellow exudate. The surrounding tissue is inflamed. Tuberculosis ulcers are most commonly found on the tongue. However, they can also be seen on other parts of the oral mucosa, lips, buccal mucosa, and palate. TREATMENT Anti-tuberculosis drugs (isoniazid, rifampicin, ethambutol, streptomycin, and pyrazinamide [or its derivative morfozinamide]) CLINICAL PRECAUTIONS Certain precautions must be taken to prevent cross-infection between staff and patients. These include: ​ Staff should wear masks, gloves, and protective goggles if necessary. ​ Disposable syringes should be used. ​ Surgical procedures should be performed during the basil (-) phase. ​ Surgical procedures should be done under local anesthesia if possible. Yrd. Doç. Dr. Erim Tandoğdu FUNGAL INFECTIONS (MYCOTIC) CAUSE OF FUNGAL INFECTIONS Candida Albicans. Candida Albicans normally exists in the oral cavity. They become pathogenic under certain conditions where tissue resistance is low. We call these predisposing factors. FACTORS REDUCING TISSUE RESISTANCE ​ Local tissue traumas (mucosal irritation, dental appliances, poor oral hygiene) ​ Malnutrition (high carbohydrate intake) ​ Long-term antibiotic therapy disrupting normal bacterial flora balance ​ Blood diseases (iron deficiency anemia) ​ Endocrine disorders (Diabetes mellitus, Addison's disease, hypothyroidism) FACTORS REDUCING TISSUE RESISTANCE ​ Conditions weakening the body (alcoholism, leukemia, AIDS, diabetes) ​ Conditions where the immune system is compromised (AIDS) ​ Individuals undergoing immunosuppressive therapy FACTORS REDUCING TISSUE RESISTANCE ​ Physiological condition changes (old age, infancy, pregnancy) ​ Salivary gland hypofunction (irradiation [treatment of disease with radiation], Sjögren's syndrome, medications causing dry mouth) LOCAL TISSUE TRAUMAS ​ Poorly made dentures ​ Old dentures ​ Edges of decayed teeth ​ Incompatible clasps ​ Poor oral hygiene ​ Appliances with sharp edges IMMUNOSUPPRESSIVE THERAPY ​ Renal transplantation ​ Organ grafts ​ Treatment of immunological diseases CANDIDIASIS CLASSIFICATION Yrd. Doç. Dr. Erim Tandoğdu Group 1 (Conditions limited to oral mucosa): ​ Acute ○​ Acute pseudomembranous candidiasis (Thrush) ○​ Acute atrophic candidiasis ​ Chronic ○​ Chronic atrophic candidiasis ○​ Candidiasis-related angular cheilitis ○​ Chronic hyperplastic candidiasis Group 2 (Oral manifestations of systemic candidiasis): ​ Chronic mucocutaneous candidiasis THRUSH Thrush is an acute yeast infection caused by Candida albicans. They appear as yellowish-cream plaques on the oral mucosa. CLINICAL FINDINGS The most important characteristic of thrush plaques: They can be scraped off, revealing painful red areas on the mucosa underneath. Thrush is an early sign of AIDS. ORAL THRUSH Thrush infection can be transmitted to infants during birth from the mother's vagina or from one baby to another using the same bottle. In adults, it can occur endogenously (in debilitating diseases) or due to flora disruption from antibiotics. THRUSH The image shows a thrush lesion on the hard palate. If the lesion settles on the posterior pharyngeal wall, it can be dangerous and potentially fatal. THRUSH The image shows a thrush lesion on the tongue. TREATMENT Nystatin and Mycostatin, when used locally for treating thrush, show no side effects. Systemic application is usually not required. Predisposing factors should be eliminated. NYSTATIN Fungostatin oral suspension (commercial name). Daily dose: 4x1 (4 times a day) 1-2 ml. The suspension should primarily be used for infants and children. Side effects: nausea, vomiting, gastrointestinal complaints, allergic reactions. MYCOSTATIN ORAL SUSPENSION Recommended dose for newborns is 1-2 ml four times a day. For children and adults, the dose is 1-6 ml four times a day. ATROPHIC CANDIDIASIS (Erythematous candidiasis) Yrd. Doç. Dr. Erim Tandoğdu ​ Different forms: ○​ Acute atrophic candidiasis ○​ Median rhomboid glossitis ○​ Chronic multifocal candidiasis ○​ Angular cheilitis ○​ Chronic atrophic candidiasis (associated with denture use) ACUTE ATROPHIC CANDIDIASIS ​ The difference from thrush is the absence of pseudomembrane. ​ The epithelium is thin and atrophic. ​ The mucosa is red and painful. ​ It can occur in individuals undergoing long-term antibiotic and steroid therapy. ACUTE ATROPHIC CANDIDIASIS ​ A burning sensation is present in the mucosa. ​ Widespread loss of filiform papillae is observed on the dorsal tongue. ​ Antifungal therapy should be initiated in susceptible individuals and those using long-term antibiotics. MEDIAN RHOMBOID GLOSSITIS ​ A well-demarcated erythematous area affecting the midline of the dorsal tongue. ​ Often asymptomatic. ​ Erythema due to the loss of filiform papillae. ​ Sometimes seen in areas like the hard palate and mouth corners (chronic multifocal candidiasis). CHRONIC ATROPHIC CANDIDIASIS (Denture Sore Mouth) ​ The most common form of oral candidiasis. ​ Painful. ​ Seen in tissues under the denture. ​ Tissue under the denture is bright red. CHRONIC ATROPHIC CANDIDIASIS ​ Erythema of varying severity is present in the mucosa where dentures sit, especially in the maxillary denture area. ​ Often asymptomatic. ​ Long-term denture use is noted in the patient's history. Yrd. Doç. Dr. Erim Tandoğdu DENTURE SORE MOUTH ​ Secondary candidal infection can start after continuous irritation of the mucosa by prosthetic appliances. ​ This lesion can also occur from using old dentures, not just poorly fitting ones. ​ Orthodontic plates can cause the same condition. DENTURE SORE MOUTH ​ More common in women. ​ May be related to endocrine disorders. ​ Sometimes confused with allergic reactions to acrylic materials since it is seen in denture-wearing areas. ​ Candidiasis can be identified by direct inoculation or biopsy in suspicious cases. DENTURE SORE MOUTH - TREATMENT ​ Addressing two factors causing this condition (tissue trauma and infection) is necessary. ​ Trauma is eliminated using appropriate prosthetic techniques. ​ Initial treatment involves using tissue conditioners. ​ Antifungal creams are applied to the area where the denture fits. DENTURE SORE MOUTH - TREATMENT ​ Before going to bed, the entire denture should be carefully cleaned and placed in an antiseptic solution or a bicarbonate solution. ANGULAR CHEILITIS: Also known as Perléche. Characterized by erythema and cracks at the corners of the mouth. It is seen both with multifocal candidiasis and in elderly patients with reduced vertical dimension. The saliva that accumulates in these areas keeps them moist and makes them susceptible to fungal infections. CANDIDAL ANGULAR CHEILITIS Angular cheilitis lesions can be infected with Candida. Candidal angular cheilitis can occur along with denture sore mouth. It can result from alveolar changes caused by poorly made and Yrd. Doç. Dr. Erim Tandoğdu long-used old dentures. CLINICAL FINDINGS ​ Clinically, cracks and infections are seen in the skin at the corner of the mouth. ​ Crust formation and repeated cracking and bleeding occur during mouth movements. ​ The tissue is infected with Candida. ​ Saliva retention occurs in the area. TREATMENT ​ First, the granulomatous lesions at the corners of the mouth are surgically removed. ​ To achieve successful results, folds at the corners of the mouth are eliminated with simple measures. In edentulous mouths, the vertical dimension is carefully adjusted, or the contour of the denture is corrected. In dentate mouths, removable appliances can be made for the same purpose. TREATMENT ​ Fungal infections are treated with antifungal creams. ​ If the infection is not fungal and is associated with Staphylococcus aureus, 'fusidic acid cream' is effective. ​ If both Candida and Staphylococcus are involved, 'miconazole cream' is effective. ​ If there is a systemic cause underlying angular cheilitis, such as diabetes, pernicious anemia, or AIDS, this cause should be addressed first. FUSIDIC ACID ​ Fusidin 2% cream or ​ Fusidin 2% ointment (commercial form) ​ Usage: Apply to infected skin 2-3 times a day. ​ Precautions: Avoid contact with eyes. ​ Side effects: Local irritation, itching, skin rash. MICONAZOLE ​ Fungustat ointment (commercial form) ​ Dosage and usage: Apply to the affected area 1-2 times a day, rub gently. ​ Treatment duration: 2-4 weeks. ​ Side effects: Allergic skin reactions may occur. CHRONIC HYPERPLASTIC CANDIDIASIS: ​ It is the least common among all types. ​ It resembles leukoplakia and cannot be removed from the mucosal surface (candidal Yrd. Doç. Dr. Erim Tandoğdu leukoplakia). ​ It is thought to result from candidiasis superimposed on pre-existing leukoplakia. ​ Diagnosis is made by detecting candidal hyphae in biopsy samples and the lesion's positive response to antifungal therapy. CANDIDAL LEUKOPLAKIA ​ The exact relationship between Candida and leukoplakia formation is not fully understood. ​ These two lesions can be differentiated by biopsy. ​ Such a lesion may more easily undergo malignant changes. CHRONIC MUCOCUTANEOUS CANDIDIASIS: ​ Serious candidal infection presenting as oral findings of the immunological disease called mucocutaneous candidiasis. ​ It is an autosomal recessive disorder. Immune dysfunction becomes apparent early in life, and lesions are seen in the patient's mouth, nails, skin, and other mucosal surfaces. ​ Oral lesions appear as thick, fixed white patches. VIRAL INFECTIONS: GENERAL INFORMATION ​ Viral infections can be seen in and around the mouth. ​ Their clinical features are not very distinct. ​ These types of infections are often found as vesicular lesions on the oral mucosa. ​ Vesicles eventually burst, leaving painful ulcers. PROBLEMS IN TREATING VIRAL INFECTIONS ​ No substance has yet been found to affect viruses within living organisms. ​ The second difficulty is that viral replication (virus multiplication) damages the cell before symptoms appear. VIRUSES ​ They reproduce in living cells. ​ Viruses affect plants, animals, humans, and even bacteria. ​ All viruses contain protein. ​ Some contain RNA, while others contain DNA. SUBSTANCES USED IN VIRAL INFECTIONS Yrd. Doç. Dr. Erim Tandoğdu ​ Interferon ​ Brivudine ​ Acyclovir CHARACTERISTICS OF SUBSTANCES USED IN TREATING VIRAL INFECTIONS ​ Interferon is not routinely used. It is used against life-threatening viruses. ​ Brivudine's effect on viruses also affects host cells, making it unsuitable for parenteral administration. In Herpes Simplex Virus-1 (HSV-1) and Varicella-Zoster Virus (VZV) infections, Brivudine is preferred over idoxuridine and trifluridine due to its safer prognosis and lower toxicity in systemic distribution. ​ Acyclovir can be used safely both systemically and locally. It is available in intravenous, 200 mg tablet, and 5% cream forms. ACYCLOVIR ​ Aklovir cream 5% (apply to the lesion five times a day for seven days) (commercial preparation). ​ Side effects: Renal failure, increased liver enzymes, blood count changes, nausea, vomiting. VIRAL INFECTIONS ​ Herpes simplex ​ Recurrent herpes ​ Varicella zoster ​ Herpes zoster ​ Epstein-Barr ​ Coxsackievirus ​ Paramyxovirus ​ Infectious mononucleosis (glandular fever) ​ AIDS HERPES VIRUS There are four major herpesviruses that affect humans: ​ Herpes simplex virus (HSV) ​ Herpes zoster virus (HZV) ​ Cytomegalovirus ​ Epstein-Barr virus (EB) Yrd. Doç. Dr. Erim Tandoğdu HERPES SIMPLEX VIRUS ​ Herpes simplex virus is a DNA virus. ​ There are two types of herpes simplex virus (Type 1 and Type 2). ​ Type 1 virus affects the oral mucosa, pharynx, and skin. ​ Type 2 virus affects the genital area. ​ Herpes simplex type 2 virus is also thought to cause cervical carcinomas. HERPES SIMPLEX VIRUS ​ The entry points for herpes simplex virus are the respiratory tract, sexual intercourse, or abrasions in the skin or mucosa. PRIMARY HERPETIC GINGIVOSTOMATITIS ​ Primary herpetic gingivostomatitis can occur in the mouth due to herpes simplex type I virus. ​ The incubation period is about one week. GENERAL SYMPTOMS ​ Malaise ​ Fever ​ Muscle pain ​ Sore throat ​ Headache ​ Irritability ​ Drooling ​ Loss of appetite ​ Swelling, redness, and enlargement of the gums PRIMARY HERPETIC GINGIVOSTOMATITIS IN CHILDREN ​ The disease can also be seen in young children and may be mistaken for teething. ​ After a short prodromal phase, the lesion appears in the mouth. ​ Initially, these lesions are thin-walled vesicles. PRIMARY HERPETIC GINGIVOSTOMATITIS IN CHILDREN ​ The vesicles eventually burst, forming ulcers. ​ The gums are inflamed and swollen. PRIMARY HERPETIC GINGIVOSTOMATITIS IN ADULTS Yrd. Doç. Dr. Erim Tandoğdu ​ This lesion can also be seen in adults. ​ The image shows lesions in the oral cavity. ​ Oral lesions manifest as redness of the mucosa, numerous vesicle formation, and ulceration after the vesicles burst. ​ Cervical lymph node enlargement and high fever occur when oral lesions form. PRIMARY HERPETIC GINGIVOSTOMATITIS ON THE TONGUE ​ Primary herpetic gingivostomatitis lesions can also appear on the tongue. ​ Round vesicles are scattered on the tongue's surface. ​ The surface of the tongue is covered with a yellowish-white coating. PRIMARY HERPETIC GINGIVOSTOMATITIS ON THE TONGUE ​ In adults, the infection can spread throughout the body, leading to encephalitis, meningitis, and other life-threatening conditions. SECONDARY HERPETIC GINGIVOSTOMATITIS SECONDARY HERPETIC LESIONS ​ After the primary infection, the herpesvirus remains latent in the trigeminal ganglion. ​ When the body's resistance decreases, the virus can reactivate, forming secondary herpetic lesions. SECONDARY HERPETIC LESIONS ​ These lesions are seen on the oral mucosa (attached gingiva, hard palate, lips). ​ Secondary herpetic lesions on the lips are called herpes labialis or cold sores. Multiple ulcers on the hard palate and gingiva SECONDARY HERPETIC LESIONS ​ Secondary herpetic lesions can be seen on the lower lip. PRECAUTIONS ​ Dentists and other healthcare personnel treating the disease can get herpes infections on their hands and nails. ​ Lesions on the nail bed can be permanent and may not heal for months. PRECAUTIONS Yrd. Doç. Dr. Erim Tandoğdu ​ The risk of infection to the healthcare provider is high when working inside the mouth without gloves. ​ Patients should also be warned to minimize contact between the hands, mouth, and eyes during the infection period. TREATMENT ​ The treatment of primary herpetic gingivostomatitis is mainly aimed at preventing secondary infection, and symptomatic treatment is recommended. These include: ○​ Rest, ○​ Antipyretic analgesics (NSAIDs, Ibuprofen, Paracetamol) ○​ Mouthwash with Chlorhexidine Gluconate or Tantum Verde, ○​ Analgesic mouthwash (benzydamine) TREATMENT ​ If there are lesions on the skin and mucous membranes, Acyclovir is used both systemically and topically. ​ If symptoms do not disappear within 2 weeks, further investigation for blood dyscrasias (abnormalities) is conducted. ACYCLOVIR (ZOVIRAX) ​ Zovirax is available in suspension and cream forms. ​ Zovirax should be used as early as possible. ​ Zovirax has low toxicity and should be used in suspension form for this disease. ​ The recommended adult dose is 200 mg, 5 times a day for 5 days. ​ Half of the adult dose is given to children. ZOVIRAX ​ Zovirax cold sore cream is applied in a thin layer to completely cover the lesions, 5 times a day for 7 days. RECURRENT HERPES ​ After the disappearance of the primary herpetic infection, recurrent lesions are seen in 50% of patients. ​ The most common sites of recurrent lesions are the lips. Less commonly, the nasal mucosa and skin can also be affected. RECURRENT HERPES ​ Sunlight, mechanical trauma, and colds can provoke this condition. Emotional factors Yrd. Doç. Dr. Erim Tandoğdu also play a role in the occurrence of this disease. CLINICAL FINDINGS ​ As the first symptom, the patient feels malaise and fatigue. ​ This is followed by itching and irritation over the recurrent area. CLINICAL FINDINGS ​ Within a few hours, vesicles surrounded by an erythematous area form. ​ These vesicles rupture shortly, forming crusts. ​ After this, a slow healing period follows, and the disease heals within 10 days. RECURRENT HERPETIC LESIONS ​ Recurrent labial and perioral herpes are common. ​ The image shows recurrent lesions on the perioral skin after a primary herpes simplex infection. RECURRENT HERPETIC LESIONS ​ Vesicles rupture, forming crusts. ​ In cases of immunodeficiency, these lesions spread over a wide area. RECURRENT HERPES ​ The image shows widespread recurrent herpetic lesions in chronic lymphocytic leukemia. RECURRENT INTRAORAL HERPETIC LESIONS ​ Recurrent intraoral herpetic lesions are quite rare. VARICELLA ZOSTER VIRUS ​ A DNA virus. ​ This virus causes two different diseases: chickenpox and herpes zoster (shingles). HERPES ZOSTER (SHINGLES) ​ 70% of patients are over 50 years old. ​ The disease is more common in men. ​ Conditions that weaken the body and immunodeficiency increase susceptibility to the disease. ​ The image shows herpes zoster erosions on the left side of the palate. Yrd. Doç. Dr. Erim Tandoğdu CLINICAL FINDINGS ​ Vesicular eruptions occur in the area supplied by the sensitive nerve. ​ The disease most commonly affects the ophthalmic branch of the trigeminal nerve. CLINICAL FINDINGS ​ Oral lesions are seen if the second and third branches of the trigeminal nerve are affected. ​ Cervical nerves can also be affected. **Initial symptoms are pain and sensitivity in the affected area. ​ Before oral and skin lesions appear, headache, malaise, pulpitis, and fever occur. ​ Within 2-4 days, vesicles form, followed by pustules and ulcers. **If the ophthalmic branch of the trigeminal nerve is affected, corneal ulceration occurs. ​ If untreated, vesicles and oral ulceration disappear within 2-4 weeks. ​ Vesicles on the skin form hard crusts, which can leave scars if disrupted. CLINICAL FINDINGS ​ The most important complication of this condition is post-herpetic neuralgia. PARALYSIS OF EYE MUSCLES ​ In this patient, the herpes zoster virus affected the ophthalmic branch of the 5th cranial nerve, resulting in ophthalmoplegia (paralysis of the eye muscles). POST-HERPETIC NEURALGIA ​ In the area where the lesions were seen: ○​ Anesthesia, ○​ Paresthesia, ○​ Pain similar to trigeminal neuralgia occurs. This condition can last for years. RAMSAY-HUNT SYNDROME ​ In a few patients, the facial nerve is also affected. In this case: ○​ Thickening of the facial skin, ○​ Facial nerve weakness, ○​ Reduced sense of taste, ○​ Vertigo due to labyrinth involvement occurs. Yrd. Doç. Dr. Erim Tandoğdu TREATMENT ​ For treating skin lesions, 40% idoxuridine (IDU) in dimethyl sulfoxide (DMSO) can be used. ​ Acyclovir cream or systemic oral acyclovir can be used. ​ Systemic steroids for permanent nerve damage, ​ Interferon for high-risk patients. HERPANGINA ​ Herpangina is seen in children with Coxsackie A, Type 4 virus. ​ It occurs in small epidemics. ​ Patients experience malaise and sore throat. Additionally, mild muscle weakness and pain are observed. HERPANGINA ​ The disease is self-limiting and ends within 3-5 days. ​ Complications are extremely rare. HERPANGINA ​ The throat becomes inflamed, small separate vesicles are seen, each surrounded by a red area. ​ Vesicles burst, leaving ulcers that heal within a week. ​ Below are similar lesions caused by herpes simplex seen more anteriorly. HAND, FOOT, AND MOUTH DISEASE ETIOLOGY AND PATHOGENESIS ​ Hand, Foot, and Mouth Disease is caused by Coxsackie virus A16. ​ Clinically, it presents as macular and vesicular eruptions on the fingers, feet, and oral mucosa, appearing as ulcers. HAND, FOOT, AND MOUTH DISEASE ​ Diagnosis is made based on clinical findings and anamnesis. Virus culture and the presence of circulating antibodies confirm the diagnosis. ​ The disease is transmitted to humans through close contact. It can cause small outbreaks in schoolchildren. ​ It is highly contagious. It can also be transmitted to teachers Yrd. Doç. Dr. Erim Tandoğdu NON-HODGKIN LYMPHOMA These lesions grow rapidly and quickly become ulcerated. The edges of the ulcers are raised, and the base is hard. AIDS-RELATED LYMPHOMA ​ Hemorrhagic mass anteriorly ​ Hemorrhagic mass in the anterior maxilla ORAL CERVICOFACIAL ACTINOMYCOSIS (OSA) ORAL CERVICOFACIAL ACTINOMYCOSIS (OSA) ​ Deep suppurative abscess and fistula formation in the perioral area, jaws, and upper neck. ​ OSA is an infection caused by microorganisms normally found in humans. It does not require contact with infected individuals. ORAL CERVICOFACIAL ACTINOMYCOSIS (OSA) ​ The causative microorganism is Actinomyces israelii. This microorganism is an anaerobic gram-positive bacterium. ​ This bacterium is found in the oral cavity and rarely becomes pathogenic. ORAL CERVICOFACIAL ACTINOMYCOSIS (OSA) ​ The organisms causing OSA infections are normally found in the crypts of the tonsils, decayed teeth, and dental calculus deposits. ​ They become pathogenic in cases of tooth extraction, periapical infection, and pericoronal infections around partially impacted teeth. ORAL CERVICOFACIAL ACTINOMYCOSIS (OSA) ​ Affected patients have red, raised, and firm swellings on their face and neck. Within these swellings are various draining abscesses containing sulfur granules. ​ Treatment includes opening the fistulas, drainage, and long-term penicillin therapy.