ACTINOMYCOSIS, TUBERCULOSIS,

LEPROSY, SYPHILIS, NOMA

EPITHELIAL CELLS OF ORAL
MUCOSA
STRATIFIED SQUAMOUS
EPITHELIUM
FIBROBLASTS
FAT CELLS
INFLAMMATORY CELLS
INFLAMMATORY CELLS
INFLAMMATORY CELLS
 ACTINOMYCES
 Causative bacteria: filamentous, anaerobic
gram positive Actinomyces israelii
 A part of normal oral flora present in dental
caries
 Predisposing factors include trauma or surgical
procedure allowing the bacteria to invade an
anaerobic area
 Site of involvement: upper neck, jaws, perioral
area
 CLINICAL FEATURES
 Deep suppurative abcess with draining sinuses
 Purulent exudate containing “sulphur granules”
 ACTINOMYCES
 Initially infection is acute
causing pain and swelling
 Causes osteomyelitis in
jaw bone
 The soft tissue abcess
drain through sinus tracts
 The sulphur granules in
the exudate is actually
calcified bacterial
colonies
 ACTINOMYCES
 HISTOPATHOLOGY
 Central portion of abcess
contains purulent exudate
 Multiple calcified colonies of
filamentous bacteria
 The central portion of colony is
basophilic and periphery is
eiosinophilic
 The bacterial filaments are
arranged in a radiating pattern at
the periphery of the colony
 “Rosette pattern” “Sunburst”
pattern of arrangement
 ACTINOMYCES
 TREATMENT
 Surgical debridement and drainage of sinus
 TUBERCULOSIS
 Causative bacteria: Acid fast Mycobacterium
tuborculosis
 Chronic granulomatous infection of lungs
 2 types of infection: primary and secondary
 Oral lesions associated with secondary TB
 TUBERCULOSIS
 MODE OF SPREAD

PRIMARY MACROPHAGES Disemination

• Aerosole • Phagocytosed • Lysis of infected cell
• Lungs • Replication • Spread to organs
 TUBERCULOSIS
 CLINICAL FEATURES
 Chronic ulcer with
indurated borders
 Tosillar swelling
 May involve bone
 Cervical lymph nodes
 May relate to
osteomyelitis
 TUBERCULOSIS
 HISTOPATHOLOGY
 Granulomatous inflammation
 Granulomas are composed of a collection of
epitheloid cells
 Langhan giant cells present
 Central areas of granulomas show caseous necrosis
 Long standing granulomas show fibroblast at
periphery along with numerous lymphocytes
TUBERCULOSIS
TUBERCULOSIS
 TUBERCULOSIS
 TREATMENT
 Isoniazid
 Rifampicin
 LEPROSY
 Also known as HANSEN’S
DISEASE
 Caused by Mycobacterium leprae
 Moderately contageious
 Two forms of leprosy:
 Tuberculoid leprosy
 Lepromatous leprosy
 Tuberculoid type is a limited
form constituting of
erythematous skin eruptions
along with peripheral nerve
involvement leading to sensory
loss
 LEPROSY
 Lepromatous leprosy
produces severe disfigurement
of face. It causes collapse of
nasal bridge and disfigurement
of hands
 In oral cavity, ant maxilla, lip
and tongue involved is seen
 Maxillary damage can lead to
breathing problems
 LEPROSY
 HISTOPATHOLGY
 Granulomatous inflammation
 Multinucleated giant cells and
macrophages seen
 Inflammatory cells infiltrate
the nerves
 Bacteria present in the
macrophages
 TL shows well formed
granulomas where as LL shows
poor granuloma formation
 LEPROSY
 Diagnosis depends upon history of contact with an
infected patient
 TREATMENT
 Chemotherapeutic drugs including dapsone, rifampin
etc
 SYPHILIS
 Traponema pallidium
 Mode of transmission: sexual contact, infected
mother to child
 Occur in four forms:
 Primary
 Secondary
 Tertiary
 Congenital
 PRIMARY SYPHILIS
 After 3_4 weeks of primary infection
 Lip and tip of tongue

Surface Ulcer
Firm nodule
breaks down (chancre)
 PRIMARY SYPHILIS
 Painless chancer
resembling a carcinoma
clinically
 Painless
 Regional
lymphadenopathy
 Treatment most effective at
this stage
 After 8 to 9 weeks, healing
occurs
 SECONDARY SYPHILIS
 1 to 4 months after infection
 Mild systemic effects like fever, sore
throat etc
 Initially a rash occurs, consisting of
coppery macules
 Usually give rise to flat ulcers covered
by grayish membrane
 Snail track ulcers or mucous patches
 Discharge from ulcers containing
spirochetes
 TERTIARY SYPHILIS
 3 or more years after infection
 GUMMA is the characteristic
lesion
 Palate, tongue and tonsil
 Gumma begins as a swelling
with yellowish centre, which
undergoes necrosis leaving an
indolent ulcer
 Ulcer has punched out edges
 Floor has a leathery appearance
 TERTIARY SYPHILIS
 Gumma after undergoing
necrosis can cause scarring
 If present in the palate ,it
may distort the palate
leading to its perforations
in the palate
 CONGENITAL SYPHILIS
 Due to transplacental infections
 If severe, it can lead to death of infant
 Less severe forms do not appear for 12 months
 Initially a rash, leading to destruction of
bones,nerves.
 Hutchinson triad consisting of blindness, deafness
and dental anomalies
 Screwdriver incisors, mulberry molars important
dental anomalies
CONGENITAL SYPHILIS
 SYPHILIS
 DIAGNOSIS:
 Screening tests like VENEREAL DISEASE RESEARCH
LABORATORY test, RAPID PLASMA ANTIGEN test
most frequently used
 FTA-ABS most effective
 Immunoflorescent staining
 TREATMENT:
 Pencilline G benzathine
 NOMA (CANCRUM ORIS)
 Noma means “to devour”
 Rapidly progressive, opportunistic infection caused
by normal flora components including
fusobacterium, provetella etc
 PREDISPOSING FACTORS
 Poverty
 Poor oral hygiene
 Poor sanitation
 Malnutrition
 malignancy
 NOMA (CANCRUM ORIS)
 Recent illness
 Immunodeficiency disorder
 CLINICAL FEATURES:
 Children 1 to 10 yrs of age
 Begins in gingiva as NUG
 NUG extends either in bone or soft tissue causing NUM
 Greyish to bluish black discolouration of overlying skin
 Necrosis in theses areas
 Fetid odour, pain, fever, malaise etc
 Scalp, neck, face, ear and shoulders
NOMA (CANCRUM ORIS)
 NOMA (CANCRUM ORIS)
 TEATMENT:
 Penicillin
 Metronidazole