Chapter 032. Oral Manifestations of Disease (Part 3) Diseases of the Oral Mucosa Infection Most oral mucosal diseases involve microorganisms (Table 32-1). Table 32- 1 Vesicular, Bullous, or Ulcerative Lesions of the Oral Mucosa Condition Usual Location Clinical Features Course Viral Diseases Primary acute herpetic gingivostomatitis [herpes simplex virus (HSV) type 1, rarely type 2] Lip and oral mucosa (buccal, gingival, lingual mucosa) Labial vesicles that rupture and crust, and intraoral vesicles tha t quickly ulcerate; extremely painful; acute gingivitis, fever, malaise, foul odor, and cervical lymphadenopathy; occurs primarily in infants, children, and young adults Heals spontaneously in 10– 14 days. Unless secondarily infected, lesions lasting >3 wee ks are not due to primary HSV infection. Recurrent herpes labialis Mucocutane ous junction of lip, perioral skin Eruption of groups of vesicles that may coalesce, then rupture and Lasts about 1 week, but condition may be prolonged if secondarily infected. crust; painful to pressure or spicy foods If severe, topical or oral antiviral may reduce healing time. Recurrent intraoral herpes simplex Palate and gingiva Small vesicles on keratinized epithelium that rupture and coalesce; painful Heals spontaneously i n about 1 week. If severe, topical or oral antiviral may reduce healing time. Chickenpox (varicella-zoster virus) Gingiva and oral mucosa Skin lesions may be accompanied by small vesicles on oral mucosa that rupture to form shallow ulcers; may coalesce to form large bullous lesions that Lesions heal spontaneously within 2 weeks. ulcerate; mucosa may have generalized erythema Herpes zoster (reactivation of varicella- zoster virus) Cheek, tongue, gingiva, or palate Unilateral vesicular eruptions and ulcerati on in linear pattern following sensory distribution of trigeminal nerve or one of its branches Gradual healing without scarring unless secondarily infected; postherpetic neuralgia is common. Oral acyclovir, famcyclovir, or valacyclovir reduce healing time and postherpetic neuralgia Infectious mononucleosis (Epstein-Barr Oral mucosa Fatigue, sore throat, malaise, fever, and Oral lesions disappear during convalescence; no virus) cervical lymphadenopathy; numerous small ulcers usually appear several days before lymphadenopathy; gingival bleeding and multip le petechiae at junction of hard and soft palates treatment though glucocorticoids indicated if tonsillar swelling compromises airway Herpangina (coxsackievirus A; also possibly coxsackie B and echovirus) Or al mucosa, pharynx, tongue Sudden onset of fever, sore throat, and oropharyngeal vesicles, usually in children under 4 years, during summer months; Incubation period 2– 9 days; fever for 1– 4 days; recovery uneventful diffuse pharyngeal congestion and vesicles (1– 2 mm), grayish-white surrounded by red areola; vesicles enlarg e and ulcerate Hand, foot, and mouth disease (coxsackievirus A16 most common) Oral mucosa, pharynx, palms, and soles Fever, malaise, headache with oropharyngeal vesicles that become painf ul, shallow ulcers; highly infectious; usually affects children under age 10 Incubation period 2– 18 days; lesions heal spontaneously in 2– 4 weeks Primary Gingiva, Acute Followed by HIV infection palate, and pharynx gingivitis and oropharyngeal ulceration, associated with febrile illness resembling mononucleosis and including lymphadenopathy HIV seroconversion, asymptomatic HIV infection, and usually ultimately by HIV disease Bacterial or Fungal Diseases Acute necrotizing ulcerative gingivitis ("trench mo uth," Vincent's infection) Gingiva Painful, bleeding gingiva characterized by necrosis and ulceration of gingival papillae and margins plus lymphadenopathy and foul odor Debridement and diluted (1:3) peroxide lavage provide relief within 24 h; antibiotics in acutely ill patients; relapse may occur Prenatal (congenital) syphilis Palate, jaws, tongue, and teeth Gummatous involvement of palate, jaws, and facial bones; Hutchinson's incisors, mulberry molars, glossitis, mucous patches, and fissures on corner of mouth Tooth deformities in permanent dentition irreversible Primary syphilis (chancre) Lesion appears where organism enters body; may occur on lips, tongue, or tonsillar area Small papule developing rapidly into a large, painless ulcer with indurated bor der; unilateral lymphadenopathy; chancre and lymph nodes containing spirochetes; Healing of chancre in 1– 2 months, followed by secondary syphilis in 6–8 weeks serologic tests positive by third to fourth weeks Secondary syphilis Oral mucosa frequently invo lved with mucous patches, primarily on palate, also at commissures of mouth Maculopapu lar lesions of oral mucosa, 5– 10 mm in diameter with central ulceration covered by grayish membrane; eruptions occurring on various mucosal surfaces and skin accompanied by fever, malaise, and sore throat Lesions may persist from several weeks to a year Tertiary syphilis Palate and tongue Gummatous infiltration of palate or tongue Gumma may destroy palate, causing complete followed by ulceration and fibrosis; atrophy of tongue papillae produces characteristic bal d tongue and glossitis perforation Gonorrhea Lesions may occur in mouth at site of inoculation or secondarily by hematogenous spread from a primary focus elsewhere Most pharyngeal infection is asymptomatic; may p roduce burning or itching sensation; oropharynx and tonsils may be ulcerated and erythematous; saliva viscous and fetid More difficult to eradicate than urogenital infection, though pharyngitis usually resolves with appropriate antimicrobial treatment [...]... severe signs of toxicity Pemphigus vulgaris Oral mucosa Usually and skin; sites of (>70%) With repeated presents occurrence of bullae, mechanical trauma with oral lesions; toxicity may lead to (soft/hard palate, fragile, frenulum, lips, bullae buccal mucosa) ruptured cachexia, and and death within 2 ulcerated areas; oral years; mostly planus Oral mucosa and skin often in controllable with oral older... Candidiasis (Table 32 -3) Dermatologic Diseases Mucous Typically membrane produces pemphigoid gingival Painful, marked grayish-white Protracted course erythema collapsed vesicles remissions with and and ulceration; or bullae of full- exacerbations; other areas of oral thickness cavity, involvement esophagus, epithelium with different sites occurs and vagina may be peripheral affected of slowly; erythematous... sites of friction; erosive lesions often occasionally causes difficult to treat, but oral mucosal ulcers may and gingivitis respond erosive glucocorticoids to Other Conditions Recurrent aphthous ulcers Usually on Single or Lesions heal nonkeratinized oral clusters of painful in 1–2 weeks but mucosa (buccal and ulcers with may recur monthly or labial mucosa, floor surrounding several times a year; of protective... Autoinnoculat tonsillar area, soft solitary, 1–5 cm, ion from pulmonary palate irregular covered ulcer infection with usual; a lesions resolve with persistent exudate; appropriate ulcer has a firm antimicrobial therapy undermined border Cervicofacia l actinomycosis Swellings in region of Infection Typically face, may be associated swelling is hard and neck, and floor of with an extraction, grows mouth... slowly; erythematous zone; glucocorticoids may gingival lesions temporarily desquamate, leaving reduce symptoms but do not ulcerated control the disease area Erythema Primarily the Intraoral Onset multiforme minor oral mucosa and the ruptured and major skin of hands and surrounded by an idiopathic, but may (Stevens-Johnson syndrome) feet bullae rapid; very usually inflammatory area; be associated with... protective mouth, soft erythematous palate, lateral and border; lesions may with ventral tongue) be 1–2 mm barrier orabase and in topical steroids give diameter in crops symptomatic relief; (herpetiform), 1–5 systemic mm (minor), or 5– glucocorticoids may 15 mm (major) be needed in severe cases Behçet's syndrome Oral mucosa, Multiple Oral eyes, genitalia, gut, aphthous ulcers in often and CNS lesions... without scarring lesions on genitalia; inflammatory bowel disease and CNS disease Traumatic ulcers Anywhere on oral Localized, mucosa; discrete dentures frequently lesions responsible ulcers in vestibule ulcerated usually heal in 7–10 with for border; Lesions red days when irritant is produced removed, unless by accidental biting secondarily infected of mucosa, penetration by a foreign object, or chronic... tissues; lip, tongue, floor of mouth and heal, pain and underlying frequently not metastasizes to prominent; lesions regional lymph nodes tend to arise in areas of erythro/leukoplakia or in smooth atrophic tongue Acute myeloid Gingiva leukemia Gingival swelling Usually and responds to systemic (usually superficial treatment monocytic) of ulceration followed leukemia; by hyperplasia of occasionally requires... extraction, grows mouth jaw fracture, or multiple painlessly; abscesses eruption of molar with draining tracks tooth; in acute develop; penicillin form resembles an first choice; surgery acute pyogenic usually necessary abscess, but contains yellow "sulfur granules" (gram-positive mycelia and their hyphae) Histoplasmo sis Any area of the Nodular, mouth, verrucous, Systemic or antifungal particularly tongue,... tonsillar area may proliferate indicate may underlying rapidly, giving the HIV infection appearance of traumatic inflammation Chemical or thermal burns Any area in mouth White slough Lesion due contact corrosive to in several weeks if with not agents infected (e.g., aspirin, hot cheese) applied locally; removal of slough leaves raw, painful surface Note: CNS, central nervous system heals secondarily . Chapter 032. Oral Manifestations of Disease (Part 3) Diseases of the Oral Mucosa Infection Most oral mucosal diseases involve microorganisms (Table. severe signs of toxicity Pemphigus vulgaris Oral mucosa and skin; sites of mechanical trauma (soft/hard palate, frenulum, lips, buccal mucosa) Usually (>70%) presents with oral lesions;. therapy Cervicofacia l actinomycosis Swellings in region of face, neck, and floor of mouth Infection may be associated with an extraction, jaw fracture, or eruption of molar tooth;