Most common infection, most are transient with few untoward sequelae.

Some are life threatening (e.g., Meningoccus, Diphtheria)

Severe, recurrent, disseminated or persistent lesions occur in Immunocompromised, organ transplant or AIDS.

Bacterial infections are diagnosed on Clinical grounds, supported by smears, culture, testing for immune responses (Serology) & examining for nucleic acids.

Antibacterial drugs can be effective therapy but, resistance can be a problem (e.g.. MRSA)

CLASSIFICATION

A) ORAL, TONSILLAR & PHARYNGEAL INFECTIONS

PULP, PERIAPICAL & PERIODONTAL LESIONS

ORAL SOFT TISSUE LESIONS

B) ORO – FACIAL SKIN LESIONS

C) MISCELLANEOUS BACTERIAL INFECTIONS

A) ORAL , TONSILLAR, PHARYNGEAL LESIONS

i) PULP, PERIAPICAL & PERIODONTAL INFECTIONS

ACUTE & CHRONIC PULPITIS

DENTOALVEOLAR ABSCESS

GINGIVITIS, PERIODONTITIS, PERIODONTAL ABSCESS

PERICORONITIS, PERICORONAL ABSCESS

CELLULITIS, OSTEOMYELITIS

ANUG, ANUP, CANCRUM ORIS

ii) ORAL SOFT TISSUE LESIONS

SCARLET FEVER

DIPTHERIA

GONORRHEA

CHANCROID

SYPHILIS

TUBERCULOSIS

STREPTOCOCCAL PHARYNGITIS & TONSILLITIS

B) ORO – FACIAL SKIN INFECTIONS

IMPETIGO

FURUNCLE & CARBUNCLE

ACUTE BACTERIAL CHELITIS

ERYSIPELAS

TUBERCULOSIS (LUPUS VULGARIS)

LEPROSY

NOMA

ACTINOMYCOSIS

CAT- SCRATCH DISEASE

C) MISCELLANEOUS BACTERIAL INFECTIONS

ANTHRAX

BRUCELLOSIS

LISTERIOSIS

GLANDERS

MENINGOCOCCEMIA

GRANULOMA INGUANALE

PERTUSIS

TULAREMIA

ACUTE NECROTISING ULCERATIVE GINGIVITIS

Acute necrotizing ulcerative gingivitis (ANUG) is an

endogenous oral infection that is characterized by necrosis

of the gingiva.

SYNONYMS:

Trench Mouth

Vincent’s Infection

Fuso Spirochetal Gingivitis

Acute Ulcero membranous Gingivitis

ETIOLOGY:

Anaerobic organisms, Treponema species, Selenomonas species, Fusobacterium species, and Bacteroides intermedius.

Tissue destruction is supposed to be caused by the release of endotoxins that act either directly or indirectly on the tissues triggering inflammatory or immunologic reactions.

PREDISPOSING FACTORS

LOCAL FACTORS

Poor oral hygiene with pre existing marginal gingivitis

Faulty dental restorations, Deep periodontal pockets

Smoking

Emotional Stress.

SYSTEMIC FACTORS

Marked Malnutrition

Severe nutritional deficiency

Leukemia’s, Aplastic anemia, AIDS,

CLINICAL FEATURES

AGE

Seen most commonly between 16 –30 yrs, can be seen also in low socioeconomic groups.

SYMPTOMS

Onset is sudden with pain, tenderness, profuse salivation and peculiar Metallic taste.

Patients experience a loss of taste sensation, decreased pleasure from smoking, bad breath.

Spontaneous bleeding from gingival tissues.

SIGNS

Teeth seem to be slightly extruded, sensitive to pressure, or to have a “woody sensation”, slightly mobile with difficulty in eating.

Gingival bleeding, Regional lymphadenitis.

Typical lesion is, Punched out, necrotic, crater like ulceration seen over the Interdental papillae and the marginal gingiva with pseudo-membrane formation.

Ulceration may develop on the cheeks, lips and the tongue, palate & pharyngeal area.

These may lead to alveolar process with sequestration of teeth and bone.

DIFFERENTIAL DIAGNOSIS

Acute Herpetic gingivostomatitis

Pemphigus vulgaris

Immunodeficiency states

Blood dyscrasias

HIV – ANUG

MANAGEMENT

Uncomplicated ANUG – Local debridement

First visit – Gingival irrigation with superficial scaling.

Earlier the removal of local factors, faster is the healing

Mild ANUG – no antibiotics are necessary. Patients are instructed to rinse with Hydrogen Peroxide (1.5 to 2.0 %) or 1.2 % Chlorhexidine mouth wash.

Severe ANUG – Antibiotics are required.

Amoxicillin 250 – 500mg, 6 hourly or Erythromycin 250-500 mg + Metronidazole 400mg 8hourly, for 7 days.

Fluid & electrolyte balance, nutritional supplements, cessation of Smoking.

Second Visit – Evaluate, perform thorough scaling and periodontal curettage.

NOMA

Rare disease of childhood characterized by destructive process of orofacial tissues.

SYNONYMS:

CANCRUM ORIS

GANGRENOUS STOMATITIS

ETIOLOGY:

Necrosis occurs due to infection with Anaerobic bacteria (fusiform bacilli) in a host whose systemic health is severely compromised.

Malnutrition, severe debilitating diseases,PCM states.

CLINICAL FEATURES

Initial lesion is painful ulceration, usually of gingiva or buccal mucosa.

Rapid spread of the ulcer which necrotises

Denudation of involved bone, leading to necrosis & sequestration.

Teeth may exfoliate. Deeper penetration of the infection leads to wide spread involvement.

Before antibiotics these were very fatal.

Treatment

Treat the underlying predisposing factor

Restore fluids, electrolytes, general nutrition

Start Antibiotics

Debridement of necrotic tissue with reconstruction.

SCARLET FEVER

Infection with Group – A Streptococci of Beta hemolytic type.

This produces a Erythrogenic toxins.

Predominately, occurs in children, between 2 & 10.

Causative organism usually enters, through the nose or mouth

It is transmitted from person to person by direct contact, that is, by sprays of droplets from the respiratory tract of an infected person.

CLINICAL FEATURES

INCUBATION PERIOD – 3 to 5 days.

SYMPTOMS – Severe Pharyngitis, tonsillitis, chills, fever & vomiting.

SIGNS – seen on the Throat, Skin, Tongue.

Throat

Highly erythematous with exudation.

Enlargement & tenderness of regional lymph nodes.

Skin

Characteristic diffuse, bright Scarlet to dusky red skin rash which appears on the second or third day of the illness.

Rash fades after 3 – 4 days.

Rash is due to toxic injury of vascular endothelium, which produces dilatation of small blood vessels & consequent hyperemia.

Oral Manifestations

Stomatitis Scarlantina is the chief Oral manifestation.

Palate is congested & throat is fiery red.

Strawberry Tongue – White coating with prominent fungiform papillae, which are edematous, hyperemic, projecting above the surface as small red knobs, appearing like a Strawberry.

Raspberry tongue – Coating is soon lost, beginning at the tip & lateral margins.

Tongue becomes deep red, glistening & smooth except for swollen hyperemic papillae.

Teeth – some cases of hypoplasia are reported in permanent teeth, if this occurs at the time of tooth development.

Treatment

Antibiotics –

Penicillin is the drug of choice

Group A streptococci are also sensitive to Erythromycin, Tetracycline & Chloramphenicol.