Oral Pathology

Periodontal DiseasesSem IV- Lecture-XIII

ByDr. Juma Alkhabuli

Periodontal Diseases

Dr. Juma Alkhabuli(BDS, MDentSci, PhD)

Associate Professor, Chair, Oral Biology Department

NonNon--PlaquePlaque induced gingival lesionsinduced gingival lesions

Gingival diseases of specific bacterial originGingival diseases of viral originGingival diseases of fungal originGingival diseases of genetic originGingival manifestations of systemic conditionsTraumatic lesionsTraumatic lesionsForeign body reactions

1.1. Gingival Gingival disease of disease of specificspecificbacteria bacteria originorigin

Streptococcal species RareRare

Usually starts as tonsolitis (A&B β-haemolytic streptococci)

Treponema pallidum (Syphilitic gingivitis)Extremely contagious

Of 3 phases (2nd/mucous patch + skin rash) Of 3 phases (2nd/mucous patch + skin rash)

Neisseria gonorrhea associated lesions

Cont’dCont’d

Streptococcal infection Mucous patch

22.. Gingival diseases of viral Gingival diseases of viral originorigin

A. Herpes virus infection:Primary herpetic gingivostomatitis (HSV-1)Primary herpetic gingivostomatitis (HSV-1) Recurrent herpes oral infection

* 1/3 of the primary infected pt. are affected* Sunlight, trauma or stress may activate the

virus and the new lesions are called herpes labialis (mucocutaneous) /cold sorelabialis (mucocutaneous) /cold sore

Varicella-zoster infection (V-Z-V; HHV-3)* cause chickenpox and herpes zoster

B. Herpes papilloma virus (HPV)

Primary Herpetic Gingivostomatitis

Recurrence

Cont’dCont’d

Recurrent oral herpes on Recurrent herpes on

Note that oral recurrent herpes affects keratinised mucosa

Recurrent oral herpes on palatal mucosa

Recurrent herpes on gingiva

Papilloma

Condyloma Accuminatum

33. Gingival diseases associated . Gingival diseases associated withwithfungal fungal infectionsinfections::

A. Candida-species infections: Generalised gingival candidoses Generalised gingival candidoses

Candida albicans (commensal organisms of 40% of population)

* C. glabrata, C. tropicalis ,C. krusei,

C. parapsilosis

Opportunistic pathogens Opportunistic pathogens

Common in immunocompromised and long-term broad spectrum antibiotic hosts

Cont’dCont’d

A. Linear Gingival Erythema (HIV +ve)

B. Histoplasmosis- systemic fungal disease caused by exposure to dust from animal dropping)

Cont’dCont’d

Linear gingivalerythema

Histoplasmosis

44.. Gingival lesions of genetic originGingival lesions of genetic origin

Hereditary Gingival Fibromatosis (rare hereditary condition)-hereditary condition)-Generalised or localised enlargement

May be associated with hypertrichosis, epilepsy, mental retardation

Involves full width of the attached gingiva

Cont’dCont’d

Gingival fibromatosis

55. Gingival manifestations of systemic . Gingival manifestations of systemic conditionsconditions

A. Mucocutaneous disordersLichen Planus (LP):Lichen Planus (LP):Affects skin and oral mucous membranes

Many forms; reticular, erosive, atrophic

Immunologically mediated dermatoses

Affects 0.1-4% of population, female>males

Skin lesions present in1/3 of cases with oral Skin lesions present in1/3 of cases with oral LP

Oral lesions present in 2/3 of cases with skin LP lesion infiltrate (CD8)

Cont’dCont’d

Histologically, characterised by hyperkeratosis, base cell degeneration and hyperkeratosis, base cell degeneration and sub-epithelial T- lymphocytic infiltrate (CD8)

LichenLichenplanus

Erosive

Erosive lichen Planus

Cont’d

Subepithelialt-lymphocytic

Hyperkeratosis

t-lymphocytic infiltrate

Epithelium

Pemphigoid:Vesiculobullous disease, slightly affects

Cont’dCont’d

Vesiculobullous disease, slightly affects F>MTwice as common as pemphigusFormation of subepithelial bullous due to

deposition of auto antibodies (C3+IgG) on hemidesmosomes and epithelial basement membranebasement membrane Involve skin and/or mucous membraneCicatricial pemphigoid = scar formation

commonly affects moist mucosa [oral mucosa, nose, eye, throat, vagina]

Mucosa lesion= mucous membrane pemphigoid (cicatricial pemphigoid)

Cont’dCont’d

pemphigoid (cicatricial pemphigoid)Skin lesion= bullous pemphigoidOn gingiva, it cause desquamative gingivitis

Cont’dCont’d

Pemphigoid

Complement 3 (C3) with/without IgGdeposition at the basement membrane

Cont’dCont’d

Adhesion- caused by pemphigoid

Extensive scarring-pemphigoid

Cont’dCont’d

Basement membrane components and sites of antibody deposition

Pemphigus vulgaris:Auto-antibodies target the inter-epithelial

Cont’dCont’d

Auto-antibodies target the inter-epithelial desmosomes

More common in Jews

4 types; vulgais, vegetans (affects oral mucosa), erythematous and foliaceus

Affects gingiva + other parts of oral Affects gingiva + other parts of oral mucosa and skin

Oral ulcerations, erosion are common features

Cont’d

Ocular lesion may be present (bilateral conjunctivitis)conjunctivitis)

50% of patients have oral lesions before skin eruptions

positive Nikolsky sign [bulla can be induced on normal-appearing skin if firm lateral pressure is appliedlateral pressure is applied

Cont’d

Pemphigus vulgaris

Erythema multiforme: Immunopathologic vascular injuries lead to

Cont’dCont’d

Immunopathologic vascular injuries lead to ischemic necrosis of skin and mucosa

Cause is unknown but allrgic to sulfonamides, and herpes simplex viral infection have been implicated

T "Target" lesions are characteristic Oral lesions occur in 70% of cases may Oral lesions occur in 70% of cases may

become hemorrhagic, life-threatening in the form of "Stevens-Johnson Syndrome“[oral mucosa+skin +(ocular /genital)]

Target lesion

Cont’d

Target lesionErythemamultiforme

lupus erythematosis It is immunologically mediate connective

Cont’dCont’d

It is immunologically mediate connective

Tissue disease, affecting oral mucosa+skin

3 types; systemic (SLE):

Cutaneous (chronic

CLE, also called discoid)

Sub-acute cutaneous (CLE) Sub-acute cutaneous (CLE)

B lymphocytes + abnormal function of T

lymphocytes

Clinically appear similar to erosive LP

Lupus erythematosisIgA desquamative gingivitis

PsoriasisDesqumative gingivitis

Cont’d

B. Allergic reactions

Dental restorative materialsDental restorative materialsMercury

Nickel

Acrylic

Other

Ractions attributable toToothpastes/dentifrices

Cont’dCont’d

Toothpastes/dentifrices

Mouthrinses/mouthwashes

Chewing gum additives

Foods and additives

Dentifrice/ reaction

Mercury from amalgam

Con’dCon’d

Allergic Gingivitis(cinnamon)

Plasma Cell Gingivitis(hot peppers)

66. Traumatic lesions. Traumatic lesions

Chemical injury e.g. Aspirin burn, alcoholChemical injury e.g. Aspirin burn, alcohol

Physical injury e.g. radiation

Thermal injury e.g. hot food

Alcohol

Aspirin burn

Con’dCon’d

Radiation

Pizza burnCocaine burn

Smokeless tobacco

Bismuth-accumulation of metal sulfides

Amalgam tattoo

77.. OtherOther

Vascular neoplasm

Epithelial malignancyEpithelial malignancy

Granulomatous diseases

Cont’dCont’d

Kaposi sarcoma

Cavernoushemangioma

Cont’dCont’d

Epithelial carcinomaSCC

Cont’dCont’d

Wegener's granulomatosis

Crohn’s disease