Infectious Disease Of Oral Cavity Essay Questions

Question 1. Enumerate the risk factors for hepatitis B infection and write the investigation for the same. Add a note on the significance of hepatitis B in dental practice.
Answer: Hepatitis is a hepatic disease affecting the parenchymal cells of the liver leading to necrosis of hepatocytes. It is caused by a DNA virus, hepatitis B.

Potential risk factors for hepatitis B transmission:

• Substance abuse (Needle drugs)
• Hepatitis B-infected sexual partner
• Polyamory practices
• Traveling to hepatitis-endemic areas
• Exposure to the outbreak of hepatitis B

Read And Learn More: Oral Medicine and Radiology Question And Answers

• Occupational hazards like needle stick injury
• Hepatitis B infected mother to newborn
• Transfusion depended on the illness
• Nonsterile tattoos/body piercing needles
• Household contact with hepatitis B infected person.

In dental practice, hepatitis should be considered on two aspects for patients:

1. Once the liver gets infected, the functions of the liver like synthesis of the enzymes, clotting factors (2, 5, 7, 9, 10), metabolism of drugs, and bilirubin are affected, and these are the points to be noted before dental treatment in a patient with a history of hepatitis.
2. There are chances for infection to spread through infected needles and blood. Hence proper sterilization protocol and protective measures are necessary.

When the patient’s medical state of hepatitis infection, then it is mandatory to advise the following investigations before dental treatment which are as follows:

Hepatitis B in dental practice Lab Investigation:

• Serum bilirubin—Raised above 1.2 mg/dL.
• SGOT and SGPT—Raised between 400¬4,000 IU.
• Prothrombin time—Prolonged (Normal PT is 11-16 seconds).
• International normalization ratio (INR)— increased (normal INR is 1.5-2).

Hepatitis B in dental practice Serological Tests:

• Hepatitis B virus has a surface (s), core (c), and envelope antigens. These three antigens and their antibodies are the diagnostic markers.

1. Hepatitis-B surface antigen and antibody (HBsAg and anti-HBs): Anti-HBs denote previous infection and immunity to HBV.

2. HBeAg and anti-HBe:

• HBeAg—Denotes viral replication, presence of high titer HBV in serum, and serum infectivity.
• Anti-HBe—Denotes carrier state (low serum titer of HBV).

3. Anti-HBc-IgM—Denotes recent HBV infection. Detectable in serum up to 4-6 weeks following infection. Anti-HBc— denotes prior infection with HBV.

• Hepatitis B is the most commonly acquired occupational infection among dentists. The exposure occurs as follows:
  • Injuries from contaminated sharp instruments (for example bur laceration, needle sticks).
  • Blood or saliva contamination on open wounds of hands and fingers.
  • Splashing of blood or saliva on the open wounds.
• Jaundice is a symptom of raised serum bilirubin level (Normal serum bilirubin level: 0.3-1.2 mg/dL) and is a common response to hepatitis B. It manifests as yellow discoloration of the skin, oral mucous membrane, sclera, and conjunctiva. When the patient’s history reveals jaundice, the tests as mentioned above should be asked before proceeding with dental treatment.
• If the jaundice history is less than a month duration, dental procedures should be avoided. In case of 6-12 months
  duration, emergency procedures alone can be considered after lab investigations with careful precautions.

Question 2. Briefly outline the deep fungal infections of the oral cavity.
Answer:

Mucormycosis:

• Mucormycosis (zygomycosis) is a ubiquitous, aerobic, opportunistic fungal hypha present in the nasal mucosa of healthy individuals.
• In rhinocerebral form (that affects facial, oral, orbital, sinuses, and cerebral structures). Rhizopus genera are the pathogen that enters through inhalation.
• The organisms affect only immunocompromised individuals, and diabetes mellitus (DM) with diabetic ketoacidosis is the associated condition is the majority of reported cases. However, malignancies, cytotoxic drugs, neutropenia, malnutrition, and deferoxamine therapy are also the said conditions.
• The clinical presentation includes facial swelling, extensive intraoral ulcers, and necrosis of the palate and alveolar bone. The maxilla is affected more than the mandible. The palate is the predominant site but may extend to involve the alveolus and cheek mucosa.

Oral Cavity Complications: Untreated condition may lead to orbital cellulitis, proptosis, diplopia, and vision loss.

Oral Cavity Investigation:

• Incisional biopsy specimen stained with 10% KOH, or eosin and hematoxylin, or periodic acid-Schiff reveals fungal hyphae without septa and necrotic tissues.
• CT and MRI to assess the extension of the lesion.

Oral Cavity Treatment:

• Management of the underlying cause (like DM).
• Intravenous administration of amphotericin B 50 mg for 1 week.
• Surgical debridement and hydrogen pero¬xide irrigation in the following week.
• Postoperative management of amphotericin B 40 mg/day for 2 weeks.

Oral Cavity Aspergillosis:

• It is caused by ubiquitous, fungal hyphae, Aspergillus species as both noninvasive and invasive diseases. It is the second most common fungal infection affecting humans next to candida.
• Inhalation of fungal spores is the mode of entry into the sinuses and respiratory system. After their entry, the spores are innocuous but when there is an immune decline, the spores germinate and spread through the blood vessels.
• Rhinosinusitis is the clinical manifestation of fever, headache, facial swelling, and nasal congestion. Sinus lesions may perforate and manifest in the oral cavity as large necrotic ulcers with pseudomembrane slough.
• In the advanced stage, destruction of gingiva, alveolar bone, osteomyelitis of jaw bones, and facial muscles takes place.

Oral Cavity Aspergillosis Investigation: Histopathological examination and culture isolation.

Oral Cavity Aspergillosis Treatment:

• Management of underlying immuno-compromised state
• Antifungal therapy
• Local tissue debridement.

Oral Cavity Histoplasmosis:

• It is caused by an endemic, saprophytic, dimorphic fungus Histoplasma capsulatum. The mode of spread is through the inhalation of spores.
• The infection occurs in acute, chronic, and subacute forms. In the oral cavity, it presents as ulcerative lesions resemble squamous cell carcinomatous ulcers. The ulcers have a central necrosis, indurated base, and rolled margins. The tongue, palate, and buccal mucosa are the common sites.

Oral Cavity Histoplasmosis Investigation: Incisional biopsy and histopathological examination.

Oral Cavity Histoplasmosis Management:

• The lesion is self-limiting.
• In uncontrolled cases, cap itraconazole 100 mg/day is the drug of choice for 3-12 months.

Oral Cavity Blastomycosis:

• A rare form of infection caused by saprophytes, Blastomyces dermatitidis present in moist soil, decomposed leaves, and wood. Oral lesions occur in variable forms including ulcers, verruciform, and granulomatous conditions.
• The mobility of the teeth and bone loss are the associated findings.

Oral Cavity Cryptococcosis:

• It is caused by encapsulated, oppor¬tunistic yeasts, Cryptococcus neoformans, and Cryptococcus gattii.
• The infection is commonly seen in AIDS patients. Any severely immunocompromised individuals and organ recipients are also prone to infection.
• Oral lesions appear as nodules and granulomas that rupture and form ulcers with the sinus orifice. Isolating the organism in culture will confirm the diagnosis.

Oral Cavity Cryptococcosis Treatment: Intravenous amphotericin B or oral fluconazole.

Infectious Disease Of Oral Cavity Viva Voce

Question 1. What is furuncle?
Answer:

• Furuncle is a deep-seated staphylococcal infection occurring as an inflammatory lesion in the hair-bearing region of the body surface. It occurs as an erythematous swelling, filled with pus and tenderness.
• They increase in size until it breaks down and drains out the pus. Diabetes and other immunocompromised states are the associative risk factors in the development of carbuncle and furuncle.
• A carbuncle is a collection of furuncles with a sinus orifice.
• Pus culture and antibiotics; incision and drainage are the treatment options.

Question 2. What is sterile pus?
Answer: An abscess containing anaerobic organisms which yield no organism on routine culture tests but respond to gram staining is known as sterile pus.

Question 3. What is an infection?
Answer: It is the multiplication and survival of microorganisms in the body. It may or may not cause disease.

Question 4. What is the incubation period?
Answer: It is the duration of the entry of infectious agents into the body till the first symptom of the disease appears. All infectious disease has an incubation stage, and in this time, the microbes either simply survive in the body or multiply.

Question 5. What is a prodromal period?
Answer: It is the period in which early symptoms of an infectious disease occur. These symptoms include malaise, fever, headache, and chills. In this time, the causative organism multiplied to a sufficiently large amount.

Question 6. What are the modes of infectious disease transmission
(or)
Spread?
Answer:

• Direct contact—Example herpes infection of fingers (herpetic whitlow).
• Indirect contact—Example hepatitis B and C infection (due to contact with contaminated instruments, surface, etc.)
• Droplet infection—For example mumps, influenza, rubella, and herpes infections.
• Airborne infection—For example tuberculosis, measles, chickenpox.

Question 7. How the microorganisms enter the body?
Answer: Through ingestion, inhalation or the breach in mucosa and skin.

Question 8. What is cell-mediated immunity?
Answer:

• The phagocytosis (destruction of micro-organisms by neutrophils and macrophages) causes activation of T-lymphocytes and the activated T-lymphocytes will turn into various types of T lymphocytes and be involved in:
  • Antibody-mediated response
  • Destruction of virus-infected cells
  • Produce lymphokines to activate phagocytes
  • Destroy noninfected but structurally or functionally altered cells (for example cancer cells).

Question 9. What is antibody-mediated immunity?
Answer:

• The phagocytosis causes activation of B-lym- phocytes, and the activated B-lymphocytes develop into different types of B-lymphocytes that produce lymphokines, and plasma cells which produce antibodies.
• The antibodies bind to specific antigens (microorganism) and either destroys or inactivates and removes them from the body.

Question 10. Name the diseases in which the mono spot test will be positive.
Answer: Monospot-positive test results in infectious mononucleosis, toxoplasmosis, rubella, lymphoma, leukemias, and lymphomas.