A summary of important fungal and viral infections in the oral cavity, includind signs and symptoms, diagnosis, management

1. FUNGAL & VIRAL
INFECTIONS OF THE ORAL
CAVITY

2. DEEPA JINAN
BAPUJI DENTAL COLLEGE &
HOSPITAL

3. CONTENTS
• Herpes simplex infections
• Varicella Zoster virus infections
• Infectious mononucleosis
• Cytomegalo virus infection
• Herpangina
• Hand foot mouth
• Rubeola
• Rubella
• Mumps
VIRAL INFECTIONS

4. Candidiasis
Angular chelitis
Phycomycosis
Rhinoporidiosis
Histoplasmosis
Coccidioidomycosis
Blastomycosis
Cryptococcosis
FUNGAL INFECTIONSCONTENTS

5. VIRAL & FUNGAL INFECTIONS SIGNIFICANCE IN DENTISTRY ??
1
DELAY TREATMENT
PRECAUTIONS TO BE
TAKEN
PROPER DIAGNOSIS &
TREATMENT
INFORMATION –
UNDERLYING CONDITIONS
ENDODONTISTS – PICTURE ACUTE
DENTAL INFECTION ??
MUMPS
MUMPS MEASLES
RECURRENT HERPES LABIALIS
CANDIDIASIS
IMMUNOCOPROMISED ??
ACTIVE HERPES INFECTION

6. VIRAL INFECTIONS INTRODUCTION
2
Submicroscopic particles – contain DNA/RNA
Transmit genetic information & replicate
Synthesis of new viral nucleic acids performed by
cells into which viruses penetrate
Viral infections affect mouth &
perioral areas
Most self limiting
Common viruses causing infection of oral mucosa -
Herpes simplex virus
HhV 1 & 2
Varicella zoster virus
HHV 3
Diagnosis – History & clinical
examination
No definitive therapy – treatment
directed at reducing pain , fever
discomfort, dehydration
Epstein barr virus
HHV - 4
Primary Herpetic stomatitis,
Recurrent herpetic stomatitis
Varicella, zoster
Infectious mononucleosis
Cytomegalo virus
HHV-5
Cytomegalovirus infection
Mumps virus, Measles virus, Rubella virus
Cocksackie virus Herpangina, hand foot & mouth disease
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

7. VIRAL INFECTIONS HERPES SIMPLEX
3
HSV – 2 TYPES
HHV – 1 HHV – 2
Non genital areas –
Eyes,mouth,CNS, skin above
waist
Genital lesions below waist –
Primary herpes simplex infection, recurrent herpes simplex infection
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

8. PRIMARY HERPETIC STOMATITIS
GENERAL & CLINICAL
ASPECTS
4
Initial exposure of individual to HSV
Childhood, Adolescence, Early adulthood
Spread by droplet spread/contact with
lesions
Complications
In immunocompromised pts- disseminated
infection, meningoencephalitis
Acute gingivostomatitis Fever Lymphadenopathy Irritability
Symptoms
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed.
New Delhi: BC Decker; p.41-76

9. PRIMARY HERPETIC STOMATITIS
GENERAL & CLINICAL
ASPECTS
5
1-3 day prodrome –
Fever, Loss of appetite
Malaise, Headache,
Nausea
Regional
lymphadenopathy
Within few
days – mouth
painful,gingiva
intensely
inflammed, fluid
filled vesicles
develop, which
rupture
Lips, tongue,
BM, Pharynx,
tonsils
Lesions heal
spontaneosly
7-14 days
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed.
New Delhi: BC Decker; p.41-76

10. ACUTE HERPETIC GINGIVOSTOMATITIS ORAL MANIFESTATIONS
6
Gingival erythema,- fiery red
multiple small ulcers and vesicles in
the attached gingiva
Gingival hyperplasia, erythema
and ulceration
Intact vesicles
Erythema of keratinized & non
keratinized mucosa
Vesicles develop
Ulcers coalesce – large ulcers scalloped
border & erythematous halo
Vesicles break – form ulcers
1-5mm
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed.
New Delhi: BC Decker; p.41-76

11. ACUTE HERPETIC
GINGIVOSTOMATITIS
DIAGNOSIS MANAGEMENT PREVENTION
7
DIFFERENTIAL DIAGNOSIS
Absence of any previous clinical history,
Signs & symptoms
Tzanck test, viral culture, PCR
MANAGEMENT
DIAGNOSIS
Acyclovir 15mg s times daily
Supportive care
Hand foot mouth disease, Herpangina
(Lesions limited to soft palate not gingiva )
Valacyclovir, Famicyclovir
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed.
New Delhi: BC Decker; p.41-76

12. RECURRENT HERPETIC ORAL INFECTION
GENERAL & CLINICAL
ASPECTS
8
Virus remains latent, in trigeminal ganglion
Reactivates time - time
Sheds in saliva
Recurrent lesions
Occur in 30% of patients ( adults)
Affects mucocutaneous junction of lip
Systemic
infections
Menstruation
Sunlight
Stress
Trauma
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed.
New Delhi: BC Decker; p.41-76

13. RECURRENT HERPETIC ORAL INFECTION ORAL MANIFESTATION
9
HERPES LABIALIS/COLD SORES
INTRAORAL RECURRENCES - ULCERS
Lesion develop in primary
site of inoculation
Adjacent area supplied by
involved ganglion
Location - preceeded by burning/tingling sensation/feeling of
tautness/swelling/soreness
Vesicles 1mm, develop - clusters
Coalesce – larger lesions
Rupture – small red ulceration,
erythematous halo
Lips – ulcer covered
by brownish crust
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed.
New Delhi: BC Decker; p.41-76

14. RECURRENT HERPES
STOMATITIS
DIAGNOSIS MANAGEMENT PREVENTION
10
DIFFERENTIAL DIAGNOSIS
Previous clinical history, Signs & symptoms
Cytology smear, viral culture, Serology
(ELISA, PCR)
MANAGEMENT
DIAGNOSIS
Topical antivirals–5% acicolvir 3-6 times daily
Supportive care - Sunscreen
Aphthous stomatitis, herpes zoster, EM,
Pemphigus, chemical burns, food/drug allerg
Syst valacyclovir/famiciclovir 500-1000mg ˣ 3
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed.
New Delhi: BC Decker; p.41-76

15. HERPETIC ORAL INFECTION DENTAL ASPECTS
11
Often misdiagnosed as “teething”
Spread by saliva – Painful herpetic whitlows in dentists
Oral or IV antiviral
treatments
Topical acyclovir has not been
shown to be effective in
management of herpetic whitlow
Never surgically debride
cause superinfection/
encephalitis
Asymptomatic shedding HSV Virus occurs in 8-19 % of patients
following dental traetment
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

16. HERPETIC ORAL INFECTION DENTAL RISK MANAGEMENT
12
Patients with an active oral herpes infection
Limit treatment to urgent or emergency care
Delay elective procedures until lesions are healed
Where the use of equipment that produces an aerosol cannot be
avoided, use extreme caution and extra PPE that fully covers the
body – FACIAL SHEILD
Use a National Institute for Occupational Safety and Health N95
rated or higher mask if aerosol may be present
Change gloves frequently if the procedure is lengthy, taking care to
wash between glove changes
Provide eye protection for the patient and recommend that the
patient wash hands and face after treatment
Browning WD, McCarthy JP. A case series: herpes simplex virus as an occupational hazard. J Esthet Restor Dent. 2012 Feb;24(1):61-6.

17. HERPETIC ORAL INFECTION DENTAL RISK MANAGEMENT
13
Dental team member has peri-oral herpes infection
Limit treatment to those who are immune competent
Provide treatment designed to reduce the time of healing
Cover the lesion area at all times with a suitable mask. An
additional covering such as a facial shield will provide additional
patient protection
Change gloves immediately if the hand is brought anywhere near
the team member's mouth
Consider informing the patient of the team member's condition and
get their consent to treat
Dental team member has Herpetic whitlow
Dental team member should not work until the lesion(s) is healed
Browning WD, McCarthy JP. A case series: herpes simplex virus as an occupational hazard. J Esthet Restor Dent. 2012 Feb;24(1):61-6.

18. VARICELLA GENERAL & CLINICAL ASPECTS
14
Primary infection with HHV – 3, VSV -Chickenpox
Spread airborne, Extremely contagious Common 1ST two decades
Fever Malaise Generalise vesicular rash Mouth ulcers
Immunocompromised, pregnancy smokers
disseminated/haemorragic type
Complications
CNS – Cerebellar ataxia, encephalitis,
pnuemonia, myocarditis, hepatitis
http://www.sciencephoto.com/media/252704/view
Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

19. VARICELLA CLINICAL ASPECTS & ORAL MANIFESTATION
15
Prodromal – Fever,
headache, anorexia
Malaise,,
Pruritic maculopapular
rash, followed by
vesicles begins on trunk
& face, spread
centrifugally
Occasionally
Small blister
like lesions –
BM, Tongue,
gingiva, palate
– vesicles with
surrounding
erythema
rupture to form
ulcers with red
margins
Disease runs
course -
7-1o days
Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

20. VARICELLA DIAGNOSIS MANAGEMENT PREVENTION
16
DIFFERENTIAL DIAGNOSIS
Signs & symptoms
Cytology smear, viral culture, Serology ( PCR)
MANAGEMENT
DIAGNOSIS
Acicolvir 800mg 5 times daily
Supportive care Pain control, hydration
HSV Infection, pemphigus, pemphigoid
PREVENTION
Varicella vaccine Preventing/modifying
severity-
Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

21. ZOSTER GENERAL & CLINICAL ASPECTS
17
Virus remains latent, in dorsal root ganglion
Elderly
Reactivation
Shingles
Immunocompromised
HIV, Lymphoma
Dermatome supplied by sensory nerve affected
Severe pain Rash
Post herpetic neuralgia
Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

22. ZOSTER CLINICAL ASPECTS & ORAL MANIFESTATION
18
Initially patient exhibits
Fever, headache,
Malaise, Pain
Often trunk is affected
Within few days patient
has linear vesicular
eruption of skin and
mucosa supplied by
affected nerves
Involve face
OM by infection
of trigeminal
nerve – BM,
tongue, uvula,
pharynx
They rupture to
leave areas of
erosion
Unilateral, vesicles
rupture and then heals
Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

23. ZOSTER ORAL MANIFESTATIONS
19
A cluster of vesicles on the hard palate
in the distribution of the maxillary
nerve
Lesions on palate stops sharply at the
midline
http://oralmaxillo-facialsurgery.blogspot.in/2010/05/viral-infections-of-mouth.html

24. ZOSTER DIAGNOSIS MANAGEMENT
20
DIFFERENTIAL DIAGNOSIS
Characteristic distribution of lesions
Cytology smear, viral culture, Serology ( PCR)
MANAGEMENT
DIAGNOSIS
Valacyclovir/Famiciclovir
HSV Infection
3 Days within appearance of rash
PREVENTION
Varicella vaccine reduces incidence/ severity
of HZI & PHN
Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

25. ZOSTER DENTAL ASPECTS
21
Pain that is often experienced in the prodrome before onset of vesicles and
ulcers as well as post herpetic neuralgia may lead to an incorrect diagnosis of
pulpitis leading to unnecessary dental treatment such as endodontic therapy
PAIN – HERPETIC NEURALGIA No response to analgesics
Tricyclic
antidepressants
Carbamazepine Gabapentin
Massage Accupuncture TENS
21

26. INFECTIOUS MONONUCLEOSIS
GENERAL & CLINICAL
ASPECTS
22
HHV-4 Epstein –barr Glandular fever
Fever FatigueLymph node enlargement
Common among young adults -
subclinical
Spread by close oral contact
Enlarged liver, spleen jaundice
Sore throat
Symptoms
Abdominal pain Headache Nausea/vomitting Body ache
Complications
Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

27. INFECTIOUS MONONUCLEOSIS
ORAL MANIFESTATIONS &
CLINICAL ASPECTS
23
C/C , fever, headache,
anorexia
Enlargement of spleen
abdominal pain, Nausea
Pharyngitis,
Tonsilitis
Lesions seen on
uvula, soft
palate, anterior
pillars – raised,
discrete,
whitish/yellowish
dark pink solid
papules/nodules
surrounded by
zone of
erythema.
Symptomatic course varies from 4-
14days & local oral lesions resolve
within 6-10 days
Posterior cervical
lymphadenopathy/through
out body
Sore throat
Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

28. INFECTIOUS
MONONUCLEOSIS
ORAL MANIFESTATIONS
24
Creamy exudate in fauces
Enlarged tonsils
Dark pink lesions – junction of
hard & soft palate
Occasionally – mucosal/gingival
ulceration
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

29. INFECTIOUS
MONONUCLEOSIS
DIAGNOSIS, MANAGEMENT,
PREVENTION
25
Differential diagnosis
Cytomegalovirus infection,Toxoplasma gondii
streptococcal pharyngitis diphtheria, common cold
flu
Diagnosis Signs and symptoms
Management
Prevention
No specific treatment
Symptomatic treatment
Avoiding contact with infected individuals
Paul bunnel test, monospot test
Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick, Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76

30. CYTOMEGALOVIRUS
INFECTION
GENERAL & CLINICAL
ASPECT
26
Spread person – person intimate
contact, (saliva,urine)
Fever
Immunodeficient, infants
Asymptomatic
primary infection
Malaise Myalgia
Complications
Symptoms
CMV remains latent
Oropharyngeal &
other epithelial cells
Reactivated when
immunosuppressed
CMV retinitis
Fetal damage
TORCH

31. CYTOMEGALOVIRUS
INFECTION
DIAGNOSIS, MANAGEMENT, PREVENTION
27
Diagnosis
Serological testing, ELISA measuring
antibody to CMV
Management (CMV-Ig IV) - immunoglobulin G (IgG)
Ganciclovir, Valganciclovir, . Foscarnet
Prevention CMV vaccine (2009) – Limited efficacy of 50%
(CMV-Ig IV) - immunoglobulin G (IgG)
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

32. HERPANGINA
GENERAL & CLINICAL
ASPECTS
28
Faeco – oral route, Droplets Children, Adolescents, adults (Summer)
Symptoms
Fever
Malaise IrritabilityAnorexia Vomiting
Sore throat Lymphadenopathy Pharyngeal ulcers
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

33. HERPANGINA ORAL MANIFESTATIONS
29
Red macules UlcerateVesicles
Pharyngeal
ulcers
Ulcers on soft
palate
Ulcers on
uvula
Ulcers on
Tongue
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

34. HERPANGINA DIAGNOSIS, MANAGEMENT, PREVENTION
30
Differential diagnosis Herpetic stomatitis, Varicella,
Diagnosis Signs and symptoms
Management No specific treatment
Symptomatic treatment
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

35. HAND FOOT & MOUTH
DISEASE
GENERAL & CLINICAL
ASPECTS
31
Faeco – oral route
Fever, Malaise, anorexia, sore throat
MeningitissEncephalitis
Infants, children, immunodeficient adults
Complications
Prodromal symptoms
Classic symptoms
Maculopapular rash, followed by blisters on
palms of hand, soles of feet
Painful perioral, intraoral, nasal, or facial
lesions, ulcers or blisters
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

36. HAND FOOT MOUTH ORAL MANIFESTATIONS
32
Lesions most common on buccal mucosa, labial mucosa, tongue
Vesicles with erythematous haloRed papules
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

37. HAND FOOT MOUTH DIAGNOSIS, MANAGEMENT, PREVENTION
33
Differential diagnosis
Herpetic stomatitis, Varicella, Herpangina,
Aphthous stomatitis
Diagnosis Signs and symptoms
Throat swab or stool specimen taken -
culture
Management
Prevention
No specific treatment
Symptomatic treatment
Vaccines are being developed
Avoiding contact with infected individuals
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

38. MEASLES
GENERAL & CLINICAL
ASPECTS
34
Spread by droplet infection
Fever Cough, Coryza Conjunctivitis Maculopapular rash
Bronchitis
ConvulsionsOtitis media
PneumoniaComplications
Rubeola
Common in children
Change color from red
to dark brown, before
disappearing
Appears 2-4 days after
initial symptoms, lasts for 8
days.
Starts back of ears
spreads to head and
neck, to cover most of
the body
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

39. MEASLES ORAL MANIFESTATIONS
35
Whitish spots in the buccal mucosa herald the onsetKOPLIKS SPOTS
Pathognomonic for measles,
Not often seen are transient and may disappear within a day of arising
DENTAL SIGNIFICANCE
Their recognition, before the affected person reaches maximum infectivity can be
used to reduce spread of epidemics
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

40. RUBELLA DIAGNOSIS, MANAGEMENT, PREVENTION
36
History & symptoms – 3 c’s
Kopliks spots
Diagnosis
Management
No specific treatment - supportive
Prevention
MMR vaccine 1st dose 12-13 mnths, 2nd 4-6yrs
Viral culture, serological tests
Antibiotics for bacterial infections
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

41. RUBELLA
GENERAL & CCLINICAL
ASPECTS
37
Spread by droplet infection
Mild Fever Sore throat
Enlarged posterior
cervical nodes
Maculopapular rash-
ArthralgiaAthritis
More Common in children
May be subclinical infection
Adults
Other complications Brain infections Bleeding pr
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

42. RUBELLA ORAL MANIFESTATION
38
Small, red papules on the area of the soft palate
FORCHHEIMER'S SIGN occurs in 20% of cases
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

43. RUBELLA DIAGNOSIS, MANAGEMENT, PREVENTION
39
Clinical signs & symptoms
Detection of Rubella specific Ig M
Charachteristic rash
Diagnosis
Management No specific treatment
Symptomatic treatment
Prevention MMR vaccine 1st dose 12-13 mnths, 2nd 36mnths
Non pregnant women of child bearing age
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

44. MUMPS GENERAL & CLINICAL ASPECTS
40
Spread by droplet infection
Fever, Malaise, anorexia, headache
Orchitis, OophoritisPancreatitis
Deafness
More Common in children
MeningoencephalitisComplications
Prodromal symptoms
Classic symptom
Swelling of 1 or both parotid glands
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

45. MUMPS ORAL MANIFESTATIONS
41
Trismus & pain
Oedema & erythema of
parotid duct orifice
1/both parotids – enlarged &
tender
Dry mouth
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

46. RUBELLA DIAGNOSIS, MANAGEMENT, PREVENTION
42
Examination - salivary glands- swelling
Salivary test
Diagnosis
Management No specific treatment
Symptomatic treatment
Prevention MMR vaccine 1st dose 12-13 mnths, 2nd 4-6yrs
Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.398-408.

47. FUNGAL INFECTIONS INTRODUCTION
43
SUPERFICIAL MYCOSIS DEEP MYCOSIS
Candidiasis
Angular stomatitis
Phycomycois
Rhinosporidiosis
Coccidiomycosis
Cryptococcosis
Blastomycosis
Tinea
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th
Ed.
Histoplasmosis

48. FUNGAL INFECTIONS PREDISPOSING FACTORS
POOR ORAL HYGEINE
IMMUNOCOMPROMISED STATE
ENVIRONMENTAL FACTORS
HUMIDITY,DRY MOUTH,DENTAL APPLIANCE
CORTICOSTERIOD & CYTOTOXIC
ANTIBIOTIC USE
HEREDITORY FACTORS
MEDICAL CONDITIONS – DIABETES,
LEUKEMIA, CANCER, ANEMIA
Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral
pathology. 5th Ed.

49. FUNGAL INFECTIONS CANDIDIASIS
45
Yeast like fungus
CANDIDA ALBICANS
C.Tropicalis
C.Parasilosis
C.Stellatoidea
c.Kruse
C.Guillermondi
Most opportunistic infection in the world
Causes infections by
superficial invasion
Normal commensals
Frequently affects
Oral cavity, skin, GIT,
vaginal tract, urinary tract,
lung
Predisposing factors
Acute/chronic diseases – TB,DM, Anemia
Myxedema, hypoparathyroidism, addison’s disease
Immunodeficiency - AIDS
Nutritional deficiency – Fe, Vit A, Vit B6
Prolonged hospitalization for chronic debilitating illness
Prolonged use of antibiotics, corticosteroids, cytotoxic drugs
Use of IV tubes, catheters, heart valves, poorly maintained
dentures, heavy smoking
Infancy ,pregnancy,old age
Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th
Ed.

50. CANDIDIASIS CLASSIFICATION
46
PSEUDOMEMBRANOUS HYPERPLASTIC
ATROPHIC MUCOCUTANEOUS
ATROPHIC
ACUTE CHRONIC
• Familial
• Localized
• Diffuse
• CES
Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.

51. ACUTE PSEUDOMEMBRANOUS GENERAL ASPECTS
47
Thrush
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
Prevalence
Patient history
Uncommon
Common in new born
Immunodeficient adults
Soreness

52. ACUTE PSEUDOMEMBRANOUS
ORAL
MANIFESTATIONS
48
Appearance of lesions
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
Size of lesions
Typical sites
Buccal mucosa
Soft creamy coloured raised patches which can
wiped off
Isolated Large areas
Soft palate

53. ACUTE PSEUDOMEMBRANOUS DIFFERENTIAL DIAGNOSIS
49
Candidiasis
Materia Alba
Burn
White patch
Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
Rubs off with
gauze??
Yes No
DiffuseYes No
Lichen planus
White sponge nevus,
verrucous leukoplakia
Leukoplakia
Frictional keratosis
Dyskeratosis congenita
Lupus erythematosus

54. ACUTE PSEUDOMEMBRANOUS DIAGNOSIS, MANAGEMENT
50
DIAGNOSIS
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
Clinical appearance
Otherwise Healthy
adult
Investigate
underlying cause
Gram stained smear
Young/ middle
aged
Possible sign of HIV
Diagnosed as candidiasis
MANAGEMENT
Investigate
underlying cause
Treatment of underlying conditions
Nystatin, amphoterecin – pastille/lozenge
Systemic fluconazole/suspension

55. ERYTHEMATOUS CANDIDIASIS GENERAL ASPECTS
51
Denture stomatitis, denture sore mouth
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
Prevalence
Patient history
Common in denture wearers
Antibiotic treatment
Xerostomia
Immunodeficiency
Soreness
Associated with angular stomatitis
Denture related stomatitis
Develops below well fitting upper
denture
Upper denture cuts off mucous
membrane from normal defense
Not seen under lower denture
Antibiotic related
stomatitis
Topical use of broad spectrum
antibiotics in mouth
Management Underlying cause, antifungals
Antibiotic sore mouth

56. ERYTHEMATOUS CANDIDIASIS ORAL MANIFESTATIONS
52
Denture related stomatitis
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
http://www.sciencephoto.com/media/252611/view
Antibiotic related stomatitis
Uniform bright erythema of
denture bearing area
Erythema may be patchy
Red eythematous mucosa
Patchy erythema with flecks of
thrush
Thrush found in protected
posterior situations

57. HYPERPLASTIC CANDIDIASIS
GENERAL & CLINICAL
ASPECTS
53
Candidial leukoplakia
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
Prevalence
Middle aged men, heavy smokers, Iron/folate
deficiency
Oral manifestation
Speckled tough firmly
adherent white lesion
Typical sites buccal mucosa, within commissures,
dorsum or edge of tongue,
Complications Malignant transformation

58. HYPERPLASTIC CANDIDIASIS DIAGNOSIS, MANAGEMENT
54
DIAGNOSIS
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
Clinical appearance & history
Biopsy – showing candidial hyphae & inflammatory
reaction
MANAGEMENT Topical miconazole
Systemic ketoconazole, fluconazole

59. ANGULAR CHELITIS GENERAL& CLINICAL ASPECTS
55
Angluar stomatitis, cheilosis, perlèche
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
Prevalence Common see with denture stomatitis
In asosciation with any intraoral
candidiasis
Classic sign of iron deficiecy anemia
Inflammation of one, or more
commonly both of the corners of
the mouth
Lesion at angle extending
onto facial skin
Deficiencystates
Anatomyrelated
Infection
fissured,crusted,ulcerated
or atrophied.[ no bleeding
Gray-white thickening and
adjacent erythema

60. ANGULAR CHELITIS DIAGNOSIS, MANAGEMENT
56
DIAGNOSIS
Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi: Elsevier; 2005 p.390-97.
Clinical appearance
MANAGEMENT Treatment of underlying conditions
Topical clotrimazole, amphotericin b,ketoconazole,
nystatin creamRHI - Lips, at the edge of lip, on
the face close to mouth
AC- Affects corners of mouth

61. PHYCOMYCOSIS GENERAL & CLINICAL ASPECTS
57
Present in nasal passages & oral
cavity of normal person
Pathogen - Fungi mucorales
Immunosuppression/AIDS
Mucormycosis involving maxillary antrum
Early manifestation – necrosis of
nasal septum with black
discharge
Necrosis extends to paranasal
sinus, in maxillary sinus presents
as mass resembling carcinoma of
antrum
Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral
pathology. 5th Ed.
Symptoms Management
Control of diabetes
Amphoterecin B

62. HISTOPLASMOSIS GENERAL & CLINICAL ASPECTS
58
Inhalation of spores/dust
Pathogen - Histoplasma capsulatum
Immunosuppression/AIDS
Fever, cough, splenomegaly,
hepatomegaly,
lymphadenopathy
Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral
pathology. 5th Ed.
Oral manifestation – nodular,
ulcerative lesions on BM,
Gingiva, tongue, palate & lips
Oral nodule with ulcerative
surface
Symptoms
Ulcers covered by non specific
grey membrane , are indurated
Management
Severe cases that do not
resolve on their own –
Amphoterecin B

63. RHINOSPORIDIOSIS GENERAL & CLINICAL ASPECTS
59
Mode not known, common in India
Pathogen -Rhinosporidium seebri
Chronic granulomatous disease –
larynx, skin, eyes, genital mucosa
Symptoms
Basal mucosa common site, lesions
appear as verrucae/warts which
become pedunculated
Oropharyngeal lesions accompanied
by mucoid discharge, appear as red
polypoid tumour like growths, soft
palate most common site
Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral
pathology. 5th Ed.
Intra oral lesions – vascular, bleed easily
Management
Surgical removal of growths

64. FUNGAL INFECTIONS
60
Coccidioides immitis
Pulmonary/respiratory symptoms
COCCIDIOIDOMYCOSIS
CRYPTOCOCCOSIS
Blastomyces dermatitidis/brasilensisBLASTOMYCOSIS
Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer, Hine, Levy. Shafer’s textbook of oral
pathology. 5th Ed.
Non specific oral ulcers
Cryptococcus neoformans
Skin lesions, meningeal involvement
Non specific oral ulcers
Skin lesions
Non specific oral ulcers
MISCELLANEOUS

65. CONCLUSION
“The dentist is sometimes the first health professional to identify a
person with a contagious disease”
Infection control
Alter patient
management
Dentists – potential to
ensure prompt treatment

66. REFERENCES
• Scully C, Cawson RA. Viral Infections. Medical problems in dentistry. 5TH Ed. New Delhi:
Elsevier; 2005 p.398-408.
• Scully C, Cawson RA. Mycosis. Medical problems in dentistry. 5TH Ed. New Delhi:
Elsevier; 2005 p.390-97.
• Browning WD, McCarthy JP. A case series: herpes simplex virus as an occupational
hazard. J Esthet Restor Dent. 2012 Feb;24(1):61-6.
• Scott DA1, Coulter WA, Lamey PJ. Oral shedding of herpes simplex virus type 1: a
review. J Oral Pathol Med. 1997 Nov;26(10):441-7.
• Rajendran R. Shivapathasundharam B. Viral infections of the oral cavity. Shafer,
Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.
• Rajendran R. Shivapathasundharam B. fungal infections of the oral cavity. Shafer,
Hine, Levy. Shafer’s textbook of oral pathology. 5th Ed.

67. REFERENCES
• Lewis MA. Herpes simplex virus: an occupational hazard in dentistry. Int Dent J. 2004
Apr;54(2):103-11.
• Woo SB, Greenberg MS. Ulcerative, Vesicular and Bullous Lesions. Greenberg, Glick,
Ship. Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76
• Samaranayake L, Huber MA, Redding sw. Infectious diseases. Greenberg, Glick, Ship.
Burket’s Oral Medicine. 11th Ed. New Delhi: BC Decker; p.41-76
• Blondeau JM1, Embil JA. Herpes simplex virus infection: what to look for. What to do!
J Can Dent Assoc. 1990 Aug;56(8):785-7.

68. FUNGAL & VIRAL
INFECTIONS OF THE ORAL
CAVITY