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Oral Pathology
 Periodontal Diseases
        Sem IV- Lecture-XIII
                       By
               Dr. Juma Alkhabuli
                (BDS, MDentSci, PhD)

Associate Professor, Chair, Oral Biology Department
Non-
Non-Plaque induced gingival lesions

 Gingival diseases of specific bacterial origin
 Gingival diseases of viral origin
 Gingival diseases of fungal origin
 Gingival diseases of genetic origin
 Gingival manifestations of systemic conditions
 Traumatic lesions
 Foreign body reactions
1. Gingival disease of specific
                bacteria origin
 Streptococcal species
   Rare
   Usually starts as tonsolitis (A&B β-haemolytic
     streptococci)
 Treponema pallidum (Syphilitic gingivitis)
  Extremely contagious
  Of 3 phases (2nd/mucous patch + skin rash)
 Neisseria gonorrhea associated lesions
Cont’d




  Mucous patch   Streptococcal infection
2. Gingival diseases of viral origin

A. Herpes virus infection:
   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 sore
   Varicella-zoster infection (V-Z-V; HHV-3)
    * cause chickenpox and herpes zoster
B. Herpes papilloma virus (HPV)
Primary Herpetic Gingivostomatitis




        Recurrence
Cont’d




Recurrent oral herpes on       Recurrent herpes on
    palatal mucosa                   gingiva


Note that oral recurrent herpes affects keratinised mucosa
Papilloma




Condyloma
Accuminatum
3. Gingival diseases associated with
          fungal infections:
                 infections:
A. Candida-species infections:
   Generalised gingival candidoses
   Candida albicans (commensal organisms
    of 40% of population)
    * C. glabrata, C. tropicalis ,C. krusei,
      C. parapsilosis
   Opportunistic pathogens
   Common in immunocompromised and
    long-term broad spectrum antibiotic
    hosts
Cont’d

A. Linear Gingival Erythema (HIV +ve)
B. Histoplasmosis- systemic fungal disease
   caused by exposure to dust from animal
   dropping)
Cont’d




 Linear gingival   Histoplasmosis
    erythema
4. Gingival lesions of genetic origin
 Hereditary Gingival Fibromatosis (rare
  hereditary condition)-
   Generalised or localised enlargement
   May be associated with hypertrichosis,
    epilepsy, mental retardation
   Involves full width of the attached gingiva
Cont’d




         Gingival fibromatosis
5. Gingival manifestations of systemic
                conditions

A. Mucocutaneous disorders
  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
       LP
      Oral lesions present in 2/3 of cases with skin
       LP lesion infiltrate (CD8)
Cont’d

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




         Erosive
Cont’d

 Erosive lichen Planus




                         Hyperkeratosis

   Subepithelial
   t-lymphocytic
   infiltrate


         Epithelium
Cont’d
  Pemphigoid:
    Vesiculobullous disease, slightly affects
     F>M
    Twice as common as pemphigus
    Formation of subepithelial bullous due to
     deposition of auto antibodies (C3+IgG) on
     hemidesmosomes and epithelial
     basement membrane
    Involve skin and/or mucous membrane
    Cicatricial pemphigoid = scar formation
     commonly affects moist mucosa [oral
     mucosa, nose, eye, throat, vagina]
Cont’d

    Mucosa lesion= mucous membrane
     pemphigoid (cicatricial pemphigoid)
    Skin lesion= bullous pemphigoid
    On gingiva, it cause desquamative gingivitis
Cont’d




         Pemphigoid
         Complement 3 (C3)
         with/without IgG
         deposition at the
         basement membrane
Cont’d




   Adhesion- caused by   Extensive scarring-
      pemphigoid             pemphigoid
Cont’d




Basement membrane components and sites of antibody deposition
Cont’d

 Pemphigus vulgaris:
  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
   mucosa and skin
  Oral ulcerations, erosion are common
   features
Cont’d
  Ocular lesion may be present (bilateral
   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 applied
Cont’d




         Pemphigus vulgaris
Cont’d

  Erythema multiforme:
    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
     become hemorrhagic, life-threatening in
     the form of "Stevens-Johnson
     Syndrome“[oral mucosa+skin +(ocular
     /genital)]
Cont’d



         Target lesion
          Erythema
           multiforme
Cont’d
 lupus erythematosis
   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)
   B lymphocytes + abnormal function of T
    lymphocytes
   Clinically appear similar to erosive LP
IgA desquamative gingivitis   Lupus erythematosis




  Desqumative gingivitis         Psoriasis
Cont’d
B. Allergic reactions
   Dental restorative materials
     Mercury
     Nickel
     Acrylic
     Other
Cont’d

  Ractions attributable to
    Toothpastes/dentifrices
    Mouthrinses/mouthwashes
    Chewing gum additives
    Foods and additives
Dentifrice/ reaction




Mercury from amalgam
Con’d




Allergic Gingivitis   Plasma Cell Gingivitis
   (cinnamon)             (hot peppers)
6. Traumatic lesions

 Chemical injury e.g. Aspirin burn, alcohol
 Physical injury e.g. radiation
 Thermal injury e.g. hot food
Con’d           Alcohol



 Aspirin burn




                Radiation
Cocaine burn   Pizza burn
Smokeless tobacco




Bismuth-accumulation
of metal sulfides




           Amalgam tattoo
7. Other
 Vascular neoplasm
 Epithelial malignancy
 Granulomatous diseases
Cont’d




   Cavernous   Kaposi
  hemangioma   sarcoma
Cont’d




         Epithelial carcinoma
                 SCC
Cont’d




    Wegener's      Crohn’s disease
  granulomatosis
Lecture xiii ju-oral pathology-lecture xiii-perio5

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Lecture xiii ju-oral pathology-lecture xiii-perio5

  • 1. Oral Pathology Periodontal Diseases Sem IV- Lecture-XIII By Dr. Juma Alkhabuli (BDS, MDentSci, PhD) Associate Professor, Chair, Oral Biology Department
  • 2. Non- Non-Plaque induced gingival lesions  Gingival diseases of specific bacterial origin  Gingival diseases of viral origin  Gingival diseases of fungal origin  Gingival diseases of genetic origin  Gingival manifestations of systemic conditions  Traumatic lesions  Foreign body reactions
  • 3. 1. Gingival disease of specific bacteria origin  Streptococcal species Rare Usually starts as tonsolitis (A&B β-haemolytic streptococci)  Treponema pallidum (Syphilitic gingivitis) Extremely contagious Of 3 phases (2nd/mucous patch + skin rash)  Neisseria gonorrhea associated lesions
  • 4. Cont’d Mucous patch Streptococcal infection
  • 5. 2. Gingival diseases of viral origin A. Herpes virus infection:  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 sore  Varicella-zoster infection (V-Z-V; HHV-3) * cause chickenpox and herpes zoster B. Herpes papilloma virus (HPV)
  • 7. Cont’d Recurrent oral herpes on Recurrent herpes on palatal mucosa gingiva Note that oral recurrent herpes affects keratinised mucosa
  • 9. 3. Gingival diseases associated with fungal infections: infections: A. Candida-species infections:  Generalised gingival candidoses  Candida albicans (commensal organisms of 40% of population) * C. glabrata, C. tropicalis ,C. krusei, C. parapsilosis  Opportunistic pathogens  Common in immunocompromised and long-term broad spectrum antibiotic hosts
  • 10. Cont’d A. Linear Gingival Erythema (HIV +ve) B. Histoplasmosis- systemic fungal disease caused by exposure to dust from animal dropping)
  • 11. Cont’d Linear gingival Histoplasmosis erythema
  • 12. 4. Gingival lesions of genetic origin  Hereditary Gingival Fibromatosis (rare hereditary condition)-  Generalised or localised enlargement  May be associated with hypertrichosis, epilepsy, mental retardation  Involves full width of the attached gingiva
  • 13. Cont’d Gingival fibromatosis
  • 14. 5. Gingival manifestations of systemic conditions A. Mucocutaneous disorders 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 LP Oral lesions present in 2/3 of cases with skin LP lesion infiltrate (CD8)
  • 15. Cont’d Histologically, characterised by hyperkeratosis, base cell degeneration and sub-epithelial T- lymphocytic infiltrate (CD8)
  • 16. Lichen planus Erosive
  • 17. Cont’d Erosive lichen Planus Hyperkeratosis Subepithelial t-lymphocytic infiltrate Epithelium
  • 18. Cont’d  Pemphigoid:  Vesiculobullous disease, slightly affects F>M  Twice as common as pemphigus  Formation of subepithelial bullous due to deposition of auto antibodies (C3+IgG) on hemidesmosomes and epithelial basement membrane  Involve skin and/or mucous membrane  Cicatricial pemphigoid = scar formation commonly affects moist mucosa [oral mucosa, nose, eye, throat, vagina]
  • 19. Cont’d  Mucosa lesion= mucous membrane pemphigoid (cicatricial pemphigoid)  Skin lesion= bullous pemphigoid  On gingiva, it cause desquamative gingivitis
  • 20. Cont’d Pemphigoid Complement 3 (C3) with/without IgG deposition at the basement membrane
  • 21. Cont’d Adhesion- caused by Extensive scarring- pemphigoid pemphigoid
  • 22. Cont’d Basement membrane components and sites of antibody deposition
  • 23. Cont’d  Pemphigus vulgaris: 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 mucosa and skin Oral ulcerations, erosion are common features
  • 24. Cont’d Ocular lesion may be present (bilateral 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 applied
  • 25. Cont’d Pemphigus vulgaris
  • 26. Cont’d  Erythema multiforme:  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 become hemorrhagic, life-threatening in the form of "Stevens-Johnson Syndrome“[oral mucosa+skin +(ocular /genital)]
  • 27. Cont’d Target lesion Erythema multiforme
  • 28. Cont’d  lupus erythematosis  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)  B lymphocytes + abnormal function of T lymphocytes  Clinically appear similar to erosive LP
  • 29. IgA desquamative gingivitis Lupus erythematosis Desqumative gingivitis Psoriasis
  • 30. Cont’d B. Allergic reactions Dental restorative materials Mercury Nickel Acrylic Other
  • 31. Cont’d  Ractions attributable to  Toothpastes/dentifrices  Mouthrinses/mouthwashes  Chewing gum additives  Foods and additives
  • 33. Con’d Allergic Gingivitis Plasma Cell Gingivitis (cinnamon) (hot peppers)
  • 34. 6. Traumatic lesions  Chemical injury e.g. Aspirin burn, alcohol  Physical injury e.g. radiation  Thermal injury e.g. hot food
  • 35. Con’d Alcohol Aspirin burn Radiation
  • 36. Cocaine burn Pizza burn
  • 38. 7. Other  Vascular neoplasm  Epithelial malignancy  Granulomatous diseases
  • 39. Cont’d Cavernous Kaposi hemangioma sarcoma
  • 40. Cont’d Epithelial carcinoma SCC
  • 41. Cont’d Wegener's Crohn’s disease granulomatosis