Infectious disorders of the oral cavity

The infectious inflammations may be caused by either virus, bacteria or fungi. There is a lot to mention, so stray strong!

Herpes simplex virus 1 and 2 (HSV 1&2)

Herpes simplex 1 is also known as labial herpes or cold sores and is the most common in the oral region. Herpes simplex 2 mostly occurs on the genitalia, but the incidence of oral HSV2 is increasing since oral sex is getting more and more common. Stop sucking on dirty ding dongs 🤪🍆

Most of us, 70-80 % have antibodies against HSV1, but not everyone get outbreaks. Primary infection is believed to take place already when you’re 2-4 years old. The first attack can be accompanied by fever, sore throat and enlarged lymph nodes. The rash or cold sore disappears by itself, but the virus remains dormant in the trigeminal ganglion. The virus may periodically reactivate and cause new sores. The reactivation can be triggered by:

• Sunlight
• Fever
• Psychological stress
• Menstruation
• Pregnancy
• Upper respiratory tract infections
• Immunosuppression

Primary attacks of HSV1 can in 10-20 % cause an acute gingivostomatitis herpetica, which is basically an onset of multiple vesicles and ulcerations in the whole oral cavity.

Herpes Simplex virus 2 stays dormant in the sacral ganglia.

Shingles – Varicella Zoster virus (Herpes virus 3)

The first incidence of the Varicella Zoster virus results in chickenpox. After that, the virus stays dormant in the nerves.

Risk factors for reactivation are old age, poor immune system and getting chickenpox before the age of 18 months. When reactivated, it’s called shingles, and appears as a very painful rash along the dermatomes where the virus was dormant, and usually only on one side. In Norway, we call shingles for “fire from hell” (helvetesild) since it burns pretty bad.

The vaccine reduces the incidence of shingles.

Scarlet fever (Scarlatina)

Scarlet fever is a result from group A streptococcus infection which includes symptoms of:

• Sore throat
• Fever
• Headaches
• Swollen lymph nodes
• Strawberry tongue
• Characteristic rash

Long-term scarlet fever can result in kidney disease, rheumatic heart disease and rheumatic arthritis.

Corynebacterium diphtheriae

Diphtheria often result in a dense, grey pseudomembrane which covers the tonsils. If its severe enough, it can extend to cover the entire tracheobronchial tree. The bacteria also release diphtheria toxins, which can result in

• Cardiac arrhythmias
• Myocarditis
• Cranial and peripheral nerve palsies

Tuberculosis

Apparently, tuberculosis can leave flat ulcers with soft edges in the oral cavity. More about tuberculosis can be studied in the pathology 1 section.

Syphilis

If you ever hear the term “lues”, it’s the old name of syphilis. Syphilis, which is very rare nowadays, exists in four stages. In the primary and secondary syphilis, ulcers and lesions can be seen around the mouth and inside the oral cavity.

Actinomycosis

This one is also rare and is a granulomatous infection. It is caused by anaerobic, gram positive filamentous bacteria, which are found in the normal flora in the oral cavity, GI-tract and female genital tract. It causes disease first when it gets the opportunity of formation in anoxic environments, like e.g. after dental disease or mandibular osteomyelitis.

It is characterized as lumpy jaw syndrome, with large abscesses located on the head and neck. The abscesses contain sulphur granules.

Acute necrotizing ulcerative gingivitis (ANUG)

Caused mostly by anaerobic bacteria, especially fusobacteria and spirochete species. The risk factors are:

• Poor oral hygiene
• Smoking
• Malnutrition
• Psychological stress
• Immunosuppression

The onset is painful and sudden, and if its severe enough, it can become noma, a gangrenous condition where the tissues of the face undergo necrosis. It’s very painful and deadly. Noma can also occur in the genitals. You can see it illustrated.

Periodontitis

These inflammatory conditions affect the tissue surrounding the teeth, the gums. In the early stage, it's called gingivitis, where the gums are red, swollen and bleed. If it gets more serious, it’s called periodontitis, where the gums can pull away from the teeth. The teeth can loosen and fall off, and the connection to the bone is lost. It also leads to bad breath.

The major risk factor for this is smoking. The reason for that is that smoking affects the immune system by decreasing wound healing, suppresses the antibody production and reduces neutrophilic phagocytosis.

Periodontitis has also some systemic effects:

• Arteriosclerosis
• Rheumatoid arthritis
• Pregnancy complications
• Alzheimer’s disease
• Chronic conjunctivitis

Oral candidiasis/thrush/moniliasis

Oral candidiasis is a fungal infection of the Candida species and affects the mucus membrane of the mouth. This infection is opportunistic.

The candidiasis can appear as pseudomembranous, erythematous (atrophic) or hyperplastic (nodular).