Dental Implications: The correct diagnosis is important essential to ensure patients are not subjected to unnecessary surgery.
Burkhart, Delong. pp 279

Method of Transmission: Not contagious
Burkhart, Delong. pp 277

Treatment and Prognosis: Analgesics may be recommended. Chlorhexadine gluconate may be recommended and treatment of candida is sometimes needed. Prognosis is excellent and healing occurs after several weeks to a month.
Burkhart, Delong. pp 280

Etiology: Originates from salivary gland ischemia that causes necrosis of the tissue, usually due to trauma in the area. This may occur from trauma due to previous surgery, and allergic response, injury to the tissue, surgical procedures, denture wear, or smoking and possibly from previous local anesthesia administered in the site.
Burkhart, Delong. pp 279

Intraoral/perioral: The tissue may appear as an elevated mass that subsequently becomes ulcerative, painful and rapidly progressing. numbness is also reported.
Burkhart, Delong. pp 279

Distinguishing: A deep, demarcated ulcer is characteristic of this. The deep lesion becomes coated with a thick yellow fibrinous covering.
Burkhart, Delong. pp 279

Significant Microscopic Feats: Necrosis of the salivary gland is involved, and there is squamous metaplasia of the salivary duct epithelium.
Burkhart, Delong. pp 279

Dental Implications: The patient may present with external skin lesions, and in some instances, there may be visible evidence of lesions around the periphery of the lip.
Burkhart, Delong. pp 282

method of Transmission: venereal transmission from, mother to fetus, sexual contact (oral, anal, or vaginal), or by the transfusion of infected blood.
Burkhart, Delong. pp 280

Treatment and Prognosis: The standard treatment is penicillin. Later stages require high doses over a period of weeks. Outcome depends upon the stage of disease and amount of damage done. tertiary stages can cause severe damage to organs.
Burkhart, Delong. pp 282

Etiology: Caused by the spirochete Treponema palllidum through direct contact with a primary lesion. It is considered an STD.
Burkhart, Delong. pp 280

Distinguishing: Some clinical manifestations may go unnoticed or be mistaken for other conditions. With congenital exposure, teeth are affected, resulting in molar teeth exhibiting rounded, berry-shaped elevations on the occlusal surfaces known as mulberry molars. Incisor will have a notched appearance due to the spirochetes infecting the enamel during formation. The effects are part of the Hutchinson triad which also includes deafness as a result of loss of function in the 8th cranial nerve. and opacification of the cornea with loss of eyesight.
Burkhart, Delong. pp 282

Extraoral: Features depend on stage of the disease. Skin lesions on extremities. Syphilis lesions appear on the genitals. Later stages can involve eyes causing blindness.
Burkhart, Delong. pp 280

Significant Microscopic Feats: Specific stains in a dark-field exam of a smear are used to view the numerous "corkscrew-like" organisms that are diagnostically significant in extraoral syphilis. Burkhart, Delong. pp 282

Secondary: Manifests with flu-like symptoms,fever, swollen lymph nodes that are nontender, skin lesions, and some mucocutaneous lesions several weeks after the primary stage. Condylomata lata may be noticed by the practitioner and there may be a rash on the infected person. The rash may be on the face, palms, feet, trunk, etc.
Burkhart, Delong. pp 281

Tertiary: Produces someserious complications that affects multiple organs. A gumma may appear initially as an indurated mass and, subsequently, an ulceration that promotes extensive tissue destruction in the localized area of the gumma. Most frequently, the tongue and the palate are involved. The palatal lesion may be extensive enough to penetrate to the nasal cavity. Gummatous Syphilis may affect skin, bones, and mucous membranes. During the late stages, Paralysis, insanity, blindness, knee joint damage, personality changes, impotency, aneurysm, and tumor on the skin or internal organs may occur Burkhart, Delong. pp 281

Primary: A chancre is developed after direct contact. Appears within 1-3 weeks after exposure. Will heal within weeks with no other signs of the disease. most common oral site is the lip. They are painless and appear firm. They are highly infectious at this stage. Burkhart, Delong. pp 281

Dental implication: oropharyngeal areas are the most vunerable. Due to oral-genital practiced, the pharyngeal tissues may appear ulcerative and erythematic.
Burkhart, Delong. pp 283

Method of Transmission: Sexual contact, mother to child across the placenta and during birth in the birth canal. Oral lesions result from oral-genital contact.
Burkhart, Delong. pp 282

Treatment and Prognosis: Since gonorrhea is usually found in conjunction with chlamydia, ceftriaxone, azithromycin, and doxycycline may be used to battle these diseases. Hepatitis C may be a concern.Prognosis is good if discovered early.
Burkhart, Delong. pp 283

Etiology: Is an STD caused by the bacterium Neisseria gonorrhoeae. It infects the genital tract, mouth, and rectum of both men and women. Often found in combination with chlamydia. Burkhart, Delong. pp 282

Intraoral/perioral: Most common site is the oral pharynx, with resultant gonococcal pharyngitis. Tonsillar region is often affected, with inflammation and pustular lesions. Other complaints include halitosis, stinging, and burning.
Burkhart, Delong. pp 283

Distinguishing: Presenting features are not diagnostic and other factors must be considered such as lifestyle, and health history.
Burkhart, Delong. pp 283

Extraoral: Person may appear in poor health and exhibit lymphadenopathy.
Burkhart, Delong. pp 283

Significant Microscopic Feats: gram stains and serologic tests are used to make a definitive diagnosis. Left untreated, the inflammatory response becomes chronic, with macrophages and lymphocytes predominant.
Burkhart, Delong. pp 283

Dental Implications: Usually occurs with other systemic diseases. So the systemic disease may go unnoticed.
Burkhart, Delong. pp 284

Method of transmission: Not a contagious disease. Develops in cases related to trauma such as surgery, tooth extraction, root canals, tonsil crypts, and carious lesions.
Burkhart, Delong. pp 284

Treatment and Prognosis: Prognosis is good upon dissolution of infection. High dose parenteral penicillin for extensive periods is required treatment and followed by oral penicillin for up to a year.
Burkhart, Delong. pp 284

Etiology: Caused by bacterium known as Actinomyces israelii.
Burkhart, Delong. pp 284

Intraoral/perioral: Site of the lesion is usually ulcerative and may have exudate associated with the ulcer. In the case of extraction sites. The infection would be at the point of the extraction. Burkhart, Delong. pp 284

Distinguishing: Exudate produced is a yellow pus-like substance containing what is known as sulfur granules.
Burkhart, Delong. pp 284

Extraoral: May become an indurated, ulcerative lesion developing into a fistula leading out through the skin of the neck or mandible. Exudates build up developing a tract leading outside the body. Burkhart, Delong. pp 284

Significant Microscopic Feats: The sulfur granules and branching filamentous bacteria/organism are identified through clinical examination, evaluated microscopically, and diagnosed with cultures.
Burkhart, Delong. pp 284

Dental Implications: Debridement of the teeth and affected soft tissue areas is the recommended treatment. Prompt treatment and monitoring is needed to prevent NUG from becoming NUP.
Burkhart, Delong. pp 285

Method of transmission: Person is predisposed by general systemic problems, stress, improper nutrition, and poor oral hygiene practices. Is infectious so care should be taken to minimize aerosols.
Burkhart, Delong. pp 285

Treatment and Prognosis: Prognosis is excellent once the infection is treated and oral hygiene is maintained. papillae do not return to normal after the damage suffered from the infection.
Burkhart, Delong. pp 285

Etiology: Factors such as stress, poor nutrition, and poor oral hygiene contribute to the disease.
Burkhart, Delong. pp 285

Dental implications: Correct diagnosis is important to establish the right treatment protocol. Also referral tot he right facility is important is necessary. Identification of the organism is important in successfully treating the lesion. Burkhart, Delong. pp 286-287

Method of Transmission: Many seem to be airborne transmission while having other methods in conjunction like water or bat/bird droppings.
Burkhart, Delong. pp 286

Treatment and Prognosis: Treatment depends upon the organism. Antimicrobial agents may be prescribed. Progress and recovery also depends on the organism as well as the hosts defenses. Lung involvement may require involvement of a pulmonologist.
Burkhart, Delong. pp 287

Etiology: May arise from soil, bird and bat droppings, or decaying vegetation. Some are part of our resident flora in the body.
Burkhart, Delong. pp 286

Intraoral/perioral: Some of the specific infections produce an ulcerative lesion with indurated lesions. These fungal infections have some oral manifestations and warrant consideration in a differential diagnosis. Burkhart, Delong. pp 286

Distinguishing: Lesions may mimic other disease states, and they may be in combination with other health conditions. Some chronic infections may persist for long periods. Burkhart, Delong. pp 286

Extraoral: Lesions are usually ulcerative, sometimes necrotic depending on the stage. They are also pseudomembranous.
Burkhart, Delong. pp 286

Significant Microscopic Feats: The organism involved is observed through special cultures and staining procedures. Further culture tests would be performed to confirm the diagnosis.
Burkhart, Delong. pp 286

Intraoral/perioral: Presents with sudden painful swelling of the free gingiva and necrosis with cratered interdental papilla. A fiery red, bleeding gingiva is common. Foul odor is present. Metallic taste may be reported. Inflammation may extend to the palate and oral pharynx.
Burkhart, Delong. pp 285

Distinguishing: The foul odor. A gray pseudomembrane forms over the necrotic gingiva in NUG and spontaneous bleeding occurs with any tissue manipulation.
Burkhart, Delong. pp 285

Extraoral: May involve the general physical health of the person as well as characteristics of fever, pain, and swollen lymph nodes.
Burkhart, Delong. pp 285

Significant Microscopic Feats: A mixed flora of spirochetes, fusobacterium, Prevotella intermedia, Veillonella spp., and streptococci has been implicated.
Burkhart, Delong. pp 285

Dental implications: Pain may make dental procedures difficult. Patients susceptible to RAU may initiate lesions by mild tissue trauma. Multiple visits may be difficult. Repairing any sharp teeth or restorations can reduce incidence of trauma. Plaque removal and increased oral lubrication are helpful. Burkhart, Delong. pp 289

Treatment and Prognosis: Chlorohexidine gluconate as a rinse is often prescribed. Topically applied corticosteroids may be used sometimes. Tetracylcine rinse may also be prescribed with the corticosteroids. Further testing and screening is necessary for more severe problems. Burkhart, Delong. pp 290

Method of Transmission: Not contagious Burkhart, Delong. pp 289

Etiology: Not fully understood. Some factors are stress, trauma, food allergies, genetic predispositions, B12 vitamin deficiencies, iron, folate, zinc deficiencies, and hormonal fluctuations.
Burkhart, Delong. pp 287

Intraoral/perioral: Appearnce and location are important in clinical diagnosis. Ulcer appears as a shallow and somewhat crater-like lesion with a yellow-to-white pseudomembrane and an erthyematous border described as a halo appearance.
Burkhart, Delong. pp 289

Distinguishing: RAUs are found on non keratinized tissue. They are not found on the dorsum of the tongue, the attached gingiva, and the hard palate mucosa because these areas are keratinized.
Burkhart, Delong. pp 289

Extraoral: None related to RAUs unless the lesion is close to the lip and produces edema in that area.General health of the patient may appear below normal. Gastrointestinal-related problems are considerations. Burkhart, Delong. pp 289

Significant Microscopic Feats: There are nonspecific findings, and biopsies are usually not needed. Common findings are increased levels of lymphocytes, macrophages, and mast cells. Generally, the biopsy specimen reveals a nonspecific inflammatory process.
Burkhart, Delong. pp 289

Dental implication: Medications like cylcosporine may produce hyperplasia, and other medications may have effects on the tissue as well. Corticosteroids and immunosuppressive agents often produce changes in the tissues, and patient should be evaluated at each visit. Burkhart, Delong. pp 291

Method of Transmission: There is no indication of possible transmission from one person to another.
Burkhart, Delong. pp 291

Treatment and Prognosis: Topical steroid treatment may be used. Cyclosporine has shown effective in treatment of mucocutaneous and ocular lesions.
Burkhart, Delong. pp 291

Etiology: Unknown cause but viral connection is suspected.
Burkhart, Delong. pp 291

Intraoral/perioral: The ulcerative apperance is similar to the aphthous ulcers. The lesions, recurrent and painful, may range in size from several millimeters to several centimeters.
Burkhart, Delong. pp 291

Distinguishing: The triad of minor ulcers, genital ulcers, and ocular lesions signals the possibility for a disease consideration. Burkhart, Delong. pp 291

Extraoral: Simultaneous cutaneous lesions may be present such as erythemia nodosum or acneform skin eruptions, arthritis, central nervous system lesions, and intestinal ulcerations. Burkhart, Delong. pp 291

Significant Microscopic Feats: Enhanced polymorphonuclear leukocyte chemotaxis and neutrophil/platelet hyperfunction. Vasculitis and perivascular infiltrate ultimately develop.
]Burkhart, Delong. pp 291

Dental implications: Assisting the patient in diagnosis of early disease is important., since the oral signs can mimic other less serious diseases such as common aphthous ulcers. When external sympotoms are present along with the intraoral lesions, referral to a medical doctor is indicated. Burkhart, Delong. pp 292

Method of Transmission: Not considered contagious although there is an association with HIV infected people that should be kept under consideration.
Burkhart, Delong. pp 292

Treatment and Prognosis: Nonsteroidal anti-inflammatory agents are the medications of choice. Disease may last from weeks to months and can become chronic. Usually remits within a year.
Burkhart, Delong. pp 293

Etiology: Usually develops after exposure to a venereal disease ir a gastrointestinal infection.
Burkhart, Delong. pp 292

Intraoral/perioral: Half of the patients have oral ulcerations. Some of the lesions may appear aphthous like. may occur anywhere in the mouth.
Burkhart, Delong. pp 292

Distinguishing: May appear similar to other disease states with common findings such as geographic tongue.
Burkhart, Delong. pp 292

Extraoral: Small joints of the patient are affected., which usually involve the lower extremities. The genitals, anus, and rectum may be affected. Thickened, hyperkeratotic nodules that resemble pustular psoriasis are characteristic.
Burkhart, Delong. pp 292

Significant Microscopic Feats: The lesions resemble psoriasis. Burkhart, Delong. pp 292