Bacterial Infections

(part ll)
Dr. sidra
 Pericoronitis
• Pericoronitis is an inflammatory process that arises
within the tissues surrounding the crown of a
partially erupted tooth.
• The inflammatory reaction often arises when food
debris and bacteria are present beneath the gingival
flap overlying the crown.
• Other predisposing factors include stress and upper
respiratory infections, especially tonsillitis or
pharyngitis.
• If the debris and bacteria become entrapped deep within the
gingival flap, then abscess formation develops.
• Abscess development is seen most frequently in association
with the mandibular third molars, and the predominant
symptoms are extreme pain in the area, a foul taste, and
inability to close the jaws.
• The pain may radiate to the throat, ear, or floor of the mouth.
• The affected area is erythematous and edematous, and the
patient often has lymphadenopathy, fever, leukocytosis, and
malaise
• NUG-like necrosis may develop in areas of persistent
pericoronitis.
 Histopathologic Features
• When soft tissue from areas of periodontitis is
examined microscopically, gingivitis is present
and the crevicular epithelium lining the pocket
is hyperplastic with extensive exocytosis of
acute inflammatory cells.
• The adjacent connective tissue exhibits an
increased vascularity and contains an
inflammatory cellular infiltrate consisting
predominantly of lymphocytes and plasma
cells, but with a variable number of
polymorphonuclear leukocytes.
 Tuberculosis (TB)
• is a chronic infectious disease caused by Mycobacterium
tuberculosis.
• Primary tuberculosis:- occurs in previously unexposed people
and almost always involves the lungs.
• Most infections are the result of direct person-to-person
spread through airborne droplets from a patient with active
disease.
• In most individuals, the primary infection results only in a
localized, fibrocalcific nodule at the initial site of involvement.
• However, viable organisms may be present in these nodules
and remain dormant for years to life.
• Active disease usually develops later in life
from a reactivation of organisms in a
previously infected person. This reactivation is
typically associated with compromised host
defenses and is called secondary tuberculosis
• Diffuse dissemination through the vascular
system may occur and often produces multiple
small foci of infection that grossly and
radiographically resemble millet seeds (miliary
tuberculosis)
• Secondary TB often is associated with
immunosuppressive medications, diabetes,
old age, poverty, and crowded living
conditions.
• Primary TB usually is asymptomatic.
Occasionally, fever and pleural effusion may
occur.
• Typically, patients have a low-grade fever,
malaise, anorexia, weight loss, and night
sweats. With pulmonary progression, a
productive cough develops, often with
hemoptysis or chest pain.
• Involvement of the skin may develop and has
been called lupus vulgaris
• The most common extrapulmonary sites in
the head and neck are the cervical lymph
nodes followed by the larynx and middle ear.
• Much less common sites include the nasal
cavity, nasopharynx, oral cavity, parotid gland,
esophagus, and spine.
• Oral lesions of TB are uncommon.
• The most common presentations for oral
involvement are chronic ulcerations or
swellings
• Less frequent findings include nonhealing
extraction sockets, areas of mucosal
granularity, or diffuse zones of inflammation
• Other affected sites include the gingiva, lips,
buccal mucosa, soft palate, and hard palate.
 Histopathologic Features
• The cell-mediated hypersensitivity reaction is
responsible for the classic histopathologic presentation
of TB.
• Areas of infection demonstrate the formation of
granulomas, which are circumscribed collections of
epithelioid histiocytes, lymphocytes, and multinucleated
giant cells, often with central caseous necrosis .
• The nuclei of the giant cells frequently are arranged
along the periphery of the cell in a horseshoe or ring
shape (Langhans giant cells). In a person with TB, one of
these granulomas is called a tubercle.