The first guest lecture is delivered by
Dr. K.S. Nagesh,
Principal, Prof and Head,
Dept. of Oral MEdicine and Radiology,
D.A. Pandu Memorial R.V. Dental College, Bangalore

Topic – Oral and Maxillofacial Infections

The time has came to close the book on infectious diseases.
4 primary
Diarrhea, Pneumonia, Tuberculosis, Malaria
Upto 1/3rd of the world population has Tuberculosis.

Oral and Maxillofacial infections -

• Bacterial infections
• Viral
• Fungal
• Rareities
• Odontogenic
• Non-Odontogenic
• Opportunistic

Bacterial infections -

• Necrotising Ulcerative Gingivitis/Periodontitis
• Tuberculosis
• Bacterial sialadenitis

Acute Necrotizing Ulcerative Gingivitis/ Acute Necrotizing Ulcerative Periodontitis -
Smokers and Immunocompromised patients, particularly in those with HIV infections.
ANUG exact cause not known
Proliferation of spirochaetes and fusiform bacteria
Soreness and bleeding of gingiva. Crater like ulcers, marked halitosus.
Management – Identify the predisposing factor, supragingival plaque control, gentle debridement of the gingival tissues, instruct to use the chlorhexidine mouth wash, and gentle toothbrushing.
Metronidazole drug of choice 200 m.g.

Tuberculosis -
M. tuberculosis and M. bovis
Worldwide endemix – upto 1/3rd world population
Resurgence of respiratory pulmonary disease
Immunodeficiency, malnutrition, non-compliance with drug regimes, AIDS-related phenomenon.
Primary oral involvement, secondarily sputum
Irregular painful lesion with undermined borders and covered by grey slough.
Commonly affects tongue, but other areas of oral mucosa, particularly towards the posterior parts of the mouth
May also present as white patches or granulating lesions.
Histopathology – Non-caseating granulomata. No. of acid fast bacilli on ZN staining. Culture of Mycobacteria seen.
Management – Look for pulmonary lesions. Referral to a chest physician too for lesions outside the field of oral medicine.

Bacterial sialadenitis -
Ascending Sialadenitis
Recurrent parotitis of childhood
Usually a secondary consequence of either a localized or systemic cause of reduced salivary flow
Also affect minor salivary gland.
Glang painful, tender, swollen, pain radiating to ear and temporal area.
Intraorally, duct may be swollen, reddened and duct papilla enlarged
Management – Penicillin group of drugs are antimicrobials of choice, adequate fluid intake, chewing saliva stimulants.

Odontogenic infections -

Causes – Dental caries, infected periapical pathologies – Dentoalveolar abscesses, periapical granuloma

Complications -
Ludwig’s angina
Infections in danger areas of face – Intracranial complications, brain abscess, sinus thrombosis, thrombophlebitis

Fungal infections of the oral cavity -

• Candidiasis
• Mucormycosis
• Histoplasmosis

Candidiasis -
Infections of skin, nails, mucous membrane, internal organs
Occurs as both primary and opportunistic infections
80% of HIV patients develop this disease
Complications – Palatal perforations, orofacial fistulas, secondary carcinomas.
Treatment -
Topica; – Clotrimazole 1% mouth paint, Ketoconazole 2% ointment for 5 mins, 4 times per day for 14 days
Systemic antifungal agents -
Ketoconazole tab 200 mg 4 times a day for 14 days
Fluconazole

Denture hygiene – Clean the denture thoroughly and regularly, and left out of mouth in Sodium hypochlorite soln.

Viral infections -

• Herpes simplex
• Varicella zoster
• Mumps
• Coxsaxckie virus
• Human papilloma virus
• Human immuno virus

Herpes Simplex Virus -
Herpes simplex type-1 oral mucosa, pharynx, skin
Herpes simplex type-2
Clinical features – Malaise with tiredness, generalized muscle aches and sometimes sore throat
Prodromal phase – 1-2 days followed by oral lesions
Complications – Post herpetic neuralgia. Anesthesia, paraesthesia, trigeminal neuralgia-like pains and persist for years, also reappear for prolonged absence, and fail to respond to any form of medical treatment.
Ramsay Hunt syndrome – Facial nerve involvement, during an episode of zoster reactivation. Facial weakness, loss of taste sensation, dizziness. Vesicular lesions in this conditions seen most on palate and around the external auditory meatus. Most cases, self-limiting condition that resolves with restoration of function, there may be permanent facial weakness in some cases.

Varicella Zoster Virus -
DNA virus, morphologically similar to HSV. Chicken pox and Herpes zoster
Vesicular eruption in an area of distribution of sensory nerve, and when it affects the trigemical nerve, the facial skin and oral mucosa in the sensory area may be affected.
Initial symptom – Prodromal pain severe and misdiagnosed as toothache lasting for 203 days Vesicles in a rash. Unilateral distribution of oral lesions.
Complications – Ophthalmic division of trigeminal nerve involved

Coxsackie virus -
Hand, foot and mouth disease -
Intraoral vesicles, ulcers. Macular rah with vesiculation seen

Mumps – Bilateral swelling of the parotid glands, although unilateral glandular swelling can occur.
Incubation period – 14-21 days
Transmission – Respiratory secretions and saliva
Ducts appear red, and inflamed.
Complications – Pancreatitis, Encephalitis, Orchitis, Oopedesis

Human Papillomavirus infections -
100 difference viruses which cause warty lesions on the skin and mucous membrane. Cauliflower like lesions on the lip are seen.

Investigations -
Cytology – Scraping from base of lesions, stained with Giesma, Wright’s stains.
Fluorescent staining
Isolation – tissue culture

Treatment – Antiviral drugs, within 72 hours
Decreased days of fever, pain, lesionsm and viral

Flossing has been a practice more in the western countries, but eastern country people have been more prone to gum diseases because of the micro-organisms. And this has been due to some periodontal pathogens and cariogenic bacteria like Treponema denticola, Porphyromonas gingivalis, Tannerella forsythia (previously T. forsythensis), Prevotella intermedia, Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), and Streptococcus mutans.

Dr. Kenneth Kornman, editor or the Journal of Periodontology said in the Jornal,

“Twins tend to share the same or similar environmental factors such as dietary habits, health and life practices, as well as genetics. In this case, the only difference was flossing, and the outcome was significant. Flossing may significantly reduce the amount of bad bacteria in the mouth.”

This states that flossing should be made an integral part of oral health care, and it has to be made a habit along with brushing of the teeth.

But ever since people have learned that Amalgams have more than 50% mercury in it, the race against this material has increased. People have made groups and associations to stop companies from manufacturing it and trying to make dentists decrease the usage of Amalgams.

Since 2002 the U.S. FDA (Federal Drug Administration) has classified amalgam dental fillings as a class II device, basically meaning that there are no restrictions placed on amalgam filling materials.

In an agreement to settle a lawsuit filed by the group Moms Against Mercury the FDA agreed in June 2008 to change their website to acknowledge the possible dangers associated with amalgam fillings. The FDA now admits that mercury vapor is released during chewing on an amalgam filling and also when the silver fillings are placed and removed from the teeth.

According to researchers, the mercury in Amalgam is harmful to the systems associated with the brain and it causes neurological symptoms in the Children or fetus developing in a pregnant woman. Also it affects the elderly people.

So it is advised to the dentists to encourage and increase the usage of Composites as restorative material rather than Silver amalgams for restorative purposes.

The people in U.S. are more prone to caries formation, just due to the fact that they have higher consumption of fluorine through food and water. A minimal amount of Fluorine is OK to prevent caries, but when it goes into excess, then it’s harmful.

Fluorine is just like some drugs, which taken in normal concentration help in a good way. But when taken in higher concentration, they go just against what we are using it for.

The American Dental Hygienists’ Association has announced a new format for National Dental Hygiene Month will kick off with October and will feature various events for each week of the month long celebration.

The theme will remain “A Healthy Smile Lasts a Lifetime.”

“The new format for National Dental Hygiene Month is a better representation of what the celebration means to the profession and the community alike,” said Diann Bomkamp, RDH, BSDH, ADHA president. “Dental hygienists belong to a community service-oriented profession, which is now honored and better utilized during the month of celebration. We’re proud of all dental hygienists and the work that they do.”

The activities seen in the time of the NDHM is -
First full week: Hygienists’ Appreciation Day
Weeks two and three: Community Service
Week four: Take a Potential Member to Lunch

In the first week you being a dentist are appreciated by your family and friends, and celebrate a particular day of the week for what all you did as a perfect dental hygienist, and as a dental professional.

In the 2nd and 3rd week, dental hygienists are volunteer oriented always, but during this week they try to make the community a better place. This can be done alone or along with your co-workers and friends, and also you can call the officials to show them about your dedication.

In the 4th week, As an ADHA member, take a friend, or a co-worker who’s not out to lunch. ADHA is the community for all dental hygienists. Show them the value, but remember, it’s not a sales pitch—just a friendly gesture on behalf of yourself and the profession.

Gum disease is due to microorganisms and this infection becomes very much easier to infect if the immune system is worsened, and the immune system is damaged generally when there are any cancerous infections.
Around 14% of gum disease patients were known to have cancer of any one of the organs.

According to L.C. Williams & Associates poll, 89% of patients who visit an endodontist for a RCT, return back for future procedures and treatments. While comparing with a normal dental professional, this number is higher as endodontists make the work in RCT much easier and painless.
People and even general dentists would prefer an endodontist to perform a Root canal treatment.

Teeth are precious for each and every individual, so their protection and cure from any problem has to be in hands of a perfect person, so a specialist in endodontics is the best for root canal procedures.
According to a patient, like a cardiologist is preferred for heart problems, and neurologist for kidney.. in the same way for a root canal treatment, an Endodontist is the best to contact.

An endodontist becomes one by pursuing a 4 year graduation of bachelor degree in dentistry, then 2-3 years course of specialization in endodontics(where they learn about administering anesthesia and use of leading-edge technologies can make root canal treatment more effective and predictable and result in a more positive patient experience.)

Endodontists are like micro-surgeons who are perfectly trained to create channels and canals inside a tooth and fill it with some biocompatible material. There are instruments like digital radiography and operating microscopes which are the recent advances in Endodontics and these things have greatly helped in making treatments like RCT painless.

According to Dr. Joseph Califano, program director of periodontics and oral surgery, in the Traditional way of surgeries, the spot decision of placement of implants do not give the complete picture of the bone and the part where an incision is made to locate the bone. The traditional manner is often less than optimal, Califano said, because it involves on-the-spot decision-making during the procedure.

A special software “SimPlant Planner”, shows the review of the denture or the oral part on 3-D computed tomography scan, which also displays the perfect anatomical part of the scanned region.

He said – “We can place implants virtually on a trial basis,” “This allows us to review many options and develop an ideal surgical plan that fully supports the prosthetic plan we developed. We can eliminate most of the unknowns, which facilitates both patient consultation and the educational process, since the treatment decisions are made preoperatively.”

Normally X-rays are used to locate the region by the periodontists but these techniques always have a few limitations which do not give perfection to the procedure. These X-rays are not as accurate as CT Scans. After the CT Scans are done, there is a special plan made with better formulation, and a drill guide is constructed that allows the surgeons to precisely place the implants in the patient’s mouth.

This type of program is helpful both to the patients and also the dental students to make better decisions in the field of operation.