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Section Questions and Answers

Mouth Infections

This section on oral medicine and pathology deals with common infections of the mouth other than caries or periodontal disease.
It is divided into two topics:

A. Mouth Infections: Bacterial, viral and fungal
B. Blister lesions of the mouth

A. Mouth Infections

  1. What bacterial mouth infections (other than tooth decay and gum disease) should I be aware of?
  2. How are bacterial infections treated?
  3. What viral infections can affect the mouth?
  4. How are viral infections treated?
  5. What fungal infections can affect the mouth?
  6. How is thrush (candidiasis) treated?
  7. What is a canker sore or aphthous ulcer?
  8. How are cankers treated?

 
1. What bacterial mouth infections (other than tooth decay and gum disease) should I be aware of?

  • Oral bacterial infections other than tooth decay and gum disease are rare, but can occur:
    • Scarlet Fever can affect the tongue or cheeks.
      A typically strawberry or raspberry coloured tongue is seen at an early stage.
      The rest of the mouth and throat are also affected.
    • Syphilis and Tuberculosis can also affect the mouth.

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2. How are bacterial infections treated?

  • Your doctor will examine you, carry out tests if necessary, and will prescribe an antibiotic to cure the infection.

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3. What viral infections can affect the mouth?

  • Herpes Simplex
    • This causes Oral Herpes, which affects from 50-60% of HIV patients.
    • It is a chronic infection, with widespread painful ulcers.
    • The ulcers are white with red borders.
    • Medications may allow it to disappear for a time, but it will re-appear.
    • It is spread by intimate physical contact.
    • Infants can acquire it from their mothers during pregnancy or birth.
    • In people with immune deficiencies it is particularly severe, and prolonged treatment may be needed.

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Herpes
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Herpes
  • Cold Sores, found on the lip, are also caused by a herpes virus.

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Cold sore
  • Measles may appear in the mouth as little white spots with a red border.
  • Chicken Pox blisters are also found in the mouth.
  • Ulcers occurring during glandular fever (Infectious Mononucleosus) may resemble herpes ulcers.

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4. How are viral infections treated?

  • There is no cure for a viral infection, and so the symptoms need to be treated.
    • This is done by using mouth-rinses, and applying topical anaesthetics and protective ointments to the ulcers.
    • In most cases the viral infection lasts for 10-14 days.

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5. What fungal infections can affect the mouth?

  • Thrush, also called candidiasis, is the most common fungal mouth infection.
    It appears as a white patch, which can easily be stripped off to leave a red, bloody area.

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Thrush

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6. How is thrush (candidiasis) treated?

  • It is treated with an antibiotic and a mild antiseptic mouthrinse will usually be prescribed.
  • Tooth brushes should be discarded after each use to prevent re-infection.

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7. What is a canker sore or aphthous ulcer?

  • This is a painful ulcer that can vary in size and appears singly or in groups.
    • The exact cause is unknown, but stress and viruses probably play a role.
    • These rounded, painful, shallow ulcers recur at intervals of a few days to a few months
    • The ulcers are less than 5 mm. in diameter.
    • They have a grey/white centre, with a red, inflamed border.
    • The lips, cheeks and the floor of the mouth are affected.
    • The healing period is about 10-14 days.

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Canker sore

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8. How are cankers treated?

  • In most instances these conditions get better spontaneously in 10-14 days.
    • Protective ointments and pain relievers are applied directly to the ulcers. They are usually the only pain relief that is needed.
    • Occasionally the doctor may prescribe steroids.
    • Chlorohexidine mouthwashes can have a beneficial effect.

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B. Blister lesions of the mouth

  1. What are blister-type lesions?
  2. What is the difference between a vesicle and a bulla?
  3. What kinds of blisters are most commonly found in the mouth?

 
1. What are blister-type lesions?

  • These are blisters or vesicles of varying size, found on the inner surfaces of the cheeks.
    They sometimes rupture (pop) leaving raw, open wounds

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2. What is the difference between a vesicle and bulla?

  • Vesicles are small, only a few millimeters in size.
    Bullae can be considerably larger.
    Both are blisters.

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3. What kinds of blisters are most commonly found in the mouth?

Blister lesions are not common. The following are some that may occur:
  • Pemphigus is a chronic skin disease, which also appears in the mouth.
    • It is related to immune system problems, and appears in middle age.
    • It requires specialist treatment using steroid medication.
  • Pemphigoid is not associated with skin problems.
    • It can also affect the eyes
    • This is a common inflammatory lesion. The erosive or ulcerated form can be pre-cancerous.
    • It needs treatment with steroids, by a specialist.

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Pemphigus
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Pemphigus
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Pemphigoid
  • Lichen Planus
    • This condition affects adult women more commonly than men.
    • It is mostly seen on the inner surface of the cheek in a lacy pattern of white raised areas.
    • The erosive or ulcerated form of this condition is rare, but can be pre-cancerous.
    • It is usually a benign condition and is not the same as leukoplakia.

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Lichen planus
  • Erythema Multiforme
    • This appears on the skin as well as in the mouth.
    • It is related to certain drugs and immune system problems, and is most commonly found in young men.
    • The symptoms need to be treated by a specialist, but the cause is often difficult to find.

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Erythema multiforme

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