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GINGIVAL TUBERCULOSIS

Presented by
S.ARUN
C.R.I.
TUBERCULOSIS

• Tuberculosis is a communicable bacterial


infection of the lungs, and possibly
extrapulmonary sites, caused principally by
the obligate aerobe Mycobacterium
tuberculosis.
• Persons who become infected with
mycobacterium are at equilibrium with the
tubercle bacilli and do not develop significant
illness. This condition is called tuberculous
infection.
ORAL TUBERCULOSIS

• Oral tuberculosis can be primary or


secondary. Primary oral tuberculosis
lesions are extremely rare and often
occur in younger patients.
• It usually involves gingiva and is
associated with regional
lymphadenopathy.
• Secondary oral tuberculosis lesions are
common and usually involve the
tongue, followed by the palate, lips,
buccal mucosa, gingiva and frenulum.
GINGIVAL TUBERCULOSIS

• Gingival tuberculosis has become a


rare entity and it may represent the first
and only clinical manifestation of a
systemic infection.
• Tuberculous lesions are seen as
superficial ulcers, patches, indurate soft
tissue lesions or even lesions within the
jaw in form of osteomyelitis.
Fiery red, granular appearance of gingiva in upper and
lower anterior area and upper posterior areas
Photograph showing bleeding from ulcerated gingiva along
with whitish necrotic material
PATHOGENESIS

• Mycobacterium tuberculosis is the most


frequent pathogen implicated in
tuberculosis, other mycobacteria such
as
– Mycobacterium bovis,
– Mycobacterium avium-intracellulare, and
– Mycobacterium kansasli
CLINICAL FEATURES

• Episodic fever and thills,


• Dyspnea,
• Fatigue,
• Anorexia,
• Weight loss,
• Sputum production, and
• Persistent cough with or without hemoptysis.
DIAGNOSIS

• Tuberculin skin test


• Radiographic findings
• Microscopic identification of acid fast
organisms from body fluids, secretions, or
tissue.
• Mycobacterium can be identified by staining
with Ziehl-Neelsen stain or carbol fuchsin
• Culturing the organism.
TREATMENT

• Successful treatment of tuberculosis


requires regular intake of several
antibiotics for several months.
• The most potent antituberculosis agents
are isoniazid (INH) and rifampin.
• These two bactericidal drugs are
administered regularly.
ANTITUBERCULOSIS
DRUGS
• BACTERICIDAL AGENTS (Kill tubercle bacilli)
– Isoniazid
– Rifampin
– Pyrazinamide
– Slreptomycin
– Capreomycin
– Kanamycin
• BACTERIOSTATIC AGENTS (Prevent emergence of
drug-resistant mutants)
– Ethambutol
– Ethionamide
– Cycloserine
– Para-amino salicvclic acid
ORAL MANIFESTATIONS
AND CONSIDERATIONS
• Dissemination of mycobacterial organisms from the
lungs to the mouth by infected sputum can result in
secondary infection of the oral cavity.
• Oral involvement occurs in about 1 % of those
infected, usually at the site of a break in gingiva.
• Characteristically, these lesions appear as gingival
ulcers that are found preferentially in the posterior
parts of the mouth, on the dorsum and lateral margin
of the tongue, and In the labial mucosa at the
commissure.
• Tuberculous ulcers may be pain fill or
painless, and without treatment they slowly
increase in size.
• The center of the ulcer is grayish, necrotic,
and depressed, whereas the peripheral region
is lumpy, "cobble-stoned," and undermined.
• The base of the lesion is purulent and
contains active organisms that can be
transmitted under appropriate conditions.
DENTAL MANAGEMENT

• Precautionary measures should be


taken for
– Patients with persistent signs and
symptoms suggestive of tuberculosis.
– Patients who have a positive reaction to
the tuberculosis skin test.
– Patients with a history of tuberculosis who
have received inadequate antituberculosis
chemotherapy.
CONCLUSION

• Tuberculosis of gingiva is relatively rare and


has largely become a forgotten diagnosis of
oral lesions.
• However, with the recent reversal in the
incidence of tuberculosis, it should always be
included in the differential diagnosis of oral
ulceration, as delay in diagnosis may have
serious consequences.