Oral tuberculosis is an infectious disease that, like other types of tuberculosis, is caused by mycobacteria. This pathology is classified as chronic. As a rule, the inflammation characteristic of tuberculosis, affecting the lining of the mouth and the red border around the lips, is secondary: that is, it occurs as a consequence or the most characteristic manifestation of other forms of tuberculosis. For example, these include tuberculous lesions of the lymph nodes and bones.
The mucous membrane of the oral cavity is far from the most favorable environment for the development and reproduction of mycobacteria that cause tuberculosis. As a rule, when entering this environment, mycobacteria die. However, in the presence of favorable circumstances (microtraumas, mechanical damage in the oral cavity, opening the gates for infection), bacteria penetrate inside and provoke the formation of a tuberculosis ulcer.
Oral tuberculosis is a relatively rare form of tuberculosis, usually diagnosed only in children. This is due to the characteristics of teething in children.
In an infant, such a disease can be extremely severe and includes the generalization of tuberculosis infection. Secondary tuberculosis infection begins to develop as tuberculous lupus or miliary ulcerative tuberculosis.
Tuberculosis is transmitted by airborne droplets. The incubation period lasts from eight to thirty days, and after this the formation of an uneven, blurred ulcer begins, which is severely painful. After a few days it begins to gradually increase. At the same time, the adjacent lymph nodes swell. There are no other signs of inflammation yet
Classification of types of oral tuberculosis
Oral tuberculosis is a disease that appears and develops mainly in patients with reduced immunity. The disease is caused by Koch's bacillus. The source of inflammation located in the patients' oral cavity is secondary in most cases. It develops as a result of the spread of infection from the main focus, and spreads through the circulatory or lymphatic systems. In the case when the patient is affected by the pulmonary form of tuberculosis, the infection spreads to the oral cavity due to the penetration of mycobacteria contained in the sputum.
There are four forms of oral tuberculosis. Among them:
- Primary tuberculosis of the oral cavity. Transmitted by the respiratory or fecal-oral route, this disease almost never occurs in adults. Most patients with this diagnosis are infants.
- Tuberculous lupus. It is the lupus form of oral tuberculosis that is most often encountered in dental practice. Erosive elements are localized on the mucous membrane of the gums. If treatment is not started on time, these tumors can develop into a malignant form.
- Miliary-ulcerative form. This form usually develops in patients who have already been weakened by tuberculosis. Along with their cough, they produce sputum, which is a source of bacteria that cause oral tuberculosis. The lesions are on the palate and tongue, in rare cases - in the area of marginal gums or on the side of the cheek.
- Scrofuloderma. This form of the disease is diagnosed in most cases in children. The clinical signs of scrofuloderma are somewhat different from those of other forms of oral tuberculosis. In the first stages - the appearance of not a tubercle, but a rather large nodule. After its softening and necrosis occurs, the stage of formation of fistula tracts begins. The healing process of the surface of the resulting ulcers takes a long time, and after it characteristic fringed scars form.
Tuberculosis of the oral mucosa
Tuberculosis of the oral mucosa occurs due to the introduction of Mycobacterium tuberculosis, also known as Mycobacterium tuberculosis. Simply put, Koch's wand. Tuberculosis of the oral mucosa is a manifestation of the main chronic disease – tuberculosis. In principle, the occurrence, manifestation, course and outcome of the disease depend on the general condition of the body, its reactivity and immunity.
The route of entry of Mycobacterium tuberculosis is simple. This is either endogenous penetration, that is, through the blood, lymph; or exogenously (airborne droplet route).
But the oral mucosa is not sensitive to this bacterium and is slightly susceptible. Therefore, the introduction of Mycobacterium tuberculosis is possible only through the oral mucosa, which is damaged, inflamed, and already has foci of inflammation: erythema, ulcers. That is, the entrance gates for oral tuberculosis can be:
- Pathological pockets;
- Gums over erupting teeth;
- Wound after tooth extraction;
- Damaged epithelium, regardless of the nature of the injury.
Tuberculosis as a chronic disease can be primary and secondary. So, primary tuberculosis of the oral mucosa most often occurs in children or infants (since Koch’s bacillus can be transmitted through the milk of cows), or in schoolchildren aged 8 to 12 years, whose families have people suffering from an open form of tuberculosis.
Tuberculosis of the oral mucosa can be of several forms: it is either tuberculous lupus, or miliary ulcerative tuberculosis, or in the form of a tuberculous ulcer. These two forms of tuberculosis of the oral mucosa are the most common.
There is also another form of tuberculosis of the oral mucosa, which is very rare - “Cold abscess,” in other words, these are isolated, separate tuberculous gummas.
Tuberculous ulcer - Clinical picture
The incubation period for the occurrence of a tuberculous ulcer in tuberculosis of the oral mucosa lasts from 8 to 30 days. After this period of time, an ulcer appears at the site of the introduction of Mycobacterium tuberculosis. The size of the ulcer in tuberculosis of the oral mucosa reaches up to 1.5 cm in diameter. The edges of a tuberculous ulcer are uneven, undermined, and can be dense or soft. The ulcer itself in tuberculosis of the oral mucosa is shallow, but painful. The bottom of a tuberculous ulcer is granular.
The shape of the ulcer is not always oval; for example, if the manifestation of tuberculosis is on the transitional fold or tongue, most likely the shape of the tuberculous ulcer will be slit-like. It is clear that the reaction of the lymph nodes in tuberculosis of the oral mucosa will be positive. Lymph nodes increase in size, become denser, at first they are mobile, but the more time passes from the day of infection, the more strongly they adhere not only to each other, but also to the skin. Moreover, over time, the lymph nodes can fester and open.
Tuberculous lupus
Tuberculous lupus is a phenomenon that manifests itself primarily on the skin, most often the skin of the face. But there are also combined forms, when in addition to the facial skin, the mucous membrane of the oral cavity is also involved in the process. The favorite place for this form of tuberculosis of the oral mucosa is the gums and soft palate. So what to look for on the gums and soft palate if tuberculosis is suspected? The answer is obvious - tuberculous tubercles!
Tuberculous lupus - Clinical picture
The clinical picture of tuberculous lupus is quite clear. There is a tuberculous tubercle on the soft palate. The size of the tuberculous tubercle is small, often compared to the head of a pin. We looked and assessed the color – yellowish-pink. Needs to be palpated. The tubercular tubercle will be soft.
Often with tuberculous lupus, tuberculous tubercles are located in groups on the soft palate. That is, they are susceptible to merging and rapid disintegration with exposure of the ulcerative surface. The ulcerative surface in tuberculous lupus is bright red, bleeds easily, covered with a yellow-gray coating, which causes pain when trying to remove it.
On the gums, tuberculous lupus also manifests itself as tubercles, but these tubercles quickly turn into ulcers and spread to the interdental papillae and the edge of the gums. All the same signs as with the appearance of tubercles on the mucous membrane of the soft palate.
Milliary - ulcerative tuberculosis - Clinical form
Milliary ulcerative tuberculosis is the most common form of secondary tuberculosis in children. Often occurs in children with open form of tuberculosis. That is, when you cough, sputum is released, in the sputum - Mycobacterium tuberculosis, which easily penetrates through the damaged oral mucosa.
The clinical picture of milliary ulcerative tuberculosis is characterized by the fact that red dots appear on the mucous membrane of the cheeks, on the back and lateral surfaces of the tongue, and on the soft palate. In this form of tuberculosis of the oral mucosa, these red dots are slightly convex and rise above the normal mucous membrane. However, this stage changes quickly and is often not even noticeable to the eye. But these red dots ulcerate and an ulcer occurs. Often these ulcers quickly grow to the periphery and can merge with each other. An ulcer in the milliary-ulcerative form of tuberculosis of the oral mucosa is irregularly shaped, with undermined, uneven edges, the bottom can be granular, the mucous membrane around the ulcers is swollen and hyperemic.
Treatment of tuberculosis of the oral mucosa
Treatment of tuberculosis of the oral mucosa, of course, should first of all be aimed at treating general tuberculosis, that is, in a special medical institution. The dentist must identify such patients and organize clinical observation.
Diagnostics
Primary tuberculosis of the oral cavity is diagnosed during an external examination. Thus, it is characterized by the presence of lacerations and ulcers in the corners of the mouth with yellow, gray and bluish layers. Areas with ulcers tend to gradually enlarge.
At the same time, the lymph nodes begin to enlarge.
Diagnosis is carried out on the basis of the collected anamnesis, as well as using histological and bacterioscopic studies. During examination, dense painful lumps or ulcers are found on the mucous membrane, depending on the severity of the condition.
There is minor inflammation. The process of formation of adhesions begins between the lymph nodes and the surrounding surface.
Syphilis of the oral mucosa
Syphilis of the oral mucosa is a manifestation of a general chronic disease that affects the entire body. In principle, all doctors, both general practitioners and dentists, know: the idea that syphilis can only manifest itself on the genitals is a misconception.
Etiology of syphilis
The etiology of syphilis is associated with a bacteria called Treponema pallidum. The route of infection is sexual, but it can also occur oral. In general, in order for the disease to develop, it is only necessary for Treponema pallidum to penetrate through the damaged mucous membrane or skin. Cases of penetration through intact skin and mucous membranes have been recorded. Syphilis is quite common; about 40% of children have manifestations of primary syphilis in the oral cavity. Secondary recurrent syphilis is less common, occurring in about 10% of cases in adolescents.
Syphilis in the 21st century is a medical and social problem.
Clinical picture of syphilis
The clinical picture of syphilis primarily depends and differs, of course, from the period of syphilis. There are 3 periods in the development of syphilis. Each period has its own characteristics in the manifestation and treatment of the disease. It must be remembered that congenital syphilis is also included in a separate group of syphilitic diseases.
For the clinical picture of syphilis to develop, it is necessary for about 3 to 4 weeks to pass, which is the incubation period of syphilis. But it is possible to shorten it to 1 - 1.5 weeks, or lengthen it to six months.
So.
Clinical picture of syphilis - First period of syphilis
The clinical picture of the primary period of syphilis is associated with the appearance at the site where treponema has invaded, the appearance of hard chancre - primary syphiloma.
Primary syphiloma will be clinically noticeable within 1.5 - 2 months, that is, about 6 - 8 weeks. What does chancre look like? In principle, a hard chakra can be either in the form of an ulcer or in the form of erosion. Often oval or round in shape, may be saucer-shaped. The edges are always smooth and crisp. Syphilitic chancre is always at the same level with the mucous membrane of the oral cavity.
In rare cases, the edges of the ulcer may be raised. The bottom of the chancre is smooth, shiny, bright red. The literature specifies that the bottom may be “greasy”, that is, slightly colored with a dull white coating. The main sign by which a tuberculous ulcer can be distinguished from a chancre is complete painlessness on palpation of a chancre. There have been cases when the size of the chancre was almost equal to the area of the entire mucous membrane of the hard and soft palate, but it did not cause any subjective sensations in the patient. Also, in the presence of hard chancre, there are no acute inflammatory processes in the surrounding mucous membrane.
Chancre is painless upon palpation, we have sorted this out, but in its consistency it is dense and “cartilage-like”.
This means the patient walks like this for 3 or 4 days. Then a week passes. And nothing seems to bother him: “Well, there’s something red in the mouth, but it doesn’t hurt.” So after a week, maximum 10 days, the lymph nodes are involved in the process. Lymph nodes in the primary period of syphilis increase in size, are dense, elastic, and painless on palpation. The lymph nodes do not merge with the skin, and the color of the skin does not change.
In addition, primary syphilis can manifest itself not only in the form of erosion or ulcers, but can also be a regular abrasion. The favorite places when primary syphilis appears in the form of an abrasion are the corners of the mouth - identical to jams, only unlike them, the abrasion will be dense at the base. On the transitional fold - elongated, on the tongue - this is the middle third, one abrasion, maximum two. If primary syphilis appears on the gums, then it will be an ulcer, bright red in color, its length corresponding to the width of 1 - 2 teeth.
Very rare cases of manifestation of primary syphilis on the tonsil. However! Primary syphilis on the tonsil is characterized by its unilateral enlargement, painlessness, with the presence of purulent plugs.
With primary syphiloma, hard chancres can be located close to each other and merge, forming a herpetiform chancre. This manifestation of primary syphilis is the most rare of all the manifestations in the oral cavity that have previously occurred.
To summarize, this is what you should remember: primary syphilis occurs 6-8 weeks after infection. Its first manifestation is chancre (here you need to read the description of chancre again), which can be located on the mucous membrane of the cheeks, palate, lips, transitional fold, tongue, and in rare cases on the tonsil. Lymph nodes enlarge a week after the onset of chancroid. The diagnosis will be established only after identifying chancre in the punctate and lymph nodes - treponema pallidum. Serological reactions are positive 4-5 weeks after infection.
Clinical picture of syphilis - Secondary period of syphilis
The secondary period of syphilis is characterized by a long course, namely from 3 to 5 years. The secondary period of syphilis will begin 1.5 - 2 months after the appearance of chancre. An important difference between the secondary period of syphilis and the primary period is not only the elements of the lesion, but also the peculiarity of the course. Since the secondary period of syphilis occurs in waves. What this means is that in the second period of syphilis there is both an active period, when there are elements of the lesion, and a latent period, when there are no elements visible to the eye.
During the active secondary period of syphilis, the clinical picture will be characterized by the presence of elements such as roseola, papules, pustules - secondary syphilides. These are elements that occur both on the skin and on the mucous membrane. The outlines of the elements in the secondary period of syphilis are rounded, smooth, the boundaries are clear and sharp. The color ranges from bright pink to scarlet and red. These elements do not have the ability to merge with each other. Secondary syphilides pass quickly, do not cause itching, and do not leave scars.
Secondary syphilides can occur in addition to the skin and mucous membranes of the lips and cheeks on the tongue, soft palate and tonsils. The main feature of the occurrence of secondary syphilides in these places is their constant tendency to merge, forming large lesions. The mucous membrane in these places is hyperemic, swollen, and pain may occur when swallowing.
However, the most common lesions on the mucous membrane are papules. Papules in secondary syphilis are round, dense, painless on palpation, surrounded by a halo of hyperemia. The size of papules can vary from 3 – 10 mm. Localization varies.
Papules can appear on the tongue; there are some peculiarities here:
- With atrophy of the filiform papillae, smooth, shiny, oval-shaped surfaces may form just below the level of the mucosa. This clinical picture is called “Mowed meadow”
- Papules on the tongue can increase in size, that is, hypertrophy, change in color, and become pale red. This type of secondary syphilis on the tongue is called hypertrophied papules;
- “Opal papules on the tongue” - trauma to the papules occurs, the surface becomes wrinkled, the papules will be loose, pale with a whitish tint.
Clinical picture of syphilis - Tertiary period of syphilis
The clinical picture of the tertiary period of syphilis is the most complex, characterized by the appearance of syphilitic gummas or tubercles, sclerosing glossitis. At the same time, syphilitic gummas differ from secondary syphilides by deeper penetration into the skin and mucous membranes and involvement in the pathological process of the central nervous system and other body systems. Tertiary syphilis can cause paralysis due to irreversible destructive processes.
The tertiary period of syphilis, fortunately, is rare, since patients seek help at the first stage of the disease. The tertiary period of syphilis is observed in patients who have undergone either poor quality treatment for syphilis or incomplete treatment. The literature identifies some predisposing factors for the occurrence of the tertiary period of syphilis:
- Childhood or old age;
- Alcoholzym;
- Presence of concomitant difficult-to-treat pathology
The tertiary period of syphilis lasts 8–10 years. For syphilitic gummas to appear, not 1, but at least 3 months must pass. An important feature of the course of the tertiary period is that after the disappearance of the gumma, scars remain.
If a bump appears, it is most often on the lips. The clinical picture of tubercular syphilis: the tubercles are red-blue in color, initially located singly, merge over time, after the collapse of which ulcers appear: painful, deep, small, with undermined edges. The ulcer heals - a scar for life.
Syphilitic gummas will be located in the oral cavity. There are always few of them. Either in a group or alone. The size of syphilistic lips is small, often compared to a nut. After the gumma disintegrates, an ulcer appears, which has undermined, uneven edges, often covered with granulations, and a dense bluish-red ridge at the bottom. Gummas can perforate the hard/soft palate if left untreated.
Most often, syphilitic gummas occur on the tongue, which leads to the development of syphilitic sclerous glossitis. The tongue thickens, becomes dense and less mobile. Permanent deformation of the tongue occurs.
When the syphilitic gum disintegrates on the alveolar process, pathological mobility of the teeth occurs; percussion will be positive.
Congenital syphilis
Congenital syphilis occurs in children when Treponema pallidum penetrates the placenta from a mother who has syphilis. Intrauterine infection occurs at the border between 3 and 4 months of pregnancy.
Congenital syphilis can be early, that is, it appears immediately after birth, within 1 - 2 months; may be late - manifests itself between 5 and 14 years.
Early congenital syphilis - Clinical picture
The clinical picture of early congenital syphilis is entirely variable. The pathological process involves not only the skin and mucous membranes, but also bones, organs, and the central nervous system.
If the manifestation is on the skin, it is syphilitic pemphigus. The bubbles are dense, with a purple rim around them.
The manifestation of early congenital syphilis on the skin of the chin or lips is characterized by Hochsinger infiltration. That is, erythema occurs either in the form of a focus or in the form of diffusion. After which infiltration develops. The skin becomes dense and loses elasticity. Lips swell and increase in size. The lips also change in color, a yellowish tint appears. If a child screams, this leads to injury, as cracks appear. The cracks often bleed and subsequently become covered with crusts. If treatment aimed at epithelization is not effective or is not carried out, then Robinson-Fournier scars appear - radial scars in the area of the corners of the mouth.
Late congenital syphilis - Clinical picture
The clinical picture of late congenital syphilis manifests itself in the period from 5 to 14 years and is characterized by the most severe changes that cause deep damage to tissues and organs.
There are two groups of symptoms by which late congenital syphilis can be diagnosed:
- Reliable signs: Hutchinson's triad: keratitis, Hutchinson's teeth, deafness;
- Probable signs: perioral scars, buttock-shaped skull, saddle nose, saber-shaped shins, purse-shaped first molars and canines.
Treatment of syphilis
Treatment of syphilis should be carried out by a dermatologist in specialized medical institutions. The dentist can only carry out local treatment: oral hygiene, antiseptic rinses, elimination of irritants.
The article was written by N. Shidlovskaya specifically for the OHI-S.COM website. Please, when copying material, do not forget to provide a link to the current page.
Treatment of oral tuberculosis
Treatment of this form, like all others, is carried out in specialized institutions - tuberculosis dispensaries. First of all, the underlying disease is treated. To prevent the bacterial infection from spreading further, antiseptic baths are prescribed.
After the acute condition has been relieved, it is necessary to take care of timely and high-quality sanitation of the oral cavity. It is important to promptly consult a specialist at the first symptoms: advanced oral tuberculosis leads to serious consequences for the patient’s health.
