Oral Manifestations
in Systemic Infections
Oral manifestations can be observed in almost
every generalized systemic infectious disease. Only the most characteristic
ones are illustrated on this page.
Measles produces a pathognomonic eruption of the mouth in
the prodromal stage before any cutaneous lesions have become evident. About the
second day after the first signs of the disease (coryza, conjunctivitis, and
fever) become evident, the palate and fauces become intensely red, and the
typical Koplik spots appear on the buccal or labial mucous membranes as
isolated rose-red spots with a pale bluish white center. At the onset, the
buccal mucosa is normal in color. Soon the eruptions become diffuse, with rose
red predominating and the bluish spots more numerous, until the coalescence of
all spots produces an even redness, with myriad white specks. The cutaneous
rash, which is dull red and macular, follows the first Koplik spots by 2 to 3
days. The oral mucosa assumes its normal color before the skin rash has
disappeared.
The vesicular eruptions of chickenpox
may be seen in the oral cavity before the skin eruptions appear, and they
are mainly seen as isolated small vesicles on the soft palate. The thin
vesicles, with a reddened halo, rupture quickly to form shallow erosions with
gray tags of epithelial debris. Usually, the size is that of a pinhead, but it
may be larger. It resembles a solitary aphtha but is generally not as painful.
The oral symptoms of scarlet fever originate
in the throat, which is red and swollen, as are the tonsils and palate and,
occasionally, the gingivae. The tongue is next involved with a heavy, grayish,
furry coating through which enlarged, red papillae are scattered. The edges of
the tongue and its tip are vividly red. Within 3 or 4 days the dorsum has
desquamated, with enlarged variously placed papillae, presenting the so-called
strawberry tongue.
Foot-and-mouth disease, or epizootic stomatitis, is an acute, highly
contagious viral infection that can be transmitted to humans by the consumption
of unsteril- ized milk or meat from cows suffering from the disease or by
direct contact with the saliva of infected animals. The oral symptoms follow
generalized fever and malaise with dry, swollen, reddened membranes. The tongue
is coated and enlarged. Within days, yellow vesicles appear and rupture.
Salivation and a fetid odor are prominent. The vesicles enlarge and then appear
also on the hands and, occasionally, the toes. Fever and lymphadenopathy increase
for 1 to 2 weeks, after which time they rapidly resolve.
Infectious mononucleosis presents as a triad of fever, tonsillary
pharyngitis, and lymphadenopathy as a result of infection with the Epstein-Barr
virus between intimate contacts. In the early stage, usually with the onset
of the fever, a reddened pharynx is seen with scattered petechiae of the buccal
and labial mucosa and of the soft palate. The presence of palatal petechiae,
splenomegaly, and cervical lymphadenopathy is highly suggestive of the
infection. A heterophile antibody agglutination test (Paul-Bunnell reaction,
sheep red blood cells; monospot, horse red blood cells) will establish the
diagnosis.
The primary lesion of syphilis is
the chancre; 5% to 10% of lesions are extragenital, often around the
oral cavity. Lip chancre is typically a sole lesion, the erosive e resembling a
herpetic lesion with a tendency to crust and ooze. Lymphadenopathy is present
and is unilateral, hard, movable, and slightly tender. The chancre contains
numerous spirochetes. Chancre of the tongue presents as a circular lesion
surrounded by indurated raised reddened tissue on the tongue tip; however, less
typical chancres can develop on the gingiva, buccal mucosa, palate, and
tonsils. By 4 to 6 weeks from the appearance of the chancre, the oral infection
increases to include mucous patches on the tongue, buccal mucosa, pharynx, and
lips, which contain numerous Treponema organisms. The tongue
often has multiple gummas in the form of pea-size nodules on the dorsum. Ulceration
and necrosis heal with stellate and grooved scars typical of leutic
interstitial glossitis, or they may be extensive, causing macroglossia.
Treatment with a penicillin-based antibiotic is very effective at the primary
stage of the disease.
