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.