Orofacial tuberculosis: Clinical manifestations, diagnosis and management

Primary Tuberculosis of Buccal and Labial Mucosa: Literature Review and a Rare Case Report of a Public Health Menace

Tuberculosis (TB) is a chronic granulomatous infectious disorder, caused by Mycobacterium tuberculosis. Despite the recent advancements in antitubercular therapy (ATT), it remains a global public health concern. TB is a leading infectious cause of global mortality, second only to coronavirus disease 2019 (COVID-19). TB of the oral cavity is an uncommon occurrence and may be classified as a primary and secondary form. The primary tubercular lesions are extremely rare, as the intact oral squamous epithelium resists the entry of tubercle bacilli. The commonest oral TB lesion is solitary ulceration with undermined edges, usually on the tongue, that does not exhibit healing with conservative therapies. Owing to the atypical presentation, the oral TB lesions often go unnoticed during clinical examination; hence, an oral physician should be familiar with the various oral manifestations of TB. A timely diagnosis coupled with interdisciplinary treatment is the key to combat disease dissemination. This manuscript aims to report a rare case of primary tuberculosis of the buccal and labial mucosa in a 43-year-old immunocompetent male patient. Buccal and labial mucosa are the infrequently affected sites for primary oral TB lesions. A detailed literature search carried out on the Google Scholar and PubMed search engines revealed only fifteen case reports and two case series of primary tuberculosis of the buccal mucosa and labial mucosa.

Oral manifestations of anti-neutrophil cytoplasmic antibody-associated vasculitis: an update and narrative review of the literature

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a multisystem disorder of small blood vessels subdivided into granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Oral manifestations (OMs) have been reported to include mucosal ulceration, gingival enlargement, alveolar bone necrosis, tooth loss, oro-antral communication, palatal perforation, parotitis, and candidal infection mainly in GPA. They may appear during the course of the disease, as a disease flare-up, or as the presenting sign. These OMs are often nonspecific and can mimic an array of conditions, therefore formulating a differential diagnosis can be challenging. This review updates the OMs of GPA, and, for the first, time includes OMs of other AAVs. It provides recommendations for the overall assessment and the diagnosis and management of all AAV OMs with considerations for treatment coordination. The role of oral health care providers in multidisciplinary care is highlighted.

A buccal mucosa ulcer as the first sign of tuberculosis

Tuberculosis (TB) is an infectious disease caused mostly by Mycobacterium tuberculosis. Oral lesions caused by this disease are not common, and most of them represent secondary involvement of the initial pulmonary focus. Therefore, the discovery of lung tuberculosis because of the investigation of oral lesions is rare. This paper reports a case of a 61-year-old male patient who presented with a painfully ulcerated lesion in labial commissure and buccal mucosa, without any comorbidities or symptoms associated. An incisional biopsy was performed, and histopathology showed a chronic granulomatous lesion extending to involve the underlying muscle. Based on these findings, investigation for tuberculosis was suggested. Chest radiography displayed excavated macronodular lesions suggestive of an inflammatory-infectious/granulomatous process of bronchogenic dissemination. The search for acid-alcohol-resistant bacillus in sputum was positive. After using drug therapy for tuberculosis for 3 months, there was a total regression of the oral lesions, in addition to weight recovery in the period. Thus, in patients with isolated oral mucosa lesions, we must consider the possibility of oral manifestation of systemic diseases, even without typical clinical signs and symptoms.

Periodontal Diseases: Major Exacerbators of Pulmonary Diseases?

Periodontal diseases are a range of polymicrobial infectious disorders, such as gingivitis and periodontitis, which affect tooth-supporting tissues and are linked to playing a role in the exacerbation of several pulmonary diseases. Pulmonary diseases, such as pneumonia, chronic obstructive pulmonary disease (COPD), asthma, tuberculosis, COVID-19, and bronchiectasis, significantly contribute to poor quality of life and mortality. The association between periodontal disease and pulmonary outcomes is an important topic and requires further attention. Numerous resident microorganisms coexist in the oral cavity and lungs. However, changes in the normal microflora due to oral disease, old age, lifestyle habits, or dental intervention may contribute to altered aspiration of oral periodontopathic bacteria into the lungs and changing inflammatory responses. Equally, periodontal diseases are associated with the longitudinal decline in spirometry lung volume. Several studies suggest a possible beneficial effect of periodontal therapy in improving lung function with a decreased frequency of exacerbations and reduced risk of adverse respiratory events and morbidity. Here, we review the current literature outlining the link between the oral cavity and pulmonary outcomes and focus on the microflora of the oral cavity, environmental and genetic factors, and preexisting conditions that can impact oral and pulmonary outcomes.

Oral Granulomatous Disease

Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is triggered by an array of infectious and noninfectious agents, and may be localized or a manifestation of systemic, disseminated disease. As in the skin, oral manifestations of granulomatous inflammation are often nonspecific in their clinical appearance. Thus, in the absence of overt foreign material or a recognizable infectious agent, identifying the underlying cause of the inflammation can be challenging. This article highlights various conditions known to induce granulomatous inflammation within the oral soft tissues.

Infectious arthritis and the temporomandibular joint. A review

OBJECTIVE

Microorganisms can cause acute infectious arthritis, chronic infectious arthritis, or reactive inflammatory arthritis. The aim of this study is to perform a narrative review of the pathophysiology, etiology, and diagnostic features of infectious arthritis and TMJ infectious arthritis.

METHODS

A search of the literature was performed using Medline, Scielo, Embase, and Google Scholar databases. The terms employed for the search were "Temporomandibular Joint Disorders" and "Infectious Arthritis"; or "Septic Arthritis"; or "Bacterial, Fungal, or Viral Arthritis." Over three hundred articles were screened for eligibility.

RESULTS

The selected articles were utilized to perform a narrative review of the general aspects of infectious arthritis and infectious arthritis affecting the TMJ.

CONCLUSION

Infectious arthritis is a rare, yet very morbid, form of arthritis. Understanding general aspects of joint infections and specific features of TMJ infectious arthritis is imperative for an adequate diagnosis.

Orofacial tuberculosis: A diagnostic challenge

Tuberculosis is typically a pulmonary chronic infectious disease with a high prevalence in developing countries which carries a substantial rate of mortality. Extrapulmonary disease may occur, mainly second to the endogenous spread of the pathogen from the primary site. Oral or mandibular involvement represents a minority among the reported cases. A 12-year-old female patient with a diffuse left-sided facial swelling and dull pain that gradually developed over 8 months, presented to us with misdiagnosis and poor management. Examination was found to have a firm swelling involving the buccal region, and left posterior mandible with intact overlying skin and mucosa, and palpable cervical lymphadenopathy. Imaging showed a heterogeneous osteolytic lesion of left ramus extending to the surrounding soft tissue. The diagnosis with oro-facial tuberculosis was established by histopathological study and confirmed by the Mantoux test and polymerase chain reaction. Although it occurs rarely, oro-facial tuberculosis has detrimental local and systemic effects, and devoid of characteristic clinical and radiographic features, poses a diagnostic challenge.

Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management

For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.

Non-plaque-induced gingival diseases

While plaque-induced gingivitis is one of the most common human inflammatory diseases, several non-plaque-induced gingival diseases are less common but often of major significance for patients. The non-plaque-induced gingival lesions are often manifestations of systemic conditions, but they may also represent pathologic changes limited to gingival tissues. A classification is proposed, based on the etiology of the lesions and includes: Genetic/Developmental disorders; Specific infections; Inflammatory and immune conditions and lesions; Reactive processes; Neoplasms; Endocrine, Nutritional and metabolic diseases; Traumatic lesions; and Gingival pigmentation.

Non-plaque-induced gingival diseases

While plaque-induced gingivitis is one of the most common human inflammatory diseases, several non-plaque-induced gingival diseases are less common but often of major significance for patients. The non-plaque-induced gingival lesions are often manifestations of systemic conditions, but they may also represent pathologic changes limited to gingival tissues. A classification is proposed, based on the etiology of the lesions and includes: Genetic/Developmental disorders; Specific infections; Inflammatory and immune conditions and lesions; Reactive processes; Neoplasms; Endocrine, Nutritional and metabolic diseases; Traumatic lesions; and Gingival pigmentation.