Infections

What infections can affect the oral cavity?

There a lots of micro-organisms (“bugs”) in the oral cavity, all living in balance and harmony….most of the time. Sometimes, the “wrong” organisms get the upper hand and infections can ensue with an impact on quality of life. Fortunately, these are rarely serious.

Common infections can include:

• bacterial odontogenic infections: these can be from acutely or chronically infected teeth, on occasion becoming serious due to involvement of fascial spaces in the head and neck with the potential risk of airway compromise necessitating emergency treatment;
• herpes simplex virus-1 and -2 (HSV-1/HSV-2): HSV-1 in particular is commonly seen in children as herpetic gingivostomatitis but is a self-resolving illness which may later on present as “cold sores” in adulthood
• varicella zoster virus (VZV): responsible for chicken pox, this can cause shingles within dermatomal distributions of the trigeminal nerve in adulthood, ultimately having the potential to cause long-term neuropathic pain in some individuals
• Ebstein Barr virus (EBV): responsible for glandular fever, this is self-limiting but may have serious consequences in some susceptible patients
• herpangina: caused by the Coxsackie virus, this causes ulceration at the back of the throat which is readily identifiable and self-limiting
• candidiasis: most commonly due to Candida albicans, an opportunistic fungal infection seen particularly in patients with compromised immune systems and/or poor denture hygiene in particular

Why might I have acquired an infection?

In many instances, acquisition of common oral infections can be just “bad luck” but often it is a combination of host factors, pathogen factors and local factors. In some instances, the infection (e.g. candidiasis) may be indicative of broader underlying problems such as a compromised immune system (e.g. due to poorly controlled diabetes or HIV/AIDS). Sometimes, the pathogens are more aggressive and gain the upper hand to cause symptomatic infections. Local factors can include poor oral hygiene e.g. wearing dentures throughout the night and/or ineffective hygiene regimens can predispose otherwise healthy individuals to opportunistic infections.

How are these diagnosed?

In many instances, the diagnosis is purely clinical. It is based on pattern recognition of the appearances of your oral cavity and other associated signs and symptoms. Where required, this can be supplemented with biopsies and/or swabs for microbiology testing. Where underlying systemic causes are suspected, suitable tests can be arranged and returned within hours for definitive exclusion (e.g. diabetes screening, HIV serology). I will closely follow your case until the point of diagnosis or resolution, with early and effective treatment where warranted.

What treatment can be offered?

In many instances, these infections can be self-limiting (e.g. the viral infections cited above). Reassurance may be all that is required, as well as good supportive management such as hydration, paracetamol, good oral hygiene and the passage of time. Some infections may have specific targeted treatment (e.g. acyclovir for HSV-1). Sometimes, it is a case of reducing patient susceptibility (e.g. improving diabetic control) and/or managing local factors (e.g. periodontal therapy, extracting or treating compromised teeth, etc.). With a dual qualification in medicine and dentistry and a specialisation in Oral and Maxillofacial Surgery, I am well placed to make a timely and accurate diagnosis, start targeted treatment where applicable and ensure that your recovery is the best and fastest that it can be.