TUBERCLOSIS:

 It is caused by myobacterium tuberculosis which

is aerobic , gram + ve rods both acid and alcohol
fast bacterium.

Pathogenesis:

The organism is capable of stimulating specific

granulomatous reaction manifested by:

1. Caseous necrosis.

2. Large mononuclear epithelioid cells

( macrophages ingesting lipids).

3. Langerhan's gaint cells (fused

macrophages).

Site Of Invasion:

· Lung pulmonary T.B ( Gohn's Focus).

· Skin lupus vulgaris .

· Vertebrae pott's disease.

· Adrenal gland cortex A disson's disease.

 · Lymph nodes Scrofula.

Oral Involvement:

1. Primary complex.

2. Secondary to pulmonary, skin or systemic

involvement.

1. Primary complex :

· Site of invasion: The microorganism invades

oropharynx through tonsils or oral mucosa after
droplet infection.

· Clinical picture: · Painless progressing ulcer

at the entry site · Enlargement of regional lymph
nodes · The enlarged lymph nodes may become:

1. Firm,matted,tender. 2. Caseation occurs

forming cold abcess discharging through sinus tract.
3. Calcification might occur.

2. Secondary To Pulmonary T.B :

Mode Of Infection:
 The coughed sputum is loaded by bacilli that
enter oral mucosa through any break of the
surface epithelium specially tongue or palate.

 Blood or lymphatic borne infection.

Clinical Features:

 Nodular growth.

 Painful ulcer, deep,well defined, undermind

edges, covered with yellowish base.

 No regional lymph node enlargement.

3. Secondary To Lupus Vulgaris Mode Of

Infection:

 Exogenous inoculation, endogenous lymphatic

or blood borne

Age Of Incidence :

 Childhood or adolesence

Clinical Features:
  Skin lesion reddish brown papules coalesce
forming patches healing at the center by scar
formation.

 +ve Diascopic examination glass slide with

slight pressure at day light reveals apple jelly
colour of the lesion.

 Oral lesion small nodular or papilamatous lesion

later fissuring and ulcerating. It responds very
well to cauterization.

4. Secondary To Advanced Systemic T.B:

 Mode of infection : Blood borne.

 Site of infection :

1. Periapical infection --------- granuloma.

2. Jaw bone -------- osteomyelitis.

 Diagnosis of T.B :
 1.Bacterial smear to demonestrate tubercle
bacilli.

2. Biopsy.

3.Chest x- ray.

4.Tuberculin test ( Mantoux- Heaf test).

1. Intradermal injection of 0.001 mg of purified

protein derivative.

2. 48 – 72 hours later the area will be examined

10 mm induration or more is considered + ve.

 Dental Management :

1. Consult the physician and do only emergency

treatment.

2. Children under age of 6 are not infectious .

3. The dental personal should wear gloves,masks

and gowns.

4. Avoid high speed.

5. Dental impressions and bite blocks should be

immersed in antiseptic solutions.