UNDER THE GUIDANCE

OF:
DR.N.N SINGH
DR.NAHILA RASHEED

Presented by:
IRAM FATIMA
B.D.S. IIIrd year

Introduction
Tuberculosis is a specific infectious
granulomatous disease caused by
Mycobacterium tuberculosis.[SHAFERS ]
Tuberculosis is very common in India and
Southeast Asia.
Fifteen percent of the tuberculous population
of the world resides in India.

History of Tuberculosis
Historically known by a
variety of names, including:
Consumption
Wasting disease
White plague
1882 Robert Koch
discovered M. tuberculosis,
the bacterium that causes
TB

Epidemiology
India accounts for nearly one fifth of global burden of
TB
Vulnerability to TB in developing countries results
from poverty, economic recession and malnutrition
Worldwide 2 billion people are infected
Each year 9 million additional individuals become
infected.
Dr.T.V.Rao MD 4
Etiological Agent
M. tuberculosis
rod-shaped,
slender
non-spore-forming
Thin aerobic bacterium
0.5 m to 3 m
cannot be decolorized by acid
alcohol; this characteristic justifies
their classification as acid-fast
bacilli.
TB Transmission
Transmission of Tubercle bacilli
through following routes:
INHALATION
INGESTION
INOCULATION
TRANSPLACENTAL ROUTE
TB Pathogenesis
Interaction of bacilli and host begins when
droplet nuclei from infectious patients are
inhaled.
Diameter of these aerosolized droplets ranges
from 1 to 5 microns




Initial stage
Host bacterial interaction
Macrophages control bacterial multiplication
Or bacteria grow and kill macrophages
Non activated monocytes attracted from blood
stream to the site
Ingest organism from lysed macrophages
Asymptomatic stage
After 2 to 4 weeks tissue damage and
macrophage acting responses develop


Specific immunity develops
Large number of activated macrophages
accumulate at the site of primary lesion
Granulomatous reaction or tubercles are
formed
Hard tubercle consists of
epithelioid cells,langhans
giant cells,plasma cells
and fibroblast
Due to cell mediated
immunity local
macrophages activate and
lymphokines are released

Central part undergoes
caseous necrosis
Calcification of caseous
material called Ranne
complex in lung
parenchyma and hilar
lymph nodes

Signs and Symptoms
associated with the TB
Cough (2-3 weeks or more)
Coughing up blood
Chest pains
Fever
Night sweats
Feeling weak and tired
Losing weight without trying
Decreased or no appetite
If you have TB outside the lungs, you may have other symptoms

TYPES OF TUBERCULOSIS
Asymptomatic primary Tuberculosis
Symptomatic Primary Tuberculosis
Progressive Primary Tuberculosis
Miliary tuberculosis
Bronchopneumonia
Intestinal Tuberculosis
Reactivation Tuberculosis or Secondary Tuberculosis



Oral manifestations are rare due to
Protective effect of saliva
Resistance of striated muscles to bacterial
invasion
Thickness of protective epithelial covering

Organism enter mucosa through small break
in surface.
Local factors responsible for invasion are:
Poor oral hygiene
Leukoplakia
Local trauma
Irritation by clove chewing

TUBERCULOUS
ULCER
Primary lesions
uncommon
seen in younger patients
present as single painless ulcer with regional lymph node
enlargement.
Secondary lesions
Common
often associated with pulmonary disease
usually present as single, indurated, irregular, painful ulcer
covered by inflammatory exudates in patients of any age group but
relatively more common in middle-aged and elderly patients.
Involves gingiva
Diffuse,hyperemic,nodular or
papillary proliferation of gingival
tissues

GINGIVAL TUBERCULOSIS
Maxillary sinus Tuberculosis
Most commonly, it presents
as nasal
discharge, stuffiness of nose,
crust formation associated
with pulmonary TB.
CASEOUS
NECROSIS

Tuberculous cervical
lymphadenitis
Mycobacterial cervical lymphadenitis, also known as
scrofula, refers to a lymphadenitis of the cervical lymph
nodes associated with tuberculosis as well as non tuberculous
(atypical) mycobacteria.
Symptoms of the disease, such as
fever, chills, malaise and weight
loss in about 43% of the patients.
As the lesion progresses, skin
becomes adhered to the mass and
may rupture, forming a sinus and
an open wound
ORAL CANDIDIASIS

Candida. albicans is the predominant
species.
The incidence of Candida species in the oral cavity and the
reasons for the establishment of infections caused by these
microorganisms have been associated to immunosuppression,
endocrine disorders, mucosal lesions, poor oral hygiene, and
long-term treatment with antibiotics or corticosteroids
DIAGONOSIS OF
TUBERCULOSIS
Sputum Examination
Chest X Ray
Tuberculin Testing
CT Scan
MRI
PCR
ELISA
Sputum examination
There are direct smear
and culture methods.
Direct smear
examination is only
positive when a large
no. of bacilli begin to
excrete
Tuberculin Test
Intradermal injection of 0.1 ml
of tuberculoprotein,purified
protein derivative[PPD]
Delayed hypersensitivity in
previosly infected individuals
Indurated area of more than
15mm in 72 hours

TREATMENT
8 week course of
isoniazid,rifampicin and
pyrizinamide,followed
by 16 week course
isoniazid and rifampicin
Direct Observation
Treatment System
{DOTS}
QUESTION ANSWERS
1) What is Bovine Tuberculosis?
Bovine tuberculosis occurs due to
Mycobacterium Bovis and humans
get infected by drinking
unpasteurised milk.
Which staining is done for
mycobacterium tuberculosis?
Zeehl neelson staining
What is BCG?
Bacilli calmette guerin.it is attenuated
strains of bovine type of tun


REFRENCES:
SHAFERS TEXTBOOK OF ORAL PATHOLOGY,7
TH

EDITION}
NAVILLE ORAL AND MAXILLOFACIAL PATHOLOGY,3
RD

EDITION
HARSHMOHAN ESSENTIAL PATHOLOGY,4
TH
EDITION
BURKETS ORAL MEDICINE DIAGNOSIS AND
TREATMENT,10
TH
EDITION
Rodrigues G, Carneilo S, Valliathon M. Primary isolated
gingival tuberculosis. Braz J Infect Dis. 2007;11:1728.
Oral manifestations of tuberculosis REVIEW ARTICLE
CHRISMED Journal of Health and Research /Vol 1/Issue
1/Jan-Apr 2014
Oral Lesions of Tuberculosis- An Overview