QUIZ: Oral Manifestations of Infectious Diseases

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Test Your Oral Manifestations of Infectious Diseases Knowledge

Lets test your knowledge on oral manifestations of infectious diseases.

1. Oral manifestations of which infectious disease includes multiple scattered lesions on the oral mucosa and oropharynx, with the tongue, lips, and jugal mucosa most affected?

1. Secondary syphilis
2. Herpes simplex 1
3. HIV
4. Human papilloma virus

“Oral manifestations of secondary syphilis include multiple, scattered lesions on the oral mucosa and oropharynx, though the tongue, lips, and jugal mucosa are the most affected sites. Aphthous ulcers like gray plaques or ulcers with irregular, whitish edges that are painful at times are also observed. The diffuse character of the inflammatory process in the oropharynx may elicit complaints of sore throat. Oral lesions vary widely in appearance, increasing the complexity of diagnosis if the dental surgeon lacks the required qualifications in stomatology. In contrast to primary syphilis, secondary syphilis in the oral cavity is not associated with oral sex habits.”

Seibt, C.E., Munerato, M.C. Secondary syphilis in the oral cavity and the role of the dental surgeon in STD prevention, diagnosis and treatment: a case series study. The Brazilian Journal of Infectious Diseases: an official publication of the Brazilian Society of Infectious Diseases. 2016; 20(4): 393-398. https://www.bjid.org.br/en-secondary-syphilis-in-oral-cavity-articulo-S1413867016300769

2. Herpangina is a sudden viral illness found mostly in children under the age of 10; it causes small blister-like bumps or ulcers in the mouth. The most common viruses that cause it are Coxsackie viruses B and C.

1. Both statements are true
2. The first statement is true, the second statement is false
3. Both statements are false
4. The first statement is false, the second statement is true

Herpangina is a sudden viral illness found mostly in children under the age of 10; it causes small blister-like bumps or ulcers in the mouth. The most common viruses that cause it are enterovirus A71, echovirus, coxsackievirus A16, A6, and B. The oral lesions are often in the back of the throat and on the roof of the mouth. Additional signs and symptoms include sudden fever (sometimes as high as 106F), pain in the mouth and throat, malaise, headache, drooling, decreased appetite, neck pain, and irritability.

Herpangina in Children. (2021, June 1). Nationwide Children’s. https://www.nationwidechildrens.org/conditions/health-library/herpangina-in-children

3. Which of the following are oral findings in individuals with measles?

1. Koplik’s spots
2. Candidiasis
3. Ulcerative gingivitis
4. All of the above

Though Koplik’s spots (tiny, erythematous maculae with white necrotic centers) are the most common oral manifestation of measles, measles can also cause candidiasis, pericoronitis, ulcerative gingivitis, and necrotizing stomatitis. The measles virus downregulates important aspects of the immune response allowing opportunistic bacterial/fungal overgrowth that contributes to the onset of multiple oral manifestations.

Katz, J., Guelmann, M., Stavropolous, F., Heft, M. Gingival and other oral manifestations in measles virus infection. Journal of Clinical Periodontology. 2003; 30(7): 665-668. https://doi.org/10.1034/j.1600-051x.2003.00356.x 

4. HIV-related oral manifestations include xerostomia, candidiasis, hairy leukoplakia, linear periodontal disease (gingival erythema), necrotizing ulcerative periodontitis, Kaposi’s sarcoma, HPV-associated papilloma, HSV lesions, recurrent aphthous ulcers, and neutropenic ulcers.

1. True
2. False

HIV exhausts and destroys lymphocytes resulting in fewer T-helper lymphocytes to protect the host from viral, bacterial, fungal, and other opportunistic infections. Oral lesions associated with HIV include Kaposi’s sarcoma, oral hairy leukoplakia, gingival and periodontal disease, aphthous ulcers, oropharyngeal candidiasis, and xerostomia (HIV-related salivary disease). 

Patton, L.L. Oral lesions associated with human immunodeficiency virus disease. Dental Clinics of North America. 2013; 57(4): 673-698. https://doi.org/10.1016/j.cden.2013.07.005

5. Which infectious disease is associated with a thick, gray, adherent pseudo membrane over the throat and tonsils?

1. Group A Streptococcus
2. Diphtheria
3. Human papilloma virus
4. None of the above

The most prominent feature of diphtheria is the thick, gray adherent pseudo membrane over the tonsils and throat. This is what gave it nicknames such as “strangling angel” and “the kiss of death.” The pseudo membrane consists of red blood cells, white blood cells, dead cell debris and organisms. The pseudo membrane forms due to the exotoxin released by the bacteria C. diphtheria. Other signs and symptoms include flu-like symptoms such as fever, sore throat, and cervical lymphadenopathy. Prior to the release of the vaccination, diphtheria was responsible for between 13,000 and 15,000 deaths per year in the U.S.

Lamichhane, A., Radhakrishnan, S. Diphtheria. [Updated 2021 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560911/

Acosta, A.M., Moro, P.L., Hariri, S., Tiwari, T.S.P. (2021, August 18). Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book. Chapter 7: Diphtheria. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/pubs/pinkbook/dip.html

6. Which of the following is the cause of “cold sores” on the lips and around the mouth?

1. Herpes simplex virus type 1
2. Herpes simplex virus type 2
3. Both of the above
4. None of the above

Both HSV 1 and HSV 2 can infect both the mouth and the genitals. Though many people mistakenly believe HSV 1 can ONLY infect the mouth and HSV 2 can ONLY infect the genitals, this is untrue. The primary infection is often the worst and can cause severe flu-like symptoms, swollen lymph nodes, and headache, in addition to the eruption of painful fluid file blisters. Herpes virus sores that infect the mouth most commonly appear on the lips or under the nose; they can also appear on the gingiva, palate, and buccal mucosa. The lesions mostly present on keratinized skin.

It should be noted that elective dental treatment (i.e., hygiene treatment) should be postponed until oral lesions have healed. 

Health Library: Herpes Simplex (HSV) Mouth Infections. (n.d.). Cedars Sinai. https://www.cedars-sinai.org/health-library/diseases-and-conditions/h/herpes-simplex-virus-hsv-mouth-infection.html

Aslanova, M., Ali, R., Zito, P.M. Herpetic Gingivostomatitis. [Updated 2021 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526068/

Vavrosky, K. (2018, January 1). Why Hygienists Should NEVER Treat Patients with Active Oral Herpes. Today’s RDH. https://www.todaysrdh.com/why-hygienists-should-never-treat-patients-with-active-oral-herpes/

7. Hepatitis C virus has been epidemiologically linked to oral lichen planus. Hepatitis C can be linked to oral basal cell carcinomas.

1. Both statements are true
2. The first statement is true, the second statement is false
3. Both statements are false
4. The first statement is false, the second statement is true

Hepatitis C may be implicated in the pathogenesis of oral lichen planus, as well as an association with Sjogren’s syndrome. Additionally, Hepatitis C can be linked to oral squamous cell carcinoma. Other oral lesions such as paraneoplastic pemphigus, pemphigus vulgaris, and Bechet’s disease have anecdotally been linked to hepatitis C. However, further studies need to be done to confirm an associating or causal link.

Carrozzo, M., Scally, K. Oral manifestations of hepatitis C virus infection. World Journal of Gastroenterology. 2014; 20(24): 7534-7543. https://doi.org/10.3748/wjg.v20.i24.7534

All 7 questions completed!


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