.Most infections of the mouth are caused by microorganisms. For example, some conditions predispose to these infections, such as the states of acquired immune deficiency or secondary to systemic diseases or viral infections. Classically, a person subjected to prolonged stress, for example a person who feeds evil, as it may, and who works under urgent stimuli, may develop oral lesions. Similarly, patients with human immunodeficiency syndrome may present due to the immunosuppression induced by HIV infection or cancer and many autoimmune and idiopathic lesions in the mouth. Some, such as oral candidiasis and hairy leukoplakia, benign epithelial hyperplasia associated with Epstein-Barr virus, are common findings of HIV infection and often precede or accompany AIDS. Others, such as Kaposi's sarcoma and lymphoma oral, are diagnostic of AIDS. Oral candidiasis can be easily treated by the administration of topical or systemic antifungals, among these is the nystatin in the form of tablets or vaginal plugs, the clotrimazole (rinsing of the mouth), fluconazole and ketoconazole. While most oral lesions of HIV infection are also seen in the general population, both hairy leukoplakia and necrotizing ulcerative periodontal disease are closely associated with HIV infection and is observed only very rarely in other conditions. In saliva can be found only small and variable amounts of HIV, but the blood, tissue fluids and exudates of gum cracks that are observed in the mouth as a result of injury or clinical manipulations are certainly a source of other viruses such as herpes simplex and Epstein-Barr virus, the same can not therefore apply to HIV.



Infections of the mouth, vesicular, bullous and ulcerative



· Primitive acute herpetic stomatitis, caused by herpes simplex virus is a fairly common disorder of the lips and oral mucosa that presents with lip blisters that break and form crusts of white-honey, oral vesicles that rapidly ulcerate; extremely painful ; acute gingivitis, fever, malaise, stench of the mouth, cervical lymphadenopathy, these diseases occur mainly in infants, children and young adults. Heal spontaneously in 10-14 days if the vesicles do not become infected secondarily



· Herpes labialis applicant is manifested in the mucocutaneous junction of the skin around the mouth, lips, such as eruption of groups of vesicles that can fuse and then break and form crusts, pain or pressure with spicy foods. It lasts about a week, but may be prolonged if secondary infection occurs. Lesions occur on the high arched palate.



· Varicella, Skin lesions may be accompanied by small blisters that break oral mucosal ulcers to form well-defined, may undergo coalescence to form large blisters that ulcerate, the mucosa may have generalized erythema.
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· Herpes zoster: vesicular eruption and ulceration following unilateral linear distribution of the trigeminal sensory or one of its branches.



· Infectious mononucleosis: fatigue, sore throat, malaise, fever and swollen cervical lymph nodes, while several small ulcers usually appear several days before the lymphadenopathy, gingival bleeding and multiple petechiae at the junction of the hard palate and soft palate.



Warts by · papillovirus: single or multiple papillary lesions, with thick white keratotic surface that contains many projections point; injury "cauliflower" covered by mucosa of normal color or multiple swellings pink or pale appearance (focal epithelial hyperplasia).



· Herpangina coxsackievurus A B and echovirus. Sudden onset of fever, sore throat and oropharyngeal vesicles, usually in children under 4 years during the summer season, pharyngeal congestion and diffuse vesicles (diameter of 1-2 mm) surrounded by a grayish-white in red areola, the vesicles enlarge and ulcerate.



· Acute necrotizing ulcerative Gingivitis (Trench Mouth, Vincent's infection), bleeding sore gums, characterized by necrosis and ulceration of gingival papillae and their margins, which is associated with lymphadenopathy and foul odor.



· Primary syphilis (chancre), the lesion appears where the germ enters the lips, tongue and tonsil area. Small papules that form a large ulcer, painless, with hardened edges; unilateral lymphadenopathy; chancre and lymph nodes containing spirochetes, positive serological tests from third to fourth week after infection



Secondary syphilis, where the oral mucosa commonly affected by mucous patches, primarily on the palate, but also to the labial commissure. Maculopapular lesions of the oral mucosa (5-10 mm diameter) and central ulceration covered with greyish membranes; eruption on various mucosal surfaces and skin accompanied by fever, malaise, or sore throat.

Tertiary syphilis, with infiltrates of chewy palate or tongue, followed by ulceration and fibrosis, atrophy of lingual papillae that determines a characteristic language "bald" and glossitis.

Gonorrhea, in the course of gonorrhea in the mouth lesions may develop at the site of inoculation or secondarily to hematogenous spread from another primary focus, early symptoms consist of burning sensation or itching, dryness and heat in the mouth, followed by acute pain in eating or speaking, tonsils and oropharynx frequently involved; oral tissues can be extensively inflamed or ulcerated, the saliva has a higher viscosity and fetid odor; submaxillary lymphadenopathy and fever in severe cases.

Tuberculosis, affecting the tongue, tonsillar area, soft palate, is characterized by solitary ulcer, irregular, covered with an exudate persistent ulcer has hard edges, undermined.

Cervicofacial actinomycosis: swelling of the face, neck and mouth floor, the infection may be associated with extraction, fracture, or eruption of a maxillary molar, the acute form resembles an acute pyogenic abscess but containing "granules sulfur "yellow (Gram-positive and their fungal hyphae)

Histoplasmosis, affecting every area of the mouth, especially the tongue, gums and palate, is characterized by numerous small nodules that may ulcerate, hoarseness, and dysphagia may occur in the presence of laryngeal lesions, usually associated with fever and malaise.

Candidiasis: pseudomembranous form with white plaques that are easily removed leaving an area of red, bloody and painful, erythematous form is flat and red, Candida leukoplakia rarely occurs in the form of white patches on the tongue that can not be scraped out ; in Candida cheilitis angular fissures and erythema are seen on the corner of her mouth, in all previous injuries can prove the presence of Candida preparing prepared with potassium hydroxide



Dermatological diseases.

· Mucomembranoso pemphigoid. Mainly the lining of the mouth is affected, but also the eyes and vagina with the rectum. It is characterized by painful blisters or bubbles, grayish white, collapsed, with the suburb erythematous, desquamative gingival lesions that leave ulcerated areas.



Erythema multiforme or Stevens-Johnson syndrome, which affects the lining of the mouth and the skin of hands and feet to break bubbles endoorali area surrounded by inflamed, the lips may show hemorrhagic crusts; injury "rainbow" or " target "on the skin is pathognomonic, and patients may have severe signs of toxicity.



· Pemphigus vulgaris, affects the oral mucosa and skin, characterized by blisters and ulcerated oral areas, mainly the elderly.



· Lichen planus of the oral mucosa and skin, is characterized by whitish streaks in the mouth, purple papules on the skin rubbed; occasionally causes oral mucosal ulcers and erosive gingivitis.



· Recurrent aphthous ulcers, which affect all parts of the keratinized oral mucosa, that is, lips, tongue, buccal mucosa, floor of the mouth, soft palate and oropharynx. It is characterized by painful ulcers in single or in groups, with walls surrounding erythematous, the lesions may have a diameter of 1-2 mm, when gathered in groups herpetiformis of 1-5 mm or 5-15 mm. The lesions heal in 1-2 weeks but may recur several times a year. Topical steroids may provide relief.



· Behcet's syndrome. These multiple aphthous ulcers of the mouth, eyes and genitals, bowel and central nervous system, which can persist for several weeks and heal without scarring.



see page on Cancer of the mouth

90% of oral malignant tumor is the squamous cell or epidermoid, while the remaining 10% is attributable to cancers of the group of adenocarcinomas (papillary cystic and undifferentiated mucoid. The language is the most frequently involved, followed by cancer of the lip, once called "the cancer of the pipe smoker, now common in fair-skinned people, particularly in subjects exposed to the sun. The oral cancer with those of the larynx and pharynx account for 10 percent of all malignancies in men and 4 percent in women. In Italy it is estimated that every year 4500 new cases are diagnosed


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