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CHANGES IN THE ORAL MUCOSA IN PATIENTS WITH TUBERCULOSIS
Kholboyeva Nasiba Asrorovna
Assistant of the Department of Therapeutic Dentistry, Faculty of Dentistry,
Samarkand State Medical University
Rabbimov Mansur Kholmirzayevich,
Arabov Abduvokhid Davronovich
5th year students
Abstract:
Tuberculosis (TB) primarily affects the lungs but can also involve the oral mucosa,
leading to ulcerations, nodules, and granulomas. Oral TB may present as a primary or secondary
infection, often mimicking other conditions like malignancies or fungal infections. Diagnosis
relies on histopathology, microbiological tests, and molecular techniques. Treatment follows
standard anti-tubercular therapy, usually resolving lesions. Early detection is critical, especially
in endemic regions and immunocompromised individuals. Dental professionals play a vital role
in identifying and managing oral TB. Increased awareness and a multidisciplinary approach are
essential for timely intervention and improved patient outcomes.
Keywords:
Tuberculosis, oral mucosa, ulceration, granuloma, Mycobacterium tuberculosis,
diagnosis, anti-tubercular therapy, oral lesions, immunosuppression, dental professionals.
Tuberculosis (TB) remains one of the most significant infectious diseases worldwide, affecting
millions of people each year. While the primary target of Mycobacterium tuberculosis, the
causative agent of TB, is the lungs, it can also affect other parts of the div, including the oral
cavity. Oral manifestations of tuberculosis are relatively uncommon but can provide crucial
diagnostic clues, particularly in endemic regions where the disease is prevalent. Changes in the
oral mucosa in TB patients can result from primary infection, secondary infection due to
pulmonary involvement, or as a consequence of systemic immunosuppression. These changes
may range from ulcerations, nodules, and granulomas to non-specific inflammation, often
mimicking other oral conditions such as malignancies, fungal infections, or traumatic lesions.
Understanding the oral manifestations of TB is essential for early diagnosis, timely intervention,
and improved patient outcomes.
Oral tuberculosis can present as either a primary or secondary infection. Primary oral TB is rare
and usually occurs in individuals who have never been exposed to Mycobacterium tuberculosis.
This form typically affects young individuals and is caused by direct inoculation of the bacteria
into the oral mucosa through contaminated food, dental procedures, or direct contact with
infected sputum. The most commonly affected sites include the tongue, gingiva, lips, and buccal
mucosa, with lesions presenting as painful ulcers, nodules, or fissures. Primary TB of the oral
cavity is usually self-limiting, but in cases where the infection persists, it may progress to deeper
tissues and cause extensive mucosal destruction. Due to its rarity and non-specific clinical
presentation, primary oral TB is often misdiagnosed as aphthous ulcers, traumatic ulcers, or even
oral squamous cell carcinoma.
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Secondary oral tuberculosis is more common and occurs due to hematogenous spread, lymphatic
dissemination, or direct extension from pulmonary tuberculosis. Patients with active pulmonary
TB may develop secondary oral lesions as a result of coughing up infected sputum, which comes
into direct contact with the oral mucosa. These lesions typically present as deep, painful ulcers
with irregular borders, often covered with a yellowish or grayish slough. The most frequently
affected sites in secondary TB are the tongue, soft palate, gingiva, and buccal mucosa. In some
cases, nodular or granulomatous lesions may develop, mimicking conditions such as oral
candidiasis, syphilis, or even malignancies. The presence of chronic non-healing ulcers in TB-
endemic areas should raise suspicion for tuberculosis, particularly in patients with other systemic
symptoms such as weight loss, night sweats, persistent cough, and fever.
The pathogenesis of oral TB lesions is closely linked to the host immune response.
Mycobacterium tuberculosis triggers a delayed-type hypersensitivity reaction, leading to
granuloma formation, caseation necrosis, and tissue destruction. Histopathological examination
of oral TB lesions typically reveals epithelioid cell granulomas with Langhans giant cells,
caseous necrosis, and lymphocytic infiltration. The definitive diagnosis of oral TB is confirmed
through microbiological and molecular techniques such as acid-fast bacilli (AFB) staining,
culture, polymerase chain reaction (PCR), and biopsy. In some cases, tuberculin skin testing and
interferon-gamma release assays (IGRAs) may aid in confirming the diagnosis. However, these
tests have limitations, particularly in regions with high TB prevalence, where latent TB infection
is common.
The differential diagnosis of oral tuberculosis is broad and includes a range of infectious,
neoplastic, and inflammatory conditions. Oral squamous cell carcinoma, which shares similar
clinical features with TB ulcers, is a primary concern, especially in older patients with risk
factors such as tobacco and alcohol use. Syphilitic ulcers, histoplasmosis, and deep fungal
infections may also resemble oral TB lesions, necessitating thorough clinical evaluation and
laboratory investigations. Other conditions, such as traumatic ulcers, pemphigus vulgaris, and
Crohn’s disease, may present with chronic non-healing oral lesions, further complicating the
diagnostic process. Given the overlap in clinical presentation, a high index of suspicion and a
multidisciplinary approach involving dentists, oral pathologists, and infectious disease specialists
are essential for accurate diagnosis and management.
Treatment of oral tuberculosis follows the standard anti-tubercular therapy (ATT) regimen,
which includes a combination of first-line drugs such as isoniazid, rifampicin, pyrazinamide, and
ethambutol. The duration of treatment typically lasts six months, although in cases of multidrug-
resistant TB (MDR-TB), longer and more complex regimens may be required. Patients with oral
TB usually experience complete resolution of mucosal lesions following successful ATT,
although some may develop residual scarring or pigmentation. Supportive therapy, including
pain management, antimicrobial mouth rinses, and maintenance of good oral hygiene, may aid in
symptom relief and prevent secondary infections. In cases where oral lesions fail to respond to
conventional TB treatment, additional investigations should be conducted to rule out drug
resistance, co-infections, or alternative diagnoses.
The presence of oral TB lesions may also serve as an indicator of underlying immunosuppression,
particularly in patients with HIV/AIDS. Co-infection with HIV significantly increases the risk of
tuberculosis and alters the typical presentation of the disease. Oral TB in HIV-positive
individuals may present with more extensive mucosal involvement, atypical ulcerations, and a
higher likelihood of co-existing opportunistic infections. The diagnosis of TB in HIV-positive
patients is often challenging due to atypical radiographic findings, lower sensitivity of sputum-
based diagnostic tests, and a higher prevalence of extrapulmonary TB. Therefore, clinicians
should maintain a high level of vigilance when evaluating oral mucosal changes in
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immunocompromised individuals.
Despite the availability of effective treatment, tuberculosis remains a major global health
challenge, particularly in developing countries with high disease burden and limited healthcare
resources. Delays in diagnosis, poor treatment adherence, and the emergence of drug-resistant
TB strains contribute to ongoing transmission and disease progression. Public health efforts
aimed at early detection, improved access to diagnostic facilities, and adherence to treatment
protocols are crucial in controlling TB and reducing its impact on affected populations. Dental
professionals play a vital role in the early recognition of oral TB lesions, referral for further
evaluation, and patient education on TB prevention and treatment adherence. Tuberculosis
remains a significant global health concern, primarily affecting the lungs but also manifesting in
extrapulmonary sites such as the oral cavity. Although oral tuberculosis is relatively uncommon,
its presence can be an essential diagnostic indicator, especially in patients with active pulmonary
TB or immunosuppression. The disease can present as primary or secondary infection, with
lesions appearing as ulcerations, nodules, granulomas, or non-healing ulcers that often mimic
malignancies, fungal infections, or traumatic lesions. This overlap in clinical presentation makes
oral TB a diagnostic challenge, requiring careful evaluation by healthcare professionals,
including dentists, oral pathologists, and infectious disease specialists.
In conclusion, changes in the oral mucosa in patients with tuberculosis can manifest in a variety
of forms, ranging from ulcerations and nodules to granulomas and caseous necrosis. While oral
TB is relatively uncommon, it remains an important diagnostic consideration, particularly in
endemic regions and immunocompromised individuals. Accurate diagnosis requires a
combination of clinical evaluation, histopathology, microbiological testing, and molecular
techniques. Treatment with anti-tubercular therapy is generally effective, although early
detection and intervention remain key to preventing complications. Given the overlap of oral TB
with other infectious and neoplastic conditions, a multidisciplinary approach is essential to
ensure timely diagnosis and appropriate management. As TB continues to pose a significant
global health burden, increased awareness among healthcare providers, including dental
professionals, is essential for improving patient outcomes and reducing the spread of this
infectious disease.
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