CHANGES IN THE ORAL MUCOSA IN PATIENTS WITH TUBERCULOSIS

Аннотация

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 body, 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, andimproved 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. https://ijmri.de/index.php/jmsi volume 4,issue2,2025 540 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 suchas weight loss, night sweats, persistent cough, andfever. 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 iscommon. 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, nec