Orofacial tuberculosis | Symptoms | Diagnosis | Treatment
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Orofacial tuberculosis - Symptoms, Diagnosis and Treatment

Published on Mar 07, 2022 and last reviewed on Dec 19, 2022   -  5 min read


The tongue, jaw, and face muscles are affected by a rare disorder called oromandibular dystonia. Please read below to know about the causes, diagnosis, and treatment.

Orofacial tuberculosis - Symptoms, Diagnosis and Treatment


Tuberculosis is a well-known infectious disease that accounts for one of the leading causes of death due to infection after HIV (human immunodeficiency virus). It has affected over 1.7 billion individuals worldwide. The disease flourishes wherever there is poverty, crowding, and chronic debilitating illness.

Tuberculosis mainly affects the elderly, and certain conditions like diabetes, malnutrition, alcoholism, immunosuppression increase the risk. Mycobacterium tuberculosis is responsible for most cases of tuberculosis. Mycobacterium Bovis causes intestinal and oropharyngeal tuberculosis contracted by drinking unpasteurized milk. Although tuberculosis affects the lungs (pulmonary tuberculosis), other sites can also be involved (extrapulmonary tuberculosis). Orofacial tuberculosis is a rare extrapulmonary manifestation of tuberculosis.

What Is Orofacial Tuberculosis?

As mentioned above, orofacial tuberculosis is an extrapulmonary manifestation occurring approximately in 0.1% to 5% of all tuberculosis-affected patients. This form is uncommon, and the clinical signs are not specific to establish the diagnosis. Any site in the oral cavity and its associated structures can be involved. Misdiagnosis is expected as the oral lesions can be present before the systemic symptoms. Dentists are generally the first clinicians to witness the signs of orofacial tuberculosis. This type of manifestation can be primary or secondary. The primary form of extrapulmonary tuberculosis affects children and adolescents, while the secondary form affects middle-aged to elderly patients.

What Are the Signs and Symptoms of Orofacial Tuberculosis?

The clinical signs and symptoms vary, and the involvement of soft and hard tissues of the oral cavity is quite common. The signs can be superficial or may involve deeper structures. The various presentations of orofacial tuberculosis include:

A. Tuberculous Ulcer:

  • The tuberculous ulcer is a common presentation of orofacial tuberculosis that can be painful or painless, single or multiple, and superficial or deep.

  • These ulcers can have an irregular border and vary in shape and size.

  • They often develop from a tubercle which then softens to form an oval ulcer with undermining margins.

  • Multiple nodules called “sentinel tubercles” can surround the ulcer.

  • The tongue is most commonly involved, followed by the floor of the mouth, gums, palate, and lips.

B. Tuberculous Gingivitis:

  • The gums (gingiva) may become inflamed, leading to gingivitis. The gingiva appears red and swollen due to the proliferation of the gingival tissues.

  • Deeper structures like the bone may not be involved initially. After the disease progresses, tooth structures can be lost, leading to loosening of the teeth.

  • The tuberculous gingivitis fails to respond to the conventional gingivitis treatment.

  • The lymph nodes of the neck may become enlarged (cervical lymphadenopathy).

C. Tuberculous Infection of Extraction Sockets of Teeth:

  • If the infection reaches the extraction site, the healing may get delayed.

  • The extraction socket may get filled with infectious tissue consisting of pink and red elevations.

  • This outbreak is uncommon, and the cases develop primary tuberculosis before the involvement of extraction sockets.

D. Osteomyelitis of the Jawbones:

  • Osteomyelitis refers to infection of the bones. It is a rare scenario, and the mandible (wisdom tooth region is commonly involved) is more affected than the maxilla.

  • Tuberculous osteomyelitis can affect adults as well as children.

  • The infection is caused through direct transfer from the sputum, through extraction sockets, a break in the mucosa, or through the circulating blood.

  • The infection causes necrosis of the jawbones leading to an abscess formation. In severe cases, the jawbone may fracture.

E. Tuberculous Infection of the Maxillary Sinus:

  • The maxillary sinus may get involved secondary to pulmonary or extrapulmonary tuberculosis.

  • It affects adults, and the symptoms include runny nose, stiffness of the nose, bleeding from the nose, and formation of crusts.

  • Nasal polyps may form because of the infection with pus discharge.

  • The lesions may resemble a cancerous growth.

F. Tuberculous Infection of the Temporomandibular Joint (TMJ):

  • The symptoms of the TMJ involvement resemble that of arthritis or any joint disease.

  • This condition occurs in low frequency, and the symptoms usually include stiffness and pain of the joint.

  • Muscle spasms may be common, leading to the inability to open the mouth.

G. Salivary Gland Infection (Sialadenitis) Due to Tuberculosis:

  • It is a rare condition involving the parotid or the submandibular salivary glands.

  • The infection of the parotid glands causes parotitis, which can be localized or diffuse, involving the entire gland.

  • The lymph nodes are initially involved and present as a non-painful, slow-growing swelling.

  • In the later stages of the infection, pain, pus, abscess, and involvement of the nerves can be seen along with general symptoms like fever, cough, weight loss, etc.

F. Lupus Vulgaris:

  • It is the most common form of superficial skin infection seen in patients with sensitivity to tuberculin (protein extracted from Mycobacterium tuberculosis).

  • The skin lesions form around the eyelids, nose, lips, cheeks, and ears with a predilection in females.

  • Lupus vulgaris can present as ulcers, plaque-like, tumor-like, papules, or nodules. The plaque form is common, accounting for 32% of cases.

  • The lesions can be single or multiple, and small lesions can merge into a larger one. The surface of the lesions exfoliates, leaving a central scar.

  • Lupus vulgaris resembles apple jelly due to its reddish-yellow or brown color nodules.

How Is Orofacial Tuberculosis Diagnosed?

Orofacial tuberculosis often goes undiagnosed due to its non-specific nature. The approach for diagnosing involves:

A. Understanding the Patient’s Medical History- The clinician asks for symptoms like cough, chest pain, fever, chills, loss of appetite, exposure to HIV, etc.

B. Physical Examination- As the oral lesions are not specific, a physical examination is not enough to confirm the tuberculosis infection.

C. Imaging Techniques- A chest X-ray, CT (computed tomography), and MRI (magnetic resonance imaging) can reveal the systemic infection.

D. Tuberculin or Mantoux Test- It is performed by injecting a purified protein of the bacteria injected intramuscularly. Development of a rash or bump at the injection site after 48 hours to 72 hours indicates the presence of the infection.

E. Microscopic Smear- Sample collected from sputum, oropharyngeal swabs, or biopsy is studied under the microscope to detect the tuberculosis bacteria.

What Is the Treatment for Orofacial Tuberculosis?

The treatment of orofacial tuberculosis is the same as systemic tuberculosis. The first choice of antibiotics includes Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E), and Streptomycin. If these drugs are not effective, injectable antibiotics like Kanamycin, Streptomycin, Levofloxacin, and Ofloxacin are prescribed. Orofacial tuberculous lesions also require surgical debridement. The first-line of medications recommended by the WHO (world health organization) has several limitations. New drugs are being developed that are effective and affordable.


Orofacial tuberculosis is a rare extrapulmonary manifestation occurring in 0.1% to 5% of all tuberculosis cases. A tuberculous ulcer occurs on various parts of the oral cavity, followed by gums, jawbones, maxillary sinus, and temporomandibular joint involvement. Lupus vulgaris is a common finding characterized by ulcers and eruptions on the facial skin. This condition goes undiagnosed due to its non-specific nature. Treatment mainly includes the use of first-line antibiotics recommended by the WHO and surgical debridement of the lesions.

Frequently Asked Questions


Can Tuberculosis Result in Facial Edema?

In the absence of tuberculosis elsewhere in the body, extra-oral involvement of the mouth is uncommon. The most typical symptom of oral TB is an inflammatory mucosa lesion, which can also appear as nodules and tuberculomas. However, the cheek's nodular swelling is visible.


What Are the Signs of Lymph Node Tuberculosis?

20 to 50 percent of people experience general symptoms such as fatigue, sweating, and weight loss. One or more painfully swollen lymph nodes are typically the result of lymph node TB. Most frequently, the illness affects the supraclavicular region or the anterior or posterior cervical chains.


How Does Tuberculosis Affect the Face?

Lupus vulgaris, often referred to as tuberculosis lupus, are painful nodular-appearing cutaneous TB skin lesions that most frequently develop on the face, particularly on the cheeks, ears, lips, eyelids, and neck. It is the most prevalent skin infection caused by Mycobacterium tuberculosis.


How Does Fnac Detect Tuberculosis?

For the diagnosis of tuberculosis, fine needle aspiration cytology (FNAC) offers a low-cost, rapid, and secure alternative to histopathology. In addition, it provides a good assessment of cytomorphological traits and is patient-friendly.


Can Lymph Nodes From TB Be Removed?

The main form of treatment for lymph node tuberculosis is anti-bacillary chemotherapy. Excision of adenopathies under 3 cm in diameter, abscesses, and fistulas based on the expertise. In cases of recurrence, resistance to anti-bacillary medications, and paradoxical upgrading reaction, lymph node dissection is also advised.


Can Lymph Node Tuberculosis Be Cured?

It is easy to treat lymph node TB, a non-communicable disease. Lymph node tuberculosis can be treated and is less harmful and communicable than tuberculosis. It is also not fatal.


What Is the Quickest Method to Treat TB?

Most patients feel better and are no longer susceptible after taking antibiotics for two weeks. Therefore, the most effective strategy to guarantee the TB bacteria are eliminated is to take treatment for six months. For six months, two antibiotics ( Isoniazid and Rifampicin) are accepted, and two additional antibiotics ( Pyrazinamide and Ethambutol) are taken for the first two months of the six-month treatment plan.


How Is TB Osteomyelitis Determined?

The isolation of Mycobacterium tuberculosis from cultures of bone biopsy material is the gold standard for diagnosis. The diagnosis of mycobacterium tuberculosis osteomyelitis is confirmed with great accuracy by the histopathology of the bone lesions.


Can a Toothbrush Spread TB?

TB is typically spread through the air when an infected person coughs, sneezes, or talks, releasing tiny droplets containing the bacteria into the air. When a person inhales these contaminated droplets, they can become infected with TB. Shaking hands, eating meals, touching toilet paper or seats, or sharing toothbrushes do not spread tuberculosis.


Is It Possible to Find TB in Saliva?

Although the testing cartridge is intended to be used with sputum, it has been discovered that patients can successfully test their saliva for TB-causing bacteria.


Can TB Be Spread Orally?

The TB bacterium can be transferred from person to person through the air. For example, TB bacteria can enter the air when a person who has TB disease of the lungs or throat coughs, speaks, or sings. People nearby could inhale these microorganisms and acquire an infection.


Can TB Be a Reason for Death?

Sudden death has also been linked to pulmonary tuberculosis. Following COVID-19 (above HIV/AIDS), TB is the second infectious killer in the world and the 13th most significant cause of death overall. Globally, 10.6 million tuberculosis (TB) cases were reported in 2021. TB exists in all nations and age groups.


Does Kissing Spread Tuberculosis?

It is impossible to spread TB by giving someone a kiss, hug, or handshake.


How to Prevent Tuberculosis?

Tuberculosis can be prevented by following the steps below:
- TB can hang in the air for several hours without ventilation, so it is essential to have excellent ventilation.
- UV light destroys the TB bacteria naturally.
- Maintain good hygiene. While coughing or sneezing, cover one’s mouth and nose to stop the transmission of TB bacteria.

Last reviewed at:
19 Dec 2022  -  5 min read




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