Viral Infections of the Oral cavity

• Viral infections impacting the oral cavity are covered
• Explains features, diseases, demographics, signs, and symptoms of common infections
• Strategies to support patients and rationale for postponing treatment, especially herpes labialis, are detailed
• Impact on dental clinicians in managing these infections is discussed

Varicella-Zoster (Human Herpes Virus 3)

• Manifests as chickenpox
• Also manifests as shingles
• Common in children
• Generally mild and self-managed
• More serious if contracted in adulthood
• Incubation period is 2 weeks
• Symptoms include fever and rash
• Papules become vesicular and itchy but painless
• Shingles presents as a rash, unlike chickenpox

Varicella (Herpes)-Zoster (Shingles)

• The virus remains dormant in the dorsal root ganglia indefinitely
• Reactivation, triggered by immune system depression or stress, leads to shingles
• Ramsay hunt involves shingles of the facial nerve and is considered rare
• Ramsay hunt includes vesicular rash on the tympanic membrane and auditory canal
• Ramsay hunt includes Unilateral facial palsy

Hand, Foot & Mouth

• Mainly caused by group A coxsackie viruses
• Main symptom is malaise
• Spots appear on buttock and groin
• Transmissible through air, coughing, faecal contact, and contaminated objects
• Common in nurseries

Herpangina

• Main feature is vesicles in the mouth
• Caused by Coxsackie A virus
• Occurs mostly in summer
• Symptoms include malaise and sore throat
• Transmitted via faecal/oral route or air droplets
• Self-managed

Epstein-Barr Virus (Human Herpesvirus 4)

• Most people are infected in early childhood
• Infection in teens or young adults can cause infectious mononucleosis (glandular fever)
• EBV becomes dormant and remains in the body without symptoms
• Lives in latent form in B-lymphocytes
• Humans are the only known host
• Diseases caused by EBV include glandular fever, Burkitt’s lymphoma, nasopharyngeal carcinoma, and oral hairy leukoplakia

Mumps

• Usually a childhood illness
• Causes parotitis, which is painful
• Symptomatic
• If contracted after puberty, 1 in 4 males may have pain and swelling of testicle
• 1 in 20 females may experience swelling of ovaries
• 1 in 20 may have temporary hearing loss
• 1 in 1000 may develop viral meningitis
• 1 in 20 may develop acute pancreatitis

Measles - Measles morbillivirus

• Highly infectious through air droplets and surfaces
• Presents as characteristic exanthematous rash
• Enters through the respiratory tract
• Symptoms: headache, fever, sore throat, and Koplik's spots
• Complications include pregnancy complications (stillbirth and miscarriage)
• Further complications include vision loss
• Fatal brain complication is subacute sclerosing panencephalitis (1 in 25,000)
• Can also cause fits/seizures and encephalitis

London Measles Outbreak Risk

• UKHSA data shows a steady rise in measles cases, with potential for resurgence in London
• Between January and June, 128 cases were reported, compared to 54 in 2022
• 66% of cases were in London
• Risk of a UK epidemic is low, but a measles outbreak in London could involve 40,000-160,000 cases due to low vaccination rates

Herpes Simplex (HSV 1 & 2)

• HS1 generally causes orofacial lesions 'above the belt'
• HS2 causes genital lesions 'below the belt'
• Primary infection of HS1 & HS2 manifest as Primary gingivostomatitis, Genital Herpes, Herpetic whitlow, Encephalitis

Secondary Herpes

• Stimuli that activate secondary herpes (cold sore) include stress, trauma, sunlight, menstruation, immunosuppression, fatigue

General management of cold sores

• Staff protection, recognition, infection control, referral, management of symptoms are key
• Common methods of alleviating symptoms involve eating cool soft foods
• Alleviate symptoms by avoiding triggers, use NSAIDs, cold compress
• Alleviate symptoms by using blocking the sun, hydration, and rest
• Additional advice includes isolation, no kissing, no oral sex, and using a tissue
• Additional advice includes no sharing food, cutlery, towels, do not touch, and hand hygiene, cleaning practices