Viral Infections of the Oral Cavity

Viral Infections of the Oral Cavity

• Common oral viral infections include: Varicella-Zoster, Hand Foot & Mouth disease, Herpangina, Epstein-Barr virus (EBV), Mumps, Measles, and Herpes Simplex.
• Viral infections can impact the oral cavity in various ways, with different symptoms and complications.
• Understanding these infections is crucial for dental professionals in preventing transmission, managing symptoms, and referring patients appropriately.

Varicella-Zoster (Human Herpes Virus 3)

• Varicella-Zoster virus causes Chickenpox and Shingles.
• Chickenpox is generally mild and self-managed but can be more serious in adults.
• Shingles usually manifests in adults and is a reactivation of the dormant virus.
• Both Chickenpox and Shingles are characterized by a vesicular rash.

Hand Foot and Mouth Disease

• Primarily caused by Group A Coxsackie viruses.
• Common symptoms include malaise and spots on the buttocks and groin.
• Transmission occurs via air droplets, coughing, fecal contact, and contaminated objects.
• Outbreaks are frequent in nurseries.

Herpangina

• Characterized by vesicles in the mouth.
• Caused by Coxsackie A virus.
• Symptoms include malaise, sore throat, and a seasonal occurrence, particularly during summer.
• Transmission occurs through the fecal-oral route and air droplets.
• Usually self-managed.

Epstein-Barr Virus (Human Herpesvirus 4)

• Most people are infected with EBV in early childhood.
• Infection in teenagers or young adults can cause infectious mononucleosis (glandular fever).
• EBV becomes dormant and remains in the body throughout life without symptoms.
• EBV lives latently in B-lymphocytes.
• Humans are the only known host.

Diseases Caused by EBV

• Glandular fever
• Burkitt’s Lymphoma
• Nasopharyngeal carcinoma
• Oral Hairy Leukoplasia

Mumps

• Often a childhood illness.
• It causes parotitis (swelling of the parotid salivary glands).
• Complications include pain and swelling of the testicles in males and ovaries in females, temporary hearing loss, viral meningitis, and acute pancreatitis.

Measles (Measles Morbillivirus)

• Highly contagious, transmitted through air droplets and surfaces.
• Causes a characteristic exanthematous rash, along with symptoms like headache, fever, sore throat, and Koplik’s spots.
• Potential complications include stillbirth, miscarriage, vision loss, subacute sclerosing panencephalitis (fatal brain complication), seizures, and encephalitis.

Herpes Simplex (HS1 & HS2)

• Typically, HS1 causes lesions above the belt (oral), while HS2 causes lesions below the belt (genital).
• Primary infection can result in primary gingivostomatitis, genital herpes, herpetic whitlow, and encephalitis.
• Secondary infection often occurs due to triggers such as stress, trauma, sunlight, menstruation, immunosuppression, or fatigue.

Herpes Labialis (Cold Sore)

• Often triggered by factors such as stress, trauma, sunlight, menstruation, immunosuppression, or fatigue.
• Managing symptoms includes eating cool soft foods, avoiding triggers, using NSAIDs, cold compresses, sunblock, hydration, and rest.

Common Advice for managing Herpes Labialis (Cold Sore)

• Isolation
• No kissing
• No oral sex
• Use a tissue
• Do not share food, cutlery, or towels
• Prevent spread
• Good hand hygiene practices
• Cleaning practices

General Management of Viral Infections

• Recognition of symptoms
• Infection control measures
• Management of symptoms
• Referral to appropriate professionals

HIV

• Information on HIV can be found in the Sexually Transmitted Disease lecture.

Common Oral Viral Infections

• Herpes Simplex Virus (HSV)

  • HSV-1: Primarily causes orofacial lesions (e.g., cold sores).
  • HSV-2: Associated with genital lesions.
  • Demographics: Both can affect any age group; transmission via contact with infected bodily fluids.
  • Primary infection: Often results in gingivostomatitis.
  • Secondary infection: Reactivation as cold sores (herpes labialis) triggered by stress, trauma, or immunosuppression.

• Varicella-Zoster Virus (VZV)

  • Varicella (Chickenpox): Common in children, usually mild with fever and vesicular rash.
  • Zoster (Shingles): A reactivation of the virus in adults, causing painful unilateral vesicular rash.
  • Ramsay Hunt Syndrome: Rare, involving facial nerve palsy.

• Epstein-Barr Virus (EBV)

  • Causes Infectious Mononucleosis (Glandular Fever) in teens and young adults.
  • Dormant in B-lymphocytes; lifelong latent infection.
  • Associated with diseases like Burkitt’s Lymphoma, Oral Hairy Leukoplakia, and Nasopharyngeal Carcinoma.

• Mumps Virus

  • Causes parotitis (inflammation of the parotid glands), typically in children.
  • Complications include orchitis in males and oophoritis in females post-puberty.

• Measles Virus

  • Highly contagious with symptoms like fever, cough, Koplik's spots, and characteristic rash.
  • Can cause severe complications such as encephalitis and subacute sclerosing panencephalitis.

• Coxsackie Viruses

  • Hand, Foot, and Mouth Disease: Mostly seen in children; causes vesicular eruptions on hands, feet, and inside the mouth.
  • Herpangina: Seasonal, mainly occurring in the summer, characterized by oral vesicles and malaise.

Signs and Symptoms of Viral Oral Infections

• Herpes Simplex: Cold sores, gingivostomatitis.
• Varicella-Zoster: Fever, rash (Chickenpox), painful unilateral vesicles (Shingles).
• Epstein-Barr Virus: Sore throat, swollen lymph nodes, fatigue (Mononucleosis).
• Mumps: Parotitis (swollen parotid glands), fever.
• Measles: Fever, rash, Koplik’s spots in the mouth.
• Coxsackie Viruses: Oral vesicles, malaise (Herpangina); vesicles on hands and feet (Hand, Foot, and Mouth Disease).

Managing Viral Oral Infections

• Symptomatic Treatment:

  • Use of NSAIDs (e.g., ibuprofen) for pain relief.
  • Cold compresses, hydration, and rest.
  • Avoidance of triggers (for herpes) like stress and sun exposure.
  • Isolation and hygiene measures (especially for highly contagious infections like measles and mumps) to prevent spread.
  • Patient education on avoiding spread (e.g., not sharing utensils or towels, hand hygiene).

• Postponing Treatment for Herpes Labialis (Cold Sores):

  • Dental treatment should be postponed if active herpes labialis is present to prevent further spread of the virus and to avoid exacerbating the lesion.

Impact on Dental Clinicians

• Infection Control:

  • Dental professionals must practice strict infection control measures, including personal protective equipment (PPE) and decontamination of instruments, to avoid transmission of viruses like HSV and Coxsackie.

• Staff Protection:

  • Education and vaccination (e.g., for MMR – measles, mumps, rubella) are crucial to protect the dental team.

• Recognition and Referral:

  • Early identification of viral infections can lead to timely management, reducing the risk of complications.

This quiz covers various viral infections affecting the oral cavity, including Varicella-Zoster, Hand Foot & Mouth disease, and others. Essential for dental professionals, understanding these infections helps in prevention and management. Test your knowledge of their symptoms, transmission, and implications.