Viral Infections of the Oral Cavity.pdf

24/09/2023 Viral Infections of the Oral Cavity Biomedical Science Sarah Balian 1 2 GDC Learning outcomes 1.1.2 Describe oral diseases and their relevance to prevention, diagnosis and treatment 1.1.3 Explain general and systemic disease and their relev...

24/09/2023 Viral Infections of the Oral Cavity Biomedical Science Sarah Balian 1 2 GDC Learning outcomes 1.1.2 Describe oral diseases and their relevance to prevention, diagnosis and treatment 1.1.3 Explain general and systemic disease and their relevance to oral health 1.1.4 Explain the aetiology and pathogenesis of oral disease 1.1.5 Describe relevant and appropriate dental, oral, craniofacial and general anatomy and explain their application to patient management 1.1.6 Describe relevant and appropriate physiology and explain its application to patient management 1.1.7 Explain the potential routes of transmission of infectious agents in dental practice, mechanisms for the prevention of infection, the cientific principles of decontamination and disinfection and their relevance to health and safety 1.9.1 Recognise and manage patients with acute oral conditions ensuring involvement of appropriate dental team members 1.11.1 Assess and manage the health of periodontal and soft tissues taking into account risk and lifestyle factors 2 1  24/09/2023 3 Intended Learning Outcomes By the end of this session students should be able to: List the most common viral infections that impact the oral cavity. Explain the features, diseases and demographics for common viral infections List the common signs and symptoms of common viral oral infections. Explain common strategies to support patients with viral oral infections. Explain the rationale for postponing treatment to a more appropriate time, particularly with herpes labialis. Explain the impact on the dental clinician in managing common oral viral infections. 3 Viral Infections of the Oral Cavity Varicella Mumps 03 Herpes Simplex / 02 Zoster 04 HIV 01 Infective 05 Mononucleosis 06 Human Papilloma 4 2  24/09/2023 5 5 Varicella - Zoster 6 3  24/09/2023 7 Varicella-Zoster (human herpes virus 3) Chickenpox Shingles Varicella Herpes Zoster 7 8 Varicella-Zoster Common in children Usually mild and self-managed More serious if contracted in adulthood 2 week incubation Fever & rash Papules become vesicular & itchy but painless Unlike rash in shingles 8 4  24/09/2023 9 Varicella (herpes)- Zoster (Shingles) Dorsal root ganglia Trigeminal nerve 9 10 Ramsay hunt Shingles of the facial nerve Rare Vesicular rash on tympanic membrane and auditory canal Unilateral facial palsy 10 5  24/09/2023 11 Unilateral presentation of Shingles 11 12 Hand Foot & Mouth Mainly caused by group A coxsackie viruses Main symptoms malaise Spots can appear on buttock & groin Transmissible – air, coughing, faecal contact & contaminated objects Common outbreaks in nurseries 12 6  24/09/2023 13 Herpangina Main features – vesicles in the mouth Coxsackie A Seasonal – occurs mostly in summer Symptoms malaise, sore throat Transmissible faecal / oral route or air droplets Self managed 13 Epstein-Barr Virus – Human Herpesvirus 4 14 7  24/09/2023 15 Epstein-Barr Virus Most people are infected by the Epstein-Barr virus (EBV) in early childhood. When teens or young adults become infected, it can cause infectious mononucleosis (glandular fever). EBV becomes dormant, and people remain infected throughout their lives without any symptoms. Lives in latent form in B-lymphocytes. Humans are only known host 15 16 Disease caused by EBV: Nasopharyngeal Glandular fever Burkitt’s Lymphoma carcinoma Oral Hairy Leukoplasia 16 8  24/09/2023 Paramyxoviridae 17 18 Mumps Usually childhood illness Causes parotitis Painful Symptomatic If contracted after puberty – 1 in 4 males can have pain & swelling of testicle 1 in 20 females get swelling of ovaries 1 in 20 temporary hearing loss 1 in 1000 viral meningitis 1 in 20 acute pancreatitis 18 9  24/09/2023 19 Measles - Measles morbillivirus Most highly infectious disease known – air droplets & surfaces Characteristic exanthematous rash Enters through respiratory tract Associated symptoms: headache, fever, sore throat & Koplik’s spots Complications 1. Pregnancy – still birth & miscarriage 2. Vision loss 3. Fatal brain complication known as subacute sclerosing panencephalitis 1 in 25,000 4. Fits seizures 5. Encephalitis 19 20 Koplik’s Spots 20 10  24/09/2023 London at risk of measles outbreaks with modelling estimating tens of thousands of cases UKHSA modelling suggests that, unless MMR vaccination rates improve, London could see a measles outbreak with tens of thousands of cases. From: UK Health Security Agency Published 14 July 2023 Last updated 14 July 2023 — See all updates London at risk of measles outbreaks with modelling estimating tens of thousands of cases - GOV.UK (www.gov.uk) 21 Herpes Simplex (HSV 1 & 2) 22 11  24/09/2023 23 HS1 & HS2 Generally – HS1 causes orofacial lesions or lesion ‘above the belt’ HS2 causes genital lesions ‘below the belt’. HS1 HS1 HS2 HS2 23 24 Primary infection Primary Genital Herpes Herpetic whitlow Encephalitis gingivostomatitis 24 12  24/09/2023 25 Secondary infection 25 26 Stimulation of activation of secondary herpes (cold sore) Stress Trauma Sunlight Menstruation Immunosuppression Fatigue 26 13  24/09/2023 27 Herpes Labialis (Cold Sore) 27 Common advice 28 14  24/09/2023 29 Common methods to alleviate symptoms if being self managed Eat cool Avoid NSAIDS Cold soft foods triggers compress Sun block Hydration Rest 29 30 Additional Advice Isolation No kissing No oral sex Use a tissue No sharing – Do not touch Hand Good food, cutlery, – avoid hygiene cleaning towels spread practices 30 15  24/09/2023 31 31 32 General management Staff Recognition protection Infection Management control of symptoms Referral 32 16  24/09/2023 HIV 33 34 Refer to Sexually Transmitted Disease lecture 34 17  24/09/2023 35 What’s in that kiss? 35 36 Image references https://www.huffpost.com/entry/not-so-fast-3-ways-to-slo_b_12661378 https://www.cdc.gov/chickenpox/about/photos.html https://raisingchildren.net.au/guides/a-z-health-reference/hand-foot-mouth-disease https://www.afterhourskids.com/blog/hand-foot-and-mouth-disease https://www.msdmanuals.com/professional/infectious-diseases/enteroviruses/herpangina https://www.nejm.org/doi/full/10.1056/NEJMicm1404522 https://www.independentnurse.co.uk/clinical-article/diagnosis-and-management-of-glandular-fever-in-primary- care/223982/ https://www.msdmanuals.com/professional/hematology-and-oncology/lymphomas/burkitt-lymphoma https://www.verywellhealth.com/hairy-leukoplakia-hiv-associated-oral-disease-48956 https://www.thesun.ie/fabulous/584447/what-is-the-mumps-signs-and-symptoms-to-look-out-for-and-best-treatments/ https://www.smiles-for-kids.com/clinical-updates-set-1/ef3zlgwe8pft87s38ztd7zb9kteahw https://www.pulse.ng/lifestyle/beauty-health/genital-herpes-causes-symptoms-and-prevention-of-this-ailment/xnv9z5t https://www.news-medical.net/health/Diagnosis-and-Treatment-of-Encephalitis.aspx https://www.cell.com/trends/microbiology/fulltext/S0966-842X(20)30074-3 https://www.medicinenet.com/image-collection/herpes_simplex_virus_type_1_picture/picture.htm https://www.medicalnewstoday.com/articles/322620 36 18  24/09/2023 37 Recommended reading Bagg, J, (1994). Virology and the mouth. Rev Med Microbiol,5, 209-216. Scully, C., & Samaranyake, L,P. (2015) Emerging and changing viral diseases in the new millennium. Oral disease,22, 171-179. 37 19