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Viral Infections and the Oral Cavity

Viral Infections and the Oral Cavity

Viral and the Oral Cavity

Sumamry We promise there's more to know about viral infections than just 'lots of fluids and '.

Viral infections

Differential diagnosis

Herpes simplex (HSV 1) Primary herpetic Herpetic Varicella Zoster (HSV 3) Chicken pox Epstein-Barr Infectious mononucleousis (glandular ) Hairy - For information, please find in the White Lesions lesson Coxsackie Hand foot and mouth Kaposi sarcoma virus Kaposi sarcoma Slapped cheek () virus German Measles (rubelola) virus Measles RubulavirusReviseDental.com (within the genus Paramyxovirus) (HSV 5) Primary Herpetic Gingivostomatitis

Aetiology and epidemiology Caused by HSV ( virus) 1 and HSV2 can sometimes be involved HSV spreads easily through saliva Causes pyrexia, cervical lymphadenopathy Mainly affects children Pathophysiology HSV infects epithelial cells forming intraepithelial Clinical features Blisters that rupture easily producing -crusted Widespread painful oral ulceration Gingivae are swollen and erythematous Diagnosis Culture of HSV using a swab Clinical examination Management Reassurance Advice on limitation of contact to prevent the spread of Analgesics and soft diet advised Dental implications

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Extra Oral Presentation Herpetic Gingivostomatitis Intra Oral Presentation Herpetic Gingivostomatitis

Recurrent Herpes Simplex infection

Aetiology and epidemiology HSV resides in neural and other tissues Pathophysiology HSV becomes reactivated by factors such as sunlight, trauma, fever, , menstruation Clinical features Herpes labialis (cold sore) on the vermillion border of the lips Sometimes starts as a tingling sensation A number of vesicles appear These rupture early leaving an erosion which then crusts over ReviseDental.comThese lesions heal 7-10 days later Intraoral ulceration can also occur Diagnosis Clinical appearance is usually enough Swab or tissue culture can give a confirmation of the diagnosis Management Inform patient about the infectivity of the lesion Dental implications Patient's should not be seen whilst having recurrent herpes simplex infection as it is highly infectious Recurrent Herpes Simplex infection - Cold Sore

Chickenpox and Shingles

Aetiology and epidemiology (VZV) produces in childhood The reactivation of latent VZV occurs later in life producing shingles Highly contageous Pathophysiology VZV proliferates within macrophages and then spreads through the blood in the primary infection VZV resides in the nerve ganglia in a latent form is affected in some cases Clinical features InitiallyReviseDental.com with a maculopapular Oral lesions on the palace and fauces are present Reactivation of VZV present with sever with unlateral vesiculobullous lesions Scars may develop with some sensory deficit Diagnosis Clinical presentation is sufficient A smear can confirm the diagnosis Management No treatment required for chickenpox Antiviral therapy should be considered for shingles Prevention A for Shingles is offered by the NHS to patients over the age of 70¹ Chicken Pox

Infectious mononucleosis (Glandular fever)

Aetiology and epidemiology Epstein-Barr Virus (EBV) causes Pathophysiology EBVReviseDental.com infects B lymphocytes T lymphocytes react and appear as atypical lymphocytes in the peripheral blood Lymphoid proliferation occurs in the blood, lymph nodes and spleen Clinical features Enlargement of , fever and of the Many patients suffer from purpura/ petechiae on the with oral ulceration Bleeding and ulceration of the gingivae may present Diagnosis IgM with EBV antigen will appear in serum Paul-Runnell-Davidsohn test and positive Monospot slide test will confirm the diagnosis Management Hospitalisation if severe, otherwise no treatment required Hand, Foot and Mouth disease

Aetiology and epidemiology Caused by Coxsackie virus type A16 Most commonly occurs in children Pathophysiology Spread by from infected hosts The virus replicates in the lymphoid tissue of the pharynx and lower intestine and spreads to lymph nodes Clinical features There are macular eruptions on the hands and feet and vesicular eruptions on the mucosa of the buccal mucosa, pharynx, soft palate and tongue Usually asymptomatic Diagnosis Clinical presentation and history Management Self-limiting and therefore only analgesics and chlorhexidine will calm any oral discomfort or pain

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Hands Foot and Mouth - Macular Eruptions on the Hand Hands Foot and Mouth - Vesicular Eruptions

Herpangina

Aetiology and epidemiology Caused by Coxsackie type A1-6, A8, A10, A16, A22 or B3 Occurs mostly in infants and young children Pathophysiology Spreads by contaminated saliva Clinical ReviseDental.comfeatures Vesicular eruptions on the soft palate, fauces and tonsils Diffuse erythematous pharyngitis Patients experience dysphagia and sore throat Diagnosis Clinical presentation Management Reassurance, advice patients to rest, use an antiseptic mouthwash and drink plenty of fluids Herpangina

Karposi's Sarcoma

Aetiology and epidemiology Mass formed by the proliferation of endothelial cells Several predisposing factors including: Genetics ReviseDental.comInfection Pathophysiology HHV8 - human herpesvirus type 8 is found in all types of Kaposi's sarcoma Clinical features Single or multiple lesions Usually visible on the palate, gingivae and the tongue Large, exophytic and nodular Range in colour: red/ blue Histopathology Mass of spindle cells Diagnosis Biopsy taken for diagnosis Management Lesions may not require any treatment Small lesions may be removed If larger lesions are causing functional or cosmetic problems then may be required for removal

Slapped cheek (fifth disease)

Aetiology and epidemiology Spread by touching or aerosols (coughing, sneezing) Mostly occurs in childhood Pathophysiology Parvovirus B19 Clinical features Initially a bright red rash on the cheeks Followed by a generalised rash all over the body Fever and flu like symptoms including , sore throat, Symptoms resolve within 14 days Diagnosis Clinical presentation and assessment of symptoms Management Fluid intake and analgesia

German measlesReviseDental.com - Rubella

Aetiology and epidemiology Spread by touching or aerosols (coughing, sneezing) If caught during , child may develop congenital defects including auditory, visual, intellectual and cardiac defects. Tooth development will also be affected Pathophysiology 14-21 days of infectivity occurs 7 days after onset of the rash Clinical features No specific intra-oral features - may affect the tonsils Rash visible starting behind the and spreading around the head and neck, then to the torso Mild fever, malaise, swollen lymph nodes, aching joints and generalised rash Diagnosis Clinical presentation and assessment of symptoms Management Fluid intake, analgesia MMR for prevention

Measles

Aetiology and epidemiology Spread by aerosols (coughing, sneezing, breathing) Can live for 2 hours in the air Complications include: , , blindness, deafness, heart and nervous disorders, and squint Pathophysiology Measles virus (rubelola) 7-14 days incubation Infectivity until 4 days after onset of rash Resolves after 7-10 days Clinical features Fever, malaise, cough, nasal congestion, Red maculo-papular lesions that start on the head 1 in 20 can get ² Intra-oral: Koplick's spots White speckling surrounded by red margin on the buccal mucosa Oral lesions precede skin lesions and disappear early on Diagnosis Clinical presentation and assessment of symptoms ManagementReviseDental.com Fluid intake, analgesia MMR vaccine for prevention at 12 and 40 months³

Mumps Aetiology and epidemiology Spread aerosols (coughing, sneezing) Complications: meningitis, infertility due to inflammation of the or testes Pathophysiology Rubulavirus - within the Paramyxovirus Incubation period 16-18 days Clinical features Fever, vomiting, facial swelling, and joint pain Symptoms last 3-7 days Intra-oral: Parotid enlargement leading to unilateral or bilateral facial swelling Opening of the (Stenson's duct) appears erythematous and enlarged Diagnosis Clinical presentation and assessment of symptoms Management Fluid intake, analgesia MMR vaccine for prevention

Mumps - noteReviseDental.com the characteristic bilateral swelling of the parotid glands

Cytomegalovirus (HSV 5)

Aetiology and epidemiology Usually asymptomatic and occurs in childhood May produce a mononucleosis syndrome which is similar to EBV Complications include hepatitis, pneumonia Can be acquired congenitally Infects solid organ transplant recipients Pathophysiology HSV 5 Clinical features Sore throat, swollen glands, swollen tonsils, tiredness, and nausea Diagnosis Culture, serology, antigen assays, PCR and cytopathology Management Fluids and analgesics Antivirals for immunocompromised patients

Conclusion There are many different viral infections that can have implications on the oral cavity. Many of these infections occur in childhood.

Third Party Links

References Specific references: ¹www.nhs.uk Singles NHS website. Accessed: 2020 May 16 ²www.cdc.gov Measles Complications Centres of Disease Control and Prevention website. Accessed: 2020 May 6 ³www.nhs.uk MMR vaccinations NHS website. Accessed 2020 May 16. Lewis MA, Lamey PJ. Oral Medicine in Primary Dental Care. Springer; 2019 Jun 21. Lewis M, Jordan . Oral Medicine. Milton: Taylor & Francis Group; 2012. Odell EW. Cawson's Essentials of Oral Pathology and Oral Medicine E-Book. Elsevier Health Sciences; 2017 May 2. These textbooks can be found here: BDA ebooks: Endodontics ReviseDental.com This content has been written by and uploaded to ReviseDental.com. It is the work of the author and should not be reproduced without express prior permission from the author through ReviseDental.com. © Revise Dental. All rights reserved.

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