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Going Viral: Oral Manifestations of Viral Diseases

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Going Viral: Oral Manifestations of Viral Diseases 9/14/2016 Going Viral: Oral Manifestations of Viral Diseases Sherri M Lukes, RDH, MS, FAADH Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes Agenda Human Papillomavirus Viral Who/What Human Immunodeficiency Human Herpes Virus Virus Viruses and YOU Coxsackie Paramyxovirus Sherri Lukes Sherri Lukes 1 9/14/2016 Viral Who/What Human Papillomavirus Human Herpes Virus Human Immunodeficiency Virus Coxsackie Paramyxovirus Viruses and You Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes 2 9/14/2016 Sherri Lukes Sherri Lukes Coxsackie HPV HIV Herpes Sherri Lukes Sherri Lukes Viral Who/What Human Papillomavirus Human Herpes Virus Human Immunodeficiency Virus Coxsackie Paramyxovirus Viruses and You Sherri Lukes Sherri Lukes 3 9/14/2016 Herpes Simplex Virus Type 1 Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes Primary Herpetic Gingivostomatitis Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes 4 9/14/2016 Primary Herpetic Gingivostomatitis Sunlight Trauma Stress Fatigue Illness Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes Secondary oral herpes simplex (recurrent oral herpes simplex, herpes labialis) Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes 5 9/14/2016 Recurrent Intraoral Herpes Simplex Type 1 Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes Herpetic Whitlow OTC-Docosanol Prescription-Antivirals Acyclovir Valacyclovir Famciclovir Penciclovir Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes Ocular Herpes Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes 6 9/14/2016 Aphthous Ulcers NOT Viral Sherri Lukes Sherri Lukes Recurrent Herpes Simplex vs Recurrent Aphthous Stomatitis Herpes Aphthous Viral Immune mediated Intraoral lesions on Intraoral lesions on non- keratinized tissue keratinized tissue Begins as a vesicle Begins as an ulcer Varicella Zoster Virus VZV Lay term: fever blister/cold Lay term: canker sore Chickenpox/Shingles sore TX: antiviral-acyclovir, TX: Topical corticosteroids valcyclovir Sherri Lukes Sherri Lukes Varicella Zoster Virus (VZV) Primary infection is varicella (chickenpox) Childhood disease Recurrent disease is herpes zoster (shingles) Elderly and immunocompromised Sherri Lukes Sherri Lukes 7 9/14/2016 Varicella (Chickenpox) Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes Zoster (Shingles) Courtesy Drs Langlais & Miller, Color Atlas Sherri Lukes Common Oral Diseases, 3e Sherri Lukes OTC Prescription-Antivirals Analgesics for pain Acyclovir Topical antibiotics Valacyclovir “Magic” mouthwash Famciclovir Penciclovir Sherri Lukes Sherri Lukes 8 9/14/2016 Epstein Barr Virus (EBV) Mononucleosis Hairy Leukoplakia Burkitt’s Lymphoma Epstein Barr Virus Nasopharyngeal carcinoma (EBV) Sherri Lukes Sherri Lukes Mononucleosis Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes Hairy Leukoplakia Burkitt Lymphoma Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes 9 9/14/2016 Nasopharyngeal Carcinoma HHV 8 Used with permission www.ghorayeb.com/ Sherri Lukes Sherri Lukes Bell’s Palsy / Herpes Bernie Brussel Sprouts Bell’s Palsy Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes Viral Who/What Human Papillomavirus Human Herpes Virus Human Immunodeficiency Virus Coxsackie Coxsackie Virus Paramyxovirus Hand-Foot-Mouth Viruses and You Herpangina Sherri Lukes Sherri Lukes 10 9/14/2016 Coxsackie Virus Hand Foot and Mouth Disease Seen in mini epidemics- children Hand-Foot-Mouth Flu like symptoms-fever, sore throat, malaise Herpangina Red macules with central vesicles-heal without crusting Sherri Lukes Sherri Lukes Hand Foot and Mouth Hand Foot and Mouth Courtesy Drs Langlais & Miller, Color Atlas Common Oral Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Diseases, 3e Sherri Lukes Sherri Lukes Herpangina Paramyxovirus Measles Mumps Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes 11 9/14/2016 Measles Vaccine Coryza, Cough, Fever Fever ends rash Conjunctivitis continues fades with color change Stage1 Fever Stage2 Maculopapular Stage3 Recent resurgence erythematous and Koplik spots rash – face, desquamation trunk Oral Koplik’s spots in extremities first stage www.cdc.gov Sherri Lukes Sherri Lukes Koplik’s Spots Measles www.cdc.gov Sherri Lukes www.cdc.gov Sherri Lukes Mumps Affects primarily Parotid Symptoms may last 4-5 weeks Vaccine Sherri Lukes Sherri Lukes 12 9/14/2016 Viral Who/What Human Papillomavirus Human Herpes Virus Human Immunodeficiency Virus Coxsackie Paramyxovirus Viruses and You Sherri Lukes Sherri Lukes Transmitted by Most infec >100 subtypes sexual/nonsexual asymptomatic contact Prevalence of Low Risk/High Human Papillomavirus oral HPV 7% Risk types HPV Sherri Lukes Sherri Lukes Human Papilloma Virus More than 150 subtypes Papilloma Verrucus Vulgaris Multifocal Epithelial Hyperplasia Subtypes noted for Oral Cancer Primarily 16 and 18 Sherri Lukes Sherri Lukes 13 9/14/2016 Papilloma Primarily HPV 6 and 11 Any age – most in 30-50 Exophytic, cauliflower like lesion May have surface keratinization TX-Surgical excision Sherri Lukes Sherri Lukes Lukes, S. M. & Barrueta, M. (June, 2010). The dental hygienist’s role in HPV detection. Dimensions of Dental Hygiene, 8(6), 72-77. Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes 14 9/14/2016 Squamous Papilloma Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Used with permission from Dr. Juan Yepes, DDS, IN Univ SOD Sherri Lukes Verucca Vulgaris Seborrheic Keratosis or HPV 2,4,6, & 41 Verucca Vulgaris? Found most in children Most common on skin but sometimes intraoral Vermillion border, labial mucosa, anterior tongue TX-Excision Sherri Lukes Sherri Lukes Multifocal Epithelial Hyperplasia HPV 13, 32 Children – ethnic pops Clustered small rounded papules Low SES, crowded living Courtesy Drs Langlais & Miller, Color Atlas Common Oral conditions, poor hygiene Diseases, 3e Sherri Lukes Sherri Lukes 15 9/14/2016 Condyloma Acuminatum HPV 2,6,11,53,54 Sexually transmitted Common in HIV+ patients Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e TX-surgical excision Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes Oral Condyloma and HIV HPV Oral Cancer Some researchers have noted an increase in condyloma in HIV+ patients Used with permission from Mona Van Kanegan, DDS Courtesy of Nancy Burkhart, RDH, PhD. http://www.rdhmag.com/articles/print/volume- Courtesy Dr B Ghorayeb at www.ghorayeb.com 29/issue-3/columns/oral-exams/squamous-cell- carcinoma.html Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes 16 9/14/2016 Risk profile Sherri Lukes Sherri Lukes Risk profile Sherri Lukes Sherri Lukes Better response to chemotherapy and/or radiation Unique biology of HPV+ and low co-morbity in younger age group Field cancerization not assoc with HPV malignancies Sherri Lukes Sherri Lukes 17 9/14/2016 Viral Who/What Human Papillomavirus Human Herpes Virus Human Immunodeficiency Virus Coxsackie Varicella Zoster Virus VZV Paramyxovirus Viruses and You Chickenpox/Shingles Sherri Lukes Sherri Lukes Human Immunodeficiency Virus HIV Sherri Lukes Sherri Lukes Acute Latency AIDS Sherri Lukes Sherri Lukes 18 9/14/2016 PrEP Sherri Lukes Sherri Lukes HIV Related Oral Lesions Oral Candidiasis – Dorsum surface of tongue (HIV-ROL) and hard palate 30% reduction of HIV-ROL with HAART* Oral Candidiasis Hairy Leukoplakia HIV assoc periodontal disease Non Hodgkin Lymphoma Kaposi Sarcoma *Cherry-Peppers G, Daniels CO, Meeks V, et al: Oral manifestations in the era of HAART, J Nat Med Assoc 95:21S-32S, 2003. Used with permission from Mona Van Kanegan, DDS Sherri Lukes Sherri Lukes Oral Candidiasis (erythematous) Oral Candidiasis Used with permission from Mona Van Kanegan, DDS Used with permission from Mona Van Kanegan, DDS Sherri Lukes Sherri Lukes 19 9/14/2016 Oral Candidiasis Oral Candidiasis Used with permission from Mona Van Kanegan, DDS Sherri Lukes Used with permission from Mona Van Kanegan, DDS Sherri Lukes Oral Hairy Leukoplakia Oral Hairy Leukoplakia Used with permission from Mona Van Kanegan, DDS Sherri Lukes Used with permission from Mona Van Kanegan, DDS Sherri Lukes Oral Hairy Leukoplakia Periodontal diseases/condition Used with permission from Mona Van Kanegan, DDS Sherri Lukes Used with permission from Mona Van Kanegan, DDS Sherri Lukes 20 9/14/2016 Linear gingival erythema Non-Hodgkin Lymphoma Courtesy Drs Langlais & Miller, www.hivdent.org Color Atlas Common Oral Diseases, 3e Used with permission Sherri Lukes Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Oral Kaposi’s sarcoma Kaposi’s sarcoma – Hard Palate Used with permission from Mona Van Kanegan, DDS Used with permission from Mona Van Kanegan, DDS Sherri Lukes Sherri Lukes Viral Who/What Human Detection of oral Papillomavirus Human Herpes Virus Human manifestations Immunodeficiency Virus critical in unaware Coxsackie individual Paramyxovirus Viruses and You Sherri Lukes Sherri Lukes 21 9/14/2016 Coxsackie HPV HIV Herpes Sherri Lukes Sherri Lukes HPV HIV Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes 22 9/14/2016 Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes 23 9/14/2016 Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes Sherri Lukes 24 9/14/2016 Sherri M Lukes, RDH, MS, FAADH Associate Professor Emerita Southern Illinois University Past President Ill Dental Hygienists’ Association 680 Wing Hill Road (home) Cobden, IL 62920 618-521-3392 (cell) [email protected] Sherri Lukes Sherri Lukes 25.
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