9/14/2016
Going Viral: Oral Manifestations of Viral Diseases
Sherri M Lukes, RDH, MS, FAADH Sherri Lukes Sherri Lukes
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Agenda Human Papillomavirus Viral Who/What Human Immunodeficiency Human Herpes Virus Virus
Viruses and YOU Coxsackie Paramyxovirus
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Viral Who/What Human Papillomavirus Human Herpes Virus Human Immunodeficiency Virus Coxsackie Paramyxovirus Viruses and You
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Coxsackie
HPV
HIV Herpes Sherri Lukes Sherri Lukes
Viral Who/What Human Papillomavirus Human Herpes Virus Human Immunodeficiency Virus Coxsackie Paramyxovirus Viruses and You
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Herpes Simplex Virus Type 1
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Primary Herpetic Gingivostomatitis
Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes
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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
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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
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Aphthous Ulcers NOT Viral
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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
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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
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8 9/14/2016
Epstein Barr Virus (EBV)
Mononucleosis Hairy Leukoplakia Burkitt’s Lymphoma Epstein Barr Virus Nasopharyngeal carcinoma (EBV)
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Mononucleosis
Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e
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Hairy Leukoplakia Burkitt Lymphoma
Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e
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9 9/14/2016
Nasopharyngeal Carcinoma HHV 8
Used with permission www.ghorayeb.com/
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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
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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
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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
Courtesy Drs Langlais & Miller, Color Atlas Common Oral Diseases, 3e Sherri Lukes Sherri Lukes
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Measles
Vaccine Coryza, Cough, Fever Fever ends rash Conjunctivitis continues fades with color change Stage 1 Stage Fever 2 Stage Maculopapular 3 Stage Recent resurgence erythematous and Koplik spots rash – face, desquamation trunk Oral Koplik’s spots in extremities first stage www.cdc.gov
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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
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Viral Who/What Human Papillomavirus Human Herpes Virus Human Immunodeficiency Virus Coxsackie Paramyxovirus Viruses and You
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Transmitted by Most infec >100 subtypes sexual/nonsexual asymptomatic contact
Prevalence of Low Risk/High Human Papillomavirus oral HPV 7% Risk types HPV
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Human Papilloma Virus
More than 150 subtypes Papilloma Verrucus Vulgaris Multifocal Epithelial Hyperplasia Subtypes noted for Oral Cancer Primarily 16 and 18
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Papilloma Primarily HPV 6 and 11 Any age – most in 30-50
Exophytic, cauliflower like lesion
May have surface keratinization
TX-Surgical excision
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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
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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
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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
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Risk profile
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Risk profile
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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
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Viral Who/What Human Papillomavirus Human Herpes Virus Human Immunodeficiency Virus Coxsackie Varicella Zoster Virus VZV Paramyxovirus Viruses and You Chickenpox/Shingles
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Human Immunodeficiency Virus HIV
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Acute Latency AIDS
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PrEP
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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
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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
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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
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Coxsackie
HPV
HIV Herpes Sherri Lukes Sherri Lukes
HPV HIV
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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]
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