Orofacial Viral Diseases

Question 1

Common oral infections caused by virus

Answer 1

• Human herpes virus (HHV1-5, HHV8)
• Coxsackie
• Human papillomavirus
• Measles
• Mumps

Question 2

Herpes virus diseases type of virus, and what are the 6 forms relevant to dentistry?

Answer 2

• Enveloped DNA virus
• More common in immunosuppression
• HHV1 = herpes simplex (oral)
• HHV2 = herpes simplex (genital)
• HHV3 = Varicella zoster
• HHV4 = Ebstein-Barr virus
• HHV5 = Cytoemgalovirus
• HHV8 = Kaposi sarcoma virus

Question 3

Pathogenesis of Herpes virus diseases

Answer 3

Primary infection can lead to clinical disease of subclinical infection (no obvious clinical lesions)

This then leads to latent phase where there is no clinical disease bu antibodies persist

Latent phase can lead to recurrent lesions if the immune status is altered or can then lead to no subsequent disease

Question 4

What diseases can HHV1 cause

Answer 4

Primary Herpetic stomatitis (usually affects children <6y. Vesicles form which rupture to form painful ulcers affecting any part of oral mucosa. Gingival margins are red and swollen
Accompanied by lymphadenopathy and fever
Acyclovir effective if given within 48h of vesicles first appearing or valaciclovir for severe cases§)

Herpes labialis (secondary infection following reactivation of latent virus causing ‘cold sore’. Vesicles enlarge and cluster along mucocutaneous junction of lips which rupture after 2-3 days and crust over)

Herpatic Whitlow (skin infection usually on finger after inoculation from another infected site)

Question 5

What diseases can HHV3 cause

Answer 5

• Primary infection: chicken pox (usually child <12y. 2 week incubation then malaise, nausea, fever, sore throat, rash producing itchy blisters that break into ulcers)
• Reactivated infection: shingles (pain or tenderness in dermatome supplied by the nerve in which the virus has become latent, then a vesicular rash forms which ruptures, ulcerates and crusts over. Also malaise and fever)

Question 6

Clinical features, management and complications of Herpes Zoster of the trigeminal nerve

Answer 6

Clinical features:
- Prodromal phase: pain may mimic pulpits
- Facial rash and stomatitis
- Location one side within distribution of a division of CN V
Management
- Mild attacks only analgesia
- Mostly treated with acyclovir
Complications
- Occasionally tooth devitalisation and bone necrosis in affected area
- Involvement of nose indicates ophthalmic division which also supplies cornea

Ramsay Hunt syndrome

• Reactivated zoster infection in facial nerve
• Facial paralysis, loss of taste on one side of auditory canal

Question 7

What disease does HHV4 cause?

Answer 7

Infection Mononucleosis

• Self-limiting lymphoproliferative disease
• Infection by saliva
• Lyphadenopathy, sore throat, fever, fatigue

Question 8

What disease does HHV5 cause?

Answer 8

Causes actor primary disease and can remain latent to cause recurrent infection
- Almost all infections are asymptomatic but sometimes resembles infections mononucleosis

Question 9

What does coxsackie A16 and Enterovirus 71 cause

Answer 9

Hand-foot-and-mouth disease

• Highly infectious
• Small scattered ulcers usually with little pain all over mouth with erythematous background
• Rash develops, consisting of vesicles and erythema, on mainly palms and soles of feet
• No tx needed- resolves in a week

Question 10

What are the clinical features of Measles

Answer 10

• Highly infectious
• Koplik’s spots form on buccal mucosa and soft palate which break in to ulcers
• Fever and rash starting on face
• Oral lesions require no treatment