Viral infections involving the mouth

Question 1

What does the VZV affect to induce ramsay hunt syndrome?

Answer 1

VZV infection affecting geniculate ganglion

Question 2

Explain the link between upper molar pain and VZV

Answer 2

Recurrent VZV in mouth (V2 & V3) must be considered as differential for unexplained dental pain involving upper molars

Question 3

Where does the VZV stay dormant for shingles?

Answer 3

Dorsal root or cranial ganglia

Question 4

What can be prescribed in severe cases of Primary Herpetic Gingivostomatitis?

Answer 4

Aciclovir suspension

Pronounced Ay-Sigh-Clo-Veer

Question 5

Define a virus

Answer 5

Obligate intracellular parasites that require host cell’s protein synthesising components for replication

Question 6

Describe the appearance of oral lesions of erythema multiforme

Answer 6

Crusty erythematous lips that can ulcer

Question 7

What medications can trigger erythema multiforme?

Answer 7

NSAIDs
Anti-fungals
Barbiturates

Also caused by infections such as HSV

Question 8

What is the management of a patient presenting with Primary Herpetic Gingivostomatitis?

Answer 8

Reassure patient that it will resolve in 2-3 weeks
Encourage rest and fluid intake
Chlorhexidine mouthwash

Question 9

What is this?

Answer 9

Erythema multiforme

Question 10

What medications can trigger erythema multiforme?

Answer 10

NSAIDs
Anti-fungals
Barbiturates

Also caused by infections such as HSV

Question 11

What is eczema herpeticum?

Answer 11

Severe Orofacial disease in patient’s with eczema caused by viral spread

Characterised by blisters around the body

Requires systemic therapy

Question 12

What causes primary herpetic gingivostomatitis?

Answer 12

Herpes simplex virus 1

Question 13

What is this?

Answer 13

Shingles

Painful erythematous lesion

Question 14

What is this?

How does it occur?

Answer 14

Herpetic whitlow
HSV acquired from patient saliva which then affects the skin on digits

Odeoma, erythema and intense pain

Question 15

What is the presentation of Ramsay Hunt syndrome?

Answer 15

Lower motor neuron facial nerve (VII) palsy
Vesicular rash present on EAM & palate
Loss of taste

Question 16

What can be prescribed in severe cases of Primary Herpetic Gingivostomatitis?

Answer 16

Aciclovir suspension

Pronounced Ay-Sigh-Clo-Veer

Question 17

In which age group is primary herpetic gingivostomatitis most common?

Answer 17

Young children

Question 18

What can reactivation of a dormant HSV1 lead to?

Answer 18

Herpes Labialias (cold sore)

Question 19

What causes chicken pox?

Answer 19

Varicella Zoster Virus (VZV)

Question 20

What are some triggers for cold sores?

Answer 20

• Sunlight (UV radiation)
• Trauma (e.g. post-operative onset)
• Immunosuppression (e.g. HIV, transplants or chemotherapy)
• Infection (e.g. pneumonia)
• Menstruation

Remember STIIM

Question 21

What is this?

Answer 21

Erythema multiforme

(skin lesions)

Question 22

What is the clinical presentaion of Primary Herpetic Gingivostomatitis?

Answer 22

2-3mm vesicles only keratinsed tissue
Ulceration
Diffuse gingivitis (enlarged perio tissues)
Lip erosions
Cervical lymphadenopathy

Question 23

What could unexplained upper molar pain be a cause of?

Answer 23

Reccurent VZV in the mouth