Viral Infections of the Orofacial Tissues Flashcards
What is a virus?
An obligate parasite that invades host cells to hijack the internal machinery in order to replicate its DNA/RNA and multiply
How does Varicella Zoster spread?
Via nasopharyngeal secretions (sneezes/coughs) or fluid from vesicles containing the virus
How does HSV1/2 spread?
Via direct contact e.g. of mucous membranes (oral/genital) or through broken skin
List the 8 types of Human Herpes Virus
HSV1 (oral herpes)
HSV2 (genital herpes)
HHV3 (Varicella Zoster Virus)
HHV4 (Epstein Barr Virus)
HHV5 (Cytomegalovirus)
HHV6, 7, 8
What is the management protocol for a patient who presents with primary herpetic gingivostomatitis?
Reassure and explain the aetiology of the disease to the patient.
Advise the patient to keep well hydrated, choosing nice soft, bland diet for a few days until the inflammation wears off.
Reinforce good OH, keeping everything as clean as possible to help the area heal.
Suggest topical anaesthetics/sprays (e.g., 0.15% benzydamine hydrochloride for comfort/analgesia where lesions are painful)
Advise Paracetamol for pyrexia (and secondarily analgesia).
Suggest Gelclair, Gengigel or other mucosal coating agents (to protect the mucosa whilst it heals/for comfort)
Encourage avoidance of SLS toothpaste/mouthwash (which are extremely irritant with oral inflammatory conditions)
Suggest 0.2% chlorhexidine digluconate (which is useful due to its broad anti microbial properties however needs dilution (1:1) as it is an astringent).
NOTE-
Anti-retrovirals not routinely given as infection is self-limiting (<2 weeks) unless patient is immunocompromised or the infection is picked up really early.
May require A&E referral due to inability to maintain oral intake. Admissions are usually short or unnecessary however.
Define neurotrophic viruses
With certain viruses, once infected, they will live on forever in the sensory neurones of the host (e.g. trigeminal ganglion with oral HSV)
Briefly describe the phases of a HSV1 infection
Natural clinical course is a primary infection
To a period of latency where the patient may not be symptomatic in displaying evidence of the disease, or a period of latency where there may be viral shedding (where infective particles are still released by the host or the time where the host remains infective)
Followed by a period of reactivation later down the line in some cases (following triggers e.g. UV exposure, stress, steroids, fever, surgery, menstruation etc.)
Describe the evolution of the lesions found in a primary HSV1 infection
The HSV1 targets deep epithelial cells in the skin/mucous membranes during the primary infection.
Results in some sessile lesions (i.e. lesions that are firmly attached to the underlying skin, broad based, red and raised lesions that are fluid filled). These are vesicles, small fluid filled sacs, typically under 5mm of maximal diameter.
Also observe some small lesions known as pustules (red based lesion, with a head on it that is a creamy white colour indicating that it is filled with pus i.e. dead or dying macrophages amongst other materials)
Final evolution of this virus leaves a crusted lesion. This forms when a vesicle ruptures, leaving a raw base to the lesion with some weeping of tissue fluid and shedding of viral particles. At this stage, the patient is in their most infective state
Describe the pathophysiology of a HSV1 primary infection
Direct contact with infected HSV1 secretions lead to deep epithelial cells of the skin/mucous membranes becoming infected.
The infected cells undergo lysis allowing HSV1 to spread
The resulting inflammation leads to oedema which produces thin walled vesicles full of virus particles
These are very fragile and rupture easily as a result to leave an erythematous base that crusts over and then heals
What is HHV
A DNA virus (obligate parasite)
A 7 year old patient presents with a sore throat, fever, small and painful blisters/vesicles on the lateral surfaces of the tongue, the labial surfaces and the lower gingiva. These vesicles/blisters have a erythematous periphery with a pale pink/cream centre. In some areas you can see multiple small ulcers and the gingivae appear generally inflamed. On E/O examination you notice cervical lymphadenopathy. On inquiry, the mother states that the child is struggling to speak and eat. What is the likely diagnosis and management protocol for this patient?
Primary herpetic gingivostomatitis
Reassure and explain the aetiology of the disease to the patient.
Advise the patient to keep well hydrated, choosing nice soft, bland diet for a few days until the inflammation wears off.
Reinforce good OH, keeping everything as clean as possible to help the area heal.
Suggest topical anaesthetics/sprays (e.g., 0.15% benzydamine hydrochloride for comfort/analgesia where lesions are painful)
Advise Paracetamol for pyrexia (and secondarily analgesia).
Suggest Gelclair, Gengigel or other mucosal coating agents (to protect the mucosa whilst it heals/for comfort)
Encourage avoidance of SLS toothpaste/mouthwash (which are extremely irritant with oral inflammatory conditions)
Suggest 0.2% chlorhexidine digluconate (which is useful due to its broad anti microbial properties however needs dilution (1:1) as it is an astringent).
NOTE-
Anti-retrovirals not routinely given as infection is self-limiting (<2 weeks) unless patient is immunocompromised or the infection is picked up really early.
May require A&E referral due to inability to maintain oral intake. Admissions are usually short or unnecessary however.
How does primary herpetic gingivostomatitis appear in adults?
Can vary from the occasional one or two aphthous like ulcers to numerous ulcers grouped in close proximity to one another
Will affect areas like the soft palate, labial mucosa etc.
Usually each ulcer will have a very wide band of perilesional erythema (redness surrounding the lesion)
In certain areas, the ulcers may join together to coalesce and form larger ulcers.
Depending on the point at which the patient is examined, we may find numerous tiny isolated ulcers or lots of tiny ulcers having grouped together making the ulcers appear larger
Describe the features of ocular herpes
Scarring
Keratitis (inflammation of the cornea i.e. the protective transparent outer layer of the eye)
Can lead to blindness in the eye (requires an urgent same day ophthalmological opinion, patient should be directed to the local A&E department if indicated)
A patient presents with a visible cold sore on the left commissure of the lip. On further examination, you notice the patient appears to have some scarring in the eye with visible keratitis. What is the likely diagnosis and management protocol for this patient?
Reactivation of HSV1 infection (herpes labialis)
Ocular herpes
Urgent same day ophthalmological opinion is indicated as ocular herpes can lead to blindness. Patient should be directed to the local A&E department
What are the different ways in which a HSV1 infection can present?
Primary herpetic gingivostomatitis
Cold sores/herpes labialis
Intra-oral herpes lesions
Ocular herpes
Herpetic Whitlow
Eczema herpeticum
Describe the features of herpetic whitlow
Historically common, herpes infection of the skin on the hands
Extremely painful
Highly infectious
Now rare
Describe the features of Eczema herpeticum
HSV infection of eczematous skin
Can be rapidly spreading
Risk of bacterial superinfection and sepsis
Requires aggressive and urgent management (referral to A&E)
What is a primary infection?
The first presentation of an infection after the patient has acquired a virus
Describe the features of cold sores/herpes labialis
Viral reactivation of HSV1
Often following triggers such as-
UV light exposure
Wind
Stress
Steroids
Menstruation
Fever
Other illness
Surgery
Often present as vesicular crusted lesions at the mucocutaneous borders of the lip or the alars of the nose.
Affected patients tend to report a short prodrome phase with itching or tingling and then the lesions appear within hours to days, usually starting with oedema, turning into fluid filled blisters, then rapidly ulcerating at which point, the vesicles burst, the virus is released and infection may occur.
Healing tends to occur within 7-10 days.
Once the lesions have thoroughly dried out and crusted over, they are no longer capable of transmitting the virus.
Self-resolving condition
A patient presents with a vesicular crusted lesion on the upper lip. On inquiry, the patient reports the area first began to itch and tingle before forming a fluid filled blister that popped after a few days. The patient reports associated pain and says he struggles to open his mouth properly. He also reports a history of similar lesions affecting the lip. What is the likely diagnosis and management protocol for this patient?
Viral reactivation of HSV1 (herpes labialis/cold sores
Reassure and explain the aetiology of the disease to the patient.
Advise identification and avoidance of triggers to prevent subsequent attacks
Prescription of Acyclovir (Zivirax) which can be bought OTC but this topical is typically ineffective in stopping the lesions from propagating, only useful in prodrome phase. Advise patient that if they want to avoid the formation of the cold sore, the ointment should be applied as soon as the prodrome phase begins i.e., the tingling burning sensation and application should be repeated every 4 hours whilst awake. Penicyclovir can also be used, but applied every 2 hours whilst awake and not to be used <12 years
Advise the patient to keep well hydrated, choosing nice soft, bland diet for a few days until the inflammation wears off.
Reinforce good OH, keeping everything as clean as possible to help the area heal.
Suggest topical anaesthetics/sprays (e.g., 0.15% benzydamine hydrochloride for comfort/analgesia where lesions are painful
Suggest Gelclair, Gengigel or other mucosal coating agents (to protect the mucosa whilst it heals/for comfort)
Encourage avoidance of SLS toothpaste/mouthwash (which are extremely irritant with oral inflammatory conditions)
Suggest 0.2% chlorhexidine digluconate (which is useful due to its broad anti microbial properties however needs to dilution (1:1) as it is an astringent).
What is the treatment protocol for cold sores?
Reassure and explain the aetiology of the disease to the patient.
Advise identification and avoidance of triggers to prevent subsequent attacks
Prescription of Acyclovir (Zivirax) which can be bought OTC but this topical is typically ineffective in stopping the lesions from propagating, only useful in prodrome phase. Advise patient that if they want to avoid the formation of the cold sore, the ointment should be applied as soon as the prodrome phase begins (i.e., the tingling burning sensation) and application should be repeated every 4 hours whilst awake. Penicyclovir can also be used, but applied every 2 hours whilst awake and not to be used <12 years
Advise the patient to keep well hydrated, choosing nice soft, bland diet for a few days until the inflammation wears off.
Reinforce good OH, keeping everything as clean as possible to help the area heal.
Suggest topical anaesthetics/sprays (e.g., 0.15% benzydamine hydrochloride for comfort/analgesia where lesions are painful
Suggest Gelclair, Gengigel or other mucosal coating agents (to protect the mucosa whilst it heals/for comfort)
Encourage avoidance of SLS toothpaste/mouthwash (which are extremely irritant with oral inflammatory conditions)
Suggest 0.2% chlorhexidine digluconate (which is useful due to its broad anti microbial properties however needs to dilution (1:1) as it is an astringent).
Which topical antiviral ointments may be used to treat cold sores? What instructions should be given to patients prior to their use?
Prescription of Acyclovir (Zivirax) which can be bought OTC but this topical is typically ineffective in stopping the lesions from propagating, only useful in prodrome phase.
Advise patient that if they want to avoid the formation of the cold sore, the ointment should be applied as soon as the prodrome phase begins (i.e., the tingling burning sensation) and application should be repeated every 4 hours whilst awake.
Penicyclovir can also be used, but applied every 2 hours whilst awake and not to be used <12 years
Whilst cold sores are very common, reactivation of latent HSV via their presentation as intra-oral herpes lesions is rare but can be seen in the following:
In those who are immunocompetent (typically will see crops of tiny ulcers with a predilection for the hard palate or attached gingiva)
In those who are immunocompromised (uncontrolled diabetes, cancer, HIV etc. Can be very severe and much more widespread affecting more of the oral mucosa)
What is the management protocol for intra-oral herpes lesions during a reactivation of HSV1?
Explanation and reassurance to patient
Prescription if Chlorhexidine mouthwash or spray
If symptoms are unacceptable, prescribe systemic (not topical) aciclovir 200mg 2/daily as a prophylactic dose
Describe the phases of a Varicella Zoster infection
Primary infection (which presents as chicken pox)
Latency (at this point, the virus lives in the trigeminal neuronal ganglions of sensory nerves and later in life could be reactivated)
Reactivation (which presents as herpes zoster or shingles)
Not all patients who have had chicken pox will go on to develop shingles in later life. Certain risk factors will make it more likely e.g., immunocompromise
Describe the features of adult chicken pox
Extremely rare to get chicken pox more than once.
But if an adult was to develop chicken pox a second time, it would be much more severe, complicated with greater fatality than the childhood form. 20x risk of fatality in adulthood than childhood.
Greater risk of disseminated disease e.g., encephalitis, pneumonia, thrombocytopenia.
An 11 year old patient presents with a widespread maculo-papular rash affecting the scalp, trunk, skin and arms. On examination of his skin, you can see some crusty spots and red fluid filled sacs. The patient reports intense itching. Intra-orally, there is evidence of painful ulcers on the hard palate with a very erythematous base. What is the likely diagnosis and management protocol for this patient?
Chicken pox
Education and reassurance
Topical symptomatic relief (Gelclair, Gengigel etc.)
Anti-pyretics (paracetamol)
Advise soft bland diet and plenty of fluid for several days
What areas can be affected by chicken pox?
Trunk, arms, scalp, skin
Mucosa
Describe the features of mucosal chicken pox
Less common than chicken pox affecting the skin.
Typically, see lesions on an erythematous base that rupture to give painful ulcers.
Will resolve with little intervention other than topical symptomatic relief, anti-pyretics, and a soft, bland diet with plenty of fluid for a few days or so.
Describe the evolution of lesions in chicken pox
Chicken pox has an incubation period of 14 days (termed 1st viraemia). It then spreads to the skin and mucosa (termed 2nd viraemia)
In the prodrome phase, it’ll take a few hours/days from this period for the patient to start feeling unwell.
Following this, we will begin to see a maculo-papular rash over 7-10 days from itchy macules (red and flat) to papules (pink and raised) to vesicles, then pustules, then scabs
What is the incubation period for Chicken pox?
Incubation period of 14 days (termed 1st viraemia).
After which the infection spreads to the skin and mucosa (termed 2nd viraemia).
What is the incubation period for HSV1 infections?
3-7 days
What infection can occur if there is a reactivation of Varicella Zoster?
Herpes Zoster/Shingles
What areas may be affected if a patient has Herpes Zoster/Shingles?
Face (facial shingles)
Trunk (body)
Mouth (oral shingles)
Ear (Ramsay Hunt Syndrome)
Eye (Opthalmic Shingles)
Disseminated throughout the body (disseminated zoster, immunocompromised individuals at risk)
Describe the features of Herpes Zoster/Shingles
A maculopapular/vesicular rash with a dermatomal distribution which doesn’t extend beyond the midline usually. Very clear, unilateral presentations seen
Induces mild systemic illness but rash can be extremely painful and itchy, with potentially serious complications.
Starts with numbness over affected area with most experiencing neuralgiform pain (shooting stabbing headache), followed by the vesicular rash which scabs over within a week.
Secondary bacterial infection with S. aureus are common.
Can affect the body, face and mouth (rare)
A 65 year old patient presents to your clinic with ulcers limited to the left side of the tongue and the palate. On general examination, you notice a few itchy red spots, some of which seem to have burst to form crusted lesions. These also seem to be limited to the left side of the face. The patient reports mild systemic symptoms but states they had a sharp stabbing headache prior to the appearance of the rash. What is the likely diagnosis?
Herpes Zoster/Shingles affecting the distribution of the 2nd and 3rd branches of the trigeminal nerve (facial shingles and oral shingles)
If Varicella Zoster affects the 1st division of the trigeminal nerve, what clinical presentation is the patient at risk of? What complication is associated with this?
Ophthalmic shingles
Potentially site threatening, if left untreated (can cause loss of eye sight)
Describe the features of Ramsay Hunt Syndrome
Variant of shingles presenting in the head and neck (reactivated disease following triggers).
Essentially a motor zoster infection of the geniculate (7th cranial nerve) ganglion resulting in-
Unilateral lower motor facial palsy
Ear pain
Vesicles in the external auditory meatus
Intra-oral vesicles that may involve the soft palate and the pharynx on the ipsilateral side
Prognosis is usually good for this condition and there is typically no risk to the affected site of the patient
What is post-herpetic neuralgia?
Extremely painful complication after the rash induced by shingles.
Neuropathic pain (burning or stabbing in character).
Needs treatment with amitriptyline/gabapentin/pregabalin for at least 6 months
HHV4 is associated with many infections. List some
Infectious mononucleosis (glandular fever)
Oral hairy leucoplakia
Burkitt’s lymphoma
Nasopharyngeal carcinoma
Describe the features of a HHV4 infection
Also known as Epstein Barr Virus
Humans are the only natural reservoir for the virus
Common infection, often sub-clinical in the young
Typically affects young adults, especially in affluent areas
Can lay latent in B cells once patients are infected
Describe the features of infectious mononucleosis (glandular fever)
Typically affects teenagers and young adults with higher SES and is spread through infected saliva (kissing disease).
Has a very long incubation period of up to 50 days.
Can make patients systemically unwell. Typically, patients will have a sore throat, dysphagia, feel unwell with headaches, anorexia, malaise and fatigue.
Normally also causes a generalised lymphadenopathy, particularly in the neck (cervical) but also in the axillae and the groin.
Maculo-papular rash across the trunk and arms, often pale brown in colour
Oral manifestation of EBV typically include pharyngitis or tonsilitis (very enlarged tonsils with an erythematous base, erosions, petechiae, tonsillar exudate (greyish, yellow slough on top of the enlarged tonsils)). Tonsillar swelling may be severe enough to cause respiratory distress.
May also see erythematous lesions affecting the palate with small petechiae, erosions and ulcers. These tend to settle within a month.
But the post-viral fatigue that the patient is troubled with after glandular fever can persist for months and months after the clinical condition has resolved.
Enlarged spleen (splenomegaly) (should not be able to palpate the spleen clinically unless extreme effort is made)
Enlarged liver (hepatomegaly)
How is infectious mononucleosis (glandular fever) spread?
Through infected saliva (kissing disease).
During latency, where does the EBV lay dormant?
B cells
How does infectious mononucleosis (glandular fever) present intra-orally?
Pharyngitis or tonsilitis (very enlarged tonsils with an erythematous base, erosions, petechiae, tonsillar exudate (greyish, yellow slough on top of the enlarged tonsils)). Tonsillar swelling may be severe enough to cause respiratory distress.
May also see erythematous lesions affecting the palate with small petechiae, erosions and ulcers. These tend to settle within a month.
How is infectious mononucleosis (glandular fever) diagnosed?
Via rapid screening test (Monospot)
EBV serology
Observance of atypical white blood cells in the FBC
Hepatitic picture on the LFTs
What antibiotic can lead to worsening of acute symptoms if prescribed to a patient with infectious mononucleosis (glandular fever)?
If glandular fever is misdiagnosed and the patient is treated with ampicillin in the acute phase, then the maculo-papular rash can be much more dramatic
Needs to be avoided!
Describe the features of oral hairy leucoplakia
Another manifestation of EBV in the mouth.
Present as vertical stripes down the lateral borders of the tongue and can be bilateral but not always completely symmetrical.
Most commonly associated with HIV infection particularly, an undiagnosed/poorly controlled one.
OR those individuals with immunocompromised immune systems for other reasons such as poorly controlled diabetes
OR patients who have recently had an organ transplant (as they will be on immunosuppressive medications)
Describe the features of a HHV5 infection
HHV5, also known as the cytomegalovirus, causes a common, lifelong infection
A glandular-fever like syndrome, which may be reactivated in immunocompromised patients.
Uncommonly, lymphadenopathy or gross tonsillar involvement may be seen
Cytomegalovirus transmission via bodily secretions can occur sporadically during LATENCY
Life-threatening during pregnancy.
Which virus is responsible for the development of Kaposi’s sarcoma?
HHV8
Which virus is associated with the development of Kaposi’s sarcoma?
HIV
Which virus is associated with the development of oral hairy leucoplakia?
HIV
Describe the features of a Kaposi’s sarcoma
Malignant condition caused by HHV8 and most commonly associated with HIV (although it can be seen in a HIV- patient)
Can affect the mouth, trunk, arms, skin etc.
Typically, the lesions have a reddish, blue or violet appearance with maculo-papular areas which can become ulcerated.
Only usually painful once ulceration begins.
Very variable presentation
In the mouth, the palate or gums are most commonly affected, where large purple/blue bruising may be seen along with a large degree of hypertrophy in the gums.
But it can also affect the skin and many other parts of the body (arms/trunk), presenting as multiple raised purplish brown lesions
A patient presents to your clinic with flat violet/purple lesions that almost look like bruising to the vault of the palate. These lesions have diffuse borders and there are evident associated satellite lesions adjacent to them. He reports no pain but there is evident hypertrophy of the gums. The medical history reveals the patient has HIV. What is the likely diagnosis and management protocol for this patient?
Kaposi’s Sarcoma
These areas of pigmentation are highly concerning and suggestive of malignancy
An urgent 2 week wait referral to OMFS unit or other appropriate services are needed to assess for dysplastic/malignant changes following an incisional biopsy
Describe the features of a HPV infection
DNA virus spread by direct contact (hand to mouth, mouth to mouth, sexual contact)
Humans are the only reservoir for HPV
1 virus with >40 subtypes in the oral mucosa alone
Epitheliotropic virus as it can cause gingival epithelium overgrowth/formation of warts
Typically acquired early on in life. Usually sub-clinical or of no consequence to the patient.
Some patients will completely clear the HPV infection from the mucosa in the mouth but others may go on to have latent HPV infection that can be reactivated later in life
Describe the phases of a HPV infection
DNA virus spread by direct contact (hand to mouth, mouth to mouth, sexual contact)
Primary infection where we may see the formation of warts/exophytic growths in the oral mucosa. Can be sub-clinical causing no symptoms to the patient
Some will completely clear the HPV infection from the oral mucosa, but for others the HPV may lay dormant to be reactivated later in life
Define epitheliotropic virus. Give an example
A virus that induces gingival epithelium overgrowth/formation of warts or exophytic growths.
HPV
Describe the intra-oral features of a HPV infection
Appearance of HPV lesions in the mouth are somewhat varied
But typically will appear as a pedunculated lesion with an exophytic fond-like surface or a cauliflower-like texture.
May be one single lesion or multiple lesions.
Less commonly, they may have a completely smooth surface.
Known as oral squamous cell papillomas
What is a squamous cell papilloma?
Exophytic wart
Some HPV subtypes are associated with a high risk of cervical cancer, cancer affecting the genitalia and oropharyngeal cancers. List these subtypes
HPV16
HPV18
What is an oropharyngeal cancer?
Oropharyngeal cancers are essentially squamous cell carcinomas of the tonsils, base of the tongue, pharynx or soft palate
List the risk factors for the development of oropharyngeal cancers
HPV infections
Alcohol
Smoking
Oral sex with multiple partners
What is Focal Epithelial Hyperplasia?
Also known as Heck’s disease, condition that arises from a HPV infection
Produces flat oral mucosal lesions
Less common
What is another term for Heck’s disease?
Focal epithelial hyperplasia
What is the Gardasil Vaccine used for?
To give immunity to HPV infections
Used to reduce cervical cancer rates. Likely to benefit those at risk of HPV related oropharyngeal cancer too.
2-3 dose course.
Aimed to be given before first sexual encounter to both females/males.
Describe the features of Coxsackie Virus A or B
Enteroviruses
RNA viruses
Infections caused by these viruses include hand, foot or mouth disease
Describe the features of hand, foot or mouth disease
Caused by enterovirus Coxsackie A or B
Presents as vesicular lesions affecting the hands, feet and mouth
Patients may also have a prodrome phase with fever, malaise, raised lymph nodes in the neck (cervical lymphadenopathy) or throat
Self limiting disease, typically resolves itself in 1-2 weeks at most
Each year, it is responsible for small epidemics in school or nursery aged children
Describe the features of HIV
HIV is an RNA virus that originates from the Lentivirus subfamily of retroviruses
Lymphotropic and neurotropic (lies in the lymph and neurones for the rest of the host’s life)
Primary infection may cause no symptoms or a non-specific viral illness.
4-6 weeks are needed for seroconversion to occur (for the patient to go from HIV- to HIV+).
Some patients are completely unaware of their diagnosis
Define AIDS
A condition where individuals have a CD4+ (T-cells) count of less than 200 and there is a presence of an “AIDS defining illness”
These patients will easily be overcome by opportunistic infections
What (intra-oral) features are commonly associated with a HIV infection?
Cervical lymphadenopathy (swelling in the neck)
Linear gingivitis (redness and inflammation restricted to the gingival margins of a tooth)
Acute necrotising ulcerative gingivitis/periodontitis (ulcerated and necrosed gingiva around the teeth, bad breath/taste and pain often reported)
Oral hairy leucoplakia (vertical white stripes/strait ions on the lateral borders of the tongue)
Kaposi’s Sarcoma
Oral papillomas (warts)
Candidosis
The oral symptoms resulting from a HIV infection are affected by the following-
Immune status
HIV viral load
Progression/age of HIV infection
Describe the general treatment protocol for HIV patients
Effective anti-retroviral drugs used to suppress viral load
HAART (Highly Active Anti-Retroviral Therapy).
Compliance is imperative for successful viral suppression and the delay/prevention of AIDS.
Patients who are taking HAART successfully, at an extremely low or undetectable level of HIV viral load, will actually experience oral side effects because of the medication! List some of these
Oral ulceration (usually aphthous form)
Erythema multiforme
Xerostomia
Major salivary gland enlargement
Dysgeusia (taste disturbances)
Dysaesthesias (abnormal sensation)
Other orofacial pain syndromes
Whilst treating a HIV+ patient, if a dentist cuts himself with a drill, what should he do?
2 approaches-
Post-Exposure Prophylaxis-
Medication given to those who have not already got HIV but have potentially been exposed to the virus. Reduces the likelihood of seroconversion. May be relevant to dentistry.
Pre-Exposure Prophylaxis also exists (PrEP) but will not be encountered in GDP