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24 Cards in this Set
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herpes simplex type 1 |
primary infection: contact with infected person incubation - 3-9 days asymptomatic usually in children remains in sensory ganglion (neuroinvasiveness) secondary/recurrent infection: reactivation of virus triggering factors (age, UV light, menstruation, stress, etc.) |
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acute herpetic gingivostomatitis |
most common clinical presentation of primary HSV1 infection usually in children under 5 clinical features: anterior cervical lymphadenopathy fever anorexia irritability oral lesions: (often get mistaken for NUG) small vesicles that rupture and ulcerate ulcers coalesce, form larger ulcers with irregular margins ulcerations on movable and bound mucosa GINGIVA are enlarged, erythematous, painful punched-out lesions on gingiva oral lesions can extend to vermilion and skin self-limiting (5-7 days) pediatric treatment: acyclovir suspension in first 3 symptomatic days 15mg/kg up to adult dose of 200mg rinse and swallow 5x a day for 5 days |
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pharyngotonsillitis |
less common clinical presentation of primary HSV1 infection usually in adults clinical features: sore throat, fever, malaise, headache vesicles and ulcers on tonsils and posterior pharynx |
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secondary HSV1 |
clinical presentations: herpes labialis intraoral recurrent herpes herpetic whitlow - fingers herpes gladiatorum or scrumpox - sites of epithelial damage eczema herpeticum - chronic skin diseases |
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herpes labialis |
clinical features: vermilion and adjacent skin of lips prodrome is 6-24 hours papules, vesicles, rupture and crust (2 days) healing takes 10 days TREATMENTS OTC: docosanol cream 10% (Abreva) prevents viral entry and replication external use only zilactin-B adhesive gel, 10% benzocaine sunblock Prescription products: penciclovir (denavir) 1% in prodrome inhibits viral replication, extraoral valtrex 2g on recognition of symptoms followed by 2g 12 hours later acyclovir 400mg 5 times daily for 5 days begun on recognition of symptoms |
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intraoral recurrent herpes |
clinical features of immunocompetent: localized in keratinized mucosa (attached to bone) small vesicles, rupture, coalesce, red macules, ulcerate self-limiting, heals in 7-10 days clinical features of immunocompromised: keratinized and non-keratinized mucosa larger lesions raised, yellow border chronic TREATMENTS acyclovir ointment treatment starts 0-8 hours of symptoms valtrex 2g on recognition of symptoms followed by 2g 12 hours later acyclovir 400mg 5 times daily for 5 days begun on recognition of symptoms |
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histopathology of herpes simplex |
ballooning degeneration TZANK CELLS - acantholytic epithelial cells multinucleated cells intercellular edema = intraepithelial vesicle vesicle rupture = fibrinopurulent membrane |
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recurrences of oral/labial HSV with known triggers |
associated with dental care: valtrex 2g taken twice on day of procedure and 1g taken twice the next day associated with prolonged trigger (beach vaca): valtrex 1g daily acyclovir 400mg twice daily long-term suppressive therapy (6 or more recurrences per year): acyclovir 400mg bid acyclovir 200mg 3-5x/day valtrex 500mg qd |
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varicella-zoster (VZV or HHV3) |
spread through air droplets and direct contact incubation 10-21 days clinical features: malaise, pharyngitis, rhinitis skin eruption, intense pruritis oral lesions: common, painless vesicles that rupture and ulcerate anywhere on oral mucosa, but common \on buccal mucosa and palate complications: reye's syndrome encephalitis and pneumonia (even in healthy kids) induce spontaneous abortion early in preg. |
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varicella diagnosis/treatment |
diagnosis: clinical, based on skin treatment: refer to physician treatment is usually supportive |
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herpes zoster (shingles) |
clinical features: prodrome 1-4 days pain can mimic dental pain if CN V is involved skin lesions do not cross midline oral lesions do not cross midline |
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herpes zoster complications |
postherpetic neuralgia: pain that does not go away within 1 month pain is severe and flares upon contact can be treated with famciclovir disseminated zoster: blistery rash that spreads over a large portion of the body and can affect heart, lungs, liver, pancreas, joints and GI infection may spread to nerves that control movement, may cause temporary weakness cranial nerve involvement: rash on side and tip of nose (hutchinson's sign) requires a referral to a ophthalmologist due to potential involvement of nasociliary branch of trigeminal |
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herpes zoster treatment |
valtrex 1g tid for 7 days begun in first 48-72 hours |
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epstein barr virus (HHV4) |
transmitted by intimate contact causes infectious mononucleosis |
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infectious mononucleosis |
asymptomatic in children incubation period 4-6 weeks prodrome with malaise, 2 weeks fever, adults especially cervical lymphadenopathy severe sore throat, tonsillar swelling petechiae on hard and soft palate splenomegaly hepatomegaly oral facial symptoms: NUG Bell's palsy diagnosis: elevated WBC Paul-bunnel heterophil antibody test immunofluorescence treatment: self-limiting |
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cytomegalovirus (HHV5) |
transmission: placenta, childbirth, body fluids, blood transfusions, organ transplants most CMV infections are silent symptomatic disease found in: neonates young adults transplant patients AIDS patients oral lesions in immunosuppressed (ulcers) |
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HPV |
dsDNA virus induces proliferation (benign and/or malignant) HPV 2,4 - verruca vulgaris HPV 6,11 - condyloma acuminatum, squamous papilloma HPV 13,32 - focal epithelial hyperplasia HPV 16 - proliferative verrucous leukoplakia subtypes HPV 6,11,16 - verrucous carcinoma HPV 16,18 - squamous cell carcinoma, condyloma |
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oral squamous papilloma |
benign epithelial proliferation HPV 6,11 clinical features: pedunculated, exophytic nodule cauliflower-like or papillary surface pink or white in color usually single approx 5mm size treatment: surgical excision if untreated, there will be no malignant transformation |
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verruca vulgaris |
wart HPV 2,4,40 contagious very common in SKIN autoinoculation spread to oral cavity clinical features: papule or nodule with papillary surface pedunculated or sessile intraoral lesions are white approx 5mm size multiple lesions can be seen common in children, on skin of hands vermilion border, labial mucosa, anterior tongue treatment: skin - excision/removal oral - surgical excision |
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condylomas acuminatum |
venereal wart proliferation of epithelium of genitals, perianal area, oral and laryngeal mucosa HPV 6,11,16,18 considered an STD incubation 1-3 months clinical features: common in anogenital mucosa sessile, nodules, papillary surface, pink color in oral cavity - labial mucosa, soft palate, lingual frenum treatment: conservative surgical excision topical agents laser ablation contagious and can spread by direct contact |
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focal epithelial hyperplasia |
heck's disease proliferation of squamous epithelium HPV 13,32 initially described in native americans and inuits, family clusters clinical features: children more commonly affected multiple papules or nodules same color mucosa 3-10mm in size cluster together in cobblestone appearance treatment: may regress spontaneously excision for diagnosis or cosmetic purposes low recurrence, no malignant transformation |
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enterovirus |
RNA virus transmitted feco-oral route childhood infectious disease incubation 4-7 days summer/fall clinical manifestations: herpangina hand-foot-and-mouth disease treatment: symptomatic relief non-aspirin antipyretics |
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herpangina |
coxsackie A virus usually clinical features: sore throat, dysphagia, fever, vomiting oral lesions: macules-vesicles-ulcers, 2-4mm located on soft palate or tonsillar pillars |
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hand-foot-and-mouth disease |
coxsackievirus A 16 clinical features: macules-vesicles that heal without crusting in palms, soles, and ventral sides of fingers and toes oral lesions appear without prodrome and before skin lesions vesicles-ulcers 2-7mm diameter, found in buccal and labial mucosa |
