2 VIRAL INFECTIONS Incubation period: The time taken for the virus to infect the host, replicate and for cellular damage is known as incubation periodDuration is from 3 to 21 daysMost severe viral infections last between 10 and 14 days after which time the host has mounted an effective immune response and the infection resolvesLess virulent infections may last only a few days
3 Viral infections in oral cavity The common viral infections affecting the oral cavity are:Herpes zoster: primary and secondaryHerpes simplex: primary and secondaryHand, foot and mouth diseaseHerpanginaOf these infections, herpes simplex is most common and important
5 A)PRIMARY HERPES Etiology: Clinical Features: Caused by herpes simplex virus type 1, which is transmitted in salivaClinical Features:Fever and enlarged lymph nodes in the neck ( cervical lymphadenopathy)Painful blisters known as vesicles develop on the gingiva, palate, buccal mucosa and tongue. These bristles burst to form superficial ulcers covered in grey- white sloughSurrounding tissues are red and lips may appear swollenDifficulty in swallowing and eatingPatient feels unwellAffects children and young adults
6 Vesicles on Lips, Fever and enlarged Lymph nodes
7 TREATMENTIsolation and bed rest advised because patients are highly infectiousMost treatment is symptomatic and the disease resolves about daysSoft diet and adequate fluid intakeAntipyretics and analgesics for the symptoms.
8 B) SECONDARY HERPES Key features: After a person’s initial herpes simplex virus infection, the herpes virus remains dormant in the ganglion of the trigeminal nerve and is reactivated by a number of agents including sunlight, stress and menstruationIt travels down the trigeminal nerve to form characteristic vesicles, which burst on the lipsThe lips may become swollen and the lesions are known as cold sores
9 TREATMENTTreatment with antiviral agents at this stage may shorten the course of the disease which otherwise lasts daysPatient is infectious during this time and dental treatment should be avoided
11 VARICELLA ZOSTER VIRAL INFECTIONS The primary infection of Varicella zoster virus( VZV) is known as Varicella or chicken poxThe recurrent disease is known as herpes zoster or shingles
12 1) PRIMARY INFECTION OF VZV ( CHICKEN POX) Clinical features:Initial infection of VZV which is common in childrenPrimary infection includes fever, headache, sore throat and lung congestionIncubation period lasts up to 21 daysAfter an incubation period, patient develops a rash accompanied by low-grade feverLesions quickly progress to vesicles that rupture and become crustedSmall number of vesicular lesions are found on oral mucosa including the tongue, buccal mucosa, gingiva and palateIf patients are immunocompromised, death can also occursTreatment:Symptomatic treatment
14 2) SECONDARY VZV INFECTION (SHINGLES) Key features:Is the recurrent form of Varicella infectionCaused by reactivation of VSV latent in the dorsal ganglion during the primary infectionMore common in adults who are immunocompromisedMost common clinical feature is the linear vesicular rash on the skinFactors that decrease immune function such as human immunodeficiency virus infection, chemotherapy and malignancies increase the risk of herpes zoster
18 Hand, foot and mouth disease and Herpangina Key Features:These two infections are caused by the coxsackie A virusRelatively mild diseases usually affect childrenIn both infections, the lesions are characterized by vesicles, which break down to form shallow ulcersIn hand, foot and mouth disease almost any part of the oral mucosa may be affected together with the hands and the plantar surfaces of the feetIn herpangina, the lesions may affect the soft palate, tonsils and pharynx and the patient usually complains of a sore throatIn both conditions lesions resolve within a few days
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