1. Dr. Shahzadi Tayyaba Hashmi
DNT 243
ORAL MUCOSA DISEASES
Dr. Shahzadi Tayyaba Hashmi

2. VIRAL INFECTIONS Incubation period:
The time taken for the virus to infect the host, replicate and for cellular damage is known as incubation period
Duration is from 3 to 21 days
Most severe viral infections last between 10 and 14 days after which time the host has mounted an effective immune response and the infection resolves
Less 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 secondary
Herpes simplex: primary and secondary
Hand, foot and mouth disease
Herpangina
Of these infections, herpes simplex is most common and important

4. 1)HERPES SIMPLEX Primary herpes ( primary gingivoherpetic stomatitis)
Secondary herpes ( cold sores)

5. A)PRIMARY HERPES Etiology: Clinical Features:
Caused by herpes simplex virus type 1, which is transmitted in saliva
Clinical 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 slough
Surrounding tissues are red and lips may appear swollen
Difficulty in swallowing and eating
Patient feels unwell
Affects children and young adults

6. Vesicles on Lips, Fever and enlarged Lymph nodes

7. TREATMENT
Isolation and bed rest advised because patients are highly infectious
Most treatment is symptomatic and the disease resolves about days
Soft diet and adequate fluid intake
Antipyretics 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 menstruation
It travels down the trigeminal nerve to form characteristic vesicles, which burst on the lips
The lips may become swollen and the lesions are known as cold sores

9. TREATMENT
Treatment with antiviral agents at this stage may shorten the course of the disease which otherwise lasts days
Patient is infectious during this time and dental treatment should be avoided

10. 2) Varicella zoster viral infections

11. VARICELLA ZOSTER VIRAL INFECTIONS
The primary infection of Varicella zoster virus
( VZV) is known as Varicella or chicken pox
The 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 children
Primary infection includes fever, headache, sore throat and lung congestion
Incubation period lasts up to 21 days
After an incubation period, patient develops a rash accompanied by low-grade fever
Lesions quickly progress to vesicles that rupture and become crusted
Small number of vesicular lesions are found on oral mucosa including the tongue, buccal mucosa, gingiva and palate
If patients are immunocompromised, death can also occurs
Treatment:
Symptomatic treatment

13. Stages of chicken pox

14. 2) SECONDARY VZV INFECTION (SHINGLES)
Key features:
Is the recurrent form of Varicella infection
Caused by reactivation of VSV latent in the dorsal ganglion during the primary infection
More common in adults who are immunocompromised
Most common clinical feature is the linear vesicular rash on the skin
Factors that decrease immune function such as human immunodeficiency virus infection, chemotherapy and malignancies increase the risk of herpes zoster

16. TREATMENT Orally administered acyclovir
The antiviral medications are most effective when started within 72 hours after the onset of the rash

17. 3)HAND, FOOT AND MOUTH DISEASE
4)HERPANGINA

18. Hand, foot and mouth disease and Herpangina
Key Features:
These two infections are caused by the coxsackie A virus
Relatively mild diseases usually affect children
In both infections, the lesions are characterized by vesicles, which break down to form shallow ulcers
In 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 feet
In herpangina, the lesions may affect the soft palate, tonsils and pharynx and the patient usually complains of a sore throat
In both conditions lesions resolve within a few days

19. HERPANGINA