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

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

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

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

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

Vesicles on Lips, Fever and enlarged Lymph nodes

TREATMENT Isolation and bed rest advised because patients are highly infectious Most treatment is symptomatic and the disease resolves about 10-14 days Soft diet and adequate fluid intake Antipyretics and analgesics for the symptoms .

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

TREATMENT Treatment with antiviral agents at this stage may shorten the course of the disease which otherwise lasts 10-14 days Patient is infectious during this time and dental treatment should be avoided

2) Varicella zoster viral infections

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

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

Stages of chicken pox

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

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

3)HAND, FOOT AND MOUTH DISEASE 4)HERPANGINA

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

HERPANGINA