| Herpes Simplex Virus
Oral Effects
here are two major types of herpes simplex virus (HSV). HSV-1 usually results
in oral infections, or skin infections above the waist. HSV-2 usually results
in genital infections. However, both types can occur in both locations.
Infection with HSV is very common in childhood. Children are infected
through close contact with family members and through contact with saliva
or nasal secretions from other children. The first time children are
infected, they may have a fever, a sore mouth, and red and inflamed gums.
A first infection also is common among teenagers and young adults, who
may have inflamed gums, oral ulcers and a sore throat. Adults who are
infected for the first time may exhibit a sore throat or tonsillitis
and occasionally some sores in the mouth. These effects are usually a
result of close contact with an infected person and usually are caused
by HSV-1.
The herpes virus can be reactivated at any time throughout life, usually
by stress, dental treatment, exposure to bright sunlight, fever or a
weakened immune system. The main symptom of reactivation is a painful
lesion on the lip, commonly referred to as a cold sore or fever blister.
At the Dentist
If you have an active herpes lesion, you should avoid elective dental treatment,
as it is easy to spread the virus in a dental setting and you may have problems
opening your mouth enough for dental treatment.
Recent studies have shown taking antiviral medicine before certain dental
procedures can help decrease recurrent HSV outbreaks.
Gonorrhea
Oral Effects
People with pharyngeal gonorrhea have the bacteria that cause gonorrhea in their
throat. They may experience sore throat. Gonorrhea does not usually affect the
mouth, but some people do have oral sores, or areas of red and swollen tissue
in their mouths.
At the Dentist
If you have active gonorrhea and have oral lesions, you can transmit the disease
to dental care personnel. If possible, avoid elective dental procedures while
you have active oral gonorrhea.
Hepatitis
Oral Effects
Hepatitis rarely causes any oral effects.
At the Dentist
Your dentist will be concerned about liver function, because liver problems can
affect your ability to metabolize drugs, as well affecting your blood-clotting
ability. Your dentist should talk with your physician about your condition and
any medications you are taking.
Patients can transmit hepatitis to dental care personnel through blood or
blood-contaminated saliva. Vaccines for type A and type B hepatitis are available,
but there is no vaccine for type C hepatitis.
Treatment of hepatitis C varies in effectiveness. Dentists and oral surgeons
are at risk of infection from patients, although the risk is relatively low.
For example, if your dentist suffered an accidental needlestick with a contaminated
needle, he or she has about a 3% chance of becoming infected. If you have hepatitis,
make sure your dentist is aware of your condition.
Syphilis
Oral Effects
Painless sores that appear ulcerated and gray (necrotic) in the mouth tend to
occur during the second stage of syphilis (within six weeks after the primary
infection). These sores are referred to as mucous patches.
At the Dentist
If you have active syphilis and have sores in your mouth, you can transmit the
disease to dental care personnel. Avoid elective dental procedures if possible.
Epstein-Barr Virus
Oral Effects
The most common disease associated with Epstein-Barr virus (EBV) infection is
infectious mononucleosis, or "kissing disease." Symptoms can include
fever, fatigue, enlarged glands and sore throat. The virus is in saliva and can
be transmitted easily from person to person by exchange of saliva, especially
while you have a fever.
Epstein-Barr virus infection may also cause an oral sore called hairy
leukoplakia. It appears as a white patch, most commonly on the side of
the tongue and mostly in people with weakened immune systems. Hairy leukoplakia
does not require treatment, but it will respond to antiviral drugs. However,
it usually returns after drug therapy is stopped.
Epstein-Barr virus has also been associated with cancer of the nasopharynx.
At the Dentist
If you have active mononucleosis, you can transmit it to dental care personnel
through your saliva and should avoid elective dental treatment if possible. If
your dentist finds a white patch in your mouth, he or she may want a biopsy performed.
Cytomegalovirus
Oral Effects
Cytomegalovirus (CMV) is a type of herpes virus. Many people may have the virus
and show no signs. However, you may get a sore throat when you are first infected.
CMV usually is reactivated only in people with weakened immune systems, and it
can cause salivary-gland enlargement and mouth sores.
At the Dentist
If you have active CMV, you may infect dental care personnel. Occasionally, a
biopsy of oral sores is needed to establish a diagnosis of CMV. If your dentist
suspects CMV infection, he or she may order blood tests to evaluate your immune
system and refer you to a physician for evaluation.
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