HERPES SIMPLEX VIRUS

&
RECURRENT APHTHOUS
STOMATITIS
HERPES SIMPLEX VIRUS
 HERPES SIMPLEX VIRUS
Human herpes virus family
*HHV-1 - Herpes simplex virus 1
*HHV-2 - Herpes simplex virus 2
*HHV-3 - Varicella zoster virus
*HHV-4 - Epstein barr virus
*HHV-5 - Cytomegalus virus
HSV - 1 :
spread- through infected saliva or
active perioral lesions.
sites - skin, oral, facial, ocular areas
pharynx and eyes.
HSV - 2 :
spread- through sexual contact
sites - genitals and skin below waist.
HSV - 3 :
Erythema Multiforme.
 CLINICAL FEATURES :
1. ACUTE HERPETIC GINGIVOSTOMATITIS
* Most common.
* Age - 6 months to 5 years.
* Onset- abrupt.
* Anterior cervical lymphadenopathy, fever,
chills and sore mouth lesions.
* Affected mucosa – pin head vesicles
collapse
shallow irregular ulceration.
* Gingiva – enlarged, painful, erythematous
and punched out erosion.
* Usually a SELF LIMITING disorder.
2. PHARYNGOTONSILLITIS

Sore throat, fever, malaise, headache.

Numerous small vesicles on tonsils & pharynx
rupture
form ulcers with diffuse greyish yellow exudate.
Involvement of oral mucosa anterior to
Waldeyer’s ring.
3. HERPES LABIALIS
Also known as COLD SORE or FEVER BLISTER.
Site : vermillion border & adjacent skin of lip.
Pain, burning, itching, erythema.
Multiple papules
vesicles
rupture
Crust
heal
4. HERPETIC WHITLOW (Herpetic paronychia)

Infection of thumb or finger.

Self inoculation in children with orofacial herpes.
Dentists- through finger contact with herpes patient.
(if gloves are not used)
Paraesthesia & permanent scarring.
5. HERPES GLADIATORUM

(scrumpox)

seen in : wrestlers and rugby players

due to : contamination of areas of

6. ECZEMA HERPETICUM

Chronic skin disease- eczema, pemphigus.

In oral cavity –
site : dorsum of tongue-----GEOMETRIC
GLOSSITIS.
i.e. deep midline fissures which exhibit multiple

peripheral branches.
HISTOPATHOLOGICAL FEATURES

Infected epithelial cells show –

* Ballooning degeneration – acantholysis
nuclear clearing
nuclear enlargement
* Tzanck cells (acantholytic cells)
Rupture of mucosal vesicles ulceration.
This is surrounded by fibrinopurulent material.
DIAGNOSIS
Culture isolation of virus
Cytologic smear
Serological test
Tissue biopsy

DIFFERENTIAL DIAGNOSIS
Recurrent apthous stomatitis
Necrotisisng stomatitis
Ulcerative periodontal disease
TREATMENT

Avoid contact with active lesions

Antivirals – Acyclovir, valacyclovir
Famciclovir
Topical rinsing with 0.5% or 1% dyclonine
hydrochloride
NSAIDS - Ibuprofen
 RECURRENT
APTHOUS STOMATITIS
DEFINITION
It is a common disease characterized by
development of recurrent, painful,
solitary or multiple ulcerations of oral
mucosa with no signs of any other
disease.
TYPES
1. MINOR APHTHAE (Canker sores)
2. MAJOR APHTHTAE (Sutton’s disease)
3. HERPETIFORM ULCERS
4. RECURRENT ULCER
ETIOLOGY
1. Bacterial infection – staphylococcus & streptococcus
2. Immunological abnormalities
3. Iron/folic acid defeciency anaemia
4. Hereditary
5. Secondary malasbsorption syndrome
6. Endocrine conditions – pregnancy, menstruation
and menopause
7. Stress condition
8. Cessation of smoking
CLINICAL FEATURES
Age : II & III rd decade of life.
Sex : F>M.
Site : buccal and labial mucosa, lingual sulci,
tongue, soft palate.
Shape : round, symmetric and shallow or deep.
Symptoms : very painful and interfere with eating.
Sign : localized areas of erythema small white papules
ulceration and gradually enlarge.
MINOR APHTHAE
Size : 0.3 – 1 cm.
Site : labial and buccal musosa
Appearance : yellowish white, removable
fibrinopurulent membrane and is
encircled by an
erythematous halo.
Duration : shortest of all.
Healing : healing without scarring in 7 – 14 days.
MAJOR APHTHAE
Size : 1 – 5 cm.
Symptoms : interfere with speech and eating.
Signs : large portions are covered with deep
PAINFUL ulcers.
decreased mobility of tongue and uvuvla.
Healing : healing is slow and leaves scar.
HERPETIFORM ULCER
Greatest number of lesions and most frequent recurrence.
Multiple small shallow ulcers
Begin as pinhead size erosions
enlarge
coalesce
Lesions are very painful.
Last for 1 – 3 years.
HISTOPATHOLOGY

Central zone of ulceration.

Fibrinopurulent membrane covers the ulcer.
Inflammatory cells – neutrophils and lymphocytes
seen in connective tissue.
Anitschkow cells.
DIFFERENTIAL DIAGNOSIS

Primary syphilitic lesion.

Atrophic candidiasis
Herpetic stomatitis
Herpetiform gingivostomatitis
Erythema multiforme
Erosive lichen planus
Necrotisisng sialometaplasia
MANAGEMENT
MILD CASE:
Topical application - emolient base (orabase)
- corticosteroid preparation.
Mouth wash --- Tetracycline, chlorhexididne.
Replacement therapy – with vit B12, ferritin,
folate & iron.
Symptomatic treatment : Xylocaine/lidocaine
Silver nitrate
Benadryl, topical.
SEVERE CASE :

Topical application – clobetasol cream

beclomethasone spray
Mouthwash -- chlortetracycline.
Injection -- corticosteroid
Drugs -- nicotine tablets, alpha interferon,
thalidomide (rarely).