Herpes Simplex Labialis

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Herpes Simplex Labialis

• What is it?
• A viral infection caused by a family of viruses
  called Herpesveridae (CMV, Epstein-Barr virus,
  HSV-1, and HSV-2)
• There is an initial infection with symptoms then
  there are periods of long dormancy with a chance
  of reactivation

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HSL

• Who has it?
• In America 80 of the population have HSL. Of
  this, about 50 will have reactivation of the
  virus at least once in their lifetime.
• Primary infection usually occurs in childhood.

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HSL continued

• How is the virus contracted?
• Via direct contact.
• Explain the pahophysiology?
• The virus enters the host through either a break
  in the skin or intact mucus membrane. The virus
  invades sensory neurons and is transported to the
  sensory ganglia where it lies dormant.

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• What are the symptoms?
• At first there is a burning, itching, tingling
  sensation in the area where the lesion will form.
• There can also be pain, fever, swollen lymph
  nodes, and malaise.
• The lesion appears as small red papules with
  fluid containing vesicle 1-3mm in diameter.

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• The boarder around the vesicle may be red and
  inflamed.
• Fully developed lesions has a crusty cover and
  if there is pus under the crust that may indicate
  a secondary bacterial infection.
• The whole symptomatic process typically lasts
  10-14 days and heals without scarring.

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• What triggers reactivate virus?
• UV radiation, stress, fatigue, cold burn, wind
  burn, fever, injury, menstruation, dental
  procedures, infectious disease, and
  immunosuppresion.

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• Side note Acute Herpetic Gingivostomatits (AHG)
• Very similar to HSL, seen mostly in children and
  immunocompromised adults
• Lesions develop on any oral mucosal surface thus
  it resembles RAS.

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• The distinguishing difference is that AHG
  presents itself as infected gums which are red
  and covered by a pseudomembrane or studded with
  ulcerations.
• When are you not to treat HSL?
• Lesions that have lasted longer than 14 days.

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• Reoccurrence rate increasing in frequency.
• Immunocompromised patients.
• What are the treatment goals?
• To relieve discomfort.
• To prevent secondary bacterial infection.

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• To prevent autoinoculation or spreading of the
  virus.
• How do you treat HSL?
• Lesions should be gently washed with mild soap
  solution and hands should be washed frequently.
• Lesions should be kept moist to prevent drying
  or cracking.

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• Doconasol 10 (Abreva) is the only otc product
  proven to reduce the severity and duration of
  symptoms. Or is it?
• All other otc products just relieve the
  discomfort
• -Benzocaine (5-20)
• -Dibucaine (0.25-1)
• -Dyclonine HCl (0.5-1)

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• -Benzyl alcohol (10-33)
• -Camphor (0.1-1)
• -Menthol (0.1-1)
• Topical steroids contraindicated.
• What other therapy is available?
• Orally administered doses of lactobacillus,
  L-lysine, citrus bioflavonoid, or pyridoxine.

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• Do not recommend any of these products, there is
  just not enough evidence.
• So what is in the formulary?
• Abreva (doconasol 10)
• Novitra (zincum oxydatum 2X, HPUS)

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• Tanac (Benzalkonium Cl 0.12 Benzocaine 10)
• Zilactin (Benzyl Alcohol 10)
• Chapstick medicated Lip balm stick (camphor 1,
  menthol 0.6, phenol 0.5)

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Xerostomia

• What is it?
• Disorder where the salivary flow is limited or
  completely inhibited this results in dry mouth.
• Who has it?
• Individuals with certain disease states
  (diabetes mellitus, Crohns disease, etc.)

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• Certain medications
• Radiations therapy of the head and neck
• lifestyle activities (alcohol, tobacco, and
  caffeine)
• Roughly 20 of the elderly have dry mouth.

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• So why is dry mouth dangerous?
• Increases the chance of caries, gingivitis,
  periodontal disease, reduced denture wearing,
  candidiosis, tooth erosion, decalcification, and
  decay.

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• What are the symptoms?
• Difficulty in talking, swallowing, stomatitis,
  burning tongue, halitosis, loss of appetite, and
  hypersensitive teeth.
• What are the goals of treatment?
• To reduce discomfort.
• To reduce risk of dental decay.

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• When are you not to treat?
• Mouth soreness associated with poor-fitting
  dentures.
• Fever or Swelling
• Loose teeth or bleeding gums
• Severe tooth pain and any other serious
  complication associated with dry mouth.

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• How are you to treat Xerostomia?
• Avoid substances that reduce salivation.
• Take medications that can dry your mouth one
  hour prior to eating.
• limit foods high in sugar and acid to prevent
  tooth decay.

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• Chewing gum stimulates salivary flow.
• Use of soft toothbrush to help prevent tooth
  decay.
• Use of artificial saliva products for as needed
  basis.
• Artificial saliva is formulated to act as
  natural saliva both chemically and physically.

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• Patients susceptible to caries should also use a
  topical fluoride product.
• What is in the formulary?
• X-ero-lube
• Oral balance Gel
• Salivart