Viral diseases 3/certified fixed orthodontic courses by Indian dental academy

Viral Infection
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com

LEARNING OBJECTIVES
At the end of the lecture student should be able
to
– Describe the etiology, clinical features,
histopathological features of HSV infection
– Describe the etiology, clinical features,
histopathological features of recurrent stomatitis
–Describe the etiology, clinical features,
histopathological features of primary stomatitis

Viruses
• Submicroscopic entities which reproduce only within
living cells .
• RNA viruses
• DNAViruses

Herpes Simplex
(Acute herpetic gingivostomatitis, Herpes labialis, Fever
blister , Cold sores)
• DNA viruses involve ectodermal tissue
• Type I- Oral
• Type II – Genital ( Oro-Genital)
Virulent , Ca cervix, venereal disease
Primary – without Ab
Recurrent - with antibody

Herpes Simplex
• H. Meningoencephalitis - sudden fever, increased
intracranial pressure, paralysis of muscle , convulsion
& death.
• H. conjunctivitis – swelling & congestion of palatable
conjunctiva although keratitis & ulceration may
occur.

• H. Eczema – herpetic infection superimposed on
eczema , vesicular lesions of skin & fever.
• Disseminated H. Simplex – child in birth canal.

Primary Herpes Simplex Stomatitis
• Rare before 6 months ( maternal Ab )
• Children & young adults
• C/F – fever , irritability, headache , pain on
swallowing & regional lymphadenitis.
• Gingiva , lip , tongue may be involved

• Yellowish fluid filled vesicle
develop & rupture & form
shallow, ragged painful ulcers
covered with grey
pseudomembrane
surrounded by
erythematous halo

• Ulcers preceded by gingival inflammation, heal
spontaneously & leave no scar.
• HSV-I can be isolated from lesion in 2-6 days.
• Transmitted by direct contact , saliva
• Viruses lost if remain 2 hrs in sunlight.
• Reach nerve ganglion supplying the area remain
latent till reactivated

• HSV –I Trigeminal HSV-II Lumbosacral
• If DNA incorporated in host then life long infection.
• Histological Features:- Intraepithelial vesicle filled
with fluid.

• Degenerated cells show ballooning degeneration
which contain intraneuclear inclusion called Lipschutz
bodies
• Lipscutz bodies are eosinophilic , ovoid ,
homogeneous structures which displace nucleolus &
chromatin & produce peri-inclusion halo .

• C.T. show inflammatory infiltration .
• Ulcer covered by exudate made up of fibrin ,
Polymorphonuclear leucocytes, degenerated cells
• T/t :- Supportive, Symptomatic, antibiotic to cover
primary infection.

Recurrent Herpes Simplex Stomatitis
• Many people have Ab
• Risky occupation without Ab
• Recurrence associated with trauma, fatigue
pregnancy, URTI, emotional upset , allergy
• Reactivated latent viruses in nerve ganglion & then
cause lesions of mucosa, skin along course of nerve.

• C/F :- once in month or year.
• Preceded by tingling or burning sensation , feeling
of tautness , vesicles are small 1mm , grey white
vesicle rupture quickly leaving small ulceration
with erythematous halo.

• On lip form brown crust.
• Degree of pain visible
• O/M :- on tight bound mucosa
(contrast to apthous)
• Heal within 7 days

• H/P :- PAP smear using fresh scrapping from base of
vesicle except to rule out Herpes Zoster
• Produce characteristic cytopathic effects such as
ballooning degeneration , chromatin margination &
lipscutz bodies & multinucleated giant cells( Tzank
cells )

• L/F :- Isolation of tissue culture before Ab formation
as Ab cause rapid clearing.
• Smear + only for short period as virus cleared
rapidly.
Methods :-
 Isolation & identification ( egg & tissue culture)
 Immunofluroscent tech.
 Immunoperoxidase tech
 Serological assays :- Complement fixation , RIA,
ELISA.

• T/t :- Symptomatic ,Antiviral like Acyclovir,
vidarabine, iodoxiuridine.
• D/D :- RAU , Herpes Zoster , Muco- cutaneous
diseases , impetigo , allergy.

Summary
Etiology, clinical features, histopathological features of
HSV infection
recurrent stomatitis
primary stomatitis

BIBLIOGRAPHY
 Text Book of Microbiology Ananthanarayan R 7th
Edition
 Text book of oral pathology Shafer's, 5 & 6th
edition
 Color Atlas of Oral Diseases Cawson, R. 2nd
edition
 Oral and Maxillofacial Pathology Neville, Brad
W. 2nd
 Lucas’s Pathology Of Tumor’s of the Oral
Tissues
 Cawson, R. A., Bennie, W. H 5th
edition

Viral diseases 3/certified fixed orthodontic courses by Indian dental academy

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