Mucocele
Etiology: Trauma and severance of an accessory salivary excretory duct
Transmission: None because it is caused by trauma
Characteristics: Blue hue, slightly transparent, slightly elevated, smooth, dome-shaped. Most commonly found lower lip lateral to the midline, floor of the mouth, ventral tongue, and buccal mucosa. Asymptomatic. Sizes between few mm and less than 1.5cm.
Dental Implications: Tissue trauma to the buccal mucosa or lip region because of elevated tissue and tendency for the patient to traumatize the area while chewing.
Treatment: If the mucocele is chronic removal may be necessary, and if removed the salivary ducts that fed the lesion may also be removed.
Prognosis: They can occur often in children and parents should be informed that the lesions are atypically benign. Suggestions can be made to prevent future trauma to the area.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 247-249.

Epidermolysis Bullosa Acquisita
Etiology: Autoimmune disease. Caused by circulating auto-antibodies to the dermal protein that is the constituent of anchoring fibrils, and auto-antibodies are directed toward type VII collagen.
Transmission: Not transmitted, it is an autoimmune disease.
Characteristics: Chronic blistering disease that can effect the skin and oral mucosa. Clinically similar to mucous membrane pemphigoid. Fragility of the skin including Nikolsky sign, with blisters that coalesce and break open, and vesicles or bullae with localized skin erosion.
Dental implications: Hygienists should use caution when scaling since vesicles and bullae form in response to trauma.
Treatment: Systemic corticosteroids and immunosupressive agents such as methotrexate, azathioprine, or cyclophosphamide.
Prognosis: Not deadly but can extremely effect a patients lifestyle and health.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pg 269.

Epidermolysis Bullosa
Etiology: Diverse group of inherited and aquired disease. Molecular basis is unknown. Genetic defects in critical components of the epidermal-dermal border including basal cells, hemidesmosomes, and anchoring connective tissue filaments.
Transmission: Autosomal dominant recessive and X-linked modes of inheritance with over 20 different forms identified.
Characteristics: Bullae formation at birth that may improve by puberty. The deeper the cleavage, the more scarring is seen. skin lesions common on hands, knees, axilla, and groin. All of the skin has an increased fragility. Crusted erosions, milia, pigmentation, and alopecia. Deformalities of the hands and feet in severe cases. Oral lesions may be occasional blisters with small discrete vesicles that heal rapidly. Bullae and painful ulcerations on the oral mucosa.
Dental implications: Enamel hypoplasia. High rate of caries. Difficulty to tolerate dental treatment. Mouth rinses without alcohol should be recommended. Systemic use of fluoride as well as topical use of fluoride.
Treatment: Treatment varies upon the severity of the disease. Wound care, antibiotics, and plastic surgeries to correct deformities. Fluoride treatment helps reduce incidence of caries.
Prognosis: Depends on the type of genetic defect and can range from good to fatal.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 266-269.

Hand-foot-and-mouth Disease
Etiology: Coxsackie A-16 and other Coxsackie A and B strains cause this disease.
Transmission: Airborne and oral or fecal routes, fomites, and respiratory droplets. Highly contagious.
Characteristics: Maculopapular rash occurs on the soles of feet and the palms of the hands. Lesions may develop central vesicles that may rupture. Systemic fever, sore throat, malaise, and lymphadenopathy. Intraoral cutaneous rash on the buccal surfaces, tongue, and palate. Lesions are painful. external lesions appear on the hands and feet.
Dental implications: The oral lesions cause pain and difficulty eating and swallowing.
Treatment: Symptom relief is the only available treatment.
Prognosis: No complications would be expected.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 258-259.

Primary Herpetic Gingivostomatitis
Etiology: Commonly acquired during childhood and is often exaggerated response to initial exposure to Herpesvirus Type 1
Transmission: Close contact such as kissing, sharing utensils, aerosols, and close living conditions. The virus lives in fluid filled sacks that are highly infectious upon bursting.
Characteristics: Commonly found on and around the oral cavity. Fiery red, marginal gingivitis that effects all areas of dental arches. Multiple, small vesicular lesions appear on the gingiva, lips, tongue, oral mucosa, and occasionally perioral skin. After vesicles rupture they appear as ulcerations surrounded by erythema. Patients experience extreme pain, elevated temperatures, and malaise. Cervical lymphadenopathy and sore throat are common. Signs and symptoms may be more severe in adults.
Dental implications: The clinical appearance and transmission are significant factors in diagnosis. Dental treatment should be postponed until the lesions have crusted over or healed as it is a highly infectious disease. Patient should be encouraged to stay hydrated.
Treatment: Soft diet, non-acidic drinks, non-carbonated drinks, cold foods. Acyclovir administration during first few days can help. Oral antivirals are not helpful unless administered in the first three days of the infection.
Prognosis: The lesions usually clear up on their own within 10-14 days, however the virus lays latent and recurrence is likely. Recurrence should not be as bad as the initial infection.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 250-252.

Secondary or Recurrent Herpes Simplex
Etiology: Recurrent infection caused by reactivation of latent HSV-1 virus. Reactivation can be due to stress, compromised immune system, cold, fever, sunburn, trauma, pregnancy, infection, debilitation, menstruation, systemic disease, and allergies.
Transmission: Virus becomes reactivated, however it is active and can be spread.
Characteristics: Localized, prodromal symptoms prior to appearance of vesicles. Symptoms such as itching, burning, tingling, warm tissue, or pain before vesicles appear. Clusters of vesicles along the vermilion boarder, perioral skin, or keratinized intraoral surfaces.
Dental implications: When lesions are present, dental treatment should be postponed to prevent patient discomfort and spreading of the virus. Lesions need to be completely healed or crusted over before dental treatment.
Treatment: Antiviral, topical ointments may reduce the duration on the outbreak. Penciclovir can be successful if used prior to outbreak. Patients can often recognize when an outbreak is about to occur. Patients should be advised to use a cotton tip applicator or gloves when applying topical to avoid spreading the virus.
Prognosis: Typically resolves on it's own within 10-14 days.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 252-253.

Genital Herpes
Etiology: HSV infection on the genitals.
Transmission: Usually spread through oral sex. can also be spread by touching an infected area and then touching the genitals.
Characteristics: Multiple herpetic vesicles on and around the genitals.
Dental implications: Does not affect dental treatment unless there is a outbreak in or around the mouth.
Treatment: Antiviral, topical ointments may reduce the duration on the outbreak. Penciclovir can be successful if used prior to outbreak.
Prognosis: Usually resolve on it's own within 10-14 days.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pg 254.

Secondary Varicella-Zoster (shingles)
Etiology: Reactivation of dormant HHV-3 virus.
Transmission: Occurs through air droplets or direct contact with lesions. Highly contagious when when lesions are present and weeping.
Characteristics: Malaise, sore throat, upper respiratory congestion, fever, lyphadenopathy, vesicular rash on the trunk, head, neck, and extremities. Vesicles form pustules and then ulcers with an erythematous border.
Dental implications: Dental treatment should be postponed until the patient has fully recovered.
Treatment: Isolation, local management of skin lesions, controlling pain, antiviral medications, and treatment of herpetic neuralgia.
Prognosis: This infection usually resolves completely within 2 to 3 weeks.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 256-258.

Primary Varicella (chickenpox)
Etiology: HHV-3 is the causative agent of primary varicella infection.
Transmission: Occurs through air droplets or direct contact with lesions. Highly contagious when when lesions are present and weeping.
Characteristics: Malaise, sore throat, upper respiratory congestion, fever, lyphadenopathy, vesicular rash on the trunk, head, neck, and extremities. Vesicles form pustules and then ulcers with an erythematous border.
Dental implications: Dental treatment should be postponed until the patient has fully recovered.
Treatment: Palliative care suggested, with topical preparations to relieve pruritus. Non-aspirin antipyretics are recommended. Acetaminophen is recommended for pain. Vaccines are available for patients who have not already had the virus.
Prognosis: This infection usually resolves completely within 2 to 3 weeks.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 254-256.

Herpetic Whitlow
Etiology: HSV causes herpetic whitlow, however the outbreak occurs on the terminal segment of the fingers.
Transmission: Healthcare workers are especially vulnerable. Patients are usual debilitated for weeks. Having the virus on the hand makes it particularly easy to spread to other areas of the body to cause a new infection.
Characteristics: HSV infection of the hand atypically occur on the tips of the fingers. Vesicles appear that erupt and spread the virus.
Dental implications: If the outbreak is on the patients hand only and not in or around their mouth, dental treatment can be cautiously given. Patient should receive instructions on how to reduce or limit the spread of the virus.
Treatment: Antiviral, topical ointments may reduce the duration on the outbreak. Penciclovir can be successful if used prior to outbreak.
Prognosis: Usually resolves on its on in 10-14 days.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 253-254.

Ocular Herpes
Etiology: HSV infection usually caused by autoinoculation.
Transmission: Although uncommon, it is transmitted by touching a herpetic lesion and then touching the eyes. It is a very serious condition that can lead to blindness.
Characteristics: Herpetic lesions in and around the eyes, that are usually accompanied by an outbreak in or around the mouth.
Dental implications: Dental treatment should be postponed until the lesions have either crusted over or healed completely.
Treatment: Antiviral, topical ointments may reduce the duration on the outbreak. Penciclovir can be successful if used prior to outbreak. Have patient avoid rubbing the eyes to prevent further spread of the virus.
Prognosis: Usually resolves on its own in 10-14 days. However, the infection can leave the patient blind.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pg 254.

Herpangina
Etiology: Coxsackie A strains, and specifically A-16 cause this disease.
Transmission: Oral and fecal route.
Characteristics: Oral lesions on the posteior regions of the mouth, soft palate, anterior and posterior pharyngeal pillars, and tonsils. Sore throat, fever, loss of appetite, abdominal pain, and vomiting. Vescular lesions ranging from 1mm-2mm. Vesicles turn to ulcerations upon bursting.
Dental implications: Dental treatment should be postpones until all vesicles and ulcerations have completely healed.
Treatment: Palliative treatment is recommended but may not be required.
Prognosis: Complications are rare.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 259-260.

Acute Lymphonodular Pharyngitis
Etiology: Coxsackievirus more specifically CVA10
Transmission: Oral or fecal route.
Characteristics: Sore throat. Small nodules in the pharyngeal area and the tonsillar pillars.
Dental implications: Dental treatment should be postponed until patient has had a full recovery.
Treatment: Therapeutic treatment of symptoms.
Prognosis: Complications are rare.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pg 260.

Rubeola (measles)
Etiology: Originates from the Paramyxoviridae family.
Transmission: Airborne spread through respiratory droplets.
Characteristics: Dermal erythematous rash begins on face and moves downward to cover trunk and extremities. Koplik spots or lesions are found on buccal and labial mucosa. Small, bluish white spots on erythematous background. May cause enamel hypoplasia.
Dental implications: Dental treatment should be postponed until the virus has been eliminated.
Treatment: Palliative treatment and non-aspirin pain medications.
Prognosis: Complications include pneumonia and encephalitis
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 260-261.

Rubella (German measles)
Etiology: Togavirus is responsible for this disease.
Transmission: Highly contagious through respiratory droplets. Can replicate in lymph nodes and travel through the bloodstream. It can also cross the placental barrier during pregnancy. Vaccine available.
Characteristics: Malaise, fever, nausea, poor appetite, lymphadenopathy. Red and pink papules on the body. Small, discrete, dark red papules on the soft and hard palate known as Forchheimer signs.
Dental implications: Not applicable.
Treatment: Non-aspirin antipyretic medications may be helpful in soothing discomfort. Physician referral if vesicles are present.
Prognosis: Pregnant women are highly susceptible.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pg 261.

Pemphigus Vulgaris
Etiology: Rare heterogeneous group of idiopathic, autoimmune vesiculo-bullous diseases of skin and mucous membranes.
Transmission: Autoimmune disease, not transmissible.
Characteristics: Oral lesions begin as bullae larger than 1 cm in size, that rupture quickly to form shallow ulcers covered by gray pseudomembrane. Ulcers are painful and found on mucosal surfaces. Untreated the lesions persist and grow. Lesion may be found on any epithelial surface including the mouth, skin, esophagus, larynx, pharynx, vagina, anus, and eyes.
Dental implications: High systemic corticosteroids and immunosupressive agents. Fluocinonide. Effective oral hygiene is crucial. Non-alcohol containing mouth rinses such as chlorhexidine mixed with water can be beneficial. Tooth-whitening, abrasive agents, and alcohol products are not recommended. Intraoral pictures should be taken to monitor the disease.
Treatment: Medications use to treat the disease may cause systemic complications. Chronic steroid treatment is uses but may cause systemic disease.
Prognosis: Potentially deadly.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 262-264.

Mucous Membrane Pemphigoid
Etiology: Antibodies, usually IgG and sometimes IgA, target subepithelial components of the basement membrane zone. Scarring and fibrosis result from the basal destruction and separation.
Transmission: Idiopathic and classified as an autoimmune disease.
Characteristics: Localized skin bulla on oral mucosa, conjunctiva, and other mucosal membranes including the genitalia. Lesions may appear on the skin, nares, rectum, urethra, and esophagus. Erythematous, shiny red gingival tissue. Gental oral hygiene can cause sloughing,leaving painful ulcerated surface.
Dental implications: Not applicable.
Treatment: Topical corticosteroids and intralesional injections are used when needed on a limited basis.
Prognosis: Not life-threatening. Corticosteroids may cause complications with candidal infections and antifungals may be considered.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pgs 264-266.

Bullous Pemphigoid
Etiology: Autoimmune disease.
Transmission: No transmission due to autoimmunity.
Characteristics: Bullae. Intraoral charateristics are rare but when they do develope they develope over several weeks to months before bursting. Usually affects the skin before the mouth.
Dental implications: Intraoral pictures should be taken to monitor the progression of the disease.
Treatment: Systemic corticosteriods alone or in combination with immunosupressive agents. Plaque control is beneficial. Dapsone, cyclosporine, sulfapyridine, and niacinmide.
Prognosis: Can be a chronic disease for some patients while others go into remission after 2 to 3 years.
Citation: DeLong, Burkhart, (2019). General and Oral Pathology for the Dental Hygienist. pg 266.

Kendra Garner