Please enable JavaScript.

Coggle requires JavaScript to display documents.

Vesiculo-Bullous Lesions - Coggle Diagram

- - - - Primary Herpetic Gingivostomatitis
        
        Etiology: HSV-1
        
        Method of Transmission: close physical contact such as kissing, shared utensils, aerosols (sneezing, couching), and crowded living conditions
        
        Characteristics: orally HSV-1, genital areas HSV-2, both indistinguishable regardless of lesion site, fiery red, marginal gingivitis that usually affects all areas of the dental arches, appear on gingiva; lips; tongue; oral mucosa; and occasionally on perioral skin, vesicles rupture quickly and appear as ulcerations surrounded by erythema, extreme pain, elevated temperature, generalized malaise
        
        Dental Implications: treatment should be rescheduled until the lesions have healed because of risk of spreading virus, eating id the most significant problem due to disease course lasting 10-14 days so Pts should be encouraged to keep hydrated
        
        Treatment/Prognosis: pallative treatment with soft diet, nonacidic liquids, noncarbonated drinks, cold food help (ice cream/sherbet), acyclovir suspension administered in the first 3 days, lesions usually resolve completely within 10-14 days, virus may have recurring pattern, anti-inflammatory drugs to help with pain
        
        Citation: pg. 250-51 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
      - Secondary/Recurrent Herpes Simplex Infections
        
        Characteristics: clusters of vesicles on the vermilion border, termed herpes labialis when occurring on the lip and perioral areas, unilateral small vesicles on palatal or attached gingiva, localized
        
        Etiology: reactivation of latent virus HSV-1
        
        Method of Transmission: virus becomes reactivated and produces a recurrent infection
        
        Dental Implications: routine dental care should be postponed to prevent patient discomfort and spread of the virus when lesions are present (lesions should be completely healed with no exudate present)
        
        Treatment/Prognosis: antiviral topical, OTC ointments/creams may reduce duration and may stop some lesions from developing (if applied early, before replication of virus occurs), instruct Pts to use a cotton applicator or rubber glove to reduce potential for transmitting virus to other parts of the body or other people, instruct Pt to avoid sunlight exposure when possible and use lip balm of SPF15 or higher to protect tissue, Penciclovir (more successful when applied during initial stage before actual lesions occur)
        
        Citation: pg. 252-53 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
    - - Primary Varicella (Chickenpox)
        
        Etiology: varicella virus aka HSV-3 aka chickenpox
        
        Method of Transmission: air droplets or direct contact with lesions, highly contagious disease when lesions are present and weeping
        
        Characteristics: malaise, sore throat, upper respiratory congestion, fever, slight lymphadenopathy, vesicular intraoral lesions usually found on the lips; hard palate; and buccal mucosa, heals without scarring in most cases
        
        Dental Implications: no treatment is to be given until lesions are completely healed without any visible exudates in them
        
        Treatment/Prognosis: palliative care with use of topical preparation to relieve pruritus, nonaspirin antipyretics for any discomfort, acetaminophen is recommended (aspirin is contraindicated for Reye syndrome), self-limiting infection with complete resolution of lesions in 2-3 weeks, occasional complications like encephalitis; Reye syndrome; pneumonia, spontaneous abortion or congenital birth defect if infected during pregnancy
        
        Citation: pg. 254-55 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
      - Ocular Herpes
        
        HSV infection caused by autoinoculation, may result from herpetic lesion elsewhere and then touching the eye, dental workers at extreme risk that may enter the eye from aerosols or debris during dental procedures, serious and can result in blindness
        
        Citation: pg. 254 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
      - Secondary Varicella-Zoster (Shingles or Herpes Zoster)
        
        Etiology: reactivation of latent varicella virus
        
        Method of Transmission: NO MOT other than that which caused the primary infection, lesions in active shingles contain active viral particles and contact with them by susceptible person can cause primary infection
        
        Characteristics: unilateral over sensory nerve affected in the head; neck; and trunk as an extremely painful vesicular rash, fever, pain, malaise, lymphadenopathy, small vesicular eruptions on any mucosal surface or on the palate
        
        Dental Implications: self-limiting condition and should resolve in 2-3 weeks, 14% of affected individuals may experience postherpetic neuralgia (PHN) which causes persistent and severe pain lasting 90 days after rash onset, Rmasay Hunt syndrome (facial paralysis, diminished hearing, vertigo) with vesicles on the tongue; palate; or ear, blindness may occur, one rare and serious complication is spontaneous tooth exfoliation; pulpal necrosis; and osteonecrosis of the mandible
        
        Treatment/Prognosis: isolation, local management of skin lesions, controlling pain, antiviral medications, treatment of herpetic neuralgia, palliative care with soothing mouth rinses and/or topical anesthetics, vaccination (preventative)
        
        Citation: pg. 256-57 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
      - Herpetic Whitlow
        
        caused by HSV, occurs on terminal segment of a finger, usually primary infection but can have cyclic recurrence, healthcare workers are susceptible (especially when working in the mouth), can be transferred and cause infection to other areas of the body (mouth, nose, eyes, any other mucosal lining)
        
        Citation: pg. 253 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
      - Herpes Simplex Virus and Genital Herpes
        
        HSV infection that is transmitted in genital secretions, produces genital ulcerations, practice of oral sex is a significant method of transmission
        
        Citation: pg. 254 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
  - - - Etiology: A-16 coxsackievirus
      - Method of Transmission: easily transmitted via oral/fecal route, summer is optimal time for transmission
      - Characteristics: posterior regions of the mouth; soft palate; anterior and posterior pharyngeal pillars and tonsils, diffuse reddening of the tissues, appearance of vesicles that rupture and ulcerate, vesicular lesions range from 1-2mm in size, located in the pharyngeal area
      - Dental Implications: treatment needs to be postponed until all vesicles and ulcerations are healed
      - Treatment/Prognosis: palliative treatment is recommended and may or may not be required, excellent prognosis, complications are rare
      - Citation: pg. 259-260 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
    - - caused by coxsackievirus, very rare condition, characterized by a sore throat, considered a variant of herpangina, caused by CVA10, small nodules in pharyngeal area and tonsillar pillars
      - Citation: pg. 260 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
    - - Etiology: coxsackie A-16 virus and other coxsackievirus A and B strains
      - Method of Transmission: airborne sand oral/fecal routes, fomites, and respiratory droplets
      - Characteristics: highly contagious, maculopalpular rash on soles of feet and palms of hands, have central vesicles that may or may not rupture and become crusted before healing, fever, sore throat, malaise, lymphadenopathy, intraoral lesions are found on the tongue; palate; and buccal mucosa
      - Dental Implications: oral lesions cause pain and difficulty with eating and swallowing
      - Treatment/Prognosis: antipyretic agents and topical medications for sore mouth are treatments of choice, excellent prognosis, no expected complications, careful hand washing is needed
      - Citation: pg. 258 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
  - - - Etiology: originates from the Paramyxoviridae family
      - Method of Transmission: airborne and spread through respiratory droplets
      - Characteristics: dermal erythematous rash begins on face and moves downward to cover the trunk and extremities, oral lesions called Koplik spots are found intraorally on the buccal and labial mucosa during initial stage, precedes the extraoral rash and are considered pathognomonic, appear as small; bluish white spots on an erythematous background, pitting in enamel in developing teeth may occur in severe cases
      - Dental Implications: all dental work should be postponed until the virus has been eliminated
      - Treatment/Prognosis: palliative care with nonaspirin antipyretics, complications may include pneumonia and encephalitis, death may occur in severely immunocompromised individuals
      - Citation: pg. 260 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer
  - - - Etiology: togavirus (NOT paramyxovirus)
      - Method of Transmission: highly contagious and spread through respiratory droplets,
      - 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 occur in some cases known as Forchheimer signs
      - Dental Implications: N/A
      - Treatment/Prognosis: vaccine (preventative), nonaspirin antipyretic medications to sooth discomfort, pregnant women are highly susceptible
      - Citation: pg. 261 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
- - - - Etiology: when affecting the gingiva, the term desquamative gingivitis is sometimes used (clinical rather than diagnositic), antibodies IgG and sometimes IgA
      - Method of Transmission: idiopathic and classified as an autoimmune disease
      - Characteristics: 80% of cases in oral mucosa, conjunctiva second most common site, occasional occurrence of localized skin bulla, short-lived bulla; break quickly; desquamate and leave a raw erythematous or ulcerated surface, confined to the gingiva in over 50% of cases
      - Dental Implications: N/A
      - Treatment/Prognosis: Topical corticosteroids and intralesional injections are used when needed on a limited basis, milder mucosal characteristics, not life-threatening, discontinuing all use of oral products that burn
      - Citation: pg. 264-65 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.
    - - Etiology: autoimmune disease
      - Method of Transmission: N/A
      - Characteristics: intraoral involvement is rare, affects the gingiva when present, cutaneous bullae develop slowly and may last for weeks to months before breaking, painful erythematous and ulcerative lesions, lesions occur on gingiva; palate; floor of mouth; tongue; or buccal mucosa
      - Dental Implications: N/A
      - Treatment/Prognosis: systemic corticosteroids alone or in combination with immunosuppressive agents, dapsone, cyclosporine, sulfapyridine, niacinamide
      - Citation: pg. 266 Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.