Does herpes simplex affect dental health?

Herpes Simplex Virus and Dental Health

Herpes simplex virus (HSV) can affect dental health through oral mucosal lesions, potential transmission risk during dental procedures, and may be reactivated by dental treatment, but does not directly impact teeth or periodontal structures. 1

HSV Infection in the Oral Cavity

• HSV-1 typically manifests above the neck, causing orolabial herpes with lesions around the mouth, lips, and chin, while HSV-2 usually affects genital areas 1
• Diseases of the oral mucosa caused by HSV are painful and will be associated with visible lesions that can affect patient comfort and oral function 1
• Primary HSV-1 infection can cause severe oro-pharyngitis that resolves spontaneously but establishes latency in cervical ganglia, leading to potential recurrences 1
• Approximately 70% of the population in western countries become infected with HSV-1 by the second decade of life 2

Dental Implications of HSV

• HSV represents an occupational hazard in dentistry as it can be transmitted through direct contact with oral fluids or lesions during dental procedures 1
• Dental treatment, particularly traumatic procedures, can trigger HSV recurrences in susceptible individuals 3, 4
• Studies have found that HSV antigens can be present in the sulcular epithelium of approximately 60% of patients with clinically healthy gingiva, suggesting the oral cavity may be a preferential site for latent HSV 3
• The percentage of patients who developed HSV recurrences after dental procedures was significantly higher in untreated patients (27%) compared to those receiving antiviral prophylaxis (11.3%) 4

Clinical Manifestations in Dental Context

• Recurrent HSV infections present as painful and disfiguring lesions that progress through stages: prodrome (itching/burning), erythema, papule, vesicle, pustule, ulceration, and scabbing 1
• Peak viral shedding occurs in the first 24 hours after lesion onset, making this period highly infectious 1
• Intraoral HSV lesions may be confused with other types of oral ulcerations, presenting a diagnostic challenge for dental practitioners 5
• Recurrent oral HSV infections primarily affect the lips (herpes labialis) but can also present as intraoral ulcerations 5

Prevention and Management in Dental Settings

• Universal precautions must be observed routinely in dental care, as HSV can be transmitted through blood, oral fluids, or respiratory secretions 1
• Dental healthcare workers should use appropriate personal protective equipment, including gloves, masks, and eye protection when treating all patients 1
• Prophylactic antiviral therapy (such as valacyclovir) has been shown to effectively suppress HSV recurrences associated with dental procedures 4
• For patients with active HSV lesions, consider postponing non-emergency dental treatment until lesions have healed to reduce transmission risk 6

Treatment Considerations

• Topical antiviral agents, when used early in the course of a recurrence, can decrease the severity and duration of herpetic episodes 6
• Oral antivirals such as acyclovir (200-400 mg five times daily), valacyclovir (500 mg two or three times daily), or famciclovir (250 mg twice daily) may be prescribed for HSV infections with oral manifestations 1
• Treatment should be initiated as soon as possible during the prodromal stage for optimal therapeutic effect 1
• For patients with frequent recurrences triggered by dental procedures, prophylactic valacyclovir (2g twice on treatment day, followed by 1g twice the next day) can significantly reduce recurrence risk 4

Important Precautions

• Delay elective dental treatment for patients with active HSV lesions to prevent spread of infection 1, 6
• Be aware that HSV can be transmitted even in the absence of visible lesions through asymptomatic viral shedding 1
• Dental professionals should be vaccinated against hepatitis B and follow strict infection control protocols to minimize risk of all bloodborne pathogens, including HSV 1
• Patients with compromised immune systems may experience more severe and prolonged HSV infections requiring special precautions during dental treatment 1