Why Would Dentist Want to Know if You Have Genital Herpes

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As a defended and meticulous dental hygienist, you may find yourself noticing small details that are unnoticed or dismissed by nearly people. So when a patient presents for her prophy with an active canker simplex lesion on her lip (herpes labialis), your antennae immediately go upwardly. Equally you mentally determine the best course of activeness to take, you calmly brainstorm to ask the patient how long her "cold sore" has been present and how often she gets them. As you speak with the patient, you learn that she is a new mother who is caring for her two-month-former babe.

Call back your teaching and grooming

Equally you caput to the back of the office to share the news with the dentist, y'all call up back to your days in hygiene school when you were taught to postpone elective dental procedures if a patient presents with an active herpes lesion. When you lot recommend that the patient be rescheduled and that the doctor prescribe an anti-viral medication, y'all brainstorm to doubt yourself when the doctor casually dismisses the lesion equally "no big bargain." Yous brainstorm to dubiety your instincts and training and inquire yourself three questions:

1. "Am I properly remembering what I was taught in hygiene schoolhouse?"
2. "Has there been a recent change in protocol for treating patients with active herpetic lesions?"
3. "Am I incorrect to suggest that the patient reschedule?"

The answer to each question in a higher place is NO. Constituent dental treatments such as debridement, periodontal maintenance, or dental prophylaxis shouldalways be postponed until the patient'due south lesions have healed. The only time a patient with active herpes virus should receive dental treatment is in the case of a truthful emergency. In these cases, laser therapy should exist used to directly treat the lesion.

What are the hallmark features of a herpes outbreak?

While symptoms vary by person and historic period, the HSV-1 virus is associated with a host of symptoms that range from unpleasant to fatal. The initial outbreak of an HSV-ane infection is typically associated with a high fever, bodily lesions, headache, and malaise. Gingivostomatitis is unremarkably present and can be particularly astringent in children. Children often feel listless, lose their ambition, and may present with a dangerously high temperature (up to 104°F).

Despite the fact that symptoms often subside within a few weeks, the canker virus never dies. (8) Information technology remains within the host's nerves for the person'southward entire life and can easily be reactivated by illness, stress, or sunlight. The reactivation of the virus often starts with burning, hurting, and itching. These symptoms are then followed by the development of pustular and ulcerating papules. (8) In addition to causing pain and suffering, these symptoms can be extremely embarrassing for people with herpes. The social stigma associated with herpes can sometimes be more devastating than the concrete consequences of the virus.

Why is HSV-1 and then dangerous?

The loftier fevers experienced by people with HSV-ane tin result in fatalities. HSV-ane can likewise infect the eye, resulting in a condition chosen stromal keratitis that can cause infectious blindness. (5, 6, 12). Perhaps the most dangerous complication of HSV-1 is herpes simplex encephalitis. While this condition is extremely rare, it is the most prevalent cause of encephalitis in America. Loftier rates of mortality and morbidity are unavoidable, even with anti-viral therapy. If encephalitis is left untreated, the mortality rate can approach lxxx% within a one to two-week timeframe. (ii, 12).

How does treating a patient with an active HSV-1 pose a threat to the patient'southward babe?

Seeing an infected patient for a prophy can cause the virus to spread and result in additional lesions on the patient. Even if you are especially careful in not touching the lesion, the virus is present in saliva, and at that place'due south no manner to avoid saliva during a dental appointment. Additionally, virus-laden aerosols emitted during the prophy can remain on the patient's skin and article of clothing for hours. These aerosols can be deadly if the babe absorbs them through contact with the mother.

HSV-1 can be fatal for infants under three months of historic period. A quick Google search of HSV-1 and infants reveals stories of babies who have died before long after receiving a kiss from an infected individual. The rate of survival among infants and children who accept herpes simplex encephalitis is less than 20%, even later on the children receive anti-viral therapy. Children who do survive often endure long-term furnishings such every bit seizures, developmental delays, and a 26% relapse rate. (2)

How does treating a patient with HSV-1 putyou at hazard?

The Herpes simplex virus blazon 1 (HSV-1) is highly contagious. The virus is primarily transmitted by contact with saliva and the sores that are present during herpes labialis. There is a plethora of risks for hygienists who treat a patient with an active lesion. Some of these risks include the following:

• Exposure to the patient'due south saliva is incommunicable to avert when you do a prophy
• It is hard to avoid touching the lesion fifty-fifty if you lot make every effort non do to so
• You can hands spread the virus just by moving your gloved manus across the patient's infected lip
• Your gloves may develop minute tears, exposing you to HSV-ane and putting you at risk (7)
• If you lot develop herpetic whitlow due to exposure to HSV-1, y'all could be out of work for weeks (7)
• You run the risk of developing ocular herpes (which can lead to blindness), fifty-fifty if you and the patient wear protective eyewear (6)

In addition to these risks, the virus can survive on plastic, fabric, and other surfaces for hours (10). Herpes can also permeate skin that is seemingly intact, even if a hygienist is vigilant about mitt washing.

Dispelling the laser therapy and disinfection myths

Some dental professionals mistakenly believe that y'all can safely do a prophy later on y'all care for a herpetic lesion with laser therapy. Others believe that yous can prevent the virus from spreading by disinfecting surfaces that may accept been exposed to the virus. Unfortunately, in that location is no research that supports the efficacy of laser treatment or disinfection as a means of completely eliminating the HSV-ane virus. While laser therapy may expedite a lesion'south healing fourth dimension and reduce pain associated with the lesion, at that place is no proof that laser therapy will forbid the virus from spreading. (4) Research has shown the ability of HSV-1 to be transmitted through irksome-speed handpieces. (9) This is why the Centers for Affliction Control and Prevention (CDC) indicates that dental handpieces should be rut sterilized after exposure to each patient in society to prevent the spread of herpes and other infectious diseases. (7)

What is the best class of action when you encounter a patient with oral herpes?

Clearly, there are many reasons to exercise caution when a patient appears with an agile herpes simplex lesion. However, as a healthcare provider, you might feel conflicted about turning a patient away. Below is a summary of dos and don'ts to follow to help ensure that you lot follow a course of activeness that is the best for you and the patient.

• Exercise non second guessyour hygiene educational activity or brush off an agile herpes lesion.
• Do educate the patient near how HSV-1 poses risks to both the patient and her baby.
• Practise not decide to "run a risk it" and proceed with elective handling.
• Practice reschedule the patient and utilise your spare time to acuminate instruments.
• Don't succumb to pressure to treat a patient yous know has an active herpetic lesion.
• Do educate your doctor of the many risks associated with treating a patient with an active virus.

The Bottom Line

There are many risks associated with the treatment of patients with herpes. Deciding to care for a patient with herpes tin have devastating consequences for a hygienist, the patient, and the patient's children. And because the virus can survive for hours on plastic, wearable, and other surfaces, you run the risk of exposing your colleagues and other patients to the virus when they handle pens, magazines, and other items that were handled by a patient with an active virus. If y'all find yourself 2nd-guessing your grooming, simply inquire yourself if it is worth it to put and then many people at risk simply to complete ane elective procedure.

NEXT: 5 Infection Command Mistakes You lot Might Not Realize Y'all're Making

References

one) American Skin Association. (2012). Canker Simplex Virus. Retrieved from http://www.americanskin.org/resource/herpes.php

2) Anderson, W.Due east. (2016, June). Herpes Simplex Encephalitis. Retrieved from http://emedicine.medscape.com/article/1165183-overview#a5

3) Browning, Westward.D., McCarthy, J.P. (2012). A Instance Series: Herpes Simplex Virus as an Occupational Hazard. Journal of Esthetic and Restorative Dentistry, 24(1): 61–66. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437498/

four) De Paula, E.C., Aranha, A.C., Simoes, A., Bello-Silva, Grand.Southward., Ramalho, K.Chiliad., Esteves-Oliveira, M., De Freitas, P.K., et. al. (2013). Laser Treatment of Recurrent Herpes Libialis: A Literature Review. Lasers in Medical Science, (iv):1517-29. Retrieved from http://world wide web.ncbi.nlm.nih.gov/pubmed/23584730

five) Farooq, A.Five., Shukla, D. (2012). Canker Simplex Epithelial and Stromal Keratitis: An Epidemiologic Update. Survey of Ophthalmology, 57(v):448-62. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22542912

vi) Loma, J., Slonim, C. (2013, Baronial) Ocular Herpes. Retrieved from http://www.allaboutvision.com/atmospheric condition/ocular-canker.htm

7) Kohn, W.G., Collins, A.S., Cleveland, J.L., Harte, J.A., Eklunt, K.J., Malvitz, D.1000. Center for Illness Control and Prevention. Guidelines for Infection Control in Dental Wellness-Care Settings – 2003. MMWR 2003; 52 (Written report No. 17). Retrieved from http://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf

8) Salvaggio, Thou.R. Medscape. (2015, September). Herpes Simplex Clinical Presentation. Retrieved from http://emedicine.medscape.com/article/218580-clinical

9) McCarthy, G.K. (2000) Risk of Transmission of Viruses in the Dental Office. J Can Dent Assoc, 66:554-v, 557. Retrieved from https://world wide web.cda-adc.ca/jcda/vol-66/issue-10/554.pdf

x) NHS Choices. (2015, October). How Long Practice Bacteria and Viruses Live Exterior the Body? Retrieved from http://world wide web.nhs.britain/chq/Pages/how-long-do-leaner-and-viruses-alive-outside-the-trunk.aspx

11) Stoopler, E.T., Kuperstein, A.Due south., Sollecito, T.P. (2012). How do I Manage a Patient with Recurrent Canker Simplex? J Tin can Paring Assoc, 78: c154. Retrieved from http://www.jcda.ca/article/c154

12) Whitley, R.J. Herpesviruses. In: Baron Southward, editor. Medical Microbiology. 4th Ed. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Affiliate 68. Retrieved from www.ncbi.nlm.nih.gov/books/NBK8157/

13) World Health Organisation. (2016, January). Herpes Simplex Virus. Retrieved from http://world wide web.who.int/mediacentre/factsheets/fs400/en/

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