Question

Your patient presented to you for a 6 month recall with the following condition appearing on her lower lip:

She indicated she gets these lesions occasionally when she is particularly stressed, then they crust up and simply go away. She is soon moving to another distant state (the reason for her stress) and therefore insisted she be able to have her dental cleaning completed as planned today- as rescheduling will be impossible. As her dental hygienist and wanting to be helpful, you comply with her request. Upon completing her prophylaxis, you find a couple of vesicles opened during treatment and also that there is a small tear in your glove which corresponds to your dominant working hand.

1)           What condition did the patient present with? What specific organism causes this and by what lay term is this commonly called?

2)            Differentiate between Primary Herpetic Gingivostomatitis acquired in childhood and recurrence as with this patient.

Answer 1

1. The patient presented with complaints of recurrent relapse of blisters and lesions on lower lips during stress.

The signs and symptoms indicate that the patient is suffering from a condition known as  Herpes labialis or cold sores.

Herpes labialis is an infection caused by the herpes simplex virus which it can be transmitted by direct non- sexual contact like kissing or using personal items of infected person. The most common virus type is HSV - 1 compared to HSV-2 which cause recurrent infection. Stress, exposure to sunlight, and fever can trigger the condition and usually resolves within two weeks.

2. Herpes labialis is usually followed by the Primary Herpetic Gingivostomatitis. Primary Herpetic Gingivostomatitis is the inflammation of gingiva and oral mucosa due to the first time infection with herpes simplex virus. It usually occur in childhood and appears more severe then Herpes labialis. The symptoms are severe than Herpes labialis and they include formation of pin-head vesicles in the mouth which rupture and eventually leads to painful lesions, sore mouth, poor feeding, and bad odor in the mouth. The causes are direct contact with infected persons saliva through kissing the child. The reactivation of the virus by triggering factors leads to Herpes labialis in future.