Virus Infection

Infectious Mononucleosis (Mono)
Cause: Epstein-Barr virus
Infectious Mononucleosis, a common infection among young adults,  is an acute systemic infection caused by exposing to Epstein-Barr virus.

Diagnostic feature:
Compare to other viral infection, Infectious Mononucleosis has a gradual onset with a longer course.  Symptoms include pharyngitis, malaise, fever,  generalized lymphadenopathy, hepatomegaly, and splenomegaly.

Clinical appearance
The most apparent oral lesions are palatal petechiae and oral
ulcers. No vesicles appear before the lesions.

How to distinguish Infectious Mononucleosis from other viral infections:

1. When you have general viral infection symptoms such as mild fever, malaise, and lymphadenopathy (chronically swollen lymph nodes) persists more than one to two weeks.

2. By Serological testing. The result demonstrates antibodies to the Epstein-Barr virus.  This test may be negative during the first week of symptoms.

Primary Herpetic Gingivostomatitis (Herpes Simplex)

Cause: contact with both type 1 or type 2 herpes simplex virus (HSV), more frequent connection with type 1 HSV.  Most adults produce antibodies to the virus.

Diagnostic feature:

1. Abrupt onset of fever, malaise, and swollen of lymph nodes

2. Lesions consist of fluid-filled vesicles that are highly contagious

3. Rapidly rupture of vesicles forming ulcers

4. The lesions appear on oral mucosa and skin

5. The gingiva is often diffuse, enlarge and ulcerated

6. The lesions, usually, resolve on its own within 10 to 14 days

7. If the lesion is at the finger, it is known as herpetic whitlow. The infection causes erythema (abnormal redness of the skin), edema, vesicles, ulcers, and pain.

How to distinguish Herpes Simplex from other viral infections:
1. Primary Herpes has similar symptoms as other viral infections except
 the difference in the appearance

2. Recurrent or secondary herpes appears without a systemic manifestation, e.g., mild fever, malaise, and lymphadenopathy.

3. Herpes simplex occurs on keratinized surface areas such as gingiva and lips

What to do
1. Bed rest
2. Analgesics
3. Maintain adequate fluid since dehydration can develop rapidly
4. Systemic acyclovir intake may limit the severity and complication of primary herpes if initiated during the first few days of the onset
5. The use of natural oil for cold sores  can hasten the healing process

Measles (Rubeola)

Cause: Measles virus

Measles is a highly contagious respiratory disease. Although most adults have had measles, and most children have been immunized, outbreaks of the illness occasionally occur and can lead to the rare possibility of severe complications including pneumonia and encephalitis. Children under the age of 5 and adults over 20 are at higher risk for measles complications. Measles is of interest in dentistry due to its oral manifestation of Koplik's spots on the inside cheeks appears 2-4 days before its general symptoms.

Koplik's spots consist of a few or a cluster of white or yellow-white pinpoint papules on an inflamed red background on the buccal mucosa ( Inner lining membrane of the cheeks).

Diagnostic features:
1. Fever, conjunctivitis, photophobia, cough, and nasal discharge
2. Koplik's spots appear on the buccal mucosa early in the infection.
3. There is skin rash all over the body.  The rash begins on the face and spreads to the trunk and extremities.
4. The skin rash and other symptoms gradually resolve in approximately one week.

How to distinguish Measles from other viral infections:
1. By a spreading of the skin rash pattern
2. History of exposing to an infected individual
3. The appearance of koplik's spots on the buccal mucosa as opposed to the diffuse distribution of ulcers in primary herpetic gingivostomatitis

What to do
In addition to supportive care, there may be an occurrence of the rare complication conditions such as pneumonia, otitis media, and encephalitis.

Varicella (Chickenpox, Herpes Zoster, Shingles)

: Varicella-zoster virus

Chicken pox is highly contagious disease, spreads through the air or direct contact with an infected person.

Diagnostic features:
1. Aching muscles
2. Loss of appetites and nausea
3. Headache
4. Low-grade fever
5. Itching
6. Blister-like rash
5. Small red dots in the oral cavity and spread to the face and extremities

Rubella (German Measles)
Cause: Virus

In children, Rubella, usually, is a mild case but is most dangerous to the fetus. It can cause pregnant women to have miscarriage or birth defects, especially in the first three months of her pregnancy.  Rubella spreads through the air and contacting with an infected person.

Diagnostic features:
1. Rash begins on the face and spreads to the rest of the body
2. Low fever, less than 101  degrees
3. Swollen glands
4. Aching joints