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Table of Content

• Abstract
• Introduction
• The Clinical Virology
• Coxsackie Virus
• Herpes Simplex Virus
  • Risk factors
  • Pathophysiology
  • Diagnosis
  • Case report discussion
• Varicella Zoster Virus
• Human Papilloma Virus
• Conclusion
• Bibliography

Abstract

The common disease of gingival is due to plaque causing inflammatory reaction.  The diseases caused by non plaque origin are very less in occurrence. But the significance caused by them is more.  The systemic conditions can results in gingival disease. The classification of gingival diseases is done based upon plaque or non plaque origin.  One of the major cause for non plaque induced gingivitis is of viral origin. In this topic let us discuss in detail about the viral origin of gingival diseases.

Introduction

The pathological lesion of non plaque origin are exhibited with different manifestation in the gingival tissues.  Sometimes they can occur due to some medical disorders or the conditions related to systemic origin.  The role of dentist is very important in identifying the underlying condition by diagnosing the oral manifestations.  Sometimes the changes can be pathological limited to gingival tissues. Dentist plays important role for the treatment plan. Dentist play important key role.  The gingival lesion of non plaque induced review was done in 1999 in workshop conducted internationally for the periodontal disease classification (Holmstrup, 1999).

The oral cavity is found to be site with rich flora condition. More than about 700 different species have been identified (JA Aas, 2005).   The detection of virus is always difficult.

The Clinical Virology

The viruses are found to infect cell of any type in human body. More significant in affected by viruses.  The viruses are found to be the entry for many host. The various viruses found affecting the oral cavity are coxsackie viruses, varicella zoster viruses, herpes simplex virus  and human papilloma virus (C Scully, 1991).

These viral infections are more commonly found to infect during the childhood days.  The adults also found to affect with the infection occurring primarily.

Coxsackie Virus

The herpangina and hand foot and mouth diseases are found to with etiology of coxsackie viruses. The hand foot mouth disease is found to have its manifestation in gingival. This disease is found to be contagious infection.  The a6, a16 and a10 virus are found to be coxsackie virus causing the hand foot and mouth disease (S Aswathyraj, 2016).  The clinical manifestation is characterized as formation of vesicles, which will rupture and result in the formation of ulcers in gingival area. Similar pattern is also found in the hand and foot.  The systemic manifestation like fever can also occur.

Fig : hand foot and mouth disease (Muppa R, 2011)

Herpes Simplex Virus

The oral manifestation occur with the infection of herpes simplex virus 1 (C Scully, 1991). This gingival manifestation is known as the herpetic gingivostomatitis.  The incubation period for this infection is found to be one week. In childhood times no symptom is found to occur. It can later result into severe manifestation of gingivostomatitis affecting the gingival area. The vesicle formation occur which later rupture. After rupturing it get coalesce and results in ulcer formation. These ulcer are found to be coated with the fibrin layer (CS Miller, 1992). In adults the recurrent infection are found to occur. Sometimes these ulcers are confused with the aphthous ulcerations.

The herpetic gingivostomatitis is found to be the combination of both gingivitis and stomatitis clinical manifestation. The prodromal symptoms that occur in the infection are fever, irritability, headache and malaise. This symptom occurs during the advanced end stages.  The lymphadenitis of the submandibular lymphnodes are found. Halitosis occurs. The patient found to have difficult in swallowing.

Risk Factors

The children are found be at high risk group. The host immune response is found to play important role for the prevalence of the infection.  As the infection is contagious the closed environment are more vulnerable for the infection. The developing countries are found more with this infection.

Pathophysiology

The infection follows series of stages. Through the dermal and epidermal cells of skin the virus can easily enter the body. Through the mucosal surfaces and the skin abrasions also act as a route. The viruses replicate and found to affect the trigeminal ganglia. There they are found to be latent phase. The reactivation of the virus is found to occur. The lesion found to affect the lips, known as herpes labialis. This lesion is called as cold sores.

Diagnosis

The histopathological studies play important role in the diagnosis. The stratified squamous epithelial cells are found to be degenerated.  The connection between cells are found to be lost, the cells of inflammation are found to be infiltrated. These infiltrations are found to be around the dermis layer capillaries. When the cells get ruptured the viral particles are found to affect the adjacent epithelial cells also. The region of lamina propria is found to be with inflammatory infiltrate. Depending on the severe nature of the disease the amount and density of the inflammatory cells are found to be varied (JV Soames, 2005).

Case Report Discussion

fig : multiple ulcer in labial region of mandible (Shah, 2014)

 

fig : linear gingival erythema (Shah, 2014)

In a case report study, a patient was found to give a chief complaint of ulcer in the lower lip region. He also found with fever. The other vital signs were found to be normal. On clinical examination there was palpation of the submandibular lymphnodes. In intraoral examination multiple ulcers were found, suggestive of herpetic gingivostomatitis.  The patient was advised to use topic antiseptic followed by anesthetic medication. The analgesic paracetemol was given for the period of 5 days. They also given with supplements like multivitamin (Shah, 2014).

Varicella Zoster Virus

The chicken pox is the primary infection of the varicella zoster. They are found affect mainly the children. In adults the reactivation of virus is found to affect. They are found to affect the gingival tissues characterized by the ulcer formation. The vesicles rupture, which results in ulcer formation. These ulcer joins to form large irregular pattern.

Human Papilloma Virus

This infection found with formation of papilloma of squamous cells. The oral lesions are found to be usually without symptoms. Later it can either progress or get regressed (Syrjanen, 2003).

fig : human papilloma virus gingival manifestation (Casu C, 2020)

Conclusion

Treatment of the viral lesion includes both management of systemic and local lesion. Antiseptic, analgesic and anesthetic agent has to be prescribed. Maintenance of good oral hygiene is very important followed by debridement.

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