Infectious diseases with oral symptoms - Infectious diseases in oral care practice

An infectious disease in the contagious phase of a cold sore disease could be a disease of the herpes virus via the aerosol that could pose a risk of infection for the team and subsequent (very young) patients. Additional infection prevention measures are not necessary, however, because it has been proven that there is a cold sore regularly that a large number of herpes viruses can be implanted every few weeks, without the occurrence of fever.

Infectious diseases with oral symptoms - Infectious diseases in oral care practice
Protection of vesicle phase with second skin patch.

Infectious diseases with oral symptoms


Herpes simplex

In children, the first infection with the herpes simplex virus usually occurs at a very young age. Newborns can become seriously ill after infection with the herpes simplex virus and even develop meningitis!


In infants a herpes simplex infection is not always recognized, because of the usually moderately severe course. The symptoms are often confused with those of break-through milk teeth. Only a few children develop a very severe inflammation of the whole oral mucosa, making eating and drinking virtually impossible. The children have fever, swollen lymph nodes in the neck and feel sick. This first infection lasts about ten days. Afterwards, the virus remains latent in the body and, with a reduced resistance, stands up in the form of a fever blare, usually on the (upper) lip. The symptoms start with a burning sensation, after which small blisters are formed. This stage of the fever is particularly contagious! The contagiousness lasts about a week and is not over until the formed crust has dried completely. Possibly an antiviral ointment can be used to relieve the symptoms. Almost all people have antibodies against the herpes simplex virus.


Very contagious blister formation herpes simplex on the lower lip


Not contagious fully dried crust herpes simplex


If a member of the dental team has a fever outbreak in the infectious phase, it is sufficient to comply with normal hygiene measures such as mouth mask and good hand hygiene. For the treatment of patients with impaired immunity, the supplement with a cold sore first applies hand disinfection before this vulnerable patient is given a hand. Extra protection for a patient's cold sore can still be obtained by using small second skin patches (Compeed patches) that can cover the skin from the beginning of the formation of the bladder.


Protection of vesicle phase with second skin patch


If a patient is being treated in the infectious phase of a cold sore, undesired spread of the herpes virus via the aerosol could pose a risk of infection for the team and subsequent (very young) patients. Additional infection prevention measures are not necessary, however, because it has been found that in patients who regularly have cold sores about a few weeks every week a greatly increased number of herpes viruses can be found in the saliva, without the occurrence of a fever. This phenomenon is called shedding and the risk of infection is at least as great at such times as with a visible fever. For this reason, there is no objection to exclude a patient with a cold sore (in any phase) from the treatment room when applying the usual measures for infection prevention. Anyone can be unnoticed with the highly contagious virus in a shedding phase. That is why in principle every patient is treated as a potential shedder and it is assumed that the prescribed standard measures provide sufficient protection for the team and the other patients.


Child diseases with symptoms in the mouth



Mumps is a viral disease that only occurs in humans. The period between the time of contamination and the outbreak of disease symptoms is two to three weeks. A few days before the symptoms appear, the virus is already detectable in the saliva and there is therefore a risk of infection. The virus occurs in the pharynx of infected people and is transmitted via saliva droplets. The contagiousness lasts for five days after the onset of the disease. The virus spreads via the blood to the salivary glands and also to other organs. Many infections occur without clinical symptoms (subclinical). If symptoms do occur, they are caused by moderate fever and bilateral swelling of the salivary glands, in particular of the parotidea (parotidea gland). This is visible in the mouth due to the redness of the output passages of these salivary glands. The infection is innocent in young children. When the other salivary glands are also inflamed, it can be painful to open the mouth. A trismus may then exist (limited mouth opening). In adults, complications can occur such as inflammation of the pancreas, brain (fleece) inflammation and even infertility. For this reason, this disease is included in the National Vaccination Program, which means that it is becoming less common. If the disease is detected anyway, there is a duty to report.


Data regarding reporting duty according to the RIVM

Group A: Possible legal measures: forced admission to isolation or home isolation, forced research, forced quarantine (including medical supervision), prohibition of professional practice.
examples: MERS, SARS, polio, smallpox
Group B1: Possible legal measures: forced admission to isolation or home insulation, forced research, prohibition of professional practice.
examples: bird flu, tuberculosis, diphtheria, rabies, plague
Group B2: Possible legal measures: prohibition of professional practice.
examples: hepatitis A, B, C, measles, whooping cough, food infection if diagnosed with two or more persons with a mutual relationship pointing to food as a source
Group C: Compulsory measures can not be imposed. But reporting and personal data are necessary to enable the use of voluntary / advisable measures around the patient or others in the community.
examples: mumps, MRSA, malaria


The measles

Measles has become rare because children are vaccinated against this in the context of the National Vaccination Program. Yet the disease is reappearing more and more often, probably because of the large immigrant flow that occurs in our country and surrounding countries. As a phenomenon in measles, so-called tap spots are visible on the mucous membrane of the cheeks, before the disease actually breaks out. The saliva of measles patients is very infectious from the moment the first symptoms occur. Usually they feel too ill to come to practice and therefore they are usually not a source of infection in oral care.


Sexually transmitted diseases (STI) with symptoms in the mouth

These diseases are also called venereal diseases or venereal diseases. The symptoms that occur in STI in the mouth are all very contagious! With suspicious ulceration in the mouth of a patient it is absolutely necessary to wear protective goggles and a mouth-nose mask, even with a simple inspection with only a mouth mirror.



Gonorrhea is a venereal disease caused by the bacteria Neisseria gonorrhoeae and is most common in people aged 20 to 30 years. The bacterium is transmitted through sexual contact and causes infection of the genitals, with pain during urination and a creamy discharge from penis or vagina. Many of the gonorrhea infections in women are without symptoms, but are therefore no less contagious! Oral sex can cause the tonsils to become inflamed. They are then red and covered with a gray-yellow horseshoe. In this disease very resistant bacteria strains are often found, which can greatly slow down the treatment.


Syphilis (lues)

The causative agent of syphilis (lues) occurs only in humans. It is the very pathogenic spirocheet Treponema pallidum. This microorganism can penetrate the body through completely intact skin and mucous membranes. The contamination is caused by direct contact. Outside the body, the pathogen only survives for a few hours. There are three stages to distinguish.


Stage 1: primary affect. This is an inflammation at the place where the Treponema has invaded the body. Within a few weeks after the infection, a ulcer is created that is extremely contagious. Depending on sexual habits, this ulcer may also occur in the mouth or on the lip. Later, a flat, crater-shaped place forms. At the same time, the lymph nodes become swollen without any complaints. The site 'heals' within a few weeks, but six to eight weeks thereafter the next stage can arise.


Stage 2: spotty skin rash on the whole body and also on the soles of the feet and palms, with fever, malaise, hair loss and sometimes with moist spots that are extremely contagious (venereal warts). If the patient is not treated at this stage, the patient remains contagious and (sometimes only after a few years) the next stage can occur.


Stage 3: neurological or psychiatric symptoms, often together with inflammation of the blood vessels. At places in the body where Treponema pallidum is still present, an inflammation can occur again that breaks out. This type of ulcer is also extremely contagious! The treatment consists of the administration of antibiotics. It is important that the diagnosis is made at an early stage. Then partners can also be alerted and this serious disease will be less able to spread.



The name AIDS (aquired immunodeficiency syndrome) indicates that it is an acquired disorder in the immune system. AIDS is caused by the HIV (human immunodeficiency virus), which was discovered in 1983. An infection with the virus is usually called an HIV infection, because the follow-up stage, AIDS, no longer necessarily follows the infection due to good medication. In general terms, people talk about HIV positively or in short seropositively. The virus is present in all bodily fluids, but can only be transmitted via blood, semen, vaginal fluid and breast milk, because the concentration of the virus is high enough. Outside the body, the virus survives only a few minutes. (HIV is therefore much less contagious than, for example, the hepatitis B virus). The infectivity depends on the amount of virus transmitted and on the physical state in which the recipient is present. For example, one can think of a vulnerability due to the existence of (micro) injuries. Brushing teeth with gingivitis or periodontitis can cause such minor injuries as a result of which oral sex can become dangerous. During the infection, a lot of virus is present in the body. When the patient is treated appropriately, the amount of free virus in the body decreases considerably. The viral load has usually decreased considerably and the patient is therefore significantly less contagious.


Mechanism of action of the HIV

The virus very selectively infects certain cells of the immune system, namely the helper cells from the group T-lymphocytes. This type of cell plays an extremely important role in the immune system and is considered the 'conductor of the immunological orchestra'. The virus penetrates the cell and during the multiplication the genetic material of the virus is converted and incorporated into the hereditary material of the lymphocyte. Because of this change, the immune function of the cell is reduced. In the meantime, new virus is also being produced in the infected cell. The newly created virus infects the other helper cells and in this way the cellular defense of the infected person is severely affected.


The disease course in an HIV infection follows the following four different stages:


Stage I: Is the acute infection. At this stage, the amount of virus in the body is very large. The patient usually only has some flu-like symptoms. The patient usually produces antibodies in the period of four to eight weeks after the infection, but they can not control the virus. So virus always circulates in the blood.


Stage II: After the first infection, the virus remains in the body without the patient being affected. The patients are then seropositive. This remains the case during the entire incubation period, which can last for years in the case of an untreated infection.


Stage III: At this stage, the patient has spread painless lymph node swelling anywhere in the body. This stage lasts longer than three months.


Stage IV: AIDS is a fact at this stage. In addition to some positive blood tests a lot of symptoms can occur.


General signs of AIDS:

  • Swollen lymph nodes
  • Weight loss
  • Fever (persistent or intermittent)
  • Diarrhea
  • Night sweats
  • Extreme fatigue
  • Opportunistic infections
  • Tumors


Specific signs of AIDS in the mouth:

  • Kaposi sarcoma that may occur as a first observable symptom. This is an irregularly shaped, blue or brownish tumor. A Kaposi sarcoma occurs regularly in the mouth. The dentist (assistant) is therefore sometimes the first to be able to detect AIDS.
  • Opportunistic infections in the mouth. The fungus Candida albicans is usually involved in this. The infections cause a lot of discomfort due to fissures in the corners of the mouth and a burning sensation in the mucous membranes. The patient suffers from cold sores very frequently.
  • Severe gum disease is not rare (anup: acute necrotizing ulcerative periodontitis), as well as various infections of the oral mucosa.
  • 'Hairy leukoplakia' is a white, non-scraping discoloration of the mucous membrane, with a somewhat rough, 'hairy' appearance.


Treatment of HIV


The most effective treatment is still prevention! The use of antiviral drugs by infected people does influence the amount of circulating virus, so that the viral load can decrease significantly. However, most antiviral drugs have a lot of side effects. For example, blistering occurs frequently in the mouth, and in addition, a dry mouth, taste disturbances and inflammations of the oral mucosa develop. General side effects are nausea, diarrhea and liver function disorders. Furthermore, it is necessary to relieve patients' complaints by combating opportunistic infections, for example by prescribing an anti-fungal preparation in case of an outbreak of opportunistic infection with Candida albicans in the mouth. Fortunately, the seropositive stage of this infectious disease is due to progress in the development of medicines nowadays in a fairly stable phase. As a result, seropositivity has in fact become a chronic disease instead of, as initially true, a disease with almost always fatal outcome.