The herpes simplex virus may be reactivated (recurrent) in an extraoral form on the lips or, inside the mouth, in an intraoral form.
a. Extraoral Herpes. Cold sore blisters, also called herpes labialis (figure 1-8), are often associated with colds, trauma, fatigue, fevers, and prolonged exposure to the sun and the wind. The common site of occurrence is on the lips at the border with the skin of the face (called the vermilion border). The lesions usually consist of clusters of small vesicles that, in the early stage, contain a clear, transparent fluid. After a few hours, the vesicles rupture and form a crust or scab. The disease is self-limiting and usually disappears in 10 to 14 days. The individual is infective until complete healing has occurred.
NOTE: Cold sore blisters on the upper lip of this patient are caused by the herpes simplex virus. This recurring infection may be activated by prolonged exposure to sunlight and/or wind.
b. Intraoral Herpes. Intraoral herpes (figure 1-9) forms on extremely firm oral tissue surfaces such as the palate (roof of the mouth) and attached gingiva. Vesicles are not usually identified because they break down almost immediately into ulcers and coalesce to form multiple jagged ulcerations.
Figure 1-9. Intraoral herpes.
NOTE: The herpes simplex virus may cause ulcers to form inside the mouth. In this example, the ulcers are on the roof of the mouth (the palate).
c. Complications. The lesions may persist and be very serious in patients with a compromised immune system. While the virus may regress, it does not disappear. The lesions caused by the virus do disappear, however. Also, it is important for dental specialists to recognize that this may be a very serious infection when it occurs in immuno-compromised patients (AIDS, renal transplant, cancer chemotherapy, and so forth).
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