Diagnosis and treatment of orofacial herpes zoster: report of cases

Article Abstract:

Herpes zoster (shingles) is a painful condition in adults resulting from previous infection with varicella virus, the virus that causes chickenpox in children. The virus lies dormant in the nerve cells until the time when it flares up. The patient initially experiences fever, pain, and tenderness, and then develops a rash and small vesicles (blisters) on the skin or in the mouth. These rupture and may become infected. The lesions have a characteristic distribution, and laboratory tests can aid in establishing the diagnosis. Herpes zoster can be distinguished from recurrent herpes simplex (cold sores) by its longer duration, more intense symptoms before vesicles appear, and distribution on one side of the body. Although usually considered a disease of the elderly or persons whose immune systems are impaired, herpes zoster can occur in young, healthy adults. The case studies of two such patients with orofacial (affecting the mouth and face) herpes zoster are presented. In both cases, the symptoms resolved after approximately one week. If the patient consults a dentist before vesicles have appeared, the possibility of misdiagnosis exists, since the pain can resemble a toothache. In general, the treatment of herpes zoster is palliative (symptomatic relief without a cure), and the disease resolves on its own. Analgesics are used if pain is severe. People with immune system dysfunction require prompt treatment with antiviral agents, and attention should be paid to patients with recurrent infections to verify that no underlying medical condition is present. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Diagnosis, Shingles (Disease), Herpes zoster

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Postexposure chemoprophylaxis for occupational exposure to HIV in the dental office

Article Abstract:

All dental offices should have a written policy detailing the proper procedure to follow should any staff member receive an injury while treating an HIV-positive patient. The US Public Health Service recommends zidovudine for all health care workers who are exposed to an HIV patient's blood through a skin wound. However, most dentists will not be exposed to enough blood and HIV is not transmitted via saliva. In a survey of 2,860 health care workers exposed to HIV, only 19 were dental workers. Consequently, most dental workers probably will not need to take zidovudine after blood exposures.

Prevention, HIV infection, HIV infections, Dentists, HIV patients

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The cracked tooth syndrome: an elusive diagnosis

Article Abstract:

Tooth fractures may be difficult to diagnose. Many teeth contain surface cracks that are relatively benign. However, when a crack in a tooth begins to cause pain, it is a sign of cracked tooth syndrome. Typically the pain occurs during chewing or biting. The crack is not always visible and can not always be seen on an X-ray. Magnifying glasses and special stains may reveal the crack. The dentist may be able to reproduce the pain by asking the patient to bite on something. Treatment includes orthodontic bands, overlays, crowns, or tooth extraction.

Teeth, Tooth diseases, Tooth injuries

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