CDA Essentials 2016 • Volume 3 • Issue 2 - page 31

NEEDTO
KNOW
What canbedone toprevent
transmissionof HSV-1?
Avoidingcontactwith theoralmucosaand thefluid
insidecoldsoreblistersof infected individuals is
paramount,butnote thatHSVcanbe transmitted
byasymptomaticcarriers.2 HSVhasbeenshown to
survive for severalhoursonvarioussurfaces in the
dental office.1
In thehome, familymemberswithHSV-1should
isolatepersonal care itemssuchas toothbrushes
andavoid sharing things suchasutensilsand
drinkingglasses. In thedental clinic,patientswith
anactiveoutbreakpresent an infection risk for staff,
andsoelectiveproceduresshouldbepostponed
until thecoldsoreepisodehas resolved.3
What are the triggers of a
recurrentHSLoutbreak?
Followingprimary infection, theviruswill lie
dormant in thenerveendingsof thebasal
epithelium,periodicallybecoming reactivated in
response to triggers that can includedentalwork,
menstruation, stress, trauma, fever, surgery, fatigue,
infectionandothers.Most infected individuals
experience twoor fewer outbreaksper year,
but up to10%mayendure sixormore.2
What is thepresentation
andprogressionof a
recurrentHSLoutbreak?
Themost commonpresentation features the
eruptionof lesionsat themucocutaneous junction
of the lips.3 Mostpatients reportburning, tingling,
itchingandpainduring theprodromalphaseof
lesiondevelopment.2,3 Multiplevesiclesare then
formed,which ruptureand formulcers that then
crustoverandheal inaprocess typically lasting
up to twoweeks.3
How isHSLdiagnosed
and treated?
Patienthistoryandcloseexaminationof lesions
areoftensufficient todiagnoseHSL.3 Atypical
presentationsmay require further investigation
or referral.Most coldsoreswill resolvewithin two
weeksofonset,but several topical andoral antiviral
agentsareavailable inCanada thatmayprevent
lesiondevelopmentorproliferation.4
Episodic treatmentwith topicalpreparations is
consideredappropriate forpatientswith less
intensiveor frequentHSLflare-ups.2 Ina recent
surveyof103patients livingwith recurrentHSL,
nearly48%admitted tousinganover-the-counter
topical agent to treat their condition.5 While
theseproductsprovidesomesymptomatic relief,
theyhavenotbeenshown topreventulceration.
Prescription topical solutions includeacyclovir
(Zovirax) andanewer topicalpreparationcontaining
5%acyclovir and1%hydrocortisone (Xerese).
The latterhasbeen shown to reduce theonset
of ulcerationby42%and shorten (by1.4days)
thehealingprocess for cold sores.6 It providesan
additionalbenefitbyameliorating theexacerbating
effectsof apatient’s inflammatory response to
theHSV infection.6
Acyclovir (Zovirax), valacyclovir (Valtrex) and
famciclovir (Famvir) are common systemic
medicationsused inHSLpatientswhoexperience
frequent outbreaks (sixormoreper year), or
forwhom symptomsare intolerable.3
All treatments forHSLaremosteffectivewhen
usedearly inacoldsoreoutbreak, andpatients
should thereforebecounseledonproperuseand
adherence.PatientswhoexperienceHSLmust also
beeducatedon identifyingandavoiding,where
possible, theiruniqueoutbreak triggers, aswell as
onmethods to reduce the riskof infectingothers.6
Follow-upofpatientswithactiveoutbreaksshould
beconductedat twoweeks, andat recall forall
individualsknown tohave recurrentHSL.3
MANAGINGHERPES SIMPLEX LABIALIS
IN THEDENTAL PRACTICE
Thisarticle issponsoredcontent fromValeant.
WHYSHOULD
DENTISTS
PAYSPECIAL
ATTENTION
TOHERPES
SIMPLEX
LABIALIS (HSL)?
Dental professionals are
inauniqueposition to
be able toeducate,
screen and treat
patients onhow to
prevent infection and
manage recurrent
outbreaksofHSLcaused
byherpes simplex1
(HSV-1) infection.
Dentists are also at
risk for contracting
and spreadingHSV-1
infection to and from
patients.1 Here’swhat
you need to know:
valeantcanada.com
Valeant Canada LP, 2150St-Elzéar Blvd.West
Laval, Quebec H7L 4A8
©2016 Valeant Canada LP. All rights reserved.
REFERENCES: 1. Gillian M. McCarthy, GM. Risk of Transmission
of Viruses in the Dental Office. J Can Dent Assoc 2000; 66:554-5,
557. 2. Fatahzadeh, M, Schwartz RA. Human herpes simplex virus
infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and
management. J Am Acad Dermatol 2007; 57:737-63. 3. Stoopler, ET.
How do I Manage a Patient with Recurrent Herpes Simplex? J Can Dent
Assoc 2012;78:c154. 4. Nasser M, Fedorowicz Z, KhoshnevisanMH, et
al. In Nasser, Mona. Cochrane Database Syst Rev 2008 (4): CD006700
5. Sibbald RG, Andriessen A. Evaluation on quality of life aspects of
early cold sore treatment. Poster: Can Derm Update, Vancouver 2012.
6. Hull CM, Harmenberg J, Arlander E et al. Early treatment of cold sores
with topical ME-609 decreases the frequency of ulcerative lesions: a
randomized, double-blind, placebo-controlled, patient-initiated clinical
trial. JAmAcadDermatol 2011;64: e1-696.e11.