Oral herpes, commonly known as cold sores or fever blisters, is caused by the Herpes Simplex Virus type 1 (HSV-1). This virus establishes a lifelong, latent infection in nerve ganglia after initial exposure. Dentists and dental hygienists are primary screeners of the entire oral and perioral region, making them highly capable of recognizing the physical signs of an active outbreak. This recognition is crucial for patient safety and preventing the spread of the highly contagious virus in the clinical setting.
How Dentists Recognize Oral Herpes
A dentist recognizes an active HSV-1 infection (herpes labialis) primarily through visual inspection and patient history. The recurrent infection typically presents as a cluster of small, fluid-filled vesicles on or near the lips, though lesions can also appear on the attached gingiva or hard palate.
These clusters progress through distinct stages. The outbreak begins with a tingling or burning sensation known as the prodrome stage, which occurs before any physical sign is visible. The vesicles quickly rupture, forming small, painful ulcers that may coalesce into a larger sore. This ulcerative phase is followed by crusting, where a golden-brown scab forms, marking the beginning of healing. This characteristic appearance is often enough for a dental professional to make a presumptive diagnosis.
Differentiating Cold Sores from Other Lesions
Dentists must differentiate recurrent herpes lesions from other common oral conditions, particularly aphthous ulcers (canker sores). Although both are painful and ulcerative, aphthous ulcers are not viral and are not contagious.
Location
A primary distinguishing factor is the location of the lesion. Recurrent herpes lesions are almost always found on keratinized, bone-bearing tissues, such as the hard palate, attached gingiva, or the outside of the lips. In contrast, aphthous ulcers occur only on non-keratinized, movable mucosa, such as the inner cheeks or the floor of the mouth.
Presentation and Recurrence
Cold sores begin as a cluster of small vesicles before ulcerating, a feature absent in canker sores, which present as white or yellow ulcers with a red border from the start. Furthermore, herpes lesions tend to recur in the same location, while aphthous ulcers may appear in different areas with each episode.
Dental Care During an Active Outbreak
If an active herpetic outbreak is detected or reported, non-urgent treatment must be postponed. This precaution is necessary because the virus is highly contagious, especially during the weeping vesicle and ulcer stages before a crust has fully formed. Proceeding with dental procedures, particularly those involving high-speed instruments like drills or ultrasonic scalers, creates aerosols containing virus particles.
These aerosols lead to two risks: autoinoculation and cross-contamination. Autoinoculation is the risk of spreading the virus to other sites on the patient’s body, such as the eyes, which can cause ocular herpes. Cross-contamination refers to the spread of the virus to the dental team, other patients, or dental equipment.
Rescheduling is a safety measure that ensures the virus is not spread and allows the patient’s lesion to heal. Treatment is generally considered safe once the lesion is completely crusted over or fully healed, which typically takes between seven and fourteen days from the onset of symptoms.
Patient Privacy and Disclosure
Concerns regarding the confidentiality of a herpes diagnosis are addressed by strict medical privacy regulations. In the United States, the Health Insurance Portability and Accountability Act (HIPAA) mandates that all health information, including the presence of HSV-1, is Protected Health Information (PHI). Dental offices that transmit health information electronically must adhere to these regulations.
A diagnosis of oral herpes is treated with the same confidentiality as any other medical finding. The information is recorded in the patient’s chart and is only used to ensure safe treatment planning and to protect the patient and the dental staff from transmission.