Herpetic whitlow: an occupational disease of practicing dentists

Herpes labialis and Nigerian dental health care providers: knowledge, attitudes, behaviors, and refusal to treat

Background

The few existing studies on herpes labialis among health care workers have been predominantly among non-dental health care workers. The purpose of this study was to determine Nigerian dental health care providers’ knowledge of, attitudes toward, preventive behaviors for, and refusal to treat patients with herpes labialis.

Methods

This cross-sectional study was conducted among final-year dental students at the University of Benin, dental house officers, and residents at the University of Benin Teaching Hospital, Benin City, Nigeria. Data collection was via a self-administered questionnaire. Bivariate statistics and logistic regression were used to relate the dependent and independent variables.

Results

Of the 120 questionnaires distributed, 110 were completed and returned, giving a 91.7 % retrieval rate. However, 15 of the returned questionnaires were discarded because they were improperly completed, leaving a total of 95 questionnaires for final analysis in this study. The majority of participants were over 28 years old (54.7 %), male (67.4 %), unmarried (66.3 %), and postgraduate dental health care providers (51.6 %). Less than half (43.2 %) of participants demonstrated adequate overall knowledge of herpes labialis. About one-tenth (10.5 %) and more than three-quarters (87.4 %) of participants reported a positive attitude and performance of adequate preventive behaviors, respectively. A total of 16.8 % of participants reported a high tendency to refuse treatment to patients with herpes labialis. Although not statistically significant, young, unmarried, male undergraduate participants reported a greater likelihood to refuse treatment to herpes labialis patients. We found a statistically significant positive correlation between attitude and refusal to treat patients with herpes labialis. However, marital status and the attitude of participants toward these patients emerged as the determinants for refusal to treat patients with herpes labialis.

Conclusions

Data from this study revealed a high level of inadequate knowledge, negative attitudes, and reasonably adequate preventive behaviors with respect to herpes labialis. One out of every six dental health care workers studied reported having refused to treat patients with herpes labialis. Unmarried dental health care providers and those with negative attitudes toward herpes labialis patients were more prone to refuse treatment to these patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-015-1023-9) contains supplementary material, which is available to authorized users.

Healthcare-associated viral and bacterial infections in dentistry

Infection prevention in dentistry is an important topic that has gained more interest in recent years and guidelines for the prevention of cross-transmission are common practice in many countries. However, little is known about the real risks of cross-transmission, specifically in the dental healthcare setting. This paper evaluated the literature to determine the risk of cross-transmission and infection of viruses and bacteria that are of particular relevance in the dental practice environment. Facts from the literature on HSV, VZV, HIV, Hepatitis B, C and D viruses, Mycobacterium spp., Pseudomonas spp., Legionella spp. and multi-resistant bacteria are presented. There is evidence that Hepatitis B virus is a real threat for cross-infection in dentistry. Data for the transmission of, and infection with, other viruses or bacteria in dental practice are scarce. However, a number of cases are probably not acknowledged by patients, healthcare workers and authorities. Furthermore, cross-transmission in dentistry is under-reported in the literature. For the above reasons, the real risks of cross-transmission are likely to be higher. There is therefore a need for prospective longitudinal research in this area, to determine the real risks of cross-infection in dentistry. This will assist the adoption of effective hygiene procedures in dental practice.

A case series: herpes simplex virus as an occupational hazard

Statement of the Problem

Herpes labialis infections are common and present a serious risk to the dental team.

Purpose of the Study

The purpose is to make dentists aware of the risks involved with treatment of patients with active herpes labialis. In addition, evidence-based risk-management strategies are presented.

Methods and Materials

The incidence and natural history of herpes simplex virus type 1 (HSV-1) are reviewed. Four previously unreported case histories are presented to illustrate the impact common sequelae of HSV-1 can have on the dental team. The differences between HSV-1 and the blood-borne diseases which are the focus of universal precautions are discussed. In particular, the highly contagious, highly transmissible nature of HSV-1 and its transmission through aerosols are highlighted. Finally, the need to include protection against aerosols in the profession's understanding of universal precautions is noted.

Results

The authors suggest limiting the treatment of patients with active lesions to urgent care only, and treating active HSV-1 lesions to reduce time of healing. For four common clinical situations involving HSV-1 infections, evidence-based methods for protecting the dental team and the patient from cross-contamination are also presented.

Conclusion

While it is clear that the treatment of patients with active herpes labialis lesions increases risk of cross-infection, there are good protocols for controlling this risk.

CLINICAL SIGNIFICANCE

By bringing common vectors of cross-infection to light and providing evidence-based protocols for preventing them, this article provides practitioners with positive steps that can be taken for controlling the risk of spreading herpes infections to the dental team.

(J Esthet Restor Dent 24:61–67, 2012)

Dentists' awareness toward vaccine preventable diseases

Effective infection control in dentistry is unfeasible without an adequate immunization program for dental health care providers (DHCPs). Such an assumption is demonstrated for some vaccine preventable infectious diseases (VPIDs), such as Hepatitis B, Influenza and Varicella. However, excluding Hepatitis B vaccine, immunization programs for DHCPs are few and often unclear about which vaccinations are recommended, thus leading to generally low awareness and consequent low vaccination rates. This survey investigated dentists' awareness toward VPIDs. At the moment of registration to a dental congress, a questionnaire regarding the immunization status toward VPIDs was anonymously filled in by 379 Italian dentists (86% of the contacted dentists), with at least fifteen years of activity. DHCP specific awareness was considered high if dentists reported to have controlled the serum level of anti-HBs during the last ten years and have received seasonal influenza vaccine annually. Awareness toward VPIDs was classified high if dentists reported to be immune against six or seven of the following VIPDs, Hepatitis B, Influenza, Varicella, Measles, Mumps, Rubella and Tetanus. DHCP specific awareness resulted high for 32.5% of subjects and low for 31.1%. None of the subjects reported high awareness toward VPIDs, while for 60% of them, such awareness was low (immunization status reported for none or one of the seven VPIDs). Low dentists' awareness stresses the need for a transparent immunization program which is effective in controlling VPID transmission in the dental health care settings and focuses on those VPIDs which pose a true risk of infection for DHCPs and patients.

Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management

Eight of the more than 80 known herpesviruses are human pathogens. Human herpes simplex virus (HSV) is a contagious infection with a large reservoir in the general population. It has a potential for significant complications in the immunocompromised host. In addition, psychological distress caused by the negative stigma associated with genital herpes and visible facial lesions in those experiencing frequent outbreaks renders it a challenging clinical dilemma. This article reviews the epidemiology, pathogenesis, and diagnostic features of HSV infections, providing the clinician with an up-to-date understanding of the available management strategies for mucocutaneous HSV-induced disease.

Herpes simplex virus: an occupational hazard in dentistry

Approximately 70% of the population in the western world become infected with the herpes simplex virus type 1 (HSV-1) by the second decade of life. This review discusses the role of the HSV-1 as a potential occupational hazard for dental workers, focusing on herpes labialis, herpetic whitlow and keratitis. The risks associated with the dental treatment of patients with HSV-1, both from the perspective of the clinician and the patient are presented. Procedures for minimising the impact of HSV-1 within the dental practice, in particular infection control, delivery of treatment and patient education, are addressed. The management options for recurrent herpes labialis are also reviewed.

Clinical manifestations and treatment considerations of herpes simplex virus infection

Herpes simplex viruses (HSV) types 1 and 2 cause infections manifesting as dermatologic, immunologic, and neurologic disorders. Some of the most important manifestations and complications of HSV infection are considered here in a neuroanatomic context. This discussion should aid in understanding the pathogenesis and, in some cases, diagnosis and management of associated HSV-related diseases. The sensory nervous system, rather than skin and mucous membranes, is the primary target of HSV infection. With the intention of extending the benefits of acyclovir, valacyclovir is now being explored in a number of HSV-related conditions. This review extends contemporary thinking about how new antiherpetic drugs might be put to greater therapeutic use in the future.

Oral shedding of herpes simplex virus type 1: a review

Herpes simplex virus type 1 (HSV-1) and, to a lesser extent, type 2 (HSV-2) are the aetiological agents of recrudescent herpes labialis (RHL). The available literature on patterns of HSV-1 shedding into the oral cavity at the prodromal stage of disease, during recrudescences and also during asymptomatic periods, is reviewed, as are the potential sources of virus and the known trigger factors leading to viral reactivation. Attention is given to the methodologies in use for the detection of HSV-1 and the relevance to the risk of cross-infection in surgery. This review also discusses the increase in incidence of HSV-1 genital infections and the significance of salivary inhibitors of the herpes simplex type 1 virus.

Primary herpes simplex virus type 1 gingivostomatitis in pediatric personnel

Herpetic gingivostomatitis is common in young children, but primary oral infection has also been described in adults. Herpetic whitlow as an occupational hazard of medical personnel has been well documented. Four cases of primary herpetic gingivostomatitis are reported in two pediatricians and two pediatric nurses who contracted the infection in their fourth decade of life. All suffered from sore throat and fever as presenting symptoms. Correct diagnosis was delayed for 4-5 days. In conclusion, pediatric personnel with pharyngitis and a negative history of herpetic gingivostomatitis or herpes labialis should bear the possibility of oral HSV infection in mind. Early diagnosis is essential to prevent the spread of the infection to their patients.

Detection of herpes simplex virus (HSV) in the saliva from 1,000 oral surgery outpatients by the polymerase chain reaction (PCR) and virus isolation

Herpes simplex virus (HSV) was detected by a polymerase chain reaction (PCR) in 47 (4.7%) out of 1,000 saliva samples from the outpatients of an oral and maxillofacial surgery department compared with 27 (2.7%) by conventional virus isolation. There were 20 PCR-positive, culture-negative cases but no culture-positive, PCR-negative cases. Patients younger than 10 years or older than 60 years secreted HSV more frequently than the others. Those with inflammatory diseases showed higher positivity for HSV than those with malignancy, trauma or other complaints. All 27 virus isolates were typed as HSV type 1 and none were resistant to acyclovir, arabinofuranosyl-adenine, iododeoxyuridine or phosphonoacetic acid.

Pediatric herpetic hand infections

Fourteen cases of pediatric herpetic hand infection were admitted over a 15-year period. Five cases were documented by viral culture, four by Tzanck smear; the remainder were diagnosed on clinical grounds. The natural history of herpetic hand infections is similar in adult and pediatric populations. Adult infections are most frequently found in medical and dental personnel; pediatric infections are most common in children between 5 months and 6 years of age. Whereas adult infections are usually the result of exogenous occupational or sexual exposure, 11 (80%) of 14 pediatric cases exhibited coexistent oral lesions. Treatment in all cases is nonsurgical; resolution is complete within 3 to 4 weeks. Antibiotics are indicated only in the advent of bacterial superinfection.

Herpes simplex virus infection of the hand

The first episode of herpes simplex virus (HSV) infection of the hand can occur in association with infection at another site, such as primary HSV-1 gingivostomatitis. Autoinoculation is the likely route of transmission. The attacks are usually solitary and last about 14 days. A first episode that results from exogenous inoculation may be severely inflammatory and may last up to 28 days. The majority of cases are recurrent infections and most often occur in adults with HSV-2 infection.

Orofacial herpes simplex virus infections: current concepts in the epidemiology, pathogenesis, and treatment, and disorders in which the virus may be implicated

Herpes simplex virus (HSV) is the causal agent of herpetic stomatitis, recurrent herpes labialis, and the recurrent intraoral infections seen particularly in the immunocompromised patient. HSV has also been implicated in some erythema multiforme, cranial neuropathies, Behçet's syndrome, and oral squamous carcinoma. Recent advances in understanding of HSV, epidemiology, pathogenesis, and treatment are reviewed because there have been numerous advances over the past 5 years.

Barrier techniques and hepatitis B vaccine policies in dental components of local health agencies

National health organizations have issued guidelines for barrier control techniques against infectious diseases and for inoculation against hepatitis B. This study surveys the policies of local health agencies regarding the safeguards used in protecting their employees. Local health agencies (N = 201) operating independently of state health departments were mailed questionnaires seeking information regarding glove, mask, and eyewear policies, as well as hepatitis B vaccine policies for new and current employees. Of the 156 programs returning the survey, 127 (76.6%) reported having a clinical component. Many agencies did not require infection control policies to be implemented for every patient. Agencies that had dental directors who have held their positions for fewer than four years were more likely to have requirements for gloves and masks than agencies run by directors with longer tenure. Those agencies that provided dental treatment to inmates at correctional institutions were also more likely to require infection control policies. The data indicate policy inconsistencies among local dental health programs nationwide. Of considerable concern is the fact that infection control was not identified as a priority for the near future. Many local health agencies would benefit from further education in infection control.

Outcome of sterilization by steam autoclaves in Danish dental offices

The aims of this study were to evaluate the performance of autoclaves and the use of biologic indicators for sterilization control, and to look for predictor variables for improperly functioning autoclaves in Danish dental offices. The study population comprised 314 Danish dental offices (participation rate 94%); 177 from the public Child Dental Service (CDS) and 137 from private practice. A minor questionnaire and five biologic indicators (Attest Biological Indicator for Steam Sterilization, 3M) were sent to the participants. CDS offices were found more inclined to use biologic indicators than PP offices (P less than 0.00001). Among CDS autoclaves 2.3% (95% confidence limit: 0.9-5.7%) failed to sterilize compared to 7.3% (95% confidence limit: 4.0-12.9) of the PP autoclaves. This difference is not statistically significant, but the confidence intervals indicate a possible true difference in favor of a better outcome in the CDS offices. Looking at the whole sample no other predictor variable for inadequate sterilization could be determined as differences were statistically insignificant with regard to years of professional experience, age and brand of autoclave, and use of biological control. Recommendations from an official body stating the approved types of sterilization control in dental offices would be of value.

Herpes simplex virus infection of the hand. A profile of 79 cases

Seventy-nine cases of herpes simplex (HSV) infection of the hand were documented by viral culture over a 40-month period. A marked bimodal age distribution was found with 32 cases occurring in adults aged 21 to 30 years and 16 occurring in children less than 10 years old. The infection most commonly occurred on the fingers (69 percent) and thumb (21 percent). All 20 herpes simplex type 2 (HSV-2) isolates came from patients over 20 years old. All of the 13 specimens that were typed after isolation from patients under 20 years old were herpes simplex type 1 (HSV-1). Only seven of the 49 adult cases were identified in health care professionals. In this series, HSV infection of the hand occurred in 2.4 cases per 100,000 population per year. In adults, women with recurrent infections from HSV-2 and a history compatible with genital herpes predominated. In children, a primary HSV-1 infection associated with gingivostomatitis was common.

Recurrent herpes simplex virus infections in the adult hand

Ten adult patients referred to the Department of Dermatology and Venereology at Akademiska Hospital, Uppsala, from different surgical units due to recurrent herpes simplex virus (HSV) infections in the hand, were investigated. At recurrence, virus isolation and typing revealed genital HSV type 2 virus in nine out of ten patients indicating that recurrent HSV infections located in the hand should be looked upon as a part of a venereal disease.

Acyclovir and the treatment of herpetic whitlow

The herpes simplex virus can cause both oral and cutaneous lesions. Herpetic whitlow is a cutaneous manifestation of a herpetic infection. The source of the infection for many medical and dental professionals is the oral cavity. Acyclovir, an antiviral agent used in the treatment of herpes simplex virus infections, was administered in the treatment of herpetic whitlow. Controlled studies of acyclovir therapy for herpetic whitlow have not been done; however, its use by health care providers to treat the symptoms of herpetic whitlow and a review of the disease are discussed in this case report.

Herpetic whitlow: report of a case with multiple recurrences

A case of recurrent herpetic whitlow is discussed. The patient, a dental assistant at the time of her initial infection, developed herpetic whitlow caused by herpes simplex virus type 2 (HSV-2). She has subsequently experienced nine recurrent infections with lesion spread, scarring, and persistent paresthesia. The severity of the most recent recurrences appears to have diminished, and prodromal sensations, that is, increased local sensitivity, have occurred without the subsequent development of lesions.