Intraoral Herpes

Dental and hygiene students should take note of these images, since lesions like this are often overlooked, or misdiagnosed. Herpes simplex lesions often erupt on intraoral tissues and, in their mildest manifestations tend to look like this. They often look larger with large eroded centers and wider white margins. Note also that they always appear on attached tissue such as the attached gingiva, the hard palate and the dorsal surface of the tongue.

Contrast this to Aphthous (cancre sores) which occurr exclusively on unattached tissue such as the buccal mucosa, vestibule, soft palate, the ventral surface of the tongue and floor of the mouth.

Whenever lesions like this occur in the oral cavity, the patient generally has flu-like symptoms such as headache, fever, malaise and overall body aches. Asking the patient if he or she has these symptoms may help to confirm the diagnosis.

The image above, as well as the two below all came from the same patient. This series demonstrates a severe primary herpes stomatitis in an 18 year old male. Note the crusting at the vermillion border on both upper and lower lips, as well as the crusting herpes blister on the upper right lip. Also note the extremely red and swollen gingiva in all three images.

The swollen, red gingiva is apparent in these images. The white "slough" on what appears to be the attached gingiva is an easily removed layer of dead epithelial cells. In normal circumstances, this layer would be brushed away, or rubbed away by the normal activity of the lips, however this condition is so painful that the patient avoids traumatizing the tissue, even with the normal pressure applied by the lips on the gingiva. When a clinician first sees a condition like this, his first thought might be that the patient has acute necrotizing gingivitis (ANUG). At first glance, it is not easy to tell the difference. ANUG is a bacterial infection, and it is always associated with a strong fetid odor, as well as a white slough directly associated with the interdental papillae. It the case presented here, the white slough overlies only the attached gingiva, and is not in direct contact with the teeth themselves, and there was no strong feted odor. Careful observation reveals involvement of the lips and also whitlows (herpes blisters) on the fingers. The patient has also been suffering from flu-like symptoms, including muscle aches, malaise, nausea and chills, as well as nighttime sweating. ANUG is localized to the gingiva and does not affect the tongue, lips or skin on the face. It does not cause the flu-like symptoms presented by this patient, and is not associated with whitlows on on other parts of the body.

The image above shows a case of herpes simplex when it involves the tongue. Note that it occurs only on the ventral (top) surface, and it causes red, swollen fungiform papillae (taste buds).

Click the button above to email Doctor Spiller.

Your browser must be Java enabled to use the email button.
If the email button does not work on your browser, click here.

I do not answer LONG emails. If you don't receive a reply, then your letter was too long. Make your questions short and precise. I don't have time to answer rambling, multiple questionnaires.
I cannot diagnose something I cannot see. Don't ask about sores in your mouth. See a dentist.

Please do not inquire about fees. See this page instead.).

I DO appreciate your help in correcting typos and broken links.

No dental insurance?
What is dental
insurance and how
does it work?

Are your fillings
killing you?
Is mercury ruining your
life??

Is Fluoride poison?
Should it be illegal?

Do Root Canals cause
multiple sclerosis or
other diseases?
Click here to find out.

Are dentures better
than real teeth?
Should you have all your
teeth pulled and get
false teeth?

Bad breath?
What is causing your bad
breath, and how can you
treat it?

Cure your dry mouth for
Free
Click here to find out how.

Check out another family website!
San Francisco Desktop Guy.
Free BIG desktop images for multiple monitors.

All material on this web site is protected by copyright and is registered with the US Copyright office. All personal uses, including public and academic presentations, are permitted. This fair use permission applies to oral and written reports, dissertations and theses for students in public and private schools, elementary and high schools, colleges and graduate schools. It also applies to teachers wishing to print this material for classroom and course work. Acknowledgement of this website as the source for this material during presentations is not required, but would be appreciated. Any dentist or other professional who finds this material useful is welcome to print and distribute it to patients, or to refer their patients to this website.

Written requests for publication on the internet or other mass media (including printed publications) will be considered on a case-by-case basis. Internet and printed publication IS permitted (without permission, but with attribution) if it is part of a qualified academic dissertation, but any other internet or mass media use of this material without written permission is STRICTLY prohibited. Requests for such usage may be forwarded to me using the email button in the right shared border. If permission is granted, you must credit me for the use of the material and link to this website prominently from your own. Dentists and web developers who cut and paste content and/or images from doctorspiller.com into their own websites and claim them as their own are forewarned that this may result in legal action. Click here for more information concerning the copyright on this material.

DISCLAIMER: Statements made on this web site are for informational purposes only and are not intended to be substituted for the advice of a medical professional. Information and statements have not been evaluated by the American Dental Association or any federal regulation agency and are not intended to diagnose, or treat any disease or medical condition. This is a personal website written by an individual dental professional whose intention is to enlighten the public with generally accepted, mainstream medical/dental information. I do not claim to represent the opinions of all dental or medical professionals. No website is a substitute for a visit to a living, breathing dentist or physician who can deal with you personally.