Anyone who knows me, has met me, has heard me scream or run across the room in horror when I encounter the above topic in the flesh will already have an idea of my opinion on the wonder that occurs on activation of the Herpes Simplex Virus.
Of course I am referring to the "common" cold sore. According to nhs.uk "Cold sores are small blisters that develop on the lips or around the mouth. They are caused by the herpes simplex virus and usually clear up without treatment within 7-10 days." Although other sources will quote a longer time span of up to 14 days and I would heavily debate the definition "small blisters".
My hatred and sheer phobia of the cold sore became such an undeniable fact that a colleague thought it appropriate to simply "give me Herpes" as a Christmas present. Now before your minds start whirring away on this information see below:
Yes, the above are in fact cuddly representations of what the Herpes Simplex looks like under the microscope. I am sure most will be in agreement that the above have a strange "cute appeal" to them, however in real life these little blighters are incredibly contagious and whilst they are hideous for the person whom they afflict they can cause some serious issues for health care workers including us dentist minions as well as having the potential to cause further misery to the owner of said blister following dental treatment.
Complications of coldsores in the dental setting
Small disclaimer - please note this applies to only non urgent dental treatment and each case would be analysed separately on an individual risk benefit basis.
Firstly, in the interests of fulfilling my GDC responsibilities of working in the best interests of the patient, carrying out dental treatment with a highly contagious cold sore outbreak can lead to spread of the virus around the patient's face and in a small number of documented cases it has even been found to cause nasty lesions on the neck and so not only is the following advice protective to myself but also to anyone we treat.
This is where the science bit comes in (sorry).
Sotiriou et al. suggested that dental drilling procedures cause saliva to be made into such small droplets that they take on an aerosol form (like your deodorant or hairspray) and these particles are small enough to penetrate deep into the lungs. Which means they can also spray across the room and land on the person we are treating as well as ourselves. This point is echoed by Bentley et al. who measured the distribution of spatter and aerosols generated by dental drills (a thrilling task I'm sure) and found that contaminated aerosol droplets travel a high distance (up to a metre and a half away from the spot marked x) and linger there. Finally Checchi et al.showed that exposed areas of the dentist's face are at risk with contaminated particles.
What this means is that treatment of someone with an active coldsore (most contagious when it is at the nice crusty oozing stage) means risk of more coldsores occurring both on the patient and on us poor toothworkers.
More seriously is a condition called "Herpetic keratoconjunctivitis". Nhs.uk describes this as "a secondary infection of the cold sore virus that affects your eyes [which] can cause inflammation (swelling and irritation) of your eye area and sores to develop on your eyelids...Left untreated, it can cause the cornea (the transparent layer at the front of your eye) to become infected, which can eventually lead to blindness". Whilst the glamourous protective goggles we insist both the patient and ourselves don during treatment have some role in preventing the aforementioned splatter droplets contaminated with the virus entering our eyes, they are sadly not impervious to everything. So bad news all around really considering that they make you look like you've walked right out of a year 10 chemistry lesson and don't protect you from the Herpes.
Therefore, please understand that from tingle until the cold sore is completely gone PLEASE DON'T GO TO YOUR DENTIST (or anywhere near me in fact, I am considering appealing to the government for some sort of immediate restraining law should one be within in 500ft of me) unless it is an emergency as it can make it more miserable for yourself as well as the person happily drilling away at your teeth.
As always, feel free to ask any questions or comments in relation to this. I am now going to douse myself with alcohol gel as even discussing the topic is making my lip tingle. Perhaps a hazmat suit might be a considered purchase for next Herptober....
References (apparently you can take the girl out of academia but can't take academia out the girl)
ONLINE RESOURCE www.nhs.uk
Generally speaking, risk is hiding under the cute apperance. Herpes Simplex really has so big damage. How can we avoid it?
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