218 Theories and techniques of oral implantology

Fig. 6-25. In the later stages of Herpes simplex, a crust forms over the blister and the lesion dries, as shown here.

caused by the virus Herpes simplex. These sores usually appear on the lips as an itching group of small blisters with a reddish base. A crust usually forms over the sore as fluid exudes from the blisters and dries (Fig. 6-25) . The crust eventually flakes off.

Herpes simplex is thought to be always present on the mucous membranes and can enter the tissues only after a common cold, "flu," an allergic reaction, menstrual difficulties, or an emotional upset has lowered body resistance. Some patients are prone to cold sores, and such a patient should be referred to an internist because cold sores are usually symptomatic of a poor resistance to infection. Once the underlying cause of the condition is corrected, implants may be inserted. It might be unwise to insert implants in an untreated patient, as creating an implant site does open the door to microbial invasion. While in a healthy person this makes little or no difference, in an infection-prone patient it might. Antibiotics should be administered in any case, to be sure.

Pemphigus. A continual succession of blisters or chronic ulceration of the mucous membranes is highly suspicious of pemphigus, an uncommon skin disease of fatal outcome if not promptly treated with adrenocortical steroid compounds. If the dentist finds repeated blisters filled with a bloody fluid, and if the affected epidermis can be easily moved away from the dermis with slight lateral pressure (Nikolsky's

sign), he should refer the patient to a medical doctor without delay.

Erythema multiforme. When blisters are super-imposed over widespread hemorrhagic lesions, the condition is probably erythema multiforme. This is an acutely painful stomatitis that is sudden in onset, lasts 2 to 4 weeks if treated, and may be recurrent in the spring and in the fall. Its etiology is not clearly understood, but an allergic reaction is suspected in some cases.

Erythema multiforme primarily affects children and young adults. Implants may be contraindicated in a patient suffering recurrent attacks, particularly if the patient exhibits other allergic manifestations.

Thrush. Thrush, or moniliasis, begins with whitish patches that coalesce to form large, uneven areas that look like milk curds. These lesions tightly ad-here to the underlying mucosa and do not flake off. They occur primarily in undernourished children and in adults whose health has been undermined by a chronic systemic disease.

A yeast-like microorganism is believed to cause thrush, and the condition can be easily cured with frequent sodium bicarbonate mouthwashes and a proper diet. Because an adult patient with thrush probably has a chronic disease, implants should be postponed until the identity and nature of that disease are known, even if the oral manifestations clear up.