Icd 10 Code For Herpetic Lesions
Nickie Koskinen
Globally, an estimated 3.7 billion people younger than 50 (67%) have herpes simplex virus (HSV)-1 infection, which primarily affects the lips, producing what are commonly called cold sores or fever blisters.1 Oral herpes infections are often asymptomatic, but can cause mild to severe symptoms for many, with painful blisters or ulcers at the site of infection.2 Oral ulcers have been associated with infections, autoimmune diseases, and inflammation. Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, available as tablets, capsules, and topical ointments, are the most commonly prescribed and effective medications.3 These medications can help reduce the severity and frequency of symptoms, but cannot cure the infection.
An alternative treatment for herpes labialis infection is the diode laser. This treatment option alters cell and tissue function, and decreases healing time.3 Based on dental hygiene practice acts and appropriate education and certification, dental hygienists can be assets in the use of diode lasers for the treatment of herpetic lesions.
Laser therapy should be conducted at the first sign of an HSV-1 outbreak. With laser therapy, the healing time for a herpes lesion may be reduced by 10 days to 14 days and the resultant pain/discomfort should decrease.6
The noninitiated tip is used in a back-and-forth or circular motion around the lesion. A circular motion is most commonly used for smaller lesions, starting at the outer edges of the lesion, slowly moving closer to the center of the lesion, while holding the tip about 5 mm from the lip.7 If the lesion is large, clinicians may find the back-and-forth method to be more thorough. No anesthesia is needed for the use of laser therapy in the treatment of herpes labialis.8
Evidence demonstrates the efficacy of laser use in the treatment of herpetic lesions. In a double-blind study, Brignardello-Peterson6 used a low level laser on 60 patients; the control group received no laser therapy. Results showed a reduction of healing time for participants receiving laser treatment for a herpes labialis lesion. Participants reported less pain and a reduction in lesion size, compared to the group that did not receive laser therapy.
In a randomized, double-blind, placebo-controlled study of 50 participants with herpes labialis lesions, De Paula Eduardo et al9 found a significant reduction in healing time and a decrease in the recurrence of herpes lesions.
Namar et al8 reported a reduction in microorganisms post-laser therapy, resulting in faster healing. It remains unclear whether healing time improved due to exposure of the actual phototoxicity or the indirect thermal changes. The researchers suggest that healing time will vary depending on the use of longer or shorter settings on the laser wand.
The following two case reports involve a one-time application of laser therapy for the treatment of herpetic lesions. The initiation times of the herpetic lesions were different in each case, but both patients reported the following post-laser therapy: less discomfort, lesions did not grow in size, and lesions crusted over within 1 day of treatment. The most significant change reported was that lesions showed signs of healing and shrinkage much quicker than lesions they had experienced in the past that did not receive laser therapy.
As with any device that emits radiation, clinicians must follow all safety rules applicable to laser use. The Association of Perioperative Registered Nurses (AORN) has established recommended safety practices when using a laser for patient care.10 Every dental practice that uses a laser for direct patient care should have an employee identified as its laser safety officer. The AORN recommends that all equipment be located on one cart, including the laser itself, eye protection (patient and operator), evacuation system, signs, and masks.10 An organized laser therapy cart promotes efficient operation and can help to prevent any untoward effects on patients or clinicians.
Compared with providers, patients are at greatest risk for skin damage. As the laser produces thermal energy, patients are susceptible to soft tissue burns.12 The operator controls and minimizes any potential burn by consistent monitoring of laser settings and appropriate direction of the laser beam. Dark skinned individuals may not be ideal candidates for laser treatments due to their higher melanin pigmentation. The greater melanin level will absorb more of the laser beam, making these individuals more prone to burning and skin damage, regardless of the setting.13 Mustached or bearded men, or women with any stray hairs in the mouth area could result in burning because the laser beam is drawn to the facial hairs, burning them and thus the skin.14
Using a laser to treat soft tissue lesions releases a plume into the air, which may consist of carcinogens, mutagens, irritants, and fine dusts. Plumes may also contain bioaerosols, viruses, blood fragments, and bacteria depending on the type of procedure.9,10 They also contain carbon monoxide, polyaromatic hydrocarbons, and various toxic gases and vapors, and chemicals such as formaldehyde, hydrogen cyanide, acrolein, and benzene.15
Currently, there are no Occupational Safety and Health Administration standards for laser plume hazards; however, these are needed.16 A high-volume evacuation system must always be used when the laser is firing. This will keep the site cool and remove the plume. Nose filters can be added to the personal protective equipment to reduce any viral plume from being inhaled. Nose filters are lightweight, discreet, latex free, and available in multiple sizes. Face masks are required for all patient care procedures and vary in micron thickness.17 The mask used during laser procedures must be 0.1 microns. This will filter 99.9% of all viruses as well as controlling any plume crossing into the mask.18
Reflective surfaces must be minimized in the patient operatory during laser therapy. When reflective surfaces are not covered or removed, the laser can be redirected by bouncing off the metal or mirrored surfaces, possibly injuring the eye. Examples of reflective surfaces are mirrors, earrings, and any metal with a reflective surface.12
Operatories used in laser therapy must be properly marked with warning signs so that others in the office (staff and patients) do not enter the room without the proper safety equipment. The safety zone for laser use is 8 feet.12 A laser safety checklist should be used prior to bringing the patient into the treatment area (Table 1).
Dental hygienists interested in using laser therapy must ensure it is within their state practice acts. The Academy of Laser Dentistry has a map demonstrating which states allow the use of laser therapy by dental hygienists. Sixteen states have a written policy that explicitly allows laser use by licensed dental hygienist. Thirty states have a range of regulations, from no mention of laser use, to stipulating the use of lasers by dentists only, to allowing dental hygienists to use laser therapy only for gingival curettage. The remaining four states are either developing a policy or simply do not allow dental hygienists to use laser therapy in any circumstance.19
Laser therapy is not a required part of dental hygiene education so the level of instruction provided on its use varies widely. Dental hygienists who want to learn how to use laser therapy may take a course approved by the state in which they plan to practice.20 Dental hygienists should check with their State Board of Dental Examiners to find a certified class.
The use of the diode laser on herpes labialis lesions can be of immense value to both patients and clinicians, reducing bacterial activity and pain.7,9,15 Laser therapy for the treatment of HSV-1 is a service that all dental hygienists should be able to provide (depending on state law).
Leila H. Liberman, RDH, EdD, serves as a clinical dental hygienist and senior staff in the advanced education in general dentistry program at the Central Texas Veterans Health Care System in Temple. She can be reached at: leila.l...@va.gov.
Angela Dudley, RDH, MA, CHES, is the patient care coordinator in Advanced Specialty Education at the University Maryland School of Dentistry in Baltimore. She has extensive experience in clinical dental hygiene and education. She became a certificated health education specialist in 1995.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
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Traditional gold-standard test for identifying acute herpes simplex virus (HSV) infection in active lesions (eg, vesicles, ulcers, inflamed mucous membranes). Molecular testing is generally preferred; Herpes Simplex Virus (HSV-1/HSV-2) Subtype by PCR (2010095). Orthopoxviruses, including monkeypox virus, cannot be identified clinically using this testing method. Refer to -testing for more information.
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