Case: Suspected Oral Herpes


A new patient came in for a cleaning and checkup. Her teeth and gums were fine, but I noticed an ulcerated area on her palate. The location was just inside the upper first molar and looked like someone had created a cluster of tiny ulcers where the palatine foramen (a hole in the palate for a nerve to come out) is located. This is a very typical place for oral herpes on the palate to show up. It is totally asymptomatic almost all of the time. As a matter of fact, most patients are totally unaware of the condition.

When I see this, I pass along the data that it looks like herpes and that it is very common. While active it is a good idea to avoid kissing and oral sex for a couple of weeks until this clears up because you could pass the condition along.

This particular patient took offense to all of this. She had just had a complete medical checkup and nothing of this sort showed up. She was quite upset and started to cry. A year has gone by and her family members are no longer patients here.

Over my many years of practice I have always mentioned this because I think the patient needs to know. However, during the last few months I have learned that the medical doctors have a very simple swab test that can be performed to see if this is in fact a herpes lesion. Had I been aware of this at the time I would have instantly referred her back to her physician to have this checked out.

With the swab they perform a Tzanck test, which is a stain applied to the stain and looked at with a microscope.  Knowing what I know now, I could have handled this a bit more knowledgeably.

In any case, herpes on the palate is VERY common, the patient is usually unaware of the condition, it will be contagious for some time, so be cautious. If this is very troubling, a simple test is available to check for this form of Herpes.