Though it comes as no surprise, kissing can spread disease (even caries). Most of these diseases in question are minor, but dental hygienists should be aware of a few changes in treatment that may be necessary.
According to an article in the Journal of Laboratory Physicians, “a 10 second intimate kiss can transfer as many as 8 million bacteria and an unknown number of viruses from one mouth to another.” (1)Kissing has been a symbol of affection dating since the second century. (2) It is believed that it was derived from “kiss feeding,” or the act of passing masticated food from mouth-to-mouth between parent and child. (2)
However, there are bacterial (e.g., dental caries, meningococcal disease, periodontal disease) and viral (e.g., glandular fever or mononucleosis, the common cold, herpes infections, hepatitis B and C, squamous papilloma) diseases and infections that can be transmitted through the mouth during a kiss. These diseases can have oral and systemic effects. Since dental hygienists are knowledgeable about dental caries and periodontal diseases, discussion on these conditions will not be included in this article.
Several diseases transmissible by kissing, as well as treatment considerations for the dental hygienist, are described below.
Virally transmitted diseases
Glandular fever
This condition can also be known as mononucleosis, Pfeiffer’s disease, or the kissing disease. (3,4) Some common signs and symptoms are pharyngitis, tonsillitis, lymphadenopathy, pyrexia, fatigue, petechiae, splenomegaly, and hepatitis. (3) All of these symptoms could last from two to three weeks and vary in severity. (3) It is more common to see this condition in teenagers than young children or adults. (3) A physician will diagnose this virus by using a sensitive test that checks for IgG and IgM antibodies. (3) There is no specific treatment for this condition other than the management of the symptoms until the virus is eliminated from the body. (3) Some of the symptoms can be severe and splenic rupture is possible. (3) A typical symptom reducer is an NSAID (e.g., ibuprofen). (3)
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When treating a patient with glandular fever, a dental professional should modify treatment by implementing shorter appointment. Also, dental professionals should be aware that during the appointment, the patient may not be aware that they have acquired this virus and that it can be detected during the vitals and extraoral exam. A high-grade pyrexia or swollen lymph nodes may be present and the patient should be made aware to monitor those conditions and seek medical attention if they persist or worsen. (3)
Common cold
A common cold is an acute viral infection of the upper respiratory tract that is usually self-limiting. Signs and symptoms of a common cold include pharyngitis, nasal congestion, rhinorrhea, sneezing, coughing, low-grade pyrexia, malaise, and headache. (4) A primary method of diagnosis is using antigen detection tests on different cultures to check for the presence of the virus.(4)
Treatment for this condition is primarily supportive and symptom relief. (4) Dental modifications include ensuring patient comfort and having a shorter appointment time, as well as checking for pyrexia because this could signal a new disease taking over the weakened immune system. (4)
Herpes infection
Herpes simplex virus types 1 and 2 are examples of closely related pathogens which invade the mucosa and penetrate into the stratified squamous epithelium especially where the overlaying stratum corneum is thin, absent, or traumatically destroyed. (5) Lesions will be present, signifying infection. The diagnosing method uses a viral smear from the lesion. (5) Treatment consists of symptom management via antivirals, including creams, ointments, pills, and injections. (5,6) The prescription antivirals include Acyclovir, Famciclovir, and Valacyclovir. (6) There is also a supplement called L-Lysine that helps shorten an outbreak. Herpes is a virus, which has no cure. (5) The virus will remain in the ganglion of the nerve that it infected and can reappear with different triggers. (5)
Dental treatment should not be completed if there is an active lesion. Once a lesion has crusted over, it is safe to treat. The lips, gingiva, and areas of around the lips and nose could be sore due to an outbreak. Making sure to use cation while treating should be used in those areas. (4) Lymphadenopathy may also be found during the extra oral exam. (5)
Hepatitis B and C
Hepatitis B and C cause a serious liver infection that is spread through blood found in saliva. (7) This infection can lead to cirrhosis of the liver and liver cancer. (7) Blood testing is a way to diagnose if an individual has acquired this virus. (7) Symptoms could include jaundice, dark urine, extreme fatigue, nausea, vomiting, loss of appetite, diarrhea, and abdominal pain. (8) The individual may also present with no symptoms at all. (8)The treatment method for this infection is extensive and prolonged use of medication, such as Tenofovir, Entecavir and Pegylated Interferon. (7,8)
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If a patient who has this infection needs local anesthesia, choose the anesthetic agent carefully. Local anesthetics that are metabolized in the liver should be avoided due to the potential of causing more liver damage. The best drug to use for anesthesia is articaine because very little of it is metastasized in the liver.
Squamous papilloma
A squamous papilloma is a dermatological condition that is caused by the human papilloma virus (HPV). (9,10) This will appear as a wart on the mucosa. This virus is transmitted through direct contact with nonintact mucosa. (9) The strains of this virus that can cause a papilloma are HPV 2, 6, 11, and 18. (9) Diagnosing this viral infection includes visual and textile examination as well as testing for the presence of HPV. (9) Currently there is no cure for squamous papillomas or HPV. However, most cases resolve on their own in approximately two years. (9) Some strains of this virus can be deadly depending on the severity. (9)
Caution must be expressed in the area of the papilloma for patient comfort.
Bacterially transmitted diseases
Meningococcal disease
Meningococcal disease is an infection cause by Neisseria meningitis, which is also known as meningococcus. (11) It results in either meningococcal septicemia, meningococcal meningitis, or a combination of both. (12) The leading cause of death in young people and children is meningococcal disease. (13) Signs and symptoms would be leg pain, cold extremities, abnormal skin color, tachycardia, and leukocyte count elevation, or depression. (14) There also could be mild bacteremia to severe sepsis with multiple organ failure, fever, vomiting, lethargy, headache, or reduced oral intake. (15) Testing and diagnosing for meningococcal disease includes samples of the blood from the cerebrospinal fluid that are tested in a laboratory. (14) There are a number of antibiotics to treat meningococcal disease. (15) There are other ways to help ease the symptoms, including breathing support, medications to treat the tachycardia, and wound care for parts of the body with damaged skin. (15)
The dental hygienist needs to keep the patient in a comfortable position without pain and use caution when using bright lights. (14) This could be solved easily by providing sunglasses instead of clear safety glasses during the procedures.
Prevention
The prevention methods are similar for all of these conditions. The first, most general method of prevention is to just avoid kissing someone who appears to have an illness or disease. (16) Also, avoid kissing someone who has an active lesion, papilloma, or ulcer around the lips or in the mouth. (16) When individuals have a condition that is accompanied by coughing or sneezing, they should be instructed to do so in a tissue or in the bend of their arm. (16) Also, there are immunizations for many contagious diseases and these options should be discussed with a doctor. (16) Another important prevention method includes good personal hygiene, such as brushing and flossing the dentition daily. (16)
Conclusion
Overall, it is very common to transmit and to be exposed to bacterial and viral infections from kissing. Another mode of transmission of these conditions could be as simple as sharing a straw. Any form of exchanging saliva could be a mode of transmission for any of these conditions and caution should be expressed when there is any concern present.
Authors’ note: The authors would like to give special thanks to Emily Holt for the guidance and assistance throughout the writing and publishing processes.
References
1. Singh S. Can establishment of human microbiome be customized after birth with local traditions of first feed and intimate kissing? J Lab Physicians. 2015;7(2):73-74. doi: 10.4103/0974-2727.163140.
2. The History of Kissing page. Psychology Today website. https://www.psychologytoday.com/blog/hide-and-seek/201402/the-history-kissing. Published February 23, 2014. Accessed February 18, 2015.
3. Solomons HD. Infectious mononucleosis or glandular fever revisited. Germs. 2012;2(4):148. doi: 10.11599/germs.2012.1027.
4. Passioti M, Maggina P, Megremis S, Papadopoulos NG. The common cold: Potential for future prevention or cure. Curr Allergy Asthma Rep. 2014;14(2):413. doi: 10.1007/s11882-013-0413-5.
5. Kim M, Truong NR, James V, et al. Relay of herpes simplex virus between langerhans cells and dermal dendritic cells in human skin. PLoS Pathog. 2015;11(4):e1004812. doi: 10.1371/journal.ppat.1004812.
6. Herpes simplex. American Academy of Dermatology website. https://www.aad.org/public/diseases/contagious-skin-diseases/herpes-simplex. Accessed March 20, 2016.
7. Caballero JB, Martin M, Weir RC, Agbayani N, Soon NA, Chen K. Hepatitis B prevention and care for Asian Americans, Native Hawaiians and Pacific Islanders at community health centers. J Health Care Poor Underserved. 2012;23(4):1547-57. doi: 10.1353/hpu.2012.0186.
8. Hepatitis Foundation International - Hepatitis Overview. Hepatitis Foundation International website. http://www.hepfi.org/hepatitis/hepatitis-overview.html. Accessed March 20, 2016.
9. HPV/Oral Cancer Facts. The Oral Cancer Foundation website. http://www.oralcancerfoundation.org/hpv/hpv-oral-cancer-facts.php. Published September 2014. Accessed September 28, 2015.
10. Gundeti M, Reddy R, Muralidhar J. Subcutaneous intraesional Ksharodaka injection: A novel treatment for the management of wars: A case series. J Ayurvead Integr Med. 2014;5(4):236-240. doi: 10.4103/0975-9476.146558.
11. My Water’s Fluoride page. Centers for Disease Control and Prevention website. https://nccd.cdc.gov/DOH_MWF/Default/Default.aspx. Accessed February 21, 2016.
12. Tanaka K, Miyake Y, Sasaki S, Hirota Y. Dairy products and calcium intake during pregnancy and dental caries in children. Nutr J. 2012;11:33. doi: 10.1186/1475-2891-11-33.
13. Dowson A. Meningococcal disease in children and teenagers. Nurs Times. 2014;110(11):12-
14. Mayo Foundation for Medical Education and Research. Mayo Clinic website. http://www.mayoclinic.org. Updated 2015. Accessed June 15, 2016.
15. Diagnosis & Treatment. Centers for Disease Control and Prevention website. http://www.cdc.gov/meningococcal/about/diagnosis-treatment.html. Published June 11, 2015. Accessed September 28, 2015.
16. Kissing and your health. Better Health Channel website. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/kissing-and-your-health. Updated July 2014. Accessed September 28, 2015.
