Herpetic gingivostomatitis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2].

Synonyms and Keywords: Gingivostomatitis, oral herpes.

Overview

Gingivostomatitis (also known as primary herpetic gingivostomatitis or orolabial herpes) is a combination of gingivitis and stomatitis, or an inflammation of the oral mucosa and gingiva.[1] Herpetic gingivostomatitis is often the initial presentation during the first ("primary") herpes simplex infection. It is of greater severity than herpes labialis (cold sores) which is often the subsequent presentations. Primary herpetic gingivostomatitis is the most common viral infection of the mouth.[2]

Primary herpetic gingivostomatitis (PHGS) represents the clinically apparent pattern of primary herpes simplex virus (HSV) infection, since the vast majority of other primary infections are symptomless. PHGS is caused predominantly by HSV-1 and affects mainly children. Prodromal symptoms, such as fever, anorexia, irritability, malaise and headache, may occur in advance of disease. The disease presents as numerous pin-head vesicles, which rupture rapidly to form painful irregular ulcerations covered by yellow–grey membranes. Sub-mandibular lymphadenitis, halitosis and refusal to drink are usual concomitant findings.[3]

Symptoms

File:Herpes Gingivalis.tiff
Herpes lesions on the gingiva.[4]

The symptoms can be mild or severe and may include:

  • Not able to chew or swallow
  • Sores on the inside of the cheeks or gums
  • Fever
  • General discomfort, uneasiness, or ill feeling
  • Very sore mouth with no desire to eat
  • Halitosis (bad breath)

Differential Diagnosis

Gingivostomatitis symptoms in infants may wrongly be dismissed as teething. "Coincidentally, primary tooth eruption begins at about the time that infants are losing maternal antibody protection against the herpes virus. Also, reports on teething difficulties have recorded symptoms which are remarkably consistent with primary oral herpetic infection such as fever, irritability, sleeplessness, and difficulty with eating."[5] "Younger infants with higher residual levels of antibodies would experience milder infections and these would be more likely to go unrecognized or be dismissed as teething difficulty."[6]

Gingivostomatitis must also be differentiated from herpangina, another disease that also commonly causes ulcers in the oral cavity of children, but is caused by the Coxsackie A virus rather than a herpes virus.[7] In herpangina, ulcers are usually isolated to the soft palate and anterior pillar of the mouth.[7] In herpetic gingivostomatitis, lesions can be found in these locations, but they are almost always accompanied by ulcerations on the gums, lips, tongue or buccal mucosa and/or by hyperemia, hypertrophy or hemorrhage of the gums.[7]

Causes

Herpes Stomatitis is caused by Herpes hominis virus, type I and II infect oral mucosa but type I is more common. Gingivostomatitis generally affects children under the age of three and young adults. There are prodromal symptoms (fever, malaise, irritability, headache, vomiting, lymphadenopathy) 1–2 days prior to local lesions. Then small, yellowish vesicles form, which rupture quickly, resulting in shallow, round, discrete ulcers with erythematous halo. It affects both the free and attached mucosa. A generalized marginal gingivitis may precede the ulcers.

In addition, chronic elemental mercury poisoning can manifest with gingivostomatitis, in addition to neurologic (tremor, paresthesias) and psychiatric (forgetfulness, mood disturbances) symptoms.

Treatment

Treatment includes fluid intake, good oral hygiene and gentle debridement of the mouth. In healthy individuals the lesions heal spontaneously in 7–14 days without scarring.

Physical examination

Gallery

Head

Oral cavity

References

  1. Gingivostomatitis at Dorland's Medical Dictionary
  2. "Oral Complications of Cancer and Its Management". By Andrew Davies, Joel Epstein. Oxford University Press, 2010. p195
  3. "Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis", A. Kolokotronis, S. Doumas, Clinical Microbiology and Infection, Volume 12, Issue 3, pages 202–211, March 2006. http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2005.01336.x/full
  4. Dorfman, J. The Center for Special Dentistry.
  5. "Herpetic gingivostomatitis and teething difficulty in infants". David L. King, William Steinhauer, Franklin Garcfa-Godoy, Cassandra J. Elkins. PEDIATRIC DENTISTRY MARCH/APRIL, 1992 VOLUME 14, NUMBER 2. p83
  6. "Herpetic gingivostomatitis and teething difficulty in infants". David L. King, William Steinhauer, Franklin Garcfa-Godoy, Cassandra J. Elkins. PEDIATRIC DENTISTRY MARCH/APRIL, 1992 VOLUME 14, NUMBER 2. p84
  7. 7.0 7.1 7.2 PARROTT, RH (August 1954). "Clinical and laboratory differentiation between herpangina and infectious (herpetic) gingivostomatitis.". Pediatrics. 14 (2): 122–9. PMID 13185685. 

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