Herpetic Ggingivostomatitis
Acute Herpetic Gingivostomatitis is the viral infection caused by herpes simplex virus. It occurs in infants and children younger than 6 years of age but is also seen in adults.
Primary infection with herpes simplex virus in the oral cavity results in a condition known as acute herpetic gingivostomatitis, which is an oral infection that is often accompanied by systemic signs and symptoms.
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Herpetic Gingivostomatitis Clinical Features
- Herpetic Gingivostomatitis develops mostly in children and young adults.
- Both males and females are equally affected.
- There is development of painful vesicular lesions on all the mucosal surfaces which rupture to produce foul smelling ulcers.
- Patient become febrile, drools and has signifiant malaise and have tender cervical lymphadenopathy.
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- Lesions and acute illness last for 10 days and resolve with scar formation.
- HSV-1 gain access to patient via direct or airborne water droplet transmission from the infected individual.
- Clinical course is limited by synthesis of viral specifi antibodies.
- After the primary infection, virus ascends through sensoryand the autonomic nerves and persists as latent herpes simplex virus in neuronal ganglia which innervates the site.
- HSV-1 resides inside the trigeminal ganglion.
Herpetic Gingivostomatitis Oral Signs
- He rpetic Gingivostomatitisappears as diffuse, shiny erythematous, involvement of gingiva and adjacent oral mucosa with varying degree of edema and gingival bleeding.
- In its initial stage, it appears as discrete, spherical, gray vesicles dispersed in different areas, e.g. labial and buccal mucosa, sof palate, pharynx and tongue. After approximately 24 hours the vessels rupture and form painful ulcers with a red, elevated, halo-like margins and a depressed yellow and grayish white central portion.
- Diffuse, edematous, erythematous enlargement of gingiva with tendency towards bleeding is seen.
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Herpetic Gingivostomatitis Oral Symptoms
- Generalized soreness of oral cavity which interferes with eating and drinking.
- The ruptured vesicles are sensitive to touch, thermal changes and foods.
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Herpetic Gingivostomatitis Diagnosis
It is established from patients history and clinical findings. For confimatory tests, the material may be obtained from the lesion and submittd to laboratory.
- Direct smear: Material is obtained from the base of lesion and smeared and stained. The finding of multinucleated cells with swelling, ballooning and regeneration is adequate for diagnosis.
- Inoculation of virus from suspected site, to tissue culture.
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Herpetic Gingivostomatitis Differential Diagnosis
- Herpangina: Group A coxsackie virus leads to herpangina. Lesions in herpes simplex are located predominantly in anterior region of mouth while of herpangina are seen in posterior oral pharynx. Duration of illness is longer with herpes simplex.
- Erythema multiforme: Vesicles in erythema multiforme are more extensive as compared to primary herpetic gingivostomatitis and on rupture they show pseudomembrane formation.
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- Stevens-Johnson syndrome: It is characterized by vesicular hemorrhagic lesions in oral cavity, hemorrhagic ocular lesions and bullous skin lesions.
- Bullous lichen planus: It is characterized by formation of large blisters on tongue and cheek which rupture and undergo ulceration; it undergoes a prolonged and indefinite course.
- Apthous ulcer: It is manifested as as single ulcer with erythematous halo which surround yellow firinopurulent membrane.
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Herpetic Gingivostomatitis Management
Various medications are used, i.e.
Herpetic Gingivostomatitis Local Application
- Using 8% zinc chloride, Talbot’s iodine, phenol, riboflavin, thiamine, etc.
- Chlortetracycline has been successfully used as mouthwash, applied topically in 3% ointment or administered systemically in form of 250 mg capsules.
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Herpetic Gingivostomatitis Palliative Treatment
- Make the patient comfortable until the disease runs its course, i.e. 7 to 10 days
- Plaque, food debris, calculus are removed to reduce gingival inflammation
- Relief in pain is obtained with dyclonine hydrochloride—a topical anesthetic mouthwash.
Herpetic Gingivostomatitis Supportive Treatment
Copious fluid intake and antiviral therapy for management of toxic systemic complications. For relief of pain, systemically administration is usually suffient.
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