gingivostomatitis and necrotizing ulcerative gingivitis. The latter is most frequently
seen in young adults, but it also affects teenagers.
11.3.1 Primary herpetic gingivostomatitis
Herpetic gingivostomatitis is an acute infectious disease caused by the herpesvirus
hominis. The primary infection is most frequently seen in children between 2 and 5
years of age, although older age groups can be affected. A degree of immunity is
transferred to the newborn from circulating maternal antibodies so an infection in the
first 12 months of life is rare. Almost 100% of urban adult populations are carriers of,
and have neutralizing antibodies to, the virus. This acquired immunity suggests that
the majority of childhood infections are subclinical.
Transmission of the virus is by droplet infection and the incubation period is about 1
week. The child develops a febrile illness with a raised temperature of 100-102 °F
(37.8-38.9 °C). Headaches, malaise, oral pain, mild dysphagia, and cervical
lymphadenopathy are the common symptoms that accompany the fever and precede
the onset of a severe, oedematous marginal gingivitis. Characteristic, fluid-filled
vesicles appear on the gingiva and other areas such as the tongue, lips, buccal, and
palatal mucosa. The vesicles, which have a grey, membranous covering, rupture
spontaneously after a few hours to leave extremely painful yellowish ulcers with red,
inflamed margins (605HFig. 11.1 (a) and (b)). The clinical episode runs a course of about
14 days and the oral lesions heal without scarring. Very rare but severe complications
of the infection are aseptic meningitis and encephalitis.
The clinical features, history, and age group of the affected children are so
characteristic that diagnosis is rarely problematic. If in doubt, however, smears from
recently ruptured vesicles reveal degenerating epithelial cells with intranuclear
inclusions. The virus protein also tends to displace the nuclear chromatin to produce
enlarged and irregular nuclei.
Herpetic gingivostomatitis does not respond well to active treatment. Bed rest and a
soft diet are recommended during the febrile stage and the child should be kept well
hydrated. Pyrexia is reduced using a paracetamol suspension and secondary infection
of ulcers may be prevented using chlorhexidine. A mouthrinse (0.2%, two to three
times a day) may be used in older children who are able to expectorate, but in younger
children (under 6 years of age) a chlorhexidine spray can be used (twice daily) or the
solution applied using a sponge swab. In severe cases of herpes simplex, systemic
acyclovir can be prescribed as a suspension (200 mg) and swallowed, five times daily
for 5 days. In children under 2 years the dose is halved. Acyclovir is active against the
herpesvirus but is unable to eradicate it completely. The drug is most effective when
given at the onset of the infection.
Key Points
Herpetic gingivostomatitis⎯clinical:
- primary/recurrent;
- viral;
- vesicular lesions;
- complications rare.