What Is Gingivostomatitis?

Gingivostomatitis is an infection or swelling of gums and lips, and it is the most frequent clinical symptom of primary herpes simplex virus (HSV) infection.¹ Majority of the primary HSV infections are symptomless but gingivostomatitis is the exception. Gingivostomatitis is also called herpes gingivostomatitis or herpes simplex gingivostomatitis or primary herpetic gingivostomatitis (PHGS).²

Almost 90% of herpetic gingivostomatitis infections are caused by herpes simplex virus type-1 (HSV-1)³ and mainly affect children in the age group of 6 months-5 years.²

There are two epidemiological peaks in terms of the age at which PHGS arises. Its first peak affects children in the age group of six months to five years, while the second peak occurs in young people in their early twenties.⁶ 

Herpetic gingivostomatitis is equally prevalent throughout gender and race groups and has no seasonal or geographic distribution.²

After a patient has contracted the herpes simplex virus, the virus remains in their bodies for the rest of their lives. Infection may periodically recur throughout their lifetime. The first herpes reactivation is typically the worst, and the child may not suffer symptoms like painful blisters again. But, they may undergo additional bouts of herpes reactivation (when the virus affects the body again). Future herpes outbreaks are frequently referred to as cold sores or herpes labialis or fever blisters.¹ Herpes labialis is a rash that affects the lips and other oral mucosae. It is characterised by erythema and blisters that are both followed and accompanied by intense pain.⁴ Cold sores or herpes labialis should heal in 10 days, but they are contagious and may be unpleasant or painful while healing.⁵ Some patients experience cold sores as a result of another sickness, sunlight, or menstrual periods. If the infection does not heal on its own, antiviral creams can be used to speed up the healing process, and paracetamol and ibuprofen are suggested to reduce pain.⁵

Therefore, I suggest you continue reading on how you can prevent, diagnose and treat herpes gingivostomatitis from progressing to more severe forms of the disease and when can you contact your GP if the lesion did not resolve on its own.

Overview

Causes of gingivostomatitis

The main cause of gingivostomatitis is infection with viruses or bacteria. Although both HSV1 and HSV2 can cause primary oral infection in gingivostomatitis, HSV1 is the most common cause. The vast majority of HSV1-induced primary orofacial infections are asymptomatic and so go unnoticed.⁷

It can happen to those who have poor dental hygiene.⁸

Signs and symptoms of gingivostomatitis

The vast majority of HSV1-induced primary orofacial infections are asymptomatic and so they go unnoticed in case of gingivostomatitis.⁹

However, following a 1-26-day incubation period, prodromal signs and symptoms such as fever and chills, nausea, anorexia, irritability, malaise, and headache appear.³

The acute phase frequently begins abruptly and is followed by painful salivation, refusal to drink, and Submandibular lymphadenitis.³

Many, temporary vesicles occur on movable and non-movable oral mucosa one or two days later and quickly rupture, causing painful, surface-level ulcerations inside and outside the oral cavity.¹⁰ (See Figure 1 below). The most common presentation is acute, widespread, marginal gingivitis which is inflammation and swelling of the gingiva.

Fig 1: Superficial lesions in and around the oral cavity.¹¹

Management and treatment for gingivostomatitis

Infections with gingivostomatitis can range from moderate to severe and unpleasant. With or without treatment, the lesions usually heal in 2 to 3 weeks.¹²

The purpose of treatment is to alleviate symptoms and promote healing.

You can perform the following at home:⁸

• Maintain good dental hygiene. Clean your teeth thoroughly to lower your chances of having another infection
• If your healthcare provider recommends it, use pain-relieving mouth rinses
• To relieve discomfort, rinse your mouth with salt water (half a teaspoon or 3 grams of salt in 1 cup or 240 millilitres of water) or mouthwash containing hydrogen peroxide or Xylocaine
• Maintain a nutritious diet. Soft, bland (non-spicy) foods may help to alleviate discomfort during eating
• Antibiotics may be required
• The affected tissue may need to be removed by the dentist (called debridement)

If the symptoms do not subside or persist longer than it should then in paediatric patients with PHGS, starting 15 mg/kg oral acyclovir suspension within 3 days of onset and continuation 5 times a day for 1 week has been proven to promote the healing of lesions, minimise viral shedding, and enhance the oral intake of meals or beverages.¹³ In addition, in children who are unable to maintain hydration and nutrition due to dysphagia (difficulty in swallowing) and mouth pain, PHGS can occasionally become a significant problem.  Antipyretic/analgesic medications that relieve fever and mouth pain may be beneficial to affected infants.¹⁴

FAQs

How is gingivostomatitis diagnosed

Herpetic gingivostomatitis is primarily detected clinically, depending on the patient's history and physical examination. The presence of oral vesicular and ulcerative lesions is enough to make the diagnosis. Herpetic gingivostomatitis can be validated by direct immunofluorescent analysis of ulcer scrapings or blister fluid if additional testing is required.²

How can I prevent gingivostomatitis

Herpes Simplex Virus is carried by around 90% of the population. There isn't much you can do to keep your child from contracting the virus during childhood.² Therefore, The current approach to HSV infection care focuses on prevention of transmission, suppression of recurrence, reduction of clinical course, viral shedding, and consequences, as well as palliation and promotion of healing.¹⁰

Moreover simple preventive measures such as the child should avoid direct contact with anyone who has a common cold. Thus, if any parent or adult acquires a cold or flu or runny nose, explain why you won't be able to kiss your children till the sore heals. The child should also avoid contact with other children who have herpetic stomatitis and encourage children to drink lots of water and fluid intake.¹⁵

If the child is diagnosed with showing symptoms of herpetic stomatitis, keep the infection from spreading to other children. While the child is experiencing symptoms of herpetic stomatitis such as:¹⁵

• Advising the affected youngster to regularly wash their hands
• Toys should be kept clean and not shared with other children
• Dishes, cups, and dining utensils should not be shared by children
• Under any circumstances the child should not make any kind of oral contact like kissing other children

Who are at risk of gingivostomatitis

PHGS usually occurs after a first-time exposure to seronegative people or those who did not create a sufficient antibody response during a previous infection with either of the two Herpes simplex viruses. Even though PHGS primarily affects children between the ages of one and five years, adults are also affected occasionally.

How common is gingivostomatitis

Gingivostomatitis is very common in children whereas re-infection, latent or reactivation of the virus is more common in adults. In asymptomatic cases, it can go unnoticed until the clinical signs and symptoms are clearly visible.

When should I see a doctor

You should see a doctor or paediatrician if:

• You have oral sores, fever, or other symptoms of sickness
• Within three weeks, mouth sores worsen or do not respond to treatment
• You experience swelling in your mouth and discomfort due to which child is unable to eat or drink which can lead to dehydration

Summary

Gingivostomatitis is a viral disease that more commonly is a disease of children but can affect adults in the later stages due to either reactivation of virus or directly coming in contact with the virus. The management of disease mainly focuses on prevention by not coming in contact with someone who is already ill as the disease is highly contagious and can be transmitted from one person to another. The disease can be cured both at home if diagnosed early or is in a mild stage. Otherwise, the severe stage of the disease can require palliative care and the scar left behind can take more time to heal even after the treatment or medication has been stopped.