What is Herpetic Gingivostomatitis?
Herpetic gingivostomatitis is a condition caused by a type of herpes simplex virus (HSV-1). It’s often defined by a high fever and painful sores in the mouth. This condition is most common in children aged between 6 months and 5 years, but adults can also get it.
The herpes simplex virus is usually spread through direct contact or through droplets from an infected person’s oral fluids or sores. The scary part is that person might not even know that they have it as they might not show any signs of being infected, but they can still spread the virus.
Once someone catches the herpes simplex virus, it stays in the body and can result in future outbreaks. These outbreaks may appear as cold sores. It’s important to know that these outbreaks can occur on and off throughout life.
What Causes Herpetic Gingivostomatitis?
The main cause of herpetic gingivostomatitis is a virus called Herpes simplex virus type 1 (HSV-1), part of a virus family known as the alphaherpesvirus. This virus has an outer coating and uses double-stranded DNA to store its genetic information. HSV-1 primarily causes infections around the mouth, eyes, and face because it tends to infect the skin of the mouth.
While HSV-1 is most often the cause, there are times when another virus, called HSV-2, is found in mouth sores. This usually happens in adults and might be due to contact between the mouth and genitals. It’s also seen more often in people with HIV or those taking medicines that weaken the immune system.
Risk Factors and Frequency for Herpetic Gingivostomatitis
Primary herpetic gingivostomatitis, a type of mouth infection, usually happens in children under 5. However, it can also happen in teenagers and adults. This condition is mainly caused by the HSV-1 virus, which people often get during childhood from contact with oral fluids. By the age of 35, it is believed that nearly 90% of all people have the HSV-1 virus. Out of these, half will see the virus ‘reactivate’ leading to a condition called herpes labialis. Herpetic gingivostomatitis does not favor any specific gender, racial group, time of the year, or geographic location.
- Primary herpetic gingivostomatitis usually happens in kids under 5, but can occur in teenagers and adults too.
- It is typically caused by the HSV-1 virus which is mainly contracted in childhood from oral fluids.
- Nearly 90% of all people possess the HSV-1 virus by the age of 35.
- Of those with the virus, half will experience a ‘reactivation’, leading to a condition known as herpes labialis.
- The chance of getting herpetic gingivostomatitis is equal regardless of gender, racial group, season, or geographic location.
Signs and Symptoms of Herpetic Gingivostomatitis
Primary herpes gingivostomatitis is a condition that often affects children who haven’t been in contact with the virus before. In some cases, there won’t be any symptoms. However, most of the time, this condition can cause a fever, loss of appetite, irritability, and the development of painful sores in the mouth. Other symptoms might include feeling unwell, tiredness, and swelling in the lymph nodes either in the neck or underneath the jaw.
The first sign of this infection is usually reddening of the oral and nearby mucosa. Following this, tiny blister-like sores develop rapidly in areas such as gums, palate, inner cheek, and inside of the lips. These sores can then ulcers and eventually burst open. When checked by a doctor, they often seem flat and have a yellowish color, measuring anywhere from 2 to 5 millimeters. These ulcers may bleed easily and usually take about 2 to 3 weeks to heal completely, without leaving a scar behind.
Around one third of patients who had primary herpetic gingivostomatitis will experience recurrent herpes lesions. Symptoms include burning and itching, followed by the development of blisters in a specific area. The most common areas include the edge of the lips, skin around the mouth, or the roof of the mouth. The outbreak of these lesions often coincides with periods of physical or emotional stress, illness, exposure to sunlight, or injury. The sores appear in the same area with each recurrence, and overall symptoms such as feeling unwell and swollen lymph nodes will be mild.
Testing for Herpetic Gingivostomatitis
Herpetic gingivostomatitis, a type of mouth infection, is usually diagnosed based on your symptoms and a physical examination. The presence of sores and ulcers in your mouth is often enough to confirm the condition. If your doctor needs more information to confirm the diagnosis, they might take a sample from the sore or blister in your mouth. This can be tested specifically for the herpes virus.
There’s another test that can be used, called a Tzanck smear. This test shows if a virus has caused the changes in your cells, but isn’t specific enough to tell whether the virus is Herpes Simplex Virus-1 (HSV-1), Herpes Simplex Virus-2 (HSV-2), or the Varicella-Zoster Virus (which causes chickenpox and shingles).
The best way to diagnose herpetic gingivostomatitis is by isolating the virus in a tissue culture, which is a laboratory method where cells are grown in a controlled environment. Additionally, a blood test can be done to determine if you’ve developed antibodies against this virus. However, this blood test doesn’t help to specifically diagnose the condition.
Treatment Options for Herpetic Gingivostomatitis
Herpes gingivostomatitis, a type of mouth infection caused by the herpes virus, is usually a minor condition that goes away on its own. Caring for the condition mainly involves taking steps that will comfort and support the person who’s feeling ill. One thing that doctors often suggest is applying lip creams like petroleum jelly to help prevent adhesions, which are connections that form between two tissues that are normally separate.
It’s very important that the patient stays hydrated during this time because it helps their body function properly and recover from the illness. Good hydration can often be achieved if the patient’s pain is well-controlled, so pain relievers such as acetaminophen and mouthwashes that numb the mouth are recommended. They help make the patient more comfortable and encourage them to drink fluids.
However, if the patient is finding it difficult to drink enough fluids to stay well-hydrated, they will need to be admitted to the hospital. Other reasons a patient might have to go to the hospital include if they have a weakened immune system, if they develop a skin condition known as eczema herpeticum, or if the herpes virus spreads and causes inflammation of the brain (encephalitis) or a lung infection (pneumonitis).
Based on several studies, the use of a medication called acyclovir has been suggested. It can come as a cream or as a liquid that can be swished in the mouth and swallowed. Acyclovir can be particularly helpful if the patient has significant pain or refuses to drink fluids and if they come to seek treatment within the first 72 hours of feeling unwell. However, it’s only recommended for patients with a properly functioning immune system.
What else can Herpetic Gingivostomatitis be?
Herpes gingivostomatitis is usually diagnosed based on symptoms, but it’s crucial to first rule out other diseases that may show similar symptoms. These diseases need to be considered because they can also occur in the same age group and might have similar medical histories. The following diseases can be confused with herpes gingivostomatitis:
- Herpes zoster (shingles)
- Primary chickenpox
- Behcet’s disease
- Herpetiform aphthae (small mouth ulcers)
- Erythema multiforme (a skin rash)
- Acute necrotizing gingivostomatitis (a severe gum infection)
- Reactive arthritis
- Cytomegalovirus ulceration (ulcers caused by a type of virus)
- Traumatic ulcers (ulcers caused by injury)
- Burns, both chemical and thermal
- Factitial injuries (self-inflicted injuries)
- Vesiculobullous disease (a group of diseases causing blisters on the skin and mucous membranes)
Therefore, you can see why a detailed diagnosis is essential to ensure correct treatment is provided.
Possible Complications When Diagnosed with Herpetic Gingivostomatitis
Complications arising from herpetic gingivostomatitis could include:
- Dehydration
- Cold sores (herpes labialis)
- Inflammation of the brain due to herpes (HSV encephalitis)
- A painful finger infection (herpetic whitlow)
- An eye infection (herpetic keratitis)
- A skin infection (eczema herpeticum)
Preventing Herpetic Gingivostomatitis
Patients and their families should understand that this illness is typically mild and tends to get better on its own. They need to know that the best way to manage the condition involves comfort measures like controlling any discomfort, drinking plenty of fluids, and eating a healthy diet. People with this condition can usually be cared for at home, but it’s important to keep an eye out for any complications. These could include trouble eating or drinking, or the sores getting worse.
Patients and their families, particularly when the patient is a young child, should maintain regular communication with their main healthcare provider. It’s also important to be aware that recurrence of the oral sores, also known as herpes labialis or cold sores, might occur in about one-third of patients who get primary herpetic gingivostomatitis, which is the initial outbreak of this type of oral herpes.
