Herpes Gingivostomatitis HSV 1 and HSV 2

⌦ Dr Lee Weinstein ⌫

Extraoral (labial) manifestation
Intraoral (palatal mucosa) manifestation

Transmission is by direct contact of lesions or oral secretions. Most common in 1-3-year-olds.

Oral manifestations dictated by whether the infection is primary or recurrent.

Primary infection occurs approx 1 week after contact with infected individual.

  • May be subclinical
  • May be associated w/ prodrome of fever, malaise, and irritability
  • Oral infection manifested by red, edematous gingiva and clusters of small vesicles.

The presentation may be abrupt with the onset of decreased PO intake, pain, fever, drooling, and bad breath. All oral surfaces may be involved, vesicles appear over 3-5days.

  • Vesicles can coalesce and rupture to form large, painful ulcers of oral and perioral tissues. The grayish membrane on a yellow base may be accompanied by fever, arthralgia, headache, and cervical lymphadenopathy
  • Perioral ulcers may be found in most children a few days after the appearance of the oral lesions. These perioral lesions help differentiate HSV infections from aphthous ulcers, herpangina, and hand, foot and mouth disease
Palatal ulcers
Labial ulcers

Recurrent disease: after primary infection, HSV migrates to trigeminal ganglion where it becomes latent.

• Reactivation may be preceded by exposure to sunlight, cold, trauma, stress, or immunosuppression
• May have the onset over a period of days with prodromal signs of itching, burning, or mild discomfort. The ulcers are much less painful than the primary disease and most often found on the lips.

Diagnosis

Tzanck smear- smear material from vesicle on slide and stain with Geisma or Wright stain.

Will see multinucleated giant cells:

  • Cell culture- results in 1-3 days
  • Direct fluorescent antibody test (DFA)
  • Serologic testing
  • PCR

Treatment

• Supportive treatment with the use of analgesics, popsicles, avoidance of citrus or spicy foods, and glyoxide rinse for oral hygiene.

• Viscous of lidocaine (Xylocaine) may be applied prior to meals to allow oral intake Be careful with young children and should be applied with cotton applicator 3-4 times /day only. Give instructions to parents to not give large amounts.

• A one-half mixture of Maalox and Diphenylhydramine applied to ulcers may help alleviate symptoms.

• Topical antivirals do not work.

• Use of oral acyclovir- if used within 48-72 hours, may shorten the duration of symptoms and shedding.

Complications

• Immunocompromised hosts may require acyclovir.

• Autoinoculation may lead to vesicle formation on other mucosal surfaces, in the eyes, and the formation of a herpetic whitlow on fingers.


Courtesy of Dr Lee Weinstein, Phoenix, Arizona, U.S.

Specialist in Pediatric Dentistry.

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