Herpetic gingivostomatitis in young children
- Martha Ann Keels, DDS, PhD
Martha Ann Keels, DDS, PhD
- Associate Professor of Pediatric Dentistry
- Duke University Medical Center
- Dennis A Clements, MD, PhD, MPH
Dennis A Clements, MD, PhD, MPH
- Professor of Pediatrics
- Duke University
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Ann Griffen, DDS, MS
Ann Griffen, DDS, MS
- Section Editor — Pediatric Oral Health
- Professor of Pediatric Dentistry
- Ohio State University
Gingivostomatitis is the most common manifestation of primary herpes simplex virus (HSV) infection during childhood . Primary herpetic gingivostomatitis is characterized by ulcerative lesions of the gingiva and mucous membranes of the mouth, often with perioral vesicular lesions (picture 1).
The clinical manifestations of mucocutaneous herpes simplex virus type 1 (HSV-1) disease are due to tissue destruction, a direct consequence of viral replication and cell lysis . Inoculation of HSV-1 at mucosal surfaces or skin sites permits entry of the virus into sensory and autonomic nerve endings through which it is transported to the cell nuclei (eg, the trigeminal ganglion), where it remains latent. Reactivation results in recurrent herpes simplex virus disease (eg, herpes gingivostomatitis, herpes labialis). (See "Pathogenesis of herpes simplex virus type 1 infection".)
Herpetic gingivostomatitis is almost always caused by herpes simplex virus type 1 .
Primary herpetic gingivostomatitis typically occurs in children between six months and five years of age, but it can occur in older children and adolescents . (See "Clinical manifestations and diagnosis of herpes simplex virus type 1 infection".)
Herpetic gingivostomatitis occurs throughout the year, with no particular seasonal distribution . In a retrospective review at a single institution, herpes simplex virus (HSV) gingivostomatitis was diagnosed in 1.6 per 10,000 emergency department visits and 5.6 per 10,000 hospital admissions .
- Kolokotronis A, Doumas S. Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. Clin Microbiol Infect 2006; 12:202.
- Kimberlin DW. Herpes simplex virus infections in neonates and early childhood. Semin Pediatr Infect Dis 2005; 16:271.
- Faden H. Management of primary herpetic gingivostomatitis in young children. Pediatr Emerg Care 2006; 22:268.
- American Academy of Pediatrics. Herpes simplex. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.432.
- Richardson M, Elliman D, Maguire H, et al. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatr Infect Dis J 2001; 20:380.
- Daniels CA, LeGoff SG. Shedding of infectious virus/antibody complexes from vesicular lesions of patients with recurrent herpes labialis. Lancet 1975; 2:524.
- Manzella JP, McConville JH, Valenti W, et al. An outbreak of herpes simplex virus type I gingivostomatitis in a dental hygiene practice. JAMA 1984; 252:2019.
- Amir J. Clinical aspects and antiviral therapy in primary herpetic gingivostomatitis. Paediatr Drugs 2001; 3:593.
- Cesario TC, Poland JD, Wulff H, et al. Six years experience with herpes simplex virus in a children's home. Am J Epidemiol 1969; 90:416.
- Schmitt DL, Johnson DW, Henderson FW. Herpes simplex type 1 infections in group day care. Pediatr Infect Dis J 1991; 10:729.
- Becker TM, Magder L, Harrison HR, et al. The epidemiology of infection with the human herpesviruses in Navajo children. Am J Epidemiol 1988; 127:1071.
- Amir J, Harel L, Smetana Z, Varsano I. The natural history of primary herpes simplex type 1 gingivostomatitis in children. Pediatr Dermatol 1999; 16:259.
- Kuzushima K, Kimura H, Kino Y, et al. Clinical manifestations of primary herpes simplex virus type 1 infection in a closed community. Pediatrics 1991; 87:152.
- King DL, Steinhauer W, García-Godoy F, Elkins CJ. Herpetic gingivostomatitis and teething difficulty in infants. Pediatr Dent 1992; 14:82.
- Gutierrez K, Pinksy B, Arvin AM. Herpes simplex viruses 1 and 2. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th, Cherry JD, Harrison GJ, Kaplan SL, et al. (Eds), Elsevier Saunders, Philadelphia 2014.
- Amir J, Yagupsky P. Invasive Kingella kingae infection associated with stomatitis in children. Pediatr Infect Dis J 1998; 17:757.
- Amir J, Nussinovitch M, Straussberg R, Harel L. Bacteremia with group A Streptococcus associated with herpetic gingivostomatitis. Pediatr Infect Dis J 2001; 20:916.
- Bogger-Goren S. Acute epiglottitis caused by herpes simplex virus. Pediatr Infect Dis J 1987; 6:1133.
- Thomas E. A complication of primary herpetic gingivostomatitis. Br Dent J 2007; 203:33.
- PARROTT RH, WOLF SI, NUDELMAN J, et al. Clinical and laboratory differentiation between herpangina and infectious (herpetic) gingivostomatitis. Pediatrics 1954; 14:122.
- Hopper SM, McCarthy M, Tancharoen C, et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med 2014; 63:292.
- Rodu B, Mattingly G. Oral mucosal ulcers: diagnosis and management. J Am Dent Assoc 1992; 123:83.
- Hess GP, Walson PD. Seizures secondary to oral viscous lidocaine. Ann Emerg Med 1988; 17:725.
- Questions & Answers: Reports of a rare, but serious and potentially fatal adverse effect with the use of over-the-counter (OTC) benzocaine gels and liquids applied to the gums or mouth www.fda.gov/Drugs/DrugSafety/ucm250029.htm (Accessed on August 03, 2012).
- McDonald RE, Avery DR, Stookey GK. Dental caries in the child and adolescent. In: Dentistry for the Child and Adolescent, 7th ed, McDonald RE, Avery DR (Eds), Mosby, Philadelphia 2000. p.209.
- Amir J, Harel L, Smetana Z, Varsano I. Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. BMJ 1997; 314:1800.
- Nasser M, Fedorowicz Z, Khoshnevisan MH, Shahiri Tabarestani M. Acyclovir for treating primary herpetic gingivostomatitis. Cochrane Database Syst Rev 2008; :CD006700.
- Hudson B, Powell C. Towards evidence based medicine for paediatricians. Does oral aciclovir improve clinical outcome in immunocompetent children with primary herpes simplex gingivostomatitis? Arch Dis Child 2009; 94:165.
- Ducoulombier H, Cousin J, Dewilde A, et al. [Herpetic stomatitis-gingivitis in children: controlled trial of acyclovir versus placebo]. Ann Pediatr (Paris) 1988; 35:212.
- Cataldo F, Violante M, Maltese I, et al. [Herpetic gingivostomatitis in children: the clinico-epidemiological aspects and findings with acyclovir treatment. A report of the cases of 162 patients]. Pediatr Med Chir 1993; 15:193.
- Mueller R, Weigand KH. The treatment of herpetic gingivostomatitis with aciclovir suspension. Der Kinderarzt 1988; 19:1189.
- Murph JR, Grose C. Routine acyclovir therapy: isn't it time? Contemp Pediatr 1999; 16:79.
- Whitley RJ, Gnann JW Jr. Acyclovir: a decade later. N Engl J Med 1992; 327:782.
- Meyers JD, Wade JC, Mitchell CD, et al. Multicenter collaborative trial of intravenous acyclovir for treatment of mucocutaneous herpes simplex virus infection in the immunocompromised host. Am J Med 1982; 73:229.
- Mitchell CD, Bean B, Gentry SR, et al. Acyclovir therapy for mucocutaneous herpes simplex infections in immunocompromised patients. Lancet 1981; 1:1389.
- Wade JC, Newton B, McLaren C, et al. Intravenous acyclovir to treat mucocutaneous herpes simplex virus infection after marrow transplantation: a double-blind trial. Ann Intern Med 1982; 96:265.
- Shepp DH, Newton BA, Dandliker PS, et al. Oral acyclovir therapy for mucocutaneous herpes simplex virus infections in immunocompromised marrow transplant recipients. Ann Intern Med 1985; 102:783.
- American Academy of Pediatrics. Non-HIV antiviral drugs. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS. (Eds), American Academy of Pediatrics, 2015. p.919.
- Incubation period
- CLINICAL FEATURES
- DIFFERENTIAL DIAGNOSIS
- Natural history
- Indications for hospitalization
- Supportive care
- - Fluid intake
- - Pain control
- - Topical therapies
- Oral acyclovir
- - Indications
- - Dose and duration
- - Adverse effects
- Topical antivirals
- Immunocompromised children
- Antibiotic therapy
- Child care
- SUMMARY AND RECOMMENDATIONS