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Primary Herpetic Gingivostomitis

Primary herpetic gingivostomititis is a childhood infection commonly seen between the ages of 2-4 years. The incubation period is approximately 6-7 days. The infection is characterized by widespread vesicles inside the mouth and sometimes outside the mouth. The gums are fiery red in color with widespread swelling and bleeding at times. The gums are very painful and the child refuses to eat or brush his/her teeth. The child can be severely ill, with malaise, high fever, lymph node enlargement and irritability. Headache and pharyngitis may also be present. The tongue is often coated with plaque and the patient has halitosis (bad breath).

The saliva is heavily infected with the herpes simple virus (HSV) which may cause lesion or vesicles around the lips and face. During this initial phase the patient is highly contagious and extreme measurements must be implemented to protect other children and adults in the household.

Following the initial manifestation, the HSV infects sensory nerve fibers and lives inside the infected cell in a latent and undetectable manner. Reactivation of the virus is often triggered by sunlight exposure, heat, stress, trauma or colds. Recurrences in the upper lip are characterized by small clusters of vesicles that erupt. Spreading is common if greasy lip ointment is used in the area.

The treatment for this condition is supportive, the patient should keep hydrated and ibuprofen is indicated when fever persist. Definite diagnosis should be made by the child’s pediatrician and/or pediatric dentist. In some instances acyclovir (antiviral agent) is indicated for treatment.

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