Primary Herpetic Gingivostomatitis
An Infectious and Contagious Disease
Kaneta Lott, DDS
Primary herpetic gingivostomatitis (PHGS) is the term for the initial infection caused by the herpes simplex virus 1 (HSV-1). This disease is transmitted through saliva and other body fluids and can cause severe discomfort in pediatric patients. The highest incidence of primary herpetic gingivostomatitis occurs between the ages of six months and three years. Infection occurs when the HSV-1 enters abraded skin or healthy mucosal membranes. Typically, symptoms are not noted during this primary infection; rather, the virus remains dormant in the ganglia of specific nerves (ie, trigeminal, facial, or dorsal), where it reproduces until infection recurs. When symptoms do present during PHGS, however, they are generally severe and cause significant discomfort to pediatric patients. It is valuable for dental hygienists to recognize PHGS symptoms in order to ensure a swift diagnosis and treatment, as well as to effectively tackle questions from parents.
There are several symptoms that the dental professional should identify in the diagnosis of PHGS. Young children commonly present with a fever, associated with crying and drooling. Upon initiating dialogue with parents or guardians, it is often reported that the child has not slept or eaten solid food for several days; swallowing may be a problem. Upon examination, red lesions will be found in and about the mouth (eg, on the gingiva, buccal mucosa, tongue, hard palate) (Figures 1 and 2). These lesions will eventually fuse to form larger, very painful ulcers.
The initial infection is self-limiting and will recede within 12 to 14 days. Antiviral medication (eg, aciclovir, famciclovir, penciclovir, valaciclovir) reduces the duration of the active lesions and other symptoms. In addition, practitioners should recommend the following treatment regimen:
1) Keep the child home until the lesions disappear;
2) Give acetaminophen or ibuprofen for comfort;
3) Swab or rinse the mouth with viscous lidocaine or a 50/50 mixture of an antacid and diphenhydramine for topical relief;
4) Offer fluids, especially water, to prevent dehydration;
5) Prescribe an antiviral agent if the child can take in liquids by mouth;
6) Hospitalize the patient to administer medication and fluids intravenously if they cannot swallow and/or are dehydrated; and
7) Follow up with an in-office visit in 10 days.
Precautions should be taken to protect others in the home, daycare center, or other environment in which the patient may encounter other children. Contact should be avoided with the child’s mouth, as a painful cross-infection can occur on the fingers or nail cuticle if infected oral membranes are touched (ie, herpes whitlow). Dental assistants and hygienists must maintain universal precautions for infection control, and parents or guardians should be informed as well. Additionally, contact with other items (eg, toys, utensils, cups, bottles) should be avoided. Parents should also be made aware that less severe recurrences are likely upon the re-activation of the dormant virus. Similar precautions should be taken in these instances, and pediatric patients should be educated on how to avoid infecting others once they are old enough.
*Assistant clinical professor, Department of Pediatric Dentistry, The Medical College of Georgia, Augusta, GA; national lecturer; private practice, Atlanta, GA.