Gingivostomatitis
Encyclopedia
Gingivostomatitis is a combination of gingivitis
and stomatitis
, or an inflammation of the oral mucosa
and gingiva
. Herpetic gingivostomatitis is often the initial presentation during the first ("primary") herpes simplex
infection. It is of greater severity than herpes labialis
(cold sores) which is often the subsequent presentations. "Primary herpetic gingivostomatitis is the most common viral infection of the mouth".
"Primary herpetic gingivostomatitis (PHGS) represents the clinically apparent pattern of primary herpes simplex virus (HSV) infection, since the vast majority of other primary infections are symptomless. PHGS is caused predominantly by HSV-1 and affects mainly children. Prodromal symptoms, such as fever, anorexia, irritability, malaise and headache, may occur in advance of disease. The disease presents as numerous pin-head vesicles, which rupture rapidly to form painful irregular ulcerations covered by yellow–grey membranes. Sub-mandibular lymphadenitis, halitosis and refusal to drink are usual concomitant findings."
) 1–2 days prior to local lesions. Then small, yellowish vesicles form, which rupture quickly, resulting in shallow, round, discrete ulcers with erythematous halo. It affects both the free and attached mucosa. A generalized marginal gingivitis may precede the ulcers.
In addition, chronic elemental mercury poisoning can manifest with gingivostomatitis, in addition to neurologic (tremor, paresthesias) and psychiatric (forgetfulness, mood disturbances)symptoms.
Gingivostomatitis symptoms in infants may wrongly be dismissed as teething
. "Coincidentally, primary tooth eruption begins at about the time that infants are losing maternal antibody protection against the herpes virus. Also, reports on teething difficulties have recorded symptoms which are remarkably consistent with primary oral herpetic infection such as fever, irritability, sleeplessness, and difficulty with eating." "Younger infants with higher residual levels of antibodies would experience milder infections and these would be more likely to go unrecognized or be dismissed as teething difficulty."
of the mouth. In healthy individuals the lesions heal spontaneously in 7–14 days without scar.
Gingivitis
Gingivitis is a term used to describe non-destructive periodontal disease. The most common form of gingivitis is in response to bacterial biofilms adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease...
and stomatitis
Stomatitis
Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth...
, or an inflammation of the oral mucosa
Oral mucosa
The oral mucosa is the mucous membrane epithelium of the mouth. It can be divided into three categories.*Masticatory mucosa, para-keratinized stratified squamous epithelium, found on the dorsum of the tongue, hard palate and attached gingiva....
and gingiva
Gingiva
The gingiva , or gums, consists of the mucosal tissue that lies over the mandible and maxilla inside the mouth.-General description:...
. Herpetic gingivostomatitis is often the initial presentation during the first ("primary") herpes simplex
Herpes simplex
Herpes simplex is a viral disease caused by both Herpes simplex virus type 1 and type 2 . Infection with the herpes virus is categorized into one of several distinct disorders based on the site of infection. Oral herpes, the visible symptoms of which are colloquially called cold sores or fever...
infection. It is of greater severity than herpes labialis
Herpes labialis
Herpes labialis or "orolabial herpes" is an infection of the lip by herpes simplex virus . An outbreak typically causes small blisters or sores on or around the mouth commonly known as cold sores or fever blisters...
(cold sores) which is often the subsequent presentations. "Primary herpetic gingivostomatitis is the most common viral infection of the mouth".
"Primary herpetic gingivostomatitis (PHGS) represents the clinically apparent pattern of primary herpes simplex virus (HSV) infection, since the vast majority of other primary infections are symptomless. PHGS is caused predominantly by HSV-1 and affects mainly children. Prodromal symptoms, such as fever, anorexia, irritability, malaise and headache, may occur in advance of disease. The disease presents as numerous pin-head vesicles, which rupture rapidly to form painful irregular ulcerations covered by yellow–grey membranes. Sub-mandibular lymphadenitis, halitosis and refusal to drink are usual concomitant findings."
Causes
Gingivostomatitis generally affects children under the age of three and young adults. There are prodromal symptoms (fever, malaise, irritability, headache, vomiting, lymphadenopathyLymphadenopathy
Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy....
) 1–2 days prior to local lesions. Then small, yellowish vesicles form, which rupture quickly, resulting in shallow, round, discrete ulcers with erythematous halo. It affects both the free and attached mucosa. A generalized marginal gingivitis may precede the ulcers.
In addition, chronic elemental mercury poisoning can manifest with gingivostomatitis, in addition to neurologic (tremor, paresthesias) and psychiatric (forgetfulness, mood disturbances)symptoms.
Symptoms
The symptoms can be mild or severe and may include:- Sores on the inside of the cheeks or gums
- FeverFeverFever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
- General discomfort, uneasiness, or ill feeling
- Very sore mouth with no desire to eat
- Bad breath
Gingivostomatitis symptoms in infants may wrongly be dismissed as teething
Teething
Teething is the process by which an infant's first teeth sequentially appear by emerging through the gums. Teething may start as early as three months or as late, in some cases, as twelve months. The typical time frame for the first teeth to appear is somewhere between six and nine months...
. "Coincidentally, primary tooth eruption begins at about the time that infants are losing maternal antibody protection against the herpes virus. Also, reports on teething difficulties have recorded symptoms which are remarkably consistent with primary oral herpetic infection such as fever, irritability, sleeplessness, and difficulty with eating." "Younger infants with higher residual levels of antibodies would experience milder infections and these would be more likely to go unrecognized or be dismissed as teething difficulty."
Treatment
Treatment includes fluid intake, good oral hygiene and gentle debridementDebridement
Debridement is the medical removal of a patient's dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue...
of the mouth. In healthy individuals the lesions heal spontaneously in 7–14 days without scar.