Cronicon O P EN A C C ESS EC DENTAL SCIENCE

Opinion

A Review of Gingivostomatitis in Children

Mohammad Karimi D.M.D*

Department of Pediatric Dentistry, Sepideh Dental Clinic, Iran

*Corresponding Author: Mohammad Karimi D.M.D, Department of Pediatric Dentistry, Sepideh Dental Clinic, Iran.

Received: October 22, 2018; Published: January 18, 2019

Oral herpes is a common infection of the mouth and gums which can appear as blistering on the tongue, the internal surface of the
cheeks and swelling of the gums is caused due to herpetic gingivostomatitis in kids. Herpetic gingivostomatitis is named gingivostomatitis
by some researches [1]. Primary herpetic gingivostomatitis is the most common viral infection in the oral cavity [2]. The appearance of
this type of lesion may looks like Canker sore. It usually occurs at the age of 1 to 3 years [3].

Children suffer from two types of herpes. The child will be exposed to the herpes virus for the first time so that the virus will cause her-
pes disease, consequently, the child will have the general symptoms. Eruptions of baby teeth and wounding gums are a beneficial factor in
the development of oral herpes. Symptoms of gingivostomatitis may be very similar to 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” [4].

Secondly, the child often suffers from herpes or, in other words, her herpes recurs once a while. Because herpes viruses remain in the
lips and face and oral cavity, and whenever the child is exposed to factors such as cold or sunshine (ultraviolet radiation), a fever or anxi-
ety, the recurrence happens again. It may also appear if high fever is present, which is why gingivostomatitis is sometimes called “fever
blisters”.

Causes

1) Coxsackie virus [5]

2) Herpes simplex virus type 1 (HSV-1)
3) Poor oral hygiene

Symptoms

It usually begins with fever and irritability for one or two days, then the child feels pain in the mouth, and the drooling starts. His par-
ents complain about his bad breath during this period due to poor oral hygiene. At this time, the child’s fever reaches 40 to 40.5 degrees
Celsius. By the examination of the child’s tongue and mouth, there are usually seen small blisters on the tongue which are, about 10 mm
in diameter, covered with a yellow-gray layer.

These ulcers are red in the middle. When the upper layer (crusted layer) is detached, superficial wounds develop. The location of these
ulcers is usually on the tongue and the inner surface of the cheeks, but there may be all over the mouth. Swelling of the gingiva occurs
sooner or simultaneously with mouth ulcers. In some cases, tonsils are also swelling. Sometimes, submandibular lymphatic glands of the
kid may enlarge and swell too.

Citation: Mohammad Karimi D.M.D. “A Review of Gingivostomatitis in Children”. EC Dental Science 18.2 (2019): 248-251.
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Fever and pain resulting from oral ulcers usually lasts for 2 to 4 days and then comes down so that it fades away, but the disease and
wound healing usually lasts 7 to 9 days. Herpes gingivostomatitis usually improves by itself, but because it is one of the diseases that cause
severe discomfort, insomnia, loss of appetite, unrest, fever, chills, nausea, irritability, malaise and headache [6-9], it may be of concern to
parents. Parents should aware and sure after the period of the disease, the child will be recovering without any complication.

Complications

In some children, gingivostomatitis can also be present at the same time with lips herpes. If a child with herpes put her scratched fin-
gers into her mouth, that fingers may be exposed to the virus and consequently results in finger herpes. If the herpes virus transmits to
any part of the body such as genital areas (very contagious) and eyes) herpes simplex keratitis (it causes a herpes outbreak in that area
[10]. Interestingly, herpes simplex keratitis can also cause permanent eye damage, even blindness along with pain and discomfort. Its
symptoms include watery, red eyes and sensitivity to light [11]. Children should always wash their hands after touching a cold sore, as the
virus can easily spread to the eyes. In the cases of viral infections, the child should be taken to the specialist physician as soon as possible.

Because eating food and even liquids are painful to him, the child usually refuses to eat. This can eventually cause dehydration and loss
of appetite which is with dry mouth, dry skin, dizziness, tiredness, and constipation. The child may have a general feeling of being weak-
ness (malaise). Parents also may notice that their child is sleeping more than usual or he is not willing to participate in his usual activities.

Pain and discomfort in the mouth, causes most children don’t feel like eat or drink anything. This would result in anorexia and dehydra-
tion in the body which consequently, resulting in the child’s constipation.

Treatments

• Washing the mouth help in healing wounds in the tongue and mouth, so if the kid is grown up enough and able to do it, he should
wash his mouth with medical salt water or diluted mouthwashes.
• If the child has a severe fever, the mother should give her child an antipyretic medicine such as Acetaminophen (oral or rectal)
for lowering the fever.
• If antiviral drug Acyclovir [12] is prescribed by a physician in the first three days of illness, it will reduce the swelling of the gums,
and also reduces pain and irritation of the mouth, consequently, the baby will be able to eat and drink. If the lip herpes is also
existed, rubbing the Calamine D Lotion will dry the wound and improves healing process.
• Baby should be encouraged to drink cold liquids (milk, juice, water). Drinking fluids, even simple water, prevents water loss and
helps reduce the fever. If the child is willing to eat, parents can provide him with soft and liquid dishes (porridge, pottage, soup),
but he should never be fed by force. The baby will eat the fluid and soft foods better without any fussing.
• To relieve pain, mouthwashes that contain anesthetics such as lidocaine or anesthetic pills should not be used, as it numbs the
tongue and mouth, causing the destruction of the mucosa covering of mouth and tongue. If only a spoon of Diphenhydramine
syrup [12] is given to the child at night and he swallows it down, it will help him eat more easily, and goes to sleep well.

Home treatments include the following:

• Taking of over-the-counter analgesics such as acetaminophen and Ibuprofen.

• Application of local topical anesthetics (Orajel, Anbesol), topical preparations containing glycerin and peroxide (Gly-Oxide) [12].
• Gargling warm mouth rinses containing 1 tsp. baking soda or salt to 1/2 cup warm water. If younger children are unable to
use the mouthwash, it is recommended to apply Chlorhexidine dental gel as the substitute for toothpaste as an adjunct to oral
hygiene.
• Interestingly, cool liquids such as milkshakes and Ice creams or clear liquids apple juice, ice cubes or popsicles, or even soft cold
foods for instances applesauce, all help to relieve pain from the mucous membrane.
• Avoid feeding him with acidic or carbonated liquids, and salty, spicy, or even hard foods.
• Follow good oral hygiene habits for the kid, including regular tooth brushing and flossing.

Citation: Mohammad Karimi D.M.D. “A Review of Gingivostomatitis in Children”. EC Dental Science 18.2 (2019): 248-251.
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Prevention

• It is obvious that keeping good oral hygiene and care of teeth and gums decrease the risk of getting gingivostomatitis.
• Brushing children’s’ teeth at least twice a day, especially, after eating, and before going to bed has a significant factor to decrease
the outbreak of this disease.
• The daily flossing and rinsing mouth with kid’s mouthwashes help to maintain the good oral health.
• Children should be examined and cleaned by a dentist every six months. In case of any dental problem, it should be done.
• In children who use pacifiers, keeping that clean to prevent bacterial growth.
• Avoid children to be kissed or touched the face of a person who is infected.

Teaching the children to wash their hands frequently, is the best way to avoid the transmission of the Coxsackie virus. This is an impor-
tant factor that mothers have to pay attention to that especially after using public bathrooms or changing a baby’s diaper; or even before
eating or preparing meals. Educating children about the importance of proper hand washing plays a key role in the prevention of this
disease.

How is gingivostomatitis diagnosed?

The mouth will be checked for different sores to differentiate that. More tests are not usually necessary but if other symptoms are also
present (such as a cough, fever, and muscle pain), the dentist may proceed with additional tests. In some cases, the physician may take a
culture (swab) from the sore to check for bacteria or viruses. He may also perform a biopsy if they suspect other mouth sores are present.

“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” [4].

Gingivostomatitis has to be differentiated from Herpangina, the disease which commonly causes the ulcers in the oral cavity of chil-
dren. The etiologic factor of Herpangina is the Coxsackie A virus. In Herpangina, ulcers are usually isolated to the soft palate and anterior
pillar of the mouth but in herpetic gingivostomatitis, even though the lesions can be found in these locations, but they are almost always
accompanied by widespread ulcerations in the oral cavity [5].

Prognosis and outlook

Despite Gingivostomatitis can be a mildly contagious disease with uncomfortable and painful sores; it usually subsides in two to three
weeks. Prescribed medicine may suppress the bacterial and viral activities and resulting in relieving the pain, and improving the heal-
ing process. The management of herpetic gingivostomatitis with oral antiviral, especially acyclovir, complementing with other palliative
therapies (antipyretic medicine, topical local anesthesia, Antihistamines and...) has demonstrated great results by decreasing the symp-
tomatic period and disappearing the lesions. Home care treatments can also decrease the symptoms.

Bibliography
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3. Brook A. “Acute herpetic gingivostomatitis in children”. Journal of Dentistry for Children 40: 12-18.

4. David L King., et al. “Herpetic gingivostomatitis and teething difficulty in infants”. Pediatric Dentistry 14.2 (1992): 82-85.

5. Parrott RH., et al. “Clinical and laboratory differentiation between herpangina and infectious (herpetic) gingivostomatitis”. Pediatrics
14.2 (1954): 122-129.

6. BW Neville., et al. “Herpes simplex virus’. BW Neville (Ed.), Oral and maxillofacial pathology (2nd edition), Saunders, Philadelphia, PA
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Citation: Mohammad Karimi D.M.D. “A Review of Gingivostomatitis in Children”. EC Dental Science 18.2 (2019): 248-251.
A Review of Gingivostomatitis in Children

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7. MA Huber. “Herpes simplex type‐1 virus infection”. Quintessence International 34.6 (2003): 453-467.

8. C Scully., et al. “Herpes simplex infections”. C Scully, R Welbury, C Flaitz, O Paes de Almeida (Eds.), A color atlas of orofacial health and
disease in children and adolescents (2nd edition), Martin Dunitz, London (2002): 152-156.

9. MS Greenberg. “Herpes virus infections”. Dental Clinics of North America 40.2 (1996): 359-368.

10. James William D and Berger Timothy G. “Andrews’ Diseases of the Skin: clinical Dermatology”. Saunders Elsevier (2006).

11. Krachmer J., et al. “CORNEA, 2nd edition”. Elsevier Mosby (2005): 1043-1074.

12. Catherine M Flaitz and Adrian D Creanga. “Herpes Virus Infection - treatment guide for children and adolescents”. OHDMBSC 2.4
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Volume 18 Issue 2 February 2019

© All rights reserved by Mohammad Karimi D.M.D.

Citation: Mohammad Karimi D.M.D. “A Review of Gingivostomatitis in Children”. EC Dental Science 18.2 (2019): 248-251.