Gingivitis acuta during gingivostomatitis herpetica

By Dr. Vishaal Bhat on Saturday, December 22, 2007 with 0 comments

Etiology - Herpes hominis virus.

Pathologic anatomy - vesicular inflammation.

Clinical picture - mostly child’s disease (maximum incidence between 1 and 3 years of age), although it affects adults between 17 and 30 years as well. The disease has an influenza-like prodromal stage marked by headaches, pains of arms and legs, nausea, sore throat. These signs are followed by a fever, sometimes quite high; the disease is rarely afebrile. Herpetic blisters appear inside a mouth. These blisters are round or oval shaped, size ranging from 1 to 10 mm, often with broken tegmens, covered with a fibrin deposit. Blisters sometimes merge into one surface and typical efflorescences can be found on its edges only. An inflammatory rim forms around the lesions. It is preferentially located at the palate gingiva behind the upper incisor teeth and on the hard palate mucosa. It may also appear on the tongue, lips, gingiva or inside a pharynx. The disease is always accompanied by catarrhal gingivitis. A necrotic decomposition of papillae tips or inflammatory hyperplasia appear as well. The sub-mandibular lymph nodes often react, and a multiple, gray and wet fur covers the tongue. The disease is accompanied by dry mouth and mucous membranes (due to breathing by mouth).

Mucous lesions inside a mouth are very sensitive and children refuse solid food and even to swallow the saliva (virtual hypersalivation). This is probably the reason why this disease is sometimes misdiagnosed by pediatricians as the foot and mouth disease (stomatitis epizootica). This disease has a similar clinical course, although it is very rare at children and a direct contact with infected cattle has to be proven.

Therapy - mouth washes with disinfecting solutions or with a solution of “Framykoin”. Small children should have mouth washed with 1-2% solution of methylene blue or gentian violet. At complicated cases, antibiotics are administered to prevent secondary infection. Antipyretics and supportive therapy with vitamins B and C should be added in case of high fever. Currently, drugs that affect the capacity of viruses to grow and live - acyclovirs (Zovirax) and iododeoxyuridine (IDU). These drugs are administered both as a general treatment and locally. Patients’ diet should be bland and pulpy.

Category: Periodontics Notes



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