Description

Gingivostomatitis is an inflammatory condition of the oral mucosa and gingiva, most commonly caused by primary herpes simplex virus type 1 (HSV-1) infection, particularly in infants and young children. It may also occur due to bacterial infection, poor oral hygiene, trauma, nutritional deficiencies, or immunosuppression. HSV-related gingivostomatitis is typically acute, painful, and self-limiting, but early antiviral therapy can reduce symptom duration and complications. Etiology

• Viral (most common):
  • HSV-1 (primary herpetic gingivostomatitis)
• Bacterial:
  • Anaerobic bacteria (e.g., Fusobacterium, Prevotella)
• Non-infectious causes:
  • Aphthous ulcers
  • Chemotherapy or radiation
  • Nutritional deficiencies (iron, folate, vitamin B12)
  • Immunocompromised states

Pathophysiology

• HSV infects oral epithelial cells → cell lysis and ulceration
• Intense local inflammation → gingival edema, bleeding, and pain
• Viral shedding occurs during acute lesions, increasing transmissibility

Clinical Presentation

Common features

• Painful oral ulcers and vesicles
• Swollen, erythematous, bleeding gums
• Fever and malaise
• Halitosis
• Drooling and refusal to eat or drink (children)

Severe cases

• Dehydration
• Cervical lymphadenopathy
• Secondary bacterial infection

Diagnosis

• Usually clinical
• Viral PCR or culture rarely needed
• Differentiate from:
  • Aphthous stomatitis
  • Hand-foot-and-mouth disease
  • Oral candidiasis
  • Stevens–Johnson syndrome (severe cases)

Pharmacist’s Role & Clinical Pearls

Treatment

Supportive care (mainstay)

• Adequate hydration
• Soft, bland diet
• Topical analgesics (e.g., lidocaine viscous – age-appropriate use)
• Systemic analgesics/antipyretics (acetaminophen, ibuprofen)

Antiviral therapy

• Oral acyclovir recommended in:
  • Moderate–severe disease
  • Initiation within 72–96 hours of symptom onset
  • Immunocompromised patients
• Reduces duration of fever, pain, and viral shedding

Safety & Counseling Points

• Avoid aspirin in children (Reye syndrome risk)
• Use topical anesthetics cautiously (risk of numbness and aspiration)
• Emphasize hand hygiene to prevent HSV spread
• Advise caregivers on signs requiring medical attention:
  • Inability to maintain hydration
  • Persistent high fever
  • Worsening oral pain