Gingivostomatitis

Causes

Primary herpetic gingivostomatitis (most common)

The first infection with herpes simplex virus type 1 often causes no symptoms, but in some children it causes gingivostomatitis. After this, the virus stays dormant in nerves and can reappear later as cold sores on the lip, which are much milder. The virus spreads through saliva, kisses, and shared cups and utensils. Incubation is about 2 to 12 days.

It is most common between 6 months and 5 years, but teenagers and young adults can also have a first infection, sometimes more severe.

Other causes

• Hand, foot and mouth disease: coxsackievirus, with mouth sores plus a rash on hands, feet and buttocks
• Herpangina: coxsackievirus sores at the back of the mouth and throat, gums usually spared
• Acute necrotizing ulcerative gingivitis: severe, painful gum infection with bad breath, in teens and adults with poor oral hygiene, stress, smoking or weak immunity
• Poor oral hygiene, nutritional deficiencies and some medicines

Symptoms

The illness often starts with:

• fever, sometimes high, irritability and poor feeding for 1 to 2 days

Then mouth findings appear:

• clusters of small blisters that burst into shallow, painful yellow-gray ulcers with red edges on the gums, tongue, inside the cheeks, palate and lips
• swollen, red gums that bleed easily
• drooling
• bad breath
• sores around the lips and chin
• swollen, tender lymph nodes in the neck
• refusing food and drink because of pain

Gingivostomatitis vs similar conditions

Diagnosis

Doctors usually diagnose it by appearance. A swab of a sore can confirm herpes with a PCR test if the diagnosis is unclear, symptoms are severe, or the person has a weak immune system.

Treatment

Antiviral medicine

Acyclovir, started within the first 72 to 96 hours of symptoms, can shorten the illness and viral shedding in children. It is prescribed by a doctor. It is especially important for babies, children with eczema and those with weak immunity.

Keeping hydrated

This is the most important part of care:

• offer small, frequent sips of cool water, milk or diluted juice
• ice pops, smoothies and cold yogurt soothe the mouth
• use a straw or a spoon if drinking from a cup hurts
• avoid acidic, salty, spicy or crunchy foods
• watch wet diapers and urine output

Pain relief

• acetaminophen (paracetamol) or ibuprofen, following the label dose for the child's age and weight. Give it 30 to 60 minutes before meals to help eating and drinking
• do not give aspirin to children or teenagers
• avoid numbing gels containing benzocaine in young children, because of a rare but serious blood reaction (methemoglobinemia)

Hospital care

Children who cannot drink enough may need IV fluids for a day or two.

Preventing spread

The infection spreads through saliva while sores are present:

• do not share cups, utensils, towels or toothbrushes
• avoid kissing, especially babies and people with eczema or weak immunity
• wash hands after touching the mouth or sores
• discourage thumb-sucking and touching the eyes, which can spread the virus to fingers (herpetic whitlow) or eyes
• many childcare settings advise keeping children home while they drool and have open sores

Outlook

Most children recover completely within 2 weeks. The herpes virus remains in the body for life, and some will have occasional cold sores later. Complications such as eye infection, eczema herpeticum and encephalitis are rare.

Frequently asked questions

What causes gingivostomatitis?

The most common cause is a first infection with herpes simplex virus type 1, usually in young children. Coxsackieviruses (hand, foot and mouth disease) and poor oral hygiene are other causes.

How long does gingivostomatitis last?

Herpetic gingivostomatitis usually lasts 10 to 14 days. Fever settles in the first few days, and the mouth sores heal gradually over about 2 weeks.

Is gingivostomatitis contagious?

Yes. Herpetic gingivostomatitis spreads through saliva and direct contact with sores, especially while sores are present and the child is drooling. Avoid sharing utensils and kissing, and wash hands often.

How is gingivostomatitis treated?

Treatment focuses on fluids and pain relief with acetaminophen or ibuprofen. Acyclovir, an antiviral prescribed by a doctor, helps if started within the first few days. Children who cannot drink enough may need IV fluids.

When should I take my child to a doctor for mouth sores?

See a doctor if your child refuses to drink, has fewer wet diapers, is very sleepy, has eye symptoms, has eczema, is under 6 weeks old, or has a fever lasting more than 5 days. Early antiviral treatment helps most when started quickly.