Management of Herpetic Gingivostomatitis

Clinical Presentation and Diagnosis

Primary herpetic gingivostomatitis (PHGS) is a self-limiting infection caused by herpes simplex virus type 1 (HSV-1), characterized by fever, irritability, tender submandibular lymphadenopathy, and painful ulcers in the gingival and oral mucosa 1, 2
Diagnosis is typically based on clinical presentation, with laboratory confirmation rarely needed in immunocompetent patients 3, 4
The disease follows a characteristic progression from prodromal symptoms to vesicle formation, pustulation, ulceration, and finally scabbing 5, 6

For a 14-year-old with herpetic gingivostomatitis, oral acyclovir is the drug of choice when initiated within 72 hours of symptom onset 1
Treatment should be started as early as possible since peak viral titers occur in the first 24 hours after lesion onset 5, 6
While the FDA has not specifically approved antiviral agents for primary gingivostomatitis, studies show acyclovir reduces healing time 4, 7

Topical anesthetics may provide temporary relief, though evidence for their effectiveness is limited 4, 7

For patients with frequent recurrences, application of sunscreen or zinc oxide may help decrease the probability of recurrent outbreaks 4, 7
Identify and avoid personal triggers for recurrence, which may include UV light exposure, fever, psychological stress, or menstruation 5, 6