All You Need To Know About Herpetic Stomatitis

Globally, an estimated 3.7 billion people under 50 have the herpes simplex virus type 1 (HSV-1) infection, according to the World Health Organization (WHO).¹ Because 67% of the world's population has been afflicted with this infection, primarily children from 6 months to 5 years old, more information should be available to educate you about this condition.

This article will take an in-depth look at herpetic gingivostomatitis, explaining:

• What herpetic gingivostomatitis is

• The causes of herpetic gingivostomatitis

• The risk factors for contracting herpetic gingivostomatitis

• What symptoms to recognize

• How herpetic gingivostomatitis can be diagnosed

• The treatments available for this condition

What is herpetic gingivostomatitis?

This condition can range from being asymptomatic to producing painful blistering lesions on the tongue, cheeks, mouth, and gums, as well as on the borders and skin around the lips.

The origin of herpetic gingivostomatitis

This condition is derived from an infection known as type 1 herpes simplex virus (HSV-1) in greater than 90% of cases. It is not to be confused with type 2 herpes simplex virus (HSV-2), a sexually transmitted disease that mainly causes genital herpes but can also cause 10% of cases of herpes gingivostomatitis. 

HSV-1 is naturally inclined to infect the cells in the epithelium barriers in different locations inside the mouth. The epithelium barriers are layers that protect the underlying tissues in the mouth from any dangers that can occur outside of these layers. Still, HSV-1, in a small number of cases of herpetic gingivostomatitis, can also result in genital herpes if there has been orogenital contact.

How common is herpetic gingivostomatitis?

Any child, adolescent, or adult is susceptible to contracting herpetic gingivostomatitis. Still, it mostly starts in childhood and becomes a lifelong condition. According to the National Library of Medicine, it is estimated that almost 90% of the world's population has a positive result for HSV-1 when their blood serum is tested.²

There are no seasonal or geographical limitations for the activity of this virus, nor does it discriminate, as all genders, races, and ethnic groups are susceptible to testing positive for HSV-1.

How does herpetic gingivostomatitis infect an individual?

Herpetic gingivostomatitis is a three-pronged nuisance:

1. Once a person has been infected, the virus can invade and reproduce in the cells of the nervous system.

2. It can take up residence and lie dormant in the nervous system without the individual knowing it's there. In other words, it doesn't present any symptoms or clues that the virus exists.

3. Stimuli can activate and reactivate the virus over time, bringing about ulcers in the mouth, gums, lips, and throat. 

Stimuli that can reactivate the virus include anything that might place stress on the body:

• Sunlight

• Fever

• Upper respiratory infections

• Menstruation

Causes

Herpetic gingivostomatitis is contagious and can be transmitted from person to person by oral secretions such as saliva and mucoid secretions.

How is herpetic gingivostomatitis spread?

It's possible that HSV-1 can be transmitted from the mouth and skin surfaces around the mouth even when they appear normal and have no sores. The risk of transmitting HSV-1 when sores are present exponentially increases. 

Risk factors

Active lesions, sores, cold sores, or fever blisters on the mouth, lips, or skin around the mouth are the most significant risk factors when considering the contagion level of HSV-1.

Symptoms

Whether during the primary infection or any infections after that, the person may experience tingling, itching, or a burning sensation around the mouth before cold sores, painful blisters, or open sores appear. 

When children are exposed to HSV-1, their first outbreak can be quite severe. The severity of the symptoms can range from mild discomfort to a crippling illness that requires hospitalization. 

Bad breath and a fever of 102°F or greater can accompany the oral sores and lesions that may appear on, around, or inside the mouth. Children may have no desire to eat or drink, depending on the pain level of the lesions.

How long does herpetic or viral gingivostomatitis last?

Although herpetic gingivostomatitis is a virus that stays with you for life, outbreaks may occur sparingly. For some, the virus may lie dormant and not cause any symptoms for years. For others, stimuli can activate the virus, causing cold sores frequently. Some individuals can get cold sores as often as five times a year.

Once the outbreak does occur, it can take a week or two from start to finish. There are five stages of the formation of a cold sore cycle:

1. A sensation of tingling, itching, or burning is felt.

2. The blister starts to form.

3. The blister bursts.

4. A scab begins to develop over the open sore.

5. The blister heals.

Complications

Dehydration

The desire to drink fluids may be lacking because of how painful lesions can be. Dehydration can result from sparingly drinking fluids because of the pain.

Autoimmune diseases

Autoimmune diseases, such as HIV, can cause HSV-1 symptoms to be more severe and reoccur with more frequency. 

Lesion misidentification

At first, it may be hard to differentiate cold sores from possible other conditions. However, a good rule of thumb is that cold sores heal and disappear in 1–2 weeks. If a lesion stays around for longer than that and continues to grow, it could be another condition, and medical advice should be sought.

HSV encephalitis

Although rare, HSV encephalitis or brain inflammation can occur because of HSV-1. HSV encephalitis is not fatal if treated early with antiviral medicine.

Assessment

Medical personnel must assess the patient to learn about their condition. They do this by reviewing the patient's medical history and considering clinical data, laboratory data, and the patient's description of the symptoms.

Diagnosis

Usually, there's not much work involved in diagnosing herpetic gingivostomatitis. An examination of the patient's history and a physical exam of the symptoms can be enough for a diagnosis. Other tests are available to confirm these findings if needed.

Differential diagnosis

Other diseases and conditions may mimic the symptoms of herpetic gingivostomatitis. Therefore, they should be considered and eliminated as a possibility before making a conclusion.

• Chickenpox

• Traumatic ulcers

• Chemical or thermal burns

• Shingles

• Hand, foot, and mouth disease

• Oral thrush

• Herpetiform aphthous ulcers resemble HSV-1 ulcers but are unrelated.

Exams

A physical examination can identify whether a patient has the symptoms of herpetic gingivostomatitis, which could include:

• Blisters all around the inside or outside of the mouth

• Ulcers or open sores inside or outside of the mouth

• Difficulty swallowing

• A fever as high as 104°F 1–2 days before the blisters appear

• Mouth pain

• Swollen gums

Tests

Medical personnel can perform tests such as viral scrapings, immunofluorescence of secretion, and serology tests to confirm herpetic gingivostomatitis findings from the physical exam.

Treatment

Treatments for herpetic gingivostomatitis can include creams, antiviral medications, low-level laser therapy, and environmental changes to minimize the risk of transmission.

Studies have shown that laser therapy can be a valuable tool in suspending the growth of new lesions and helping heal already-formed lesions faster. In addition, laser therapy significantly decreased pain and inflammation during outbreaks. More research is needed to determine the exact treatment regimes with low-level laser therapy. 

Can you prevent gingivostomatitis?

People with symptoms of herpetic gingivostomatitis can prevent transmission to others by avoiding oral contact like kissing. Transmission to others can also be avoided by not sharing objects that may have touched saliva, like toothbrushes. 

The lowdown

Herpetic gingivostomatitis, although not fatal, can be a painful and misunderstood condition. It is a common condition with multiple treatment options to heal outbreaks and minimize discomfort. In addition, understanding herpetic gingivostomatitis may make it more bearable if you or anyone in your family have to experience it.