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The primary episode of herpetic gingivostomatitis is characterized by constitutional symptoms such as malaise, fever and regional lymphadenopathy. Acute ulcerative gingivostomatitis occurs as a result of virus replication in the affected tissues. Vesicular eruptions may occur throughout the mouth. The gingivae are red and swollen and bleed readily. They may have a mottled appearance in the maxillary areas. Touching them or attempting to consume food causes severe pain.

(3) Herpetic Whitlow:

Herpetic infection of the digits occurs through a break in the skin and results from localized virus replication which causes swelling, redness, and tenderness with subsequent vesiculation. Healing follows in 2 weeks; as in other HSV infections, latency and periodic reactivations are common.

The differential diagnosis:

There are two types of herpes simplex virus that cause disease in humans. The type 1 virus is primarily associated with infections of the skin and oral mucous membrane, and type 2 with infections of the genitalia (although the converse can and does occur).

The diagnosis of primary herpetic gingivostomatitis is usually made on a clinical basis. The patient has a number of vesicles or small painful ulcers throughout the oral cavity. A history of systemic signs and symptoms of a viral illness helps to establish the diagnosis. The differential diagnosis of primary herpetic gingivostomatitis has been reviewed in the differential diagnosis of recurrent aphthous stomatitis. In addition, hand-foot-mouth disease (viral etiology) needs to be considered because multiple pinpoint oral vesicles and ulcers, as well as fever, are common signs. The absence of lesions on the palms and soles eliminates hand-foot-mouth disease from consideration. Herpangina (coxsackievirus) can generally he identified by the limited distribution of the small vesicles and ulcers to the soft palate and oropharvnx.

The recommended treatment:

Confirmation of the viral infection by lahoratory methods is available but not routinely used. The virus may be isolated in tissue culture if fluid can be obtained from an intact vesicle. Primary infections are associated with an increase in antibody titer, and paired acute and convalescent sera may be studied.

There is no specific treatment for primary herpetic gingivostomatitis. Acvclovir (Zovirax) is effective in the management of initial herpes genitalis. It is also useful in treating non-lifethreatening mucocutaneous herpes simplex virus infections in immunocompromised patients (Myers et al., 1982; Whitley et al., 1982). In these patients a decrease in the duration .of viral shedding has been reported. There is no reported clinical evidence of benefit in treating herpes labialis in non-immunocompromised patients.

The usual supportive measures for an acute viral infection should be instituted. These include maintenance of proper oral hygiene, adequate fluid intake to prevent dehydration, and the use of systemic analgesics for control of pain. Antipyretic agents are also prescribed when fever is a symptom. In severe cases it may be necessary to use a topical anesthetic mouth rinse such as viscous lidocaine or elixir of diphenhyclramine. The patient is often able to tolerate cold liquids, and they may aid in preventing dehydration. Secondary bacterial infection of the many small punctate ulcers invariably is a major contributor to the pain after the vesicles rupture.

Herpetic Whitlow is a recognized occupational hazard of dental personnel and may be contracted through treatment of patients with oral herpetic lesions. The dentist, hygienist, or assistant in turn, may transmit this infection to other patients. To prevent this infection, gloves should be used routinely when examining or treating patients.

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