Treatment Of Acute Herpetic Gingivostomatitis

Primary infection with herpes simplex virus in the oral cavity results in «1 condition known as acute herpetic gingivostomatitis, which is an oral infection often, accompanied by systemic symptoms (see Chapter 19). This infection typically occurs in c hildren, but it can and does occur in adults as well. It runs a 7- to 10-day course and heals without scars. A recurrent herpetic episode may he precipitated in individuals with a history of herpes virus infections and by respiratory infections, sunlight exposure, fever, trauma, exposure to chemicals, and emotional stress

Various medications have been used to treat herpes gingivostomatitis with little success; these have included local applications ol escharotics, vitamins, radiation and antibiotics. Limited success was initially reported with the use of herpesvirtis-specihc drugs, such as acyclovir ointment.8 However, a recent clinical report has suggested good results using systemic acyclovir to prevent (or lessen the severity of) recurrent herpes virus infection associated with dental treatment.1 I he patient, who was known to have recurrent infections after dental treatment, did not experience any recurrence when treated with acyclovir. Most strains of herpes virus are susceptible to acyclovir, and it has been suggested that topical application of acyclovir is useful in decreasing the spread and severity of I he infec tion.

Treatment consists of palliative measures to imike the patient comfortable until the disease runs its comse. Plaque, food debris and superficial calculus are removed to reduce gingival inflammation, which complicates the acute herpetic involvement. I xlensivc periodontal therapy should be postponed until the acute symptoms subside to avoid the possibility of exacerbation d ig. 45-7). For symptomatic relief, especially before meals, topical local anesthetic, such as lidocaine hydrochloride viscous solution can be applied to the affected areas. Before each meal the patient should rinse with I tablespoon ot this solution. If the patient is experiencing pain of longer duration, aspirin or a nonsteroidal antiinflammatory agent can he given system ically.

Local or systemic application of antibiotics is sometimes advised to prevent opportunistic infection of ulcerations. This is especially true in the immune compromised Individual. II the condition does not resolve within a 2-week period, the patient should be referred to a physician tor medical consultation.

Herpes GingivostomatitisAcute PericoronitisFlap Third Molar

Fiy. 45 6 Treatment ol acute pericoronitis A, Inflamed pericoronal flap (arrow) in relation to the mandibular third molar B, Ante rior view ol third molar and flap. C, Lateral view with scaler in posi lion to gently remove debris under Map. D, Anterior view ol scaler in position. E, Removal ol section of the gingiva distal to the third molar, after the acute symptoms subside. The line of incision is indicated by the broken line. F, Appearance of the healed area G, Incorrect removal ol the tip of the flap, permitting the deep pocket to remain distal to the molar.

Fiy. 45 6 Treatment ol acute pericoronitis A, Inflamed pericoronal flap (arrow) in relation to the mandibular third molar B, Ante rior view ol third molar and flap. C, Lateral view with scaler in posi lion to gently remove debris under Map. D, Anterior view ol scaler in position. E, Removal ol section of the gingiva distal to the third molar, after the acute symptoms subside. The line of incision is indicated by the broken line. F, Appearance of the healed area G, Incorrect removal ol the tip of the flap, permitting the deep pocket to remain distal to the molar.

The patient should be informed that the disease is contagious at certain stages such as when vesicles are present (highest viral titer). All individuals exposed to an infected patient should take precautions. Herpetic inlec-tion of a clinician's linger, referred to as herpetic whitlow. can occur it a seronegative clinician becomes infected with a patient's herpetic lesions/"

Supportive Treatment

Supportive measures include copious fluid intake and systemic antibiotic therapy tor the management of toxic systemic complications, lor the relief ot pain, aspirin is usually sufficient. A dosage of .425 mg to 650 nig every I hours may be prescribed for adults, with smaller doses used lor c hildren.

Acute Herpetic Gingivostomatitis

Fig. 45-7 Treatment of acute herpetic gingivostomatitis A, Before treatment Note diffuse erythema and surface vesicles B, Before treatment, lingual view, showing gingival edema and ruptured vesicle on palate C, One month after treatment, showing restoration of normal gingival contour and stippling D, One month after treatment, lingual view.

Fig. 45-7 Treatment of acute herpetic gingivostomatitis A, Before treatment Note diffuse erythema and surface vesicles B, Before treatment, lingual view, showing gingival edema and ruptured vesicle on palate C, One month after treatment, showing restoration of normal gingival contour and stippling D, One month after treatment, lingual view.

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