Herpetic gingivostomatitis
Synonyms and keywords: Gingivostomatitis, oral herpes.

# Overview
Gingivostomatitis (also known as primary herpetic gingivostomatitis or orolabial herpes) is a combination of gingivitis and stomatitis, or an inflammation of the oral mucosa and gingiva. Herpetic gingivostomatitis is often the initial presentation during the first ("primary") herpes simplex infection. It is of greater severity than herpes labialis (cold sores) which is often the subsequent presentations. Primary herpetic gingivostomatitis is the most common viral infection of the mouth.
Primary herpetic gingivostomatitis (PHGS) represents the clinically apparent pattern of primary herpes simplex virus (HSV) infection, since the vast majority of other primary infections are symptomless. PHGS is caused predominantly by HSV-1 and affects mainly children. Prodromal symptoms, such as fever, anorexia, irritability, malaise and headache, may occur in advance of disease. The disease presents as numerous pin-head vesicles, which rupture rapidly to form painful irregular ulcerations covered by yellowgrey membranes. Sub-mandibular lymphadenitis, halitosis and refusal to drink are usual concomitant findings.

# Symptoms
The symptoms can be mild or severe and may include:
- Not able to chew or swallow
- Sores on the inside of the cheeks or gums
- Fever
- General discomfort, uneasiness, or ill feeling
- Very sore mouth with no desire to eat
- Halitosis (bad breath)

## Differential Diagnosis
Gingivostomatitis symptoms in infants may wrongly be dismissed as teething. "Coincidentally,  primary  tooth  eruption begins  at  about the  time that  infants  are  losing  maternal antibody protection  against  the  herpes  virus. Also, reports  on  teething  difficulties  have  recorded  symptoms  which  are  remarkably  consistent  with  primary oral  herpetic  infection  such as  fever,  irritability,  sleeplessness,  and difficulty  with eating." "Younger infants  with  higher residual  levels  of  antibodies  would experience  milder infections  and  these  would be  more likely  to  go unrecognized  or  be  dismissed  as  teething  difficulty."
Gingivostomatitis must also be differentiated from herpangina, another disease that also commonly causes ulcers in the oral cavity of children, but is caused by the Coxsackie A virus rather than a herpes virus. In herpangina, ulcers are usually isolated to the soft palate and anterior pillar of the mouth. In herpetic gingivostomatitis, lesions can be found in these locations, but they are almost always accompanied by ulcerations on the gums, lips, tongue or buccal mucosa and/or by hyperemia, hypertrophy or hemorrhage of the gums.

# Causes
Herpes Stomatitis is caused by Herpes hominis virus, type I and II infect oral mucosa but type I is more common.
Gingivostomatitis generally affects children under the age of three and young adults. There are prodromal symptoms (fever, malaise, irritability, headache, vomiting, lymphadenopathy) 12 days prior to local lesions. Then small, yellowish vesicles form, which rupture quickly, resulting in shallow, round, discrete ulcers with erythematous halo. It affects both the free and attached mucosa. A generalized marginal gingivitis may precede the ulcers.
In addition, chronic elemental mercury poisoning can manifest with gingivostomatitis, in addition to neurologic (tremor, paresthesias) and psychiatric (forgetfulness, mood disturbances) symptoms.

# Treatment
Treatment includes fluid intake, good oral hygiene and gentle debridement of the mouth. In healthy individuals the lesions heal spontaneously in 714 days without scarring.

# Physical examination

## Gallery

### Head
- url = >
- url = >

### Oral cavity
- url = >
- url = >