Gingivostomatitis: What Is It and Who Is at Risk?
Gingivostomatitis is an acute infectious-inflammatory lesion of the oral mucosa and gingival margin. The disease is characterized by the formation of painful elements: from small vesicles (blisters) to extensive ulcerations with a risk of tissue necrosis. The pathology has no gender predisposition, but its etiology is closely linked to age and immune status. For example, primary acute herpetic gingivostomatitis primarily affects children aged 6 months to 5 years encountering the herpes simplex virus (HSV-1) for the first time. In adults, especially under conditions of stress or seasonal immune decline, recurrences of the herpetic form or the development of ulcerative necrotizing gingivostomatitis (Vincent's gingivitis) are often observed.
Main Causes and Triggers in Our Region
The etiology of the disease is polymicrobial. The leading role belongs to herpes simplex virus type I, streptococci (Streptococcus pyogenes), and anaerobic flora (Fusobacterium, spirochetes). In the conditions of Barcelona, with its Mediterranean climate, it is important to consider local triggers. High summer temperatures and low humidity in air-conditioned spaces promote mucosal dryness (xerostomia), making it vulnerable to microtrauma and pathogen penetration. Active leisure, including swimming in the sea (contact with salt water) and possible sun micro-burns, can also act as triggering factors. The key link is the decrease in local and general immunity against the background of acute viral respiratory infections (AVRI), stress, hypovitaminosis, or exacerbation of chronic pathologies.
Clinical Picture: From First Symptoms to Severe Manifestations
Symptoms develop in stages and depend on the form. The initial stage includes malaise, low-grade fever, and burning in the oral cavity. The peak of the disease is characterized by the appearance of specific elements. In the herpetic form, grouped vesicles with serous content appear, which quickly rupture, forming painful aphthae surrounded by a halo of erythema. For ulcerative necrotizing gingivostomatitis (Vincent's), pathognomonic signs are ulcers covered with a gray-green necrotic plaque, sharp putrid breath (halitosis), and pronounced gum bleeding at minimal touch. General symptoms include fever up to 39°C, regional lymphadenitis (enlargement of submandibular nodes), and intoxication.
Classification and Diagnosis: Modern Protocols
Classification is based on etiology and severity:
-
By pathogen: herpetic (viral), streptococcal (bacterial), ulcerative necrotizing (mixed anaerobic flora).
-
By course: acute (mild, moderate, severe) and chronic recurrent.
Diagnosis in clinics following current recommendations includes several stages:
-
Clinical examination: assessment of mucosal condition, ulcer characteristics, degree of necrosis, hygiene index.
-
Laboratory diagnostics: to verify the pathogen, PCR testing of a smear to detect HSV DNA or bacteriological culture with antibiotic sensitivity determination may be used if a bacterial origin is suspected.
-
Differential diagnosis: exclusion of chronic recurrent aphthous stomatitis, specific lesions in blood diseases, secondary manifestations in COVID-19 (relevant in 2026).
Comprehensive Treatment: Etiological and Symptomatic Therapy
Treatment of gingivostomatitis in 2026 remains comprehensive and is based on clinical guidelines. The protocol includes the following mandatory stages:
-
Professional hygiene treatment: gentle removal of necrotic masses and dental plaque under local anesthesia (topical or infiltrative).
-
Topical drug therapy: use of modern antiseptics (chlorhexidine, sodium hypochlorite), antiviral ointments based on acyclovir (for herpes), application of anti-inflammatory and keratoplastic gels with hyaluronic acid.
-
Systemic therapy: prescription of NSAIDs for pain and inflammation relief; in severe bacterial forms, broad-spectrum antibiotics (e.g., amoxicillin with clavulanic acid) considering antibiogram data. For herpetic gingivostomatitis, systemic antiviral drugs (valacyclovir).
-
Lifestyle and nutritional correction: a gentle diet (food at room temperature, pureed consistency), exclusion of acidic, spicy, and salty foods. Recommendations for maintaining adequate fluid balance, especially important in hot climates.
Prevention of Relapses and Prognosis
Prevention is aimed at eliminating triggers: maintaining impeccable oral hygiene, using humidifiers in the dry season, protecting lips from UV rays, managing stress, and strengthening general immunity. With timely diagnosis and adequate therapy, the prognosis is favorable: ulcer epithelialization occurs on average within 7-14 days. Lack of treatment risks chronicity, destruction of periodontal bone tissue, and systemic infection (sepsis).
