What is the treatment for gingivostomatitis?

From the Guidelines

Treatment for gingivostomatitis should prioritize a combination of supportive care, medication, and good oral hygiene, with antiviral medications like acyclovir, valacyclovir, or famciclovir considered for herpetic gingivostomatitis, especially if started within 72 hours of symptom onset, as supported by the most recent evidence 1.

Key Considerations

• For mild cases, over-the-counter pain relievers like acetaminophen or ibuprofen at standard dosages can help manage pain and reduce inflammation.
• Topical anesthetics such as benzocaine gel or lidocaine rinses can provide temporary relief when applied to affected areas.
• Maintaining good oral hygiene is essential, including gentle brushing with a soft toothbrush and rinsing with warm salt water several times daily.
• Antiviral medications are beneficial for herpetic gingivostomatitis, with acyclovir (400 mg orally five times daily for 5-10 days) being a commonly prescribed option 1.

Additional Measures

• Staying hydrated is crucial, though cold liquids and straws are preferable to avoid irritating sensitive tissues.
• Avoiding spicy, acidic, or rough-textured foods can prevent further irritation.
• Most cases resolve within 7-14 days, but severe cases or those in immunocompromised patients may require more aggressive treatment or hospitalization for IV fluids and medication.
• Children with difficulty eating or drinking due to pain should be monitored closely for dehydration.

Evidence-Based Recommendations

• The use of polyherbal products like Arimedadi oil has shown comparable effects to chlorhexidine in reducing plaque levels and gingival inflammation, as seen in a recent 3-arm randomized controlled clinical trial 1.
• Topical corticosteroids, such as betamethasone sodium phosphate or clobetasol propionate, may be considered for reducing inflammation and promoting healing, as suggested by guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis 1.

From the FDA Drug Label

Fusospirochetosis (Vincent's gingivitis and pharyngitis): Mild to moderately severe infections of the oropharynx usually respond to therapy with oral penicillin. NOTE: Necessary dental care should be accomplished in infections involving the gum tissue

The treatment for gingivostomatitis (also known as Vincent's gingivitis) is oral penicillin. It is essential to note that necessary dental care should be accomplished in infections involving the gum tissue 2.

From the Research

Treatment Options for Gingivostomatitis

• The treatment for gingivostomatitis typically involves a combination of antiviral medication, analgesics, and topical therapies to manage symptoms and reduce the duration of the illness 3, 4, 5.
• Antiviral medication, such as acyclovir, is recommended for the treatment of herpetic gingivostomatitis, particularly when started within the first 72 hours of symptom onset 3, 4, 5.
• The proposed therapeutic dose of acyclovir is 15 mg/kg, 5 times daily for 5 to 7 days 3, 5.
• Analgesics, such as acetaminophen and ibuprofen, are commonly used to manage pain and discomfort associated with gingivostomatitis 6, 7.
• Topical therapies, including mixtures of Maalox and diphenhydramine, viscous lidocaine, and compounded topical formulas, may also be used to provide symptomatic relief 6, 7.

Administration and Dosage

• The administration and dosage of topical agents can be problematic in preschoolers, and clinical experience with a medication may influence practice patterns 6, 7.
• Oral morphine and topical compounded agents are also frequently prescribed as second-line analgesics for severe gingivostomatitis 6.
• The most commonly cited barrier to adequate analgesia is difficulty in administering topical or oral medication to children 6.

Recommendations

• Treatment should be started within the first three days of disease onset for optimal effectiveness 3, 5.
• A combination of acetaminophen and ibuprofen is often preferred for analgesia, followed by either agent alone 6.
• Further research is needed to determine the most effective and best-tolerated analgesic and route of administration for gingivostomatitis 6.