If you have experienced a cold sore, you are already familiar with herpes simplex virus type 1 (HSV1). These sores begin as a tingling or mildly painful sensation, usually near the lip or nose. A blister forms and then breaks open, becoming more painful. After crusting over, it eventually goes away after a week or two. But did you know that cold sore actually began much earlier, typically during your toddler years?
It’s a big name, so let’s break it down. Herpetic refers to a family of viruses, which includes HSV1. Gingivo means the gums, and stoma is an opening, in this case the mouth and lips. The suffix -itis refers to inflammation. So, herpetic gingivostomatitis is an inflammation of the lips, mouth and gums caused by HSV1 and most often seen in young children. It’s kind of like having a cold sore, except there may be hundreds of them inside and around the mouth.
Like most viruses, the immune system does a good job fighting the infection, but in this case some of the virus retreats up into a nerve and lives there for the rest of your life. The immune system usually keeps the retreating virus in check but in some instances, the virus reactivates, travels back down the nerve and causes a cold sore. Other infections, sunlight, cold weather, stress and menstrual periods are some of the triggers that can result in viral reactivation.
More Interesting Facts
A different herpes virus, HSV2, is responsible for a sexually transmitted infection. Like HSV1, this virus remains dormant in nerve cells and can reactivate after the initial outbreak. Another virus in the herpes family is varicella-zoster virus (VZV), which causes chicken pox. Following an initial VZV infection or the chicken pox vaccine, some of the virus becomes dormant and can reactivate many years later, resulting in a condition called shingles.
Treating Herpes Mouth Sores
A healthy immune system will fight herpetic gingivostomatitis and cold sores very well. Antiviral medications can speed up the process if started early in the illness. These antivirals can also prevent the infection from becoming worse, especially in those with weakened immune systems. The mainstay of treatment is supportive care while the immune system does its job.
In addition to mouth sores, herpetic gingivostomatitis may result in fever, pain, drooling and decreased appetite. Keeping fever and pain under control, encouraging rest and providing lots of fluids are important parts of treatment. You should also check in with your child’s doctor because dehydration can set in and IV fluids might be needed.
Herpangina and Hand-Foot-Mouth Disease
A few non-herpes viruses also cause small blisters inside the mouth, especially in young children. These include strains of coxsackie virus and other enteroviruses. Antiviral medications are NOT helpful in treating these infections.
Non-herpetic blisters primarily affect the back of the throat and roof of the mouth while sparing the lips and gums. When the mouth is the only place affected, we call this condition herpangina. Sometimes these viruses also cause small skin blisters, which is then called hand-foot-mouth disease. When non-herpes viruses cause mouth sores, the immune system completely eliminates the virus and there is no reactivation down the road.
As you can see, the cause, name and treatment of mouth sores can be a little confusing. When in doubt or if concerns arise, be sure to touch base with your child’s doctor!
Dr Mike Patrick is an Assistant Professor of Pediatrics at the Ohio State University College of Medicine and Medical Director of Interactive Media for Nationwide Children's Hospital. Since 2006, he has hosted the award-winning PediaCast, a pediatric podcast for parents. Dr Mike also produces a national podcast for healthcare providers—PediaCast CME, which explores general pediatric and faculty development topics and offers free AMA PRA Category 1 Credit™ to listeners.
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