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Primary Herpetic Gingivostomatitis — ORE Part 1 MCQ

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ModeratePaediatric DentistryPrimary Herpetic GingivostomatitisORE Part 1

A 4-year-old child has primary herpetic gingivostomatitis. Symptoms began 48 hours ago. The child has painful oral ulceration, is drinking poorly despite paracetamol, and has no immunocompromise or signs of bacterial infection. What is the most appropriate management?

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Correct answer: E — Give oral aciclovir and continue fluids, soft food and analgesia

**A is correct.** Supportive care—regular analgesia, fluids and a soft diet—is essential, but this child has substantial pain with reduced drinking and presents within 72 hours. UK SDCEP guidance advises considering antiviral treatment for severe primary herpetic gingivostomatitis; trial evidence shows that early **oral** aciclovir reduces the duration of lesions and eating/drinking difficulties. Amoxicillin is not indicated without evidence of bacterial infection. Chlorhexidine does not treat HSV and is not the decisive treatment in a young child with painful ulceration. Topical aciclovir cream is unsuitable for widespread intra-oral disease; the evidence for benefit concerns systemic oral aciclovir. Supportive care alone would be reasonable for mild illness or later presentation, but here it fails to address the specific indication for early antiviral therapy.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Acute Dental Problems, section on oral ulceration/primary herpetic gingivostomatitis, March 2013. https://www.sdcep.org.uk/media/ixlpeakb/sdcep-madp-guidance-march-2013.pdf