Aciclovir Primary Herpes — MFDS Part 1 MCQ

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ModerateOral MedicineAciclovir Primary HerpesMFDS Part 1

A 5-year-old immunocompetent child presents 48 hours after the onset of fever, diffuse painful gingivitis and multiple oral vesicles and ulcers. Primary herpetic gingivostomatitis is diagnosed. Symptoms are severe, with difficulty eating and drinking, but there are no clinical signs of dehydration. Alongside analgesia and advice on maintaining fluid intake, which oral antiviral is most appropriate to consider in UK primary dental care?

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Correct answer: E — Aciclovir

Aciclovir is the most appropriate antiviral. This child has severe primary herpetic gingivostomatitis and presents within 48 hours, when antiviral treatment is most likely to be beneficial. SDCEP advises considering an antiviral for severe disease or immunocompromise, ideally during the early stages. In a placebo-controlled trial of children presenting within 72 hours, oral aciclovir shortened oral lesions, fever, eating and drinking difficulties, and viral shedding. Analgesia and maintenance of hydration remain essential; clinical dehydration would require urgent or emergency medical assessment. Valaciclovir and famciclovir have activity against herpes viruses but are not the standard evidence-supported UK dental choice for this presentation in a young child. Ganciclovir is primarily used for cytomegalovirus, while oseltamivir treats influenza.

Reference: Coppola N et al. Supportive care and antiviral treatments in primary herpetic gingivostomatitis: a systematic review. Clinical Oral Investigations. 2023;27:6333–6344. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/oral-ulceration/