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3, I-'DI WIIO C.lohal Goals for Oral

Heallh in Ihe Year 2000. hit Dent ,/ 1982;,>',?.' 74 7.

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Primary herpetic gingivostomatitis:no longer a (disease of chiWhooid?

Joseph Katz,̂ Itchak Marmary,^Amos Ben-Yehuda,' Shiomo Barak'and Yehuda Danon'''Israel Defense Forces. Dental Medicine Center'Department ot Oral Medicine. HebrewUniversity-Hadassah School of DentalMedicine, Jerusalem. '̂ Maccabi Health Care.Tel Aviv, ''Israel Defense Forces. Israel

Katz ,T, Marinary 1, Ben-Yclntda A, Barak S, Danon Y: Pritnary hcrpelic gingivoslo-malitis; no longer a di.sease of childhood? Community Deni Oral Epidetniol 1991;19; 309,

Key words: primary herpetic gingivostomatitis

Dr Shiomo Barak, Division of Dentistry and OralSurgery, Maccabi Health Care. 27 Hamered.Tel Aviv. Israel

Accepted for publication 14 December 1990

Dtiring 1987-89, 65 cases of pritnary her-pelic gingivoslonialitis (PHGS) werediagnosetl iti the Departmenl of OralMedicine, Israel Defense Forces DentalMedicine Center, Their ages ranged from18 to 38 yr wilh a mean age of 18,3 (64subjects were aged 18 yr and one was38 yr). This group was selected becausecompulsory artny ,service is retiitired olall citi/ens; generally 3 yr for males and2 yr for females of full titne service, andreserve duty for males until age 54,Therefore, this provides a good cross-section of the possible patietit poptila-t ion. The patients were referred by medi-cal officers who, in all cases, establishedt h e diagnosis of follicular loiisililis duet o elevated body temperaUire and sorethroal , Phenoxyiiiclhyl penicillin (Rafa,Israel), 2 g/day was preseribed, Paiientsvs'ere seen a few days after the appearanceo f the oral uleers, Syslemie diseases, suchas infectious motiomtcleosis atul HIV in-fection were ruled oul by physical atidlaboratory tests.

The diagnosis of PHGS was confirmedby clinical and laboratory lests includingvirus isolalion in cell ciilUircs and lhepresence of high tiler of igM specific an-tibodies lo herpes type 1 (Elisa), All pa-tients suffered from dyspliagia, coated

longtie, and typical herpetic lesions oithe oral mucosa, gingiva, and tongue.

Therapy consisted of local irrigationwith aqueous chlorhexidine and l.ido-caine 2%, anlifungal therapy wilh Mico-na/.olc (Abie, Israel) 2% gel, anlipyrclicagents (Paracetatnol, Teva, Israel), andisolation. In five diabetic patients,Acyclovir (Protnedico, Israel) 200 mg (6tablels/day) was administered. In mosteases, symptoms resolved wilhin 10 18days. In one case, symptoms remainedfor 3 monllis and lhe palient had a con-siderable weight loss.

In the past, PHGS was considered tobe a disease of early childhood (1), Asurvey of 3278 patients with PHGS dur-ing 1952 62 in Yugoslavia (2), showedlliat most of the patienls were in theirsecond year of life and only a few paiientswere over 10 yr old.

Recently MAtN (3) reported the clinicaldata of 102 |iatients referred lo LeedsDental Hospital during 1978 87, Only5% of the patienls were younger thanII yr, whereas 51% were in llieir thirddecade. Statistical analysis shows a gen-eral trend lor lhe mean age of patienlslo increase progressively over the lO-yrperiod.

Although we do not have dala con-

cerning the annual total of PHGS pa-tients in the Israeli population and theirage distribution, the overwhelmingnumber of PHGS patients reported inlhe present study indicates a trend ofincreasing age. However, it ,seems pos-sible ihat the epidemiology ofthc diseaseis shiftitig towards a peak incidence inthe secotid atid third decades. The signifi-cance of this possible trend is unclear.It may rcpresetit an iticrease in socialinlimacN during the late teens and early2O's which facilitates lhe direct inocula-tion of the virus by direct physical con-lacl (3),

Poor hygiene and overcrowding ap-pear to predispose to the spread of theherpes virus (3), The reputed shift inPHGS epidemiology tna\' reprcsenl anitnprox'etneiil in persotial hygiene atidhcallh education in the Israeli populationas il relates to children.

References

1. l\Lt)i;si.t;v WR. Oral Medicine. Oxford:Oxford University Press, 1981; 41 3.

2. ,UiRi';Ti7, M. Natural liislovy of Ucrpelicinfection, Hely Pcdiair Ada I9(i6; 21:356-68,

3. MAIN DMG. Aeule lierpelic gingixosto-nialitis. Referrals lo Leeds Denial Hospi-tal 197S-1987. Br Dem .1 1989; t66\ 14-7,