Spherical grey vesicles

Sir, herpetic gingivostomatitis is an infection of the oral cavity caused by herpes simplex virus type 1 (HSV-type 1). Although this infection is often seen in infants and children younger than six years of age, it can also be seen in adults.¹ Recurrent infection is commonly seen in adults due to various stimuli like sunlight, trauma, fever and stress. Recurrent infection has also been seen after initiation of dental treatment.² A female patient aged 45 years reported to the Department of Periodontics complaining of tartar on her teeth (Fig. 1). Oral prophylaxis was initiated using hand instruments and the patient was recalled three days later for further scaling. At the recall visit she complained of pain in the labial and buccal gingiva of the lower arch. Discrete, spherical grey vesicles were noticed on the gingiva (Fig. 2) and she complained of a sore throat with tender and palpable submandibular lymph nodes. Based on the history and clinical examination a diagnosis of acute herpetic gingivostomatitis was made. The antiviral drug acyclovir was given for five days and palliative treatment included lignocaine gel and the analgesic drug paracetamol. The case serves as a reminder that age, although it may make a diagnosis seem implausible, does not alone exclude it.³

Figure 1

Clinical image before initiation of scaling

Figure 2

Clinical image three days later, arrows point to the presence of discrete, spherical gray vesicles on the gingiva