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Title Weak Evidence for acyclovir use for primary herpetic gingivostomatitis
Clinical Question In children and young adults with primary herpetic gingivostomatitis, does treatment with acyclovir reduce the number of oral lesions and prevent the development of new extra-oral lesions compared to no treatment at all?
Clinical Bottom Line There was weak evidence that treatment with acyclovir yielded better treatment than placebo for those with primary herpetic gingivostomatitis. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18843726Nasser/2008 Children and young adults < 25 years of age with a diagnosis of primary herpetic gingivostomatitisCochrane review of randomized controlled trials
Key resultsOnly two clinical trials, one with 72 participants and the other with 20 participants were included in this review. The second study failed to report several methodological items and was inconsistent in its reporting of the outcomes measurement. The first trial, with a moderate risk of bias, showed better results in the acyclovir group compared to the placebo group in children < 6 years of age in reducing the number of individuals with oral lesions (risk ratio (RR) 0.10 (95% confidence interval (CI) 0.02 to 0.38)), new extra-oral lesions (RR 0.04 (95% CI 0.00 to 0.65)), difficulty in eating (RR 0.14 (95% CI 0.03 to 0.58)), and drinking difficulties (RR 0.11 (95% CI 0.01 to 0.83)) after 8 days of treatment. Following the onset of treatment, three patients from the placebo group were admitted to hospital for rehydration (P = 0.11). Four children (two from the acyclovir, and two from the placebo group) showed mild gastrointestinal symptoms that resolved spontaneously after 24 to 48 hours without a change in the study treatment.
Evidence Search Search oral lesions; Search "Stomatitis, Herpetic"[Mesh] AND "Acyclovir"[Mesh] ...view in PubMed
Comments on
The Evidence
Two review authors independently and in duplicate screened and extracted information from, and assessed the risk of bias in the included clinical trials. The Cochrane Collaboration statistical guidelines were followed for data synthesis.
Applicability The subjects in this trial might have expected the treatment to work better than the outcomes showed and the results showed that there was weak evidence to show that acyclovir gave any substantial benefit to the improvement of lesions that might occur.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry) (Periodontics)
Keywords primary herpetic gingivostomatitis, acyclovir, oral lesions
ID# 555
Date of submission: 03/30/2010spacer
E-mail gajraj@livemail.uthscsa.edu
Author Anil Gajraj
Co-author(s) e-mail
Faculty mentor/Co-author Archie Jones, DDS, MBA
Faculty mentor/Co-author e-mail JonesA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by J.C Reagan (San Antonio, TX) on 05/06/2012
A PubMed search was performed in April 2012. The CAT contains the most recent and best evidence pertaining to the clinical question asked.

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