Subject: Acute herpetic stomatitis. Etiology, pathogenesis. Clinical manifestations, diagnosis, treatment, prevention .

Total lesson time: 7 o'clock.

Motivational characteristics of the topic: human herpes infection is currently one of the most common - up to 95% of the world's population is infected. The herpes simplex virus can infect almost all human organs and systems, causing various clinical forms of infection. Among diseases of the oral mucosa, the leading role belongs to pathology of herpetic nature. The most commonly diagnosed is acute herpetic stomatitis (AHS), which accounts for 85% of all diseases of the oral mucosa (OMD) in children.

Target: learn to diagnose AGS in children, carry out differential diagnosis of the disease, master a tabular version of predicting the transition of AGS to a chronic recurrent form, carry out general and local treatment, preventive and anti-epidemic measures.

Lesson objectives

As a result of mastering the theoretical part of this topic, the student must know:

1. Etiology and pathogenesis of acute herpetic stomatitis.

2. Diagnosis and differential diagnosis

3. Morphological elements characteristic of herpes infection in the oral cavity.

4. Clinical manifestations of AHS in children.

5. Basic and additional methods for diagnosing herpes infection.

6. Features clinical picture and treatment of AHS in children at risk.

7. Medicines used for the treatment and prevention of AHS in children.

8. Indications for issuing certificates of temporary disability to parents to care for a sick child.

After completing the practical part of the lesson, the student must be able to:

1. Examine a child with AHS.

2. Carry out a differential diagnosis of OGS.

3. Draw up a plan for comprehensive treatment of a child with AHS.

1) at least once a year;

2) 2-4 times a year;

3) more than 4 times a year.

Suffers from chronic diseases of the respiratory tract (bronchitis, pneumonia, tonsillitis, sinusitis).

2) eat with exacerbations 1-2 times a year;

3) eat with frequent exacerbations.

There is an eye disease such as conjunctivitis, keratoconjunctivitis, blepharitis.

The presence of a traumatic factor in the oral cavity (sharp parts of the crowns or roots of teeth, malocclusion, bad habits, promoting

mucosal injury).

SUM

The lesion elements are predominantly localized at the border of the hard and soft palate, symmetrically on both sides, less often in the center or on one side on the palatine arches. As a rule, 2 elements of damage are observed, much less often ─ 3-5 elements. In half of newborns they appear in the first 10 days of life, in every fourth on the 3rd-4th day of life. Incubation period The duration of the disease ranges from 2 to 12 days (on average 2-6 days), in most cases the disease begins 4-7 days after the birth of the child. In another part of children, signs of herpetic pathology in the oral cavity appear later ─ at the age of 10 to 30 days.

Along with the localization of the lesion elements described above, there are other options. Elements of the lesion can be localized on the mucous membrane of the gums, on the red border of the lips, on the palatine arches, and extremely rarely on the tongue in the form of single vesicular rashes. In this case, the vesicles quickly open and small erosions form on a somewhat infiltrated base.

Erosions epithelialize on the oral mucosa, in newborns quickly, on days 4-8 from the beginning of their appearance.

With herpetic stomatitis, the general condition of newborn children suffers little. Temperature reaction, as a rule, is absent; rarely there is an increase in body temperature to subfebrile levels.

Diagnosis of herpetic infection is carried out on the basis of the clinical picture of the disease and the results additional methods research. Virological, serological and cytological research methods are used. Currently, laboratory methods are most often used to diagnose herpes infection: cytological, virological, polymerase chain reaction, immunofluorescence reactions, gene probing, enzyme-linked immunosorbent assay, radioimmunoassay, immunoblotting.

Usage laboratory methods in practical healthcare is difficult. This is primarily due to the complexity special methods research, and also with the fact that with their help, results can be obtained in most cases by the end of the disease or some time after recovery. Such a retrospective diagnosis cannot satisfy the clinician.

Treatment of OGS must be complex: etiological, pathogenetic, symptomatic, general and local, taking into account individual characteristics the child, the stage of development of the disease and the presence of symptoms of concomitant pathology.

Due to the peculiarities of the clinical course of AGS, an important place is occupied in the complex of treatment measures. balanced diet And proper organization child care. Food should be complete, high in calories and not irritating. Before feeding, it is necessary to numb the mucous membrane.

The baby is fed primarily liquid or semi-liquid food, not irritating the inflamed mucous membrane. Great care must be taken to ensure adequate fluid intake.

Objectives of general treatment:

1) antiviral effect;

2) reduction of symptoms of intoxication;

3) normalization of metabolic processes.

For moderate to severe disease general treatment It is advisable to do this together with a pediatrician.

Objectives of local treatment:

1) eliminate or weaken painful symptoms in the oral cavity;

2) prevent repeated eruptions of lesions;

3) help accelerate the epithelization of lesion elements.

Treatment of mild forms of AGS mainly local and includes treating the oral cavity with antiseptic drugs and antiviral ointments and creams after meals 3-4 times a day. In the stage of extinction of the disease (epithelialization), after treatment with antiseptics, treatment with antiviral drugs is alternated with treatment with agents promoting epithelization

Treatment of moderate and severe forms of AHS is complex: general and local.

The child is isolated with any form of AHS. Treatment of severe forms of OHS is often carried out in a hospital setting to create adequate conditions for replacing tablet forms antiviral drugs for injection, organization of detoxification therapy and parenteral nutrition.

Preparations for general treatment.

Preparations for local treatment

Assignment for independent work of students

The class is held in an office for the treatment of diseases of the oral mucosa.

While receiving a sick child, a student:

1) clarifies complaints;

2) collects anamnesis;

3) conducts an external examination of the child;

4) examination of the oral cavity: reveals the presence of morphological elements, their location and quantity;

5) determines the IG of the oral cavity, dental formula;

6) carries out medicinal treatment of the oral cavity with anesthetics, antiseptics, applications of antiviral drugs or agents that promote epithelization;

8) fills out a prognostic table for the occurrence of recurrent herpetic stomatitis in a child;

9) writes prescriptions;

10) draws up a certificate of temporary incapacity for work to care for a sick child.

Self-control of mastering the topic: After studying the topic, to control the quality of learning the educational material, it is proposed to solve the following situational problems:

Task 1. The child is 3 years old. The mother complains of fever, increased salivation, redness of the gums. Signs appeared 2 days ago.

Objectively: temperature 37.20C, facial skin clean, pale. The submandibular lymph nodes are enlarged to 1.5 cm in diameter and are painful on palpation. In the oral cavity, hyperemia of the mucous membrane, gingivitis in the area of ​​the frontal group of teeth, on the soft palate and mucous membrane inner surface top and lower lip 4 erosions.

Task 2. The child is 1.5 years old. According to the mother, the child fell ill 2 days ago. The disease began acutely with a rise in temperature to 38.20C. The child has become irritable, restless, and refuses to eat. On examination: the submandibular lymph nodes are enlarged and painful on palpation. On the skin upper lip 2 vials with clear serous contents. In the oral cavity: the mucous membrane of the gums is swollen, hyperemic, and bleeds when touched. On the mucous membrane of the lips, cheeks, and lateral surfaces of the tongue there are lesions in the form of 10 areas of superficial epithelial necrosis. The tongue is covered with a white coating.

Formulate a diagnosis. Make a treatment plan.

Task 3. The child is 2 years 8 months old. According to the mother, the child has been sick for 3 days. The disease began acutely. We complained of an increase in body temperature to 39.50C, headache, nosebleeds, profuse salivation, lack of appetite, restless sleep. The day before, the pediatrician was called, who prescribed ampicillin and referred the child to the dentist.

Objectively: the child is lethargic, passive, on the skin of the child’s face in the oral area, near the nasal passages, on the eyelids, earlobe there are small grouped bubbles with serous contents. The red border of the lips is dry, bright red, with crusts in the corners of the mouth and cracks that bleed when talking and crying. Lymphadenitis of the submandibular and cervical lymph nodes, pain on palpation. When examining the oral cavity: the gum mucosa is hyperemic, swollen, and painful on palpation. On the mucous membrane of the lips, cheeks, tongue, soft and hard palate, palatine arches, tonsils, there are multiple fused lesions and foci of superficial epithelial necrosis, covered with a yellowish-gray coating. Saliva is viscous, bad breath.

Formulate a diagnosis. What's your tactic?

Task 4. The child is 2 years 3 months old. A mother and child came to the clinic with complaints of pain when eating and rashes in the mouth that appeared 4 days ago. According to the mother: the mucous membranes are treated at home for 3 days oxolinic ointment and rinse with chamomile decoction (prescribed by the pediatrician). Body temperature 36.80C.

Objectively: facial skin is clean, the red border of the lips is dry, the submandibular lymph nodes are enlarged to 1 cm in diameter, painful. In the oral cavity: the mucous membrane is slightly hyperemic, on the mucous membrane of the lips and the lateral surface of the tongue there are single elements of damage in the form of aphthae. Catarrhal gingivitis in the area of ​​the anterior teeth of the upper and lower jaws.

Formulate a diagnosis. What's your tactic?

Task 5. The child is 1 year 8 months old. According to the mother, he has been sick for 2 days. The disease began acutely with a rise in temperature to 38.30C, the child refused food, was restless, and slept poorly. From the anamnesis it was possible to find out: the child often suffers from ARVI, the older brother suffers from RHS, the mother has rashes on her lip after hypothermia.

Upon inspection: submandibular The lymph nodes enlarged, painful on palpation. In the oral cavity, the mucous membrane in the gum area of ​​the front teeth is swollen, hyperemic, and light touching it causes bleeding. On the mucous membrane of the lips, cheeks, and lateral surfaces of the tongue there are elements of damage in the form of superficial foci of epithelial necrosis in the amount of 12-13. The tongue is covered with a white coating.

Formulate a diagnosis, fill out a prognostic table, draw up a treatment plan.

Task 6. Child 2 years 3 months. According to the mother, the child has been sick for 4 days. Body temperature 39.20C, vomiting, profuse salivation, lethargy, poor sleep and lack of appetite. On the skin of the right cheek in the corner of the mouth there are small blisters with serous contents, lymphadenitis of the submandibular and cervical lymph nodes. The mucous membrane of the oral cavity is hyperemic, edematous, elements of the lesion are in the form of numerous fused foci of epithelial necrosis.

Make a diagnosis and create a treatment plan for your child.

Task 7. A 3-year-old child came for a preventive examination. The skin of the face is clean, the submandibular lymph nodes are enlarged, painful on palpation, temperature is C. The mucous membrane of the oral cavity is hyperemic, there are 4 aphthae on the mucous membrane of the cheeks and tongue on the left.

Make a guess about the diagnosis. What data is needed to make a diagnosis? Treatment tactics?

Task 8. Child 2 years old. According to the mother, he has been sick for the 2nd day: he refuses food, sleeps poorly, is capricious and cries. The disease began with a rise in body temperature to 38.60C in the evening of the previous day. In the morning (on the day of visiting the doctor), diffusely located multiple erosions appeared in the mouth. Your guess about the diagnosis.

What methods can be used to confirm the etiology of the disease in a clinic setting? Treatment?

Task 9. When examining kindergarten children, two children were found to have single erosions on the cheeks and transitional folds, gingivitis, and submandibular lymphadenitis.

What anti-epidemic measures need to be taken? Carry out a differential diagnosis with acute trauma to the oral mucosa

Problem 10. The mother complains that her 1.5 year old child has red gums and rashes in the mouth that appeared 2 days ago; body temperature 37.30C. In the oral cavity, examination revealed hyperemia of the mucous membrane, gingivitis, single erosions on the mucous membrane of the lateral surface of the tongue on the left, the tip of the tongue, and the soft palate. The submandibular lymph nodes are enlarged and painful on palpation.

Make a diagnosis and prescribe treatment.

Problem 11. A 4-year-old child has been sick for 5 days. The disease began acutely with a rise in body temperature to 37.50C, irritability, and headache. The child slept poorly, began to refuse food, drooling and rashes appeared in the mouth. There is a hemorrhagic crust on the skin of the upper lip, and two vesicles with transparent serous contents on the lower lip. The submandibular lymph nodes are enlarged and painful. In the oral cavity, the mucous membrane is hyperemic, swollen, and bleeds when touched. On the mucous membrane of the lips, cheeks, soft palate─ aphthae. The tongue is covered with a gray-white coating, and there is erosion on the tip of the tongue.

Make a diagnosis and justify the diagnosis. Make a treatment plan.

Literature

Main

1. Lecture material.

2. Pediatric Dentistry, ed. . ─ M.: Medicine, 1991. ─ P.257-260.

Additional

1. Anokhin principles of clinical and laboratory diagnosis of herpetic infections / Kazan Medical Journal. ─ 2000. ─ No. 2. ─ P. 127-129.

2. White stomatitis in newborns. Author's abstract. dis... cand. honey. Sci. ─ Minsk, 1992. ─ 18 s.

3. , Danilevsky diseases of the oral mucosa. ─ M.: Medicine. ─ 1981. ─ P. 48-62, 104-112.

4. , Melnichenko periodontal disease and oral mucosa in children. ─ M.: Medicine, 1983. ─ 208.

5. Herpes simplex virus and its role in human pathology /, etc. ─ Minsk: Science and Technology, 1986. ─262 p.

6. Generalized herpetic infection: Facts and concept /, etc.; Under general ed. , . ─ Minsk: Navuka and technology, 1992. ─ 351 p.

7. Germanenko herpes and new herpes viruses in human pathology: methodological recommendations. Minsk: BSMU, 2001. ─ 36 p.

8. , Chizhov viral infections. / Clinical pharmacology and therapy. ─ 1995. ─ No. 4. ─ P. 75-78.

9. Karmalkova of acute herpetic stomatitis in children using a helium-neon laser. Author's abstract. dis... cand. honey. Sci. ─ Minsk, 1991. ─ 18 p.

10. Mikhailovskaya acute herpetic stomatitis in children. Author's abstract. dis... cand. honey. Sci. ─ Minsk ─ 1990. ─ 20 C.

11. , Gubanova’s ideas about the clinic, features, epidemiology and treatment of herpes simplex. /Attending doctor. ─ 1999. ─ No. 2-3. ─ pp. 10-16.

12. Pediatric Dentistry, ed. prof. . ─ M., 1987. ─ P.354-364.

13. Amir J. Clinical Aspects and Antiviral Therapy in Primary Herpetic Gingivostomatitis / Pediatric Drugs / 2001. ─ Vol. 3. ─ P. 593-596.

14. Miller G. S., Reading S. W. Diagnosis and management of orofacial herpes simplex virus infections. Dent. Clin. North. Am. ─ 1992. Oct.: 36(4). ─ R. 879-895.

Reading time: 10 minutes

Has your child begun to be capricious and eat poorly, and a rash in the form of small blisters has appeared in the mouth? There is a high probability that this viral infection, which causes not only inflammatory processes in the oral cavity, but also general intoxication of the body. Herpetic stomatitis in children is a common disease that requires timely diagnosis and proper comprehensive treatment.

What it is

Herpetic stomatitis is an infectious lesion of the oral cavity that occurs when a child’s body first comes into contact with the herpes simplex virus type 1. This infection develops in children with weakened or immature cellular and specific immunity, so it is more common between the ages of six months and three years.

Depending on the character infectious process There are acute and chronic recurrent types of herpetic stomatitis in children. A child who has had an acute form of the disease may become an asymptomatic carrier of the virus or suffer from a chronic form of this infection. To understand in more detail the features of the course, as well as the treatment of herpetic stomatitis in childhood, watch the video with Professor of the Department of Therapeutic Dentistry S.Yu. Stakhova.

Causes and symptoms of herpetic stomatitis

Herpes simplex virus type 1 (HSV-1), the causative agent of the disease, enters the child’s body mainly through the skin, mucous membranes upon contact with a sick person or virus carrier, household or by airborne droplets. After penetration into the body, it begins to function inside the cells, actively multiplying, using the resources and components of the cells. Activation of symptoms is associated with intensive reproduction of the virus, which manifests itself in a mild, moderate or severe form of the disease.

Clinical manifestations of herpetic stomatitis in children occur if there are factors that reduce resistance:

• weakened immune system;
• abrupt change temperature regime, overheating or hypothermia;
• injuries to the oral cavity, lips;
• non-compliance with sanitary and hygienic rules;
• stress, nervous tension.

Mild symptoms:

• the child becomes lethargic, capricious, and there is a slight increase in temperature;
• redness, swelling of the oral mucosa, inflammation of the gums;
• swollen lymph nodes;
• a small number of painful blisters, ulcers in the mouth.

In cases of moderate severity, the following is noted:

• temperature rise to 38-39 degrees;
• weakness, nausea, chills, headache;
• enlarged submandibular and cervical lymph nodes;
• inflammation and swelling of the gums, oral mucosa;
• the appearance of a rash in the form of blisters on the mucous membranes of the mouth, tongue, cheeks, lips, and skin around the mouth.

A severe form of the disease is characterized by:

• high critical body temperature;
• severe general condition, signs of severe intoxication;
• severe headache, muscle pain;
• nausea, vomiting;
• low blood pressure, heart rhythm disturbances;
• lymphadenitis of the cervical, submandibular lymph nodes;
• multiple painful rashes in the form of blisters, erosions that spread to the area around the mouth, wings of the nose, eyelids, and conjunctiva of the eyes.

Bubbles characteristic of stomatitis appear in a group and tend to merge. After the herpetic vesicle bursts, a focus of painful erosion forms. If there are no complications, then scars do not form on the affected areas of the skin. Such damage to the mucous membranes and skin is typical only for this disease, therefore it is important diagnostic sign. In the photo you can see a rash typical of herpetic stomatitis.

Diagnosis of the disease is based on analysis of symptoms, clinical manifestations, as well as cytological examination of scrapings of the contents of a vesicle or erosion. The duration of the active phase of the disease depends on the general condition of the child, the timeliness of treatment measures and the severity of the disease. With a mild form of herpetic stomatitis, treatment takes up to 7 days, with a moderate form – several weeks, and a severe form requires immediate hospitalization. The length of time a child develops symptoms will depend on the effectiveness of treatment measures.

Treatment of herpetic stomatitis in children

Doctors recommend that at the first signs of illness in a child, immediately contact a specialist. You will probably need to consult a pediatrician, dentist, neurologist, and in severe cases, hospitalization in a hospital. The sooner it is appointed effective therapy, the easier the course of the disease will be and the lower the risk of developing severe complications.

Herpetic stomatitis in children is treated comprehensively, in several areas:

• Antiviral therapy. Aimed at neutralizing the causative agent of infection, it is carried out using drugs in the form of tablets and ointments for topical use.
• Anti-inflammatory and antihistamines. Prescribed to relieve symptoms of intoxication and reduce body temperature.
• Increasing the body's resistance and strengthening the immune system with the help of vitamin-mineral complexes and immunostimulating drugs.
• To speed up healing, relieve inflammation and pain, gels, ointments with an analgesic effect, as well as drugs with keratoplasty properties are prescribed.

How and with what to treat

For herpetic stomatitis in children drug therapy prescribed by the attending physician, taking into account the severity of the disease, condition, and age of the child. Experts recommend to parents:

• provide the baby with plenty of fluids at a comfortable temperature and a balanced diet;
• avoid foods that can injure the affected areas;
• it is advisable to feed the baby 3-4 times a day, and not to give additional food in between, so that the time interval necessary for the effects of medications is observed;
• follow the rules of hygiene and oral care to avoid bacterial infection;
• provide a sick child with separate dishes and toys;
• treat the affected areas several times a day in accordance with the doctor’s recommendations;
• do not self-medicate using information from forums on the Internet and consult a doctor at the first signs of illness.

Treatment of the oral cavity in a child with herpetic stomatitis:

• Rinse. Babies do not know how to rinse their mouths on their own, so they irrigate the oral cavity by carefully tilting their heads over a basin. Older children can rinse their mouths with herbal decoctions, a water-salt solution, or medications prescribed by the pediatrician.
• Treatment of areas of the mucous membranes of the mouth and skin affected by stomatitis. After rinsing, it is recommended to treat healthy and damaged areas with antiviral, analgesic or wound healing agents. This is done using a cotton swab. It is necessary to carefully lubricate the affected areas, trying to do this carefully so that the child does not get hurt.
• Lotions. Applications and lotions for stomatitis can be made if herpetic crusts form, as well as to prolong the effect of the medicine. Procedures with herbal remedies, analgesic drugs help relieve pain and inflammation. At the healing stage, it is recommended to use sea buckthorn oil, rosehip oil, and oil solutions of vitamins A and E to speed up healing.

During the period of illness, it is necessary to follow the instructions and rules for caring for a sick child, because the herpes simplex virus is highly contagious and can actively spread. For herpetic stomatitis are prescribed medications various forms of release, pharmaceutical action. The sooner treatment is started, the greater the likelihood that the disease will pass without complications and in a mild form, so it is important to contact a pediatrician or dentist in a timely manner. We provide you with an overview of pharmaceuticals recommended by experts.

Review of pharmaceutical drugs

Holisal

• Ingredients: active substances choline salicylate and cytaclonium chloride, auxiliary components.
• Action: anti-inflammatory, analgesic, antiviral and antifungal.
• Application: for herpetic stomatitis, children over 1 year of age are prescribed topically 2-3 times a day. It is recommended to squeeze out a 0.5 cm strip of gel onto a clean finger and gently apply it with light massaging movements to the area of ​​the child’s mouth affected by stomatitis. It is used as an analgesic before meals, as an antimicrobial and anti-inflammatory - after breakfast, before bedtime.
• Price: from 260 rubles (10 g)

Viferon

• Compound: active substance Interferon alpha-2b human recombinant.
• Action: antiviral and immunomodulatory.
• Application: at the first signs of stomatitis, a 0.5 cm strip of gel is squeezed onto a spatula or cotton swab and applied to a pre-dried surface 4-5 times a day for 6-7 days.
• Price: from 130 rubles (12 g)

Oxolinic ointment 0.25%

• Ingredients: active ingredient oxolin.
• Action: antiviral.
• Application: for herpetic stomatitis, it is recommended only for children over 2 years old. Apply with a cotton swab or bandage 3-4 times a day to the affected areas of the mouth and lips for a week.
• Price: from 20 rubles (10 g)

Acyclovir

• Action: antiviral.
• Application: for the treatment of herpetic stomatitis, children over 2 years old are prescribed 1 tablet 4-5 times a day, under 2 years old - half the dose. The cream is applied to the skin 5 times a day for 5-10 days.
• Price: tablets 200 mg No. 20 – from 40 rubles, cream 5% 2 g – from 50.

Zovirax

• Compound: active substance acyclovir
• Action: antiviral.
• Application: for herpetic stomatitis, children over 2 years old are prescribed one tablet (200 mg) 4 times a day or two tablets 2 times a day, children under 2 years old receive half the dose. Intravenous injections used at a dosage of 10 mg/kg with an interval of 8 hours. The cream for external use is applied to the affected areas 4-5 times a day at the first symptoms of the disease.
• Price: tablets 200 mg No. 25 – from 780 rubles, cream 5% 5 g – from 185 rubles.

Immunal

• Ingredients: active ingredient – ​​plant extract of Echinacea purpurea.
• Action: stimulant specific immunity, increases resistance to infectious diseases, has an antiviral effect.
• Application: children from 6 to 12 years old are recommended to take 1.5 ml of solution with a small amount of liquid 3 times a day or 1 tablet 2-3 times a day for 10 days.
• Price: tablets No. 20 – from 210 rubles, drops 50 ml – from 220 rubles.

Oil solutions A and E

• Ingredients: vitamins A (retinol), E (tocopherol).
• Action: keratoplasty, accelerate tissue regeneration and epithelization.
• Application: local. Areas affected by herpetic stomatitis are lubricated with an oil solution of vitamins A or E several times a day for 5-7 days.
• Price: vitamin E 25% oil solution – from 120 rubles (100 ml), vitamin A – from 2 rubles per 1 ampoule (10 ml).

Folk remedies

Vegetable oils, decoctions in the form of lotions, applications, rinses relieve swelling of the mucous membrane and inflammation, pain, promote healing and regeneration. But folk remedies for the treatment of herpetic stomatitis cannot be an alternative to antiviral therapy. Before taking herbal remedies or using traditional medicine methods, consult your doctor. Here are a few recipes that experts recommend using along with other therapeutic measures in the treatment of this disease.

Chamomile decoction. Has anti-inflammatory and analgesic effects. To prepare the decoction, 4 tbsp. Chamomile flowers are poured into 1.5 liters of water and boiled for 5-10 minutes. After 45-60 minutes, filter. Doctors recommend using it for herpetic stomatitis several times a day for rinsing or irrigating damaged areas of the skin, mucous membranes oral cavity.

Decoction of calendula flowers. Calendula relieves swelling and inflammation. To prepare the decoction, 1 tbsp. pour 1 cup of boiling water over the flowers and cover with a lid. Keep for 10 minutes on low heat and filter after 45-60 minutes. This remedy is intended for rinsing and irrigating the mouth, and can also be used for applications to areas with herpetic blisters and erosions.

Kalanchoe juice and aloe leaf pulp. Kalanchoe juice has powerful anti-inflammatory and bactericidal properties, and is also used as an analgesic for herpetic stomatitis. The pulp of aloe leaves relieves inflammation, prevents bacterial infections and promotes tissue regeneration. The products are applied to the foci of the disease in the form of applications several times a day for 15-20 minutes.

Vegetable oils of rose hips and sea buckthorn. They contain unsaturated fatty acids, complexes of vitamins and microelements. These natural oils relieve pain, inflammation, irritation and promote regeneration and healing. The keratoplastic effect of sea buckthorn and rose hips is especially important, therefore, during the recovery stage, it is recommended to lubricate herpetic erosions or apply them as applications to the affected areas 1-2 times a day.

Solution chicken protein and water. Raw protein is mixed with 0.5 liters of boiled water, stirred thoroughly and used for rinsing. Helps with lysozyme deficiency in the saliva of a sick child and has an analgesic effect. Use several times a day to rinse after meals.

Water-soda solution. Add a dessert spoon to a glass of boiled water baking soda and stir thoroughly. The remedy is relevant at the first signs of herpetic stomatitis in a child, when swelling and redness of the oral mucosa occurs. It is recommended to rinse your mouth with it 3-4 times a day or irrigate inflamed areas with this liquid.

Prevention of herpetic stomatitis in children

Preventive measures include avoiding contact of the child with patients and virus carriers in the active phase of the disease. Doctors also recommend following the rules of oral hygiene and, if there are traumatic factors, eliminating them in a timely manner. Good nutrition and increasing the body's resistance can minimize the risks of complications.

If your child has had herpetic stomatitis, he becomes a virus carrier, so relapses are possible. To avoid the disease becoming chronic, it is important to adhere to general principles prevention and take measures to correct immunity.

Video: How to recognize stomatitis in a child - Doctor Komarovsky

We invite you to watch the recording of the program “Doctor Komarovsky’s School”, dedicated to the topic of stomatitis. A well-known pediatrician will teach you to recognize the signs of the disease and give recommendations for treatment.

This review examines acute herpetic stomatitis in children as the most common disease of viral etiology. Acute herpetic stomatitis (AHS) along with others inflammatory diseases of the oral mucosa in children is usually accompanied by a decrease in general immunity. The authors recommend A complex approach, including general and local treatment, with the use of immunomodulators, which will reduce the treatment time for acute herpetic stomatitis and reduce the severity of this disease and restore normal immunity in a shorter time.

Acute herpetic gingivostomatitis in children

Here is reviewed an acute herpetic gingivostomatitis in children as the most common disease of viral etiology. Acute herpetic gingivostomatitis (AHG) along with other inflammatory diseases of children’s oral mucosa is generally accompanied by a decrease in systematic immunity. The authors suggest the complex approach including general and local treatment with the application of immunomodulators that will reduce the terms of acute herpetic gingivostomatitis treatment, decrease the severity of this disease and in shorter terms recover normal immunity.

Acute herpetic stomatitis in children - infectious viral disease, caused by primary contact with the herpes simplex virus, characterized by inflammation of the oral mucosa with the appearance of blistering rashes, increased body temperature and decreased immunity.

A third of the world's population is affected by herpes infection; over half of these patients suffer several attacks of infection per year, often including manifestations in the oral cavity. It has been established that the infection rate of children with the herpes simplex virus between the ages of 6 months and 5 years is 60%, and by the age of 15 it is already 90%. A similar situation is typical for dentistry, since the incidence of acute (primary) herpetic stomatitis in children increases every year.

The role of the herpes simplex virus in diseases of the oral mucosa was first pointed out at the beginning of the 20th century. N.F. Filatov (1902). He suggested the possible herpetic nature of the most common acute aphthous stomatitis among children. This evidence was obtained later, when antigens of the herpes simplex virus were discovered in the epithelial cells of the affected areas of the oral mucosa.

Acute herpetic stomatitis not only ranks first among all lesions of the oral mucosa, but is also included in the leading group among all infectious pathologies of childhood. Moreover, in every 7–10th child, acute herpetic stomatitis very early turns into a chronic form with periodic relapses.

Herpes simplex virus is a DNA virus. The size of the vibrio is 100-160 nm. Develops intracellularly. The virus is thermolabile and is inactivated at a temperature of 50-52°C for 30 minutes. At a temperature of 37°C, inactivation of the virus occurs within 10 hours. The virus persists for a long time at low temperatures (-70°C). He calls various diseases central and peripheral nervous systems, liver, other parenchymal organs, eyes, skin, gastrointestinal mucosa, genital organs, and also has a certain significance in the intrauterine pathology of the fetus. A combination of various clinical forms of herpetic infection is often observed.

Acute herpetic stomatitis has a relatively high contagiousness among non-immune individuals. The spread of the disease at the age of 6 months to 3 years is explained by the fact that at this age the antibodies received from the mother interplacentally disappear in children, as well as the lack of mature specific immune systems. Among older children, the incidence is significantly lower due to acquired immunity after a herpes infection in its various clinical manifestations.

Herpetic infection, which manifests itself mainly in the oral cavity, is caused by the herpes simplex virus serotype 1 - HSV-1 (Herpes simplex virus HSV-1). Infection occurs through airborne droplets, contact and household routes (through toys, dishes and other household items), as well as from persons suffering from recurrent herpes of the lips.

In the development of herpetic infection, the structure of the oral mucosa in children in early childhood and the activity of local tissue immunity are of great importance. The highest prevalence of acute herpetic stomatitis in the period up to 3 years may be due to age-morphological indicators, indicating high permeability of histohematic barriers during this period and a decrease in morphological reactions of the immune system: thin epithelial cover with low level glycogen and ribonucleic acids, looseness and low differentiation of the basement membrane and fibrous structures of connective tissue (abundant vascularization, high level content of mast cells with their low functional activity, etc.).

The pathogenesis of acute herpetic stomatitis has not been fully studied at present. In all cases, a viral infection begins with a violation of the integrity of the mucous membranes and skin, adsorption of viral particles and penetration of the virus into the cell. Further ways of spreading the introduced virus throughout the body are complex and poorly understood. There are a number of provisions indicating the spread of the virus by hematogenous and neural routes. IN acute period stomatitis in children, viremia is noted.

The lymph nodes and elements of the reticuloendothelial system are of great importance in the pathogenesis of the disease, which is quite consistent with the pathogenesis of the sequential development clinical signs stomatitis. The appearance of lesions on the oral mucosa is preceded by lymphadenitis varying degrees expressiveness. In moderate and severe clinical forms, bilateral inflammation of the submandibular lymph nodes often develops. All groups of cervical lymph nodes (anterior, middle, posterior) can be involved in the process. Lymphadenitis in acute herpetic stomatitis precedes rashes in the oral cavity, accompanies the entire course of the disease and remains for 7-10 days after complete epithelization of the rash elements.

Immune defense plays a certain role in the body’s resistance to disease and in its protective reactions. Both specific and nonspecific immune factors play a role in immune reactivity. Studies of nonspecific immune reactivity have established a violation of the body's protective barriers, which reflected the severity of the disease and the periods of its development. Moderate and severe forms of stomatitis sharply depress natural immunity, which is restored 7-14 days after the child’s clinical recovery.

Primary infection usually occurs after 6 months of life, since before this the blood of most newborns contains antibodies to the herpes simplex virus, received from the mother transplacentally. Most often, the disease occurs between the ages of 1 and 5 years - 62-65% of cases. Children 4-5 years old account for 13-25%, then the incidence sharply decreases, amounting to 1-2 cases per 1000 in schoolchildren. The high incidence in children from 6 months to 3 years is explained by the fact that at this age antibodies received from the mother disappear , but there are still no mature systems of specific immunity and the role of nonspecific immunity is still small. Among older children, the incidence is much lower, since immunity is acquired after undergoing one or another clinical form herpetic infection.

For the development of herpes infection, which primarily affects the oral cavity, the structure of the oral mucosa is of great importance. Thus, the highest prevalence of OGS in the period up to 3 years may be due to the high permeability of histological barriers during this period and a decrease in morphological immune responses, thin epithelial cover with low levels of glycogen and ribonucleic acids, friability and low differentiation of the basement membrane and fibrous structures of connective tissue.

Herpetic stomatitis can occur in newborn premature babies. It is believed that it is a consequence of ante- and perinatal infection, which is observed in 1/3 of cases.

Acute herpetic stomatitis, like many other childhood infectious diseases, occurs in mild, moderate and severe forms. The incubation period lasts from 2 to 17 days, and in newborns it can last up to 30 days. During the course of the disease, five periods are distinguished: incubation, prodromal, disease development, extinction and clinical recovery. During the development of the disease, two phases can be distinguished - catarrhal and rash of lesions.

Symptoms of damage to the oral mucosa appear in the third period of disease development. Intense hyperemia of the entire oral mucosa is observed; after a day, or less often two, lesions are usually found in the oral cavity. The severity of acute herpetic stomatitis is assessed by the severity and nature of the symptom of toxicosis and the symptom of damage to the oral mucosa.

The mild form of acute herpetic stomatitis is characterized by the external absence of symptoms of intoxication of the body; the prodromal period is clinically absent. The disease begins suddenly with an increase in body temperature to 37-37.5°C. The general condition of the child is quite satisfactory. Minor phenomena of inflammation of the nasal mucosa and upper respiratory tract may be detected. Sometimes hyperemia and slight swelling occur in the oral cavity, mainly in the area of ​​the gingival margin (catarrhal gingivitis). The duration of the period is 1-2 days. The vesicle stage is usually not noticed by parents and doctors, since the vesicle quickly bursts and turns into erosion-aphtha. Afta-erosion is round or oval in shape with smooth edges and a smooth bottom gray with a rim of hyperemia around.

In most cases, against the background of increased hyperemia, single or grouped lesions appear in the oral cavity, the number of which usually does not exceed five. The rashes are one-time only. The duration of the disease development is 1-2 days.

The period of extinction of the disease is longer. Within 1-2 days, the elements acquire a marble-like color, their edges and center are blurred. They are already less painful. After epithelization of the elements, the phenomena of catarrhal gingivitis persist for 2-3 days, especially in the area of ​​the anterior teeth of the upper and lower jaws.

In children suffering from this form of the disease, as a rule, there are no changes in the blood, sometimes only towards the end of the disease a slight lymphocytosis appears. In this form of the disease are well expressed defense mechanisms saliva: pH 7.4±0.04, which corresponds to the optimal state. During the height of the disease, an antiviral factor, interferon, appears in saliva (from 8 to 12 units/ml). The decrease in lysozyme in saliva is not pronounced.

Natural immunity in mild forms of stomatitis suffers slightly, and during the period of clinical recovery, the child’s body’s defenses are almost at the level of healthy children, i.e. in mild forms of acute herpetic stomatitis, clinical recovery means complete restoration of the body’s impaired defenses.

The moderate form of acute herpetic stomatitis is characterized by fairly clearly defined symptoms of toxicosis and damage to the oral mucosa during all periods of the disease. Already in the prodromal period, the child’s well-being worsens, weakness, whims, loss of appetite appear, catarrhal sore throat or symptoms of acute respiratory disease The submandibular lymph nodes enlarge and become painful. The temperature rises to 37-37.5°C.

As the disease progresses during the development of the disease (catarrhal phase), the temperature rises to 38-39°C, headache, nausea, and pale skin appear. At the peak of the rise in temperature, increased hyperemia and severe swelling of the mucous membrane, elements of a rash appear, both in the oral cavity and often on the skin of the face in the mouth area. In the oral cavity, from 10 to 20-25 lesions are usually noted. During this period, salivation increases, saliva becomes viscous and viscous. Marked inflammation and bleeding of the gums are noted.

Rashes often recur, as a result of which, when examining the oral cavity, one can see elements of the lesion that are at different stages of clinical and cytological development. After the first eruption of lesions, body temperature usually drops to 37-37.5°C. However, subsequent rashes are usually accompanied by a rise in temperature to the previous levels. The child does not eat, sleeps poorly, and symptoms of secondary toxicosis increase.

An increase in ESR up to 20 mm/h is noted in the blood, often leukopenia, sometimes slight leukocytosis; band leukocytes and monocytes are within higher boundaries norms; lymphocytosis and plasmacytosis are observed. An increase in the titer of herpetic complement-fixing antibodies is detected more often than after a mild form of stomatitis.

The duration of the period of extinction of the disease depends on the resistance of the child’s body, the presence of carious and damaged teeth in the oral cavity, and irrational treatment. The latter factors contribute to the fusion of lesion elements, their subsequent ulceration, and the appearance of ulcerative gingivitis. Epithelization of the lesion elements takes up to 4-5 days. Gingivitis, severe bleeding of the gums and lymphadenitis last the longest.

With moderate disease, the pH of saliva becomes more acidic. The amount of interferon is less than in children with a mild form of the disease, but does not exceed 8 units/ml and is not found in all children. The content of lysozyme in saliva decreases more than in mild forms of stomatitis.

The severe form of acute herpetic stomatitis is much less common than the moderate and mild form. In the prodromal period, the child exhibits all the signs of an incipient acute infectious disease: apathy, adynamia, headache, cutaneous hyperesthesia and arthralgia, etc. Symptoms of damage are often observed of cardio-vascular system: bradycardia and tachycardia, muffled heart sounds, arterial hypotension. Some children experience nosebleeds, nausea, vomiting, and pronounced lymphadenitis of not only the submandibular, but also the cervical lymph nodes.

During the development of the disease, the temperature rises to 39-40°C. The child develops a mournful expression on his face and is characterized by suffering, sunken eyes. A mild runny nose and cough are observed; the conjunctivae are somewhat swollen and hyperemic. Lips are dry, bright, parched. The mucous membrane of the oral cavity is swollen, clearly hyperemic, and acute catarrhal gingivitis is pronounced. After 1-2 days, elements of the rash begin to appear in the oral cavity (up to 20-25). Often, rashes in the form of typical herpetic blisters appear on the skin of the oral area, the skin of the eyelids and conjunctiva of the eyes, earlobes, on the fingers, like a panaritium. Rashes in the oral cavity recur and therefore, at the height of the disease in a seriously ill child, there are about 100 of them. The elements merge, forming large areas of necrosis of the mucous membrane. Not only the lips, cheeks, tongue, soft and hard palate are affected, but also the gingival margin. Catarrhal gingivitis turns into ulcerative-necrotic, with a sharp putrid smell from mouth, profuse drooling mixed with blood. Inflammation on the mucous membrane of the nose, respiratory tract, and eyes worsens. Streaks of blood are also found in secretions from the nose and larynx, and sometimes nosebleeds are noted. In this state, children need active treatment from a pediatrician and dentist, and therefore it is advisable to hospitalize the child in the isolation ward of a pediatric or infectious diseases hospital.

In the blood of children with a severe form of acute herpetic stomatitis, leukopenia, a band shift to the left, eosinophilia, single plasma cells, and young forms of neutrophils are detected. In the latter, toxic granularity is very rarely observed. Herpetic complement-fixing antibodies are, as a rule, always detected during the period of convalescence.

The reaction of saliva is acidic (pH 6.55±0.2), but after some time it changes to alkaline (8.1-8.4). Interferon is usually absent, the content of lysozyme is sharply reduced.

The period of extinction of the disease depends on timely and correctly prescribed treatment and on the child’s history of concomitant diseases.

Despite the clinical recovery of a patient with a severe form of acute herpetic stomatitis, profound changes in homeostasis are observed during the period of convalescence.

The diagnosis of acute herpetic stomatitis is established on the basis of anamnestic, epidemiological data, characteristic clinical symptoms, as well as cytomorphological data. Cytologically, the clinical diagnosis is confirmed by the presence in fingerprint smears, characteristic of herpetic infection, of epithelial cells with eosinophilic intranuclear inclusions, as well as giant multinucleated cells.

All children under observation undergo a complex of clinical, laboratory and instrumental studies, including clinical analysis blood, immunological studies.

It is known that immunosuppression is one of the main factors in the implementation of herpes virus infection. In this regard, the state of local immunity of the oral mucosa is studied: the content of lysozyme, the level of immunoglobulins (in particular secretory IgA) in mixed saliva. The material for the study is smear impressions from the oral mucosa. Tests in which cell nuclei are stained with fluorescein and polymorphonuclear neutrophils and macrophages that are specifically stained with herpetic antiserum are observed as positive for herpes antigen; also determine the presence of virus-specific nucleotide sequences of the herpes simplex virus in swabs from the oral mucosa. For this purpose, the PCR method is used.

The essence of PCR diagnostics is to identify the pathogen using the indication of specific regions of the genome. The method provides high sensitivity and specificity of identifying an infectious agent, starting from the very early stages development of the infectious process. The material for research is scrapings from the oral mucosa.

Strepto-staphylococcal lesions (pyoderma)

The leading symptoms of the disease are caused by the addition of pyogenic microflora. Body temperature is increased - in severe cases up to 38-39°C, signs of intoxication and lymphadenitis of regional nodes, prone to abscess formation, are expressed. On the red border and skin of the lips there are single or multiple purulent pustules, thick straw-yellow crusts; the surrounding skin is often hyperemic and infiltrated. The anterior parts of the oral mucosa may also be affected: lips, gums, tip of the tongue. In this case, against a hyperemic background, separate and merging erosions, covered with a loose coating, are revealed.

Vincent's ulcerative gingivostomatitis

Rarely observed in young children. In recent years, schoolchildren and teenagers also rarely get sick. The causative agents are considered to be saprophytes of the oral cavity: fusiform bacillus and spirochetes, which under certain conditions become pathogenic; they are found in large quantities in the discharge from the surface of ulcers.

The general condition of the child is serious, since the absorption of tissue decay products causes significant intoxication of the body, the body temperature is elevated, the regional lymph nodes are enlarged and painful, and salivation is increased. The gums are swollen, dark red in color; in the area of ​​ulceration, the interdental papillae seem to be cut off due to the disintegration of the tissue at their apex and are covered with a dirty, soiled coating with a putrid odor.

The goals of treatment of acute herpetic stomatitis are:

— elimination of the cause of the disease;

- prevention of complications (streptostaphylococcal pyoderma, ulcerative necrotizing gingivostomatitis).

The doctor’s tactics when treating patients with acute herpetic stomatitis should be determined by the severity of the disease and the period of its development.

Indications for hospitalization:

- prolonged dehydration and intoxication;

- severe and complicated course of the disease.

Complex therapy for acute herpetic stomatitis includes general and local treatment. For moderate and severe disease, it is advisable to carry out general treatment together with a pediatrician. Due to the peculiarities of the clinical course of acute herpetic stomatitis, rational nutrition and proper organization of feeding the patient occupy an important place in the complex of therapeutic measures. Food must be complete, i.e. contain all the necessary nutrients and vitamins. Considering that the pain factor often forces the child to refuse food, first of all, before feeding, it is necessary to treat the oral mucosa with Cholisal gel, which provides a quick analgesic effect, topical anesthetics, a 5-10% oil solution of benzocaine or a gel containing lidocaine + chlorhexidine (lidochlor).

The child is fed predominantly liquid or semi-liquid food that does not irritate the inflamed mucous membrane. Much attention is paid to administering a sufficient amount of fluid. This is especially important during intoxication.

Local treatment for acute herpetic stomatitis requires the following tasks:

Relieve or reduce painful symptoms in the oral cavity;

Prevent repeated rashes of lesions (reinfection);

Promote the acceleration of epithelization of lesion elements.

From the first days of the development of acute herpetic stomatitis, taking into account the etiology of the disease, serious attention should be paid to antiviral treatment. For this purpose, it is recommended to use ointment with bromonaphthoquinone (bonaftone ointment), tebrofen ointment, acyclovir ointment, interferon alpha-2 (viferon), herpferon, alpizarin ointment (0.5-2%), solution of leukocyte human interferon and others antivirals.

Named medicines It is recommended to use it repeatedly (5-6 times a day) not only when visiting a dentist, but also at home. It should be borne in mind that it is advisable to use antiviral agents both on the affected areas of the mucous membrane and on areas without elements of the rash, since they are to a greater extent have a preventive effect rather than a therapeutic one. During the period of extinction of the disease, antiviral drugs and their inducers are replaced with anti-inflammatory and keratoplasty drugs.

Weak antiseptics and keratoplastics are of leading importance during this period of the disease. This is an oil solution of vitamin A, sea ​​buckthorn oil, Vitaon oil, rosehip seed oil, ointments with methyluracil, solcoseryl, Actovegin (gel, ointment, cream, dental adhesive paste). The preparations are applied to the treated wound surface until complete epithelization.

The study of the state of local immunity in children with acute herpetic stomatitis made it possible to clarify the characteristic dynamics of various factors of local immunity in this disease. Thus, the content of IgA, which plays a major role in protecting the oral mucosa, correlates with the severity and nature of the pathological process. The content of lysozyme in saliva in patients with acute herpetic stomatitis depends on the severity of stomatitis and gingivitis. The revealed patterns of dynamics of indicators of local immunity of the oral cavity allow us to consider it pathogenetically justified to include drugs aimed at their correction in the complex treatment regimen for acute herpetic stomatitis. These drugs include immunomodulatory agents: imudon, glucosaminyl muramyl dipeptide (lycopid), azoximer bromide (polyoxidonium), lysobact, etc.

In case of severe damage, the elements of the skin rash are lubricated with salicylic-zinc paste (lassara) to form a thin crust in order to prevent complications (streptostaphylococcal pyoderma). Physiotherapeutic procedures are also used - ultraviolet irradiation and helium-neon laser irradiation.

It should be noted that acute herpetic stomatitis occurring in any form is an acute infectious disease, in all cases requiring the attention of a pediatrician and dentist in order to ensure complex treatment, exclude contact of a sick child with healthy children, take measures to prevent this disease in children's groups.

Treatment algorithm for children with acute herpetic stomatitis

Local treatment:

In the prodromal period, use 2-3 drops in the nose and under the tongue every 4 hours:

• human leukocyte interferon;
• meglumine acridone acetate (cycloferon).

The following are used as painkillers (before eating and before treating the oral mucosa):

• 5-10% suspension of benzocaine (anesthetic) in peach oil;
• lidocaine + chlorhexidine (lidochlor gel), Kamistad gel, 2% xylocaine solution.

To remove necrotic tissue and clean the mucous membrane and gingival margin and teeth from plaque, enzyme solutions are used: trypsin, chymotrypsin, chymopsin, ribonuclease, lysoamidase, etc.

For the purpose of antiseptic treatment of the oral cavity, we recommend the following groups drugs:

• group of oxidizing agents (potassium permanganate, 1% hydrogen peroxide);
• cationic detergents (hexetidine solution (hexoral) or 0.02% chlorhexidine solution, miramistin solution);
• drugs of the nitrofuran series (furacilin); 1:5000 or 1:10000;
• corsodil solution or 0.02% chlorhexidine solution.

0.25% oxolinic, 0.25-1% tebrophenic, 2% alpizarin, 0.25-0.5% florenal, 1% bonafthonic, 0.25% adimalic, 5% liniment helepin or alpizarin, Viferon, solutions of interferon and reaferon.

During the period of extinction of the disease, anti-inflammatory and keratoplasty drugs are prescribed: solcoseryl jelly, Actovegin, Cholisal gel, Vitaon oil, Aekol, sea buckthorn oil, rosehip oil, etc.

General treatment

Prescribe the following drugs as antipyretics and painkillers: paracetamol (tablets, syrup), efferalgan (tablets, syrup), panadol (syrup), calpol (syrup), cefekon in the form of suppositories (5-10 mg/kg body weight 3- 4 times a day), Tylenol (syrup, tablets), Nurofen (syrup), etc. Recommended antihistamines- mebhydrolin (Diazolin), hifenadine (Fenkarol), loratadine (Claritin), clemastine (Tavegil), suprastin.

Among the antiviral drugs prescribed acyclovir (5 mg per day can be used from 3 months of life), bonafton (0.025 g 1 to 4 times depending on age), alpizarin, meglumine acridone acetate (cycloferon), interferon alpha-2 (viferon-1 rectal suppositories ).

Immunomodulatory drugs used in this treatment regimen are imunal, lycopid, polyoxidonium, lysobact, and immunomishki. In addition, drinking plenty of fluids and eating non-irritating foods is recommended.

Treatment of complications of acute herpetic stomatitis

Treatment of pyoderma includes removal of purulent crusts and treatment of the mucous membrane. The crusts are removed after application of anesthesia, having previously softened them with a 1% solution of hydrogen peroxide. The oral mucosa and erosive surfaces are thoroughly washed with antiseptic agents, treated with proteolytic enzymes, and then lubricated with antibacterial agents, for example, 2% lincomycin, 2% neomycin, erythromycin (10,000 units per 1 g), 10% dermatol and other ointments. If there is a history allergic reactions for antibiotics, creams with glucocorticoids (fluorocort, flucinar, lorinden hyoxysone, etc.) are added to antibacterial ointments.

Treatment of Vincent's ulcerative gingivostomatitis is symptomatic.

Caring for a child with acute herpetic stomatitis

A sick child must be isolated from other children and report the disease to a child care facility if the child attends one.

In order to stop the spread of infection in children's institutions, it is necessary to disinfect premises, household items, toys with a 3% solution of chloramine B*, as well as quartzize the premises.

All children who have been in contact with sick people are lubricated with 0.25% oxolinic ointment on the mucous membranes of the nose and mouth or instilled in the nose with a solution of human leukocyte interferon, and also given ascorbic acid orally for 5 days.

The patient is given separate dishes, bed, and towel. He needs to stay in bed and follow all doctor's orders. Receive special food. Fresh vegetable decoctions in meat or fish broth are recommended, to which crushed boiled meat or fish or chicken fillet, boiled vegetables. Warm low-fat milk and dairy products, scrambled eggs. The patient's food can include freshly prepared, non-irritating juices from vegetables and fruits (for example, a mixture of carrot, cabbage and apple juices). Plenty of fluids and chemically and mechanically gentle food are recommended. Before eating, the oral mucosa should be numbed. To do this, first carefully lubricate the lips, and then the affected areas of the oral mucosa with an anesthetic emulsion. The emulsion is applied to the lips with the index finger wrapped in cotton wool. After eating, the oral cavity must be freed from food debris by rinsing the mouth with warm boiled water. For small children, the head is slightly lowered and the mouth is washed out with a rubber spray.

K.V. Tidgen, R.Z. Urazova, R.M. Safina

Kazan State Medical University

Dental clinic No. 9, Kazan

Tidgen Kristina Vladimirovna – graduate student of the Department of Pediatric Dentistry

Literature:

1. Pediatric therapeutic dentistry. National leadership / ed. VC. Leontyeva, L.P. Kiselnikova. - M.: GEOTAR-Media, 2010. - 896 p. (National Guidelines Series).

2. Persin L.S. Pediatric dentistry. - Ed. 5th, revised and additional / L.S. Persin, V.M. Elizarova, S.V. Dyakova. - M.: Medicine, 2003. - 640 pp.: ill. (Educational literature for students of medical universities).

3. Handbook of pediatric dentistry / ed. A. Cameron, R. Widmer; lane from English / ed. T.F. Vinogradova, N.V. Ginali, O.Z. Topolnitsky. - 2nd ed., rev. and processed - M.: MEDpres-inform, 2010. - 392 p.: ill.

4. Vinogradova T.F. Periodontal diseases and oral mucosa in children / T.F. Vinogradova, O.P. Maksimova, E.M. Melnichenko. - M.: Medicine, 1983. - 208 p.: ill.

5. Selected reports and lectures on dentistry / Intro. Art. acad. RAMS E.I. Sokolova. - M.: MEDpress, 2000. - 140 p.

Briefly about herpetic stomatitis

The disease is a disease that affects the oral mucosa and is caused by the herpes simplex virus. Occurs in children from six months to three years. A child becomes infected through airborne infection from a virus carrier or a sick person, as well as through sexual contact. As a rule, the soil for the disease is prepared by weakened immunity.

Classification of herpetic stomatitis

According to the course of the disease there are:

• spicy;
• chronic recurrent.

Based on severity:

• light;
• medium-heavy;
• heavy.

Clinical picture of herpetic stomatitis

In all of the above forms, both acute and recurrent herpes can occur. The severity of the disease is diagnosed based on general well-being, degree of violation and local manifestations.

Mild severity
Characterized practically complete absence common symptoms. The exception is a slight increase in body temperature to 37 or 37.5 degrees. The appearance of lesions is preceded by gingivitis, or in other words, inflammation of the gums. The elements of damage should be understood as bubbles in the amount of 3 to 4 pieces, which quickly open and form erosions. It is on such an eroded surface that fibrinous plaque is observed. In addition to what has already been said, it is also necessary to pay attention to the presence of signs of submandibular lymphadenitis.

Moderate severity
It is characterized by a significant increase in temperature, which ranges from 38 to 38.5 degrees. The patient is accompanied by:

• headache;
• weakness;
• malaise;
• nausea;
• loss of appetite.

There is strong salivation. The number of lesions totals about twenty foci, which appear not only on the mucous membrane, but also around the mouth. In the dominant case, signs of lymphadenitis and gingivitis appear.

Severe severity
It is characterized by initial, quite strong, disturbances in the general condition. The patient suffers from:

• muscle and headache;
• ailments;
• elevated body temperature (up to 40 degrees);
• nausea and vomiting (in some cases);
• lesions of the cervical and submandibular lymph nodes

In addition to the mucous membrane of the oral cavity, the lesion affects the skin of the fingers, eyelids, and conjunctiva. The most obvious place of localization is the mucous membrane of the lips, hard and soft palate, and lips. Elements of the lesion are also present in the perioral area. All of them are located in groups and number more than 25 pieces.

General symptoms of herpetic stomatitis in children

Its harbinger is always an increase in temperature to 38 degrees. The child becomes capricious and irritable. However, it is possible to suspect the disease only after a rash, which appears on the second or third day of the disease. However, before the rash, a picture of intoxication is observed, caused by enlarged lymph nodes and the presence of gingivitis in the oral cavity. This causes the gums to swell and the child’s mouth remains slightly open due to which saliva constantly flows out. In turn, due to the disease, it becomes painful for him to swallow it. Painful sensations increase especially during the rash.

Based on the fact that grouped small rashes open extremely quickly, forming painful ulcers, the child:

• refuses food;
• sleeps poorly;
• cries constantly.

Erosion formed in the oral cavity quickly covers white coating. Over time, they self-clean and become covered with a layer of epithelium.

Choice of treatment tactics

Treatment will always depend on the severity of the disease. For the treatment of herpetic stomatitis in children, the following are used:

• antiviral ointments;
• antiseptics that are used three to four times a day.

If positive dynamics are observed, epithelializing drugs are also prescribed. However, it is worth noting that any manifestations of the disease disappear after seven days.

In the case of moderate or severe forms of the disease, not only local therapy is used, but also general therapy. Its essence lies in taking antiviral drugs, which include valacyclovir or acyclovir, vitamins and immunocorrective agents.

Mandatory are:

1. Diet;
2. Bed rest;
3. Drink plenty of fluids.

In case of muscle pain and headaches, high temperature Symptomatic therapy is also used, which consists of taking painkillers and antipyretics. To treat emerging ulcers, treatment of the surface of the affected areas with antiviral ointments, enzymes that accelerate epithelization and enzymes is prescribed.

Important!!!

The approach to the treatment of herpetic stomatitis in children and adults is radically different.

Forms of herpetic stomatitis

Regarding this disease, there is a classification into two forms:

• acute herpetic stomatitis;
• chronic recurrent stomatitis.

Acute herpetic stomatitis in children

It has five periods of development, namely:

1. Incubation period;
2. Prodromal period;
3. The period of the height of the disease;
4. Fading of her symptoms;
5. Clinical recovery.

In children, acute herpetic stomatitis occurs against the background of primary infection with the herpes simplex virus due to a weakened immune system. We will not repeat the symptoms, since they are described above.

Diagnosis of acute herpetic stomatitis

It is quite a difficult task. As a rule, diagnosis is based on the use of special virological, immunological, molecular biological cytological and serological studies. A blood test confirms nonspecific changes that are characteristic of inflammatory process in its acute form. The pH level in saliva first shifts to the acidic side and then to the alkaline side. It also reveals a reduced content of lysocythyme and the absence of interferon.

Histological analysis reveals characteristic intraepithelial locations of vesicles, namely in the styloid layers. Lenticular and ballooning degeneration and acantholysis in epithelial cells are also observed, and an acute inflammatory process is expressed in the mucous membrane.

In its turn cytological examination provides a different picture. Gestiocytes and neutrophils predominate. The presence of layers of epithelial cells is noticeable, in which the phenomenon of polymorphism, expressed in the form of syncytia, is very often observed. Characteristic giant multinucleated cells from 30 to 120 microns in diameter also appear, which differ in size, color and shape by sharp polymorphism. As a rule, nucleoli are not observed, however, this does not mean their absence, but their scarcity.

After the onset of clinical recovery, the herpes virus is not destroyed, but remains in the carrier’s body throughout his life. In this regard, a person has a non-sterile, unstable immunity.

Treatment of acute herpetic stomatitis

Treatment is carried out by a combination of antiviral therapy and elimination of painful symptoms of the disease. A necessary condition Treatment is regular cleansing of the oral cavity from the accumulation of necrotic masses. In case of severe disease, treatment is carried out in a hospital setting. In order to speed up recovery, as well as prevent possible relapses, vitamins and drugs that stimulate the immune system are used. The patient's condition is alleviated by drinking plenty of fluids and completely eliminating spicy and fried foods. Adults give up bad habits.

Chronic recurrent herpes

The line between acute stomatitis and recurrent is extremely thin. Recurrent herpes is characterized by multiple or single rashes on the lips or mouth, which the latter case localized in the sky. They may appear on the wings of the nose, genitals or mucous membranes of the eyes. The rash is accompanied by a burning sensation, followed by the formation of a blistering rash and its transition to fused erosion. Discomfort in the mouth and pain are caused by eating.

In the case of relapses of herpetic stomatitis, the provocateurs are a wide variety of microtraumas inflicted on the oral mucosa due to bad habits, which include:

• chewing or biting cheeks, lips;
• tongue biting;
• putting toys in mouth.

Among the provocateurs are also:

• dental diseases;
• hypothermia;
• insolation.

Symptoms of chronic recurrent herpes

It proceeds like acute herpetic stomatitis, therefore special symptoms the disease does not.

Treatment of chronic recurrent herpes

During the period of exacerbation, there are no fundamental differences in treatment. Decaris is usually prescribed in an amount of 50 mg. from one to two times a day. The period of application is from five to ten days. At the same time, local treatment is carried out to ensure the appearance of so-called “light” long-term gaps.

Causes of herpetic stomatitis in adults

As a rule, it manifests itself in those who have previously had this disease. The disease returns under the influence of the following factors:

• hypothermia;
• reduced immunity;
• ARVI;
• exacerbation of inflammatory chronic diseases (sinusitis or tonsillitis);
• seasonal vitamin deficiency;
• allergic reactions;
• stress;
• injuries to the mucous membrane, red border of the lips;
• medications that reduce immunity.

The following reasons, which also affect the return of herpetic stomatitis, are:

• accumulation of stone or soft plaque on the teeth;
• carious lesions of teeth;
• untreated periodontitis or hygiivitis;
• mouth breathing;
• chronic disease of the tonsils.

Treatment of herpetic stomatitis in adults

The basis of treatment is antiviral and immunostimulating agents. Vitamins are also used, which are prescribed taking into account a three-month intake to maintain immunity. Antiseptic solutions are also used to rinse the mouth. Symptomatic remedies are indispensable to combat high temperatures exceeding 38 degrees.

Important!!!
If the temperature is below this mark, there is a decrease in the production of interferon in the body, which prevents the full formation of immunity.

It must be remembered that the disease is contagious. Therefore, it is advisable to avoid kissing, drinking drinks and food from the same container, and using the same cutlery.

Traditional methods of treating herpetic stomatitis

At a time when medicine was not yet as popular as it is today, most of our ancestors treated themselves for the illness we describe. So, for the treatment of herpetic stomatitis:

1. Pour 20 grams of boiling water over it. crushed dry oak bark and leave it in a water bath for thirty minutes. After this, strain and bring the solution to a quantity of 200 ml;
2. 5 gr. leaves walnut pour one glass of boiling water. Let it brew for thirty minutes and strain. Use 1 dessert spoon three times a day to rinse for 10 to 12 days;
3. Add freshly prepared cabbage juice to boiled water. The composition is a wonderful remedy against inflammatory processes.;
4. Stir two tablespoons of white birch, three tablespoons of knotweed and burnet, four tablespoons of ordinary flax. Mix well. Take three tablespoons of the resulting mixture and pour one liter of boiling water. Take 3 ml. 7 times a day.

Sometimes small ulcers form on the mucous membrane of the child’s mouth, which cause great discomfort. Painful sensations when chewing food, when swallowing water, the baby is capricious and does not sleep well. Most likely, the reason for everything is herpetic stomatitis.

Herpetic stomatitis is the most common type of inflammation of the oral mucosa caused by the herpes virus.

If it enters the body, the herpes virus can cause damage to the skin, mucous membranes, eyes, nervous and cardiovascular systems.

However, the most common area of ​​manifestation herpetic virus- oral cavity, lips, nose and skin around the mouth.

Video: childhood stomatitis

Causes

The only cause of herpes stomatitis is infection with the pathogen.

Certain categories of children are more susceptible to it:

• children with weakened immune systems;
• children with chronic diseases;
• children with HIV;
• children with diabetes and other endocrine diseases.

Pathogen

The causative agent is the herpes simplex virus.

According to its antigenic properties, it is divided into 2 types:

• causes damage to the oral mucosa;
• causes damage to the genital organs.

Primary infection usually occurs between the ages of 1 and 3 years, since during this period babies have not developed their own body defense systems, and the antibodies received from the mother disappear by the age of one year, and the child becomes susceptible to infection.

Video: herpetic infection

Routes of infection

The source of infection is a sick person (or a virus carrier).

These could be relatives, other children, and service staff. Infection occurs through airborne droplets, through household items and contaminated toys.

Epidemic outbreak in kindergarten can affect up to 75% of children, the virus is so strong.

Symptoms

Herpetic stomatitis in children is very difficult to recognize in the first 2-3 days of the disease, since the rash does not appear immediately.

Symptoms in children are as follows:

• a sharp increase in temperature (above 370 - 390 C);
• enlargement of the submandibular and cervical lymph nodes;
• swelling and redness of the soft tissues of the oral cavity;
• saliva constantly flows from the baby’s slightly open mouth;
• general poor health of the child: he becomes capricious, restless;
• On the 2nd–3rd day of the disease, small blisters appear, which cause pain in the baby.
• after the blisters burst, characteristic erosions and ulcers appear, which take quite a long time to heal (3–5 days);
• erosions in the oral cavity become covered with a white coating and gradually clear and epithelialize;
• the child may refuse to eat all this time due to painful sensations in the mouth.

Classification

Herpetic stomatitis is classified depending on the course and severity of the disease.

With the flow

Depending on whether the disease first appeared or whether it relapsed, acute and chronic herpetic stomatitis are distinguished.

Acute form in children

It develops when the herpes virus first enters the body. The incubation period can last from 2 days to 3 weeks, depending on the immunity of its carrier. In children under one year of age, this period is up to 3 days.

Accompanied by elevated body temperature, hyperemic oral mucosa, single or grouped lesions, inflammation and bleeding of the gums.

Depending on the severity, the rash may also appear on the skin around the mouth. It is better to isolate a sick person due to to a large extent contagiousness.

Video: acute herpetic stomatitis

Chronic relapsing

This type of stomatitis occurs when:

• exacerbation of chronic diseases;
• weakened immune system;
• frequent ARVI;
• regular damage to the soft tissues of the oral cavity (with traumatic bite, biting lips and cheeks);
• the presence of carious cavities.

Usually herpetic rashes with chronic form stomatitis occurs on the tongue, lower and upper sky, cheeks. Lesions appear in groups, eventually merging and turning into very painful erosions.

Main difference from acute form– absence of other manifestations of the disease other than rashes.

Treatment is usually carried out in the same way.

By severity

Acute herpetic stomatitis occurs in three forms of manifestation: mild, moderate and severe.

The condition is assessed by the nature and severity of symptoms.

Light form

The mild form is characterized by a minor impairment of the child’s condition:

• low-grade body temperature (37–37.5°C);
• catarrhal gingitis or mild inflammation of the mucous membrane at the site of the future rash may occur;
• pain when eating;
• During the rash, the mucous membrane is hyperemic and swollen, and individual erosions appear, covered with a fibrous coating.

Rashes appear once and new elements no longer appear. Changes in the blood are usually absent. The duration of the disease is 4–5 days.

Photo: Mild form of herpetic stomatitis

Moderate form

Already in the initial period it has quite bright severe symptoms toxicosis and damage to the oral mucosa:

• deterioration in the child’s well-being: weakness, loss of appetite, the baby becomes capricious;
• catarrhal tonsillitis is possible, there may be symptoms of acute respiratory infections;
• enlargement and tenderness of the submandibular lymph nodes;
• low-grade body temperature.

As the disease progresses, the following are observed:

• nausea;
• headache;
• pale skin;
• temperature rise to 38–39°C;
• rash of lesions in the oral cavity (10–25 pieces), on the skin of the perioral area;
• increased salivation;
• gingitis becomes pronounced, the gums bleed.

With this form of the disease, the rashes often recur.

The duration of the period of extinction of the disease depends on the resistance of the baby’s body, the condition of the teeth and the rationality of therapy.

Healing of the lesions lasts about 4-5 days. Gingitis, lymphadenitis and bleeding gums last longer. In the blood, an increase in ESR up to 20 mm/hour is observed, often - leukopenia, less often - slight leukocytosis.

Severe form

Acute herpetic stomatitis in children in severe form is quite rare.

The initial period is characterized by the presence of all the signs of an incipient acute infectious disease:

• apathy;
• headache;
• adynamia;
• increased sensitivity of the skin.

Signs of damage to the cardiovascular system are often observed:

• heart rhythm disturbances;
• lowering blood pressure;
• muffling of heart sounds.

Some children develop:

• nausea and vomiting;
• nosebleeds;
• inflammation and enlargement of the submandibular and cervical lymph nodes.

As the disease progresses, the body temperature rises to 39–40°C, a slight runny nose, slight coughing may occur, the child’s eyes are sunken, and the lips are parched, dry and bright. The mucous membrane in the oral cavity is severely hyperemic, gingitis is pronounced.

After 2 days, up to 25 lesions appear in the oral cavity. Often, rashes in the form of herpetic blisters appear in the perioral area, on the skin of the eyelids, and the conjunctiva of the eyes. In the oral cavity, the rashes recur; at the height of the disease, up to 100 of them form.

Groups of elements merge, and large areas of necrosis of the mucous membrane are formed. A putrid odor appears from the mouth, profuse salivation with blood admixture.

When a severe form of herpetic stomatitis is observed, treatment at home becomes ineffective. The active participation of the dentist and pediatrician is necessary, so hospitalization is recommended.

Diagnostics

The diagnosis is made based on the clinical picture of the disease. Due to the fact that virological and serological research methods are quite lengthy, Lately The immunofluorescence method is becoming popular. In addition, a clinical blood test is performed.

Treatment

Treatment for acute herpetic stomatitis in children should begin immediately, before the disease develops into a more severe form.

The results of medical studies have shown that with this disease, clinical recovery occurs much earlier than the baby’s immune system is restored.

Therefore, treatment should not be limited only to direct treatment of stomatitis: it is necessary to obtain recommendations from a pediatrician, dentist, immunologist and neurologist.

Treatment should be aimed at both healing the ulcers and restoring the body's defenses. The method of treatment is determined by the degree of its severity. The choice of therapy also depends on how quickly the parents noticed the disease and sought help from a specialist.

Local

Local treatment is aimed at relieving or reducing pain in the oral cavity, as well as preventing recurrence of rashes and healing existing lesions.

Antiviral drugs are used for these purposes:

• 0.25% oxolinic ointment;
• 0.5% tebrofen ointment;
• Zovirax;
• Interferon solution.

These medications should be used 3-4 times a day. They should be applied both to the affected area and to those areas of the mucous membrane that are not yet affected by the disease.

Photo: Antiviral drugs - Zovirax and Oxolinic ointment

These drugs can be discontinued during the period of extinction of the disease.

In addition, for local therapy fit:

• oil solutions A and E;
• sea ​​buckthorn oil;
• rosehip oil;
• oxygen cocktail.

General

General treatment should include:

1. Taking antiviral drugs orally. It can be:
   • acyclovir;
   • Zovirax;
   • alpizarin.
2. Stimulation of immunity. The following drugs may be suitable for this:
   • imudon (for children over 3 years old);
   • levamisole;
   • immunal solution (for children over 1 year);
   • Immunal tablets (for children over 4 years old).
3. Vitamin therapy. It should include:
   • B vitamins;
   • vitamin A;
   • vitamin C;
   • folic acid;
   • minerals (iron, zinc).

The treatment regimen is prescribed by the doctor depending on the severity of the disease and the age of the child.

Photo: Antiviral tablets Alpizarin and Acyclovir

Video: vitamins for children

Symptomatic

Symptomatic treatment of herpes stomatitis involves local anesthesia. To do this, it is recommended to smear painful areas of the oral mucosa with an anesthetic solution or gels for teething gums based on lidocaine (Kamistad, Kalgel).

Photo: Pain relieving gels Kamistad and Kalgel

When the inflammation passes, wound-healing drugs are used that help restore the oral mucosa (solcoseryl, vinylsol, panthenol).

To reduce high fever and relieve pain, use:

• preparations with ibuprofen - Ibufen, Nurofen;
• preparations with paracetamol - Calpol, Panadol
• preparations with nimesulide - Nimesil, Nise.

The choice of drug, as well as its form and dosage, must correspond to the age of the child.

Diet

Due to the nature of the course of this disease, diet during treatment is of great importance. Food should be complete, rich in vitamins and all nutrients.

Must be used:

• fresh fruits and vegetables, berries – neutral in taste;
• juices (especially carrot), fruit drinks;
• dairy products;
• minced meat dishes (in limited quantities);
• tea, rose hip decoction, water.

• salty;
• sweet;
• sour;
• bitter.

Before feeding the child, it is necessary to numb the oral mucosa with a 2-5% solution of anesthetic emulsion.

Food should generally be liquid or semi-liquid and not irritate the mucous membranes. The same applies to the temperature of the food - it should not be hot or cold, as this can cause additional irritation to the oral cavity.

The child should drink enough fluid, especially if intoxicated.

Prognosis and possible complications

Once it enters a child’s body and causes a primary herpetic infection, the virus remains latent for life or sometimes causes relapses of the disease (chronic recurrent stomatitis).

Herpetic stomatitis in a child can turn out like this serious complication, such as herpetic keratoconjunctivitis. This is a dangerous disease that can lead to blindness.

In addition, if your child refuses to eat or drink because the mouth is sore, it can lead to dehydration.

Prevention

The most effective methods of prevention:

• hardening the child;
• thorough oral hygiene;
• balanced diet;
• isolating the child from sick people.

These measures, of course, will not be able to protect a child from infection one hundred percent, but will reduce the possibility of complications and the development of a severe form of the disease.

Photo

On days 2–3, herpetic stomatitis gives rise to rashes in the form of ulcers. At this time, making a diagnosis is not particularly difficult.

FAQ

How many days is a child contagious?

On average, the duration of the disease is 8 days, during which a child can infect another person through close contact. After this time, the baby ceases to be dangerous to others.