Causes of herpetic gingivostomatitis and treatment features

From this article you will learn:

• viral stomatitis in children: photos,
• herpetic stomatitis - symptoms and treatment,
• effective drugs for children and adults,
• vaccination (Vitagerpavac vaccine).

Herpetic stomatitis is an infection of the oral mucosa caused by the herpes simplex virus (types HSV-1 and HSV-2). Clinical studies show that the peak incidence occurs in children aged 9 months to 3 years, and recurrent cases of the disease most often occur before 6 years of age. In adolescents and adults, if relapses occur, they are usually due to a weakened immune system (for example, after a cold).

Herpetic viral stomatitis is usually divided into “acute primary” and “recurrent” (chronic) forms. The development of the acute primary form of the disease always occurs in early childhood - this can happen between 3-6 months and up to 3 years. This is due to the fact that it is at this time that the child’s specific antibodies to the herpes virus, which the child received from the mother during pregnancy, gradually disappear (but the child’s own antibodies have not yet appeared).

Herpetic stomatitis: photo

In 90% of children, primary acute herpetic stomatitis develops against the background of a still fairly high residual level of antibodies (received from the mother), and therefore there are no acute symptoms of the disease. Parents in most cases generally mistake this condition for symptoms of teething. But in 10% of children, development occurs against the background of a low residual level of antibodies - in this case, herpes stomatitis in children can be extremely severe and very painful (including symptoms of intoxication and dehydration).

In every seventh to tenth child, acute primary herpetic stomatitis becomes chronic with periodic relapses. However, the choice of drug therapy does not depend on whether you have a primary acute or chronic form of herpetic stomatitis, but solely on the severity of the clinical manifestations. And below in the article we will dwell in detail on the symptoms, strategies and treatment regimens for viral herpetic stomatitis. An equally important point is the correct diagnosis of this disease, because Herpetic stomatitis must first be distinguished:

• from aphthous stomatitis,
• enteroviral vesicular stomatitis (EVS),
• from “herpetic sore throat.”

Important: correct diagnosis is important because for EVS and herpetic sore throat, it will no longer be Acyclovir that will be used, but completely different groups of drugs. For example, if for herpetic stomatitis the treatment is based on drugs with antiviral activity, then for “herpetic sore throat” (which in fact has nothing to do with the herpes virus at all) the antibiotic amoxicillin with clavulanic acid, for example, Amoxiclav, is used.

Herpetic stomatitis in children: symptoms and treatment

In acute primary herpetic stomatitis, general symptoms may be observed: fever, lack of appetite, muscle pain, irritability, malaise and headache, sometimes redness of the conjunctiva of the eyes, enlargement of the submandibular/cervical lymph nodes (lymphadenopathy), nausea and vomiting. Based on the severity of these symptoms, one can speak of a mild, moderate or severe course of this disease.

With a mild course of primary acute herpetic stomatitis, fever and other symptoms of intoxication may be completely absent or reach 37.2-37.5 ° C. In case of moderate to severe flow, the temperature can rise to 38-39 °C, and in severe case – up to 39.5-40 °C. In its development, acute primary herpetic stomatitis goes through 5 stages: prodromal, catarrhal, the stage of the onset of rashes, the stage of extinction and the stage of clinical recovery (source). At this link you can learn more about the symptoms of acute herpetic stomatitis - at each of these stages.

If we are talking about relapses of herpetic stomatitis (including in adults), then in the prodromal period patients complain mainly only of itching or burning, as well as slight soreness in some areas of the oral mucosa. Systemic manifestations during relapses are most often absent or mild. With recurrent herpetic stomatitis, lesions (herpetic blisters) often appear not only on the oral mucosa, but also on the red border of the lips.

Important: many patients note that in the places where the bubbles appear they always first feel a slight burning, itching or tingling of the mucous membrane. It is very important to teach patients to feel this moment in order to begin treatment of herpetic stomatitis in this very initial period of the disease (in this case, therapy will be most effective).

Symptoms upon examination of the oral cavity –

The main objective symptom of herpetic stomatitis is the formation on the mucous membrane of the gums, cheeks, palate, tongue - numerous small blisters (Fig. 4), which quickly open, turning into painful ulcerations (Fig. 1-3). The blisters are initially small, about 1 mm in size, then they enlarge and open - as a result of which numerous small ulcerations merge with each other, forming large ulcerations with jagged boundaries (Fig. 5-6).

Herpetic lesions are bright red in color and are usually very painful. It is because of the pain that many children stop drinking water - as a result, their general condition worsens even more, and symptoms of dehydration also develop (according to statistics, in approximately 86% of children). Due to pain, children may also refuse to eat, they are diagnosed with bad breath, and the submandibular and cervical lymph nodes are enlarged.

Manifestations of herpetic stomatitis -

Then the following happens - the ulcerations are gradually covered with yellowish-gray films (Fig. 5-6). The total duration of the disease from the moment the blisters appear until the epithelization of the ulcers is usually 10 days, but if we are talking about severe forms of herpetic stomatitis, healing can occur only after 2 weeks. If herpetic stomatitis in children causes dehydration, dry mouth will occur in parallel (+ very little urine will be produced).

However, if there is no dehydration, then with stomatitis in children, on the contrary, drooling from the mouth can often be observed. If one of the localization sites for herpetic stomatitis is the gums, then severe swelling, redness + bleeding may be observed when brushing your teeth. In this case, a diagnosis of “herpetic gingivostomatitis” is made (Fig. 5-7). As a rule, herpetic stomatitis in adults and children is combined with the appearance of ordinary herpetic rashes in the corners of the mouth and on the red border of the lips (Fig. 8).

Herpetic gingivostomatitis –

Features of herpetic stomatitis in children -

We have already said above that with the development of viral stomatitis in children, the symptoms of intoxication can be aggravated by the development of dehydration associated with the child’s refusal to drink water and eat food. In these cases, even with fairly small herpetic lesions, the child may have a high fever and feel unwell. Also, in children (more often than in adults) “herpetic gingivostomatitis” develops, in which there is severe swelling and redness of the entire gingival margin around the teeth.

Important: you must understand that a child is born with a sterile oral cavity, and is infected with the herpes simplex virus from parents or relatives (remember this when you kiss a child on the lips, lick his spoon or put his pacifier in your mouth). It is worth knowing that you can infect your child with herpes, even if you do not have any clinical manifestations (rashes) at all, because. in approximately 10% of adults, the herpes virus is constantly present in the saliva.

In addition, it is worth knowing that, unlike the non-contagious aphthous form of stomatitis, herpes stomatitis in children and adults is extremely contagious. The most contagious period is from the moment the vesicles burst until they are completely healed. Therefore, if you have several children, then you should at least limit their contacts. In addition, if a child touches herpetic rashes near the mouth or licks his fingers, and then rubs his eyes with these hands, the development of herpetic eye lesions is possible. In this regard, in young children it is often recommended to instill special antiviral drops into the eyes for prevention.

Features of herpetic stomatitis in adults -

As we said above, herpetic viral stomatitis in the oral cavity is most often caused by the herpes simplex virus type HSV-1, less often - type HSV-2. The latter, according to statistics, causes about 10% of all cases of herpetic stomatitis, and it occurs mainly only in adults. HSV-2 is the type of virus that is most often responsible for the development of genital herpes, but the spread of oral sex has led to the fact that this type of virus also begins to cause stomatitis.

Why is this worth special mention... The fact is that the HSV-2 virus type is much more virulent (pathogenic, harmful) - in comparison with the HSV-1 virus type. Herpetic stomatitis in adults, which is caused by the herpes virus HSV-2, will be much more severe, and it will be much more difficult to treat. Also, the HSV-2 virus develops resistance much faster to the main antiviral drugs, for example, Acyclovir.

If in children Acyclovir is quite effective, then in adults the resistance of herpes simplex viruses to Acyclovir reaches approximately 10%, and some recent clinical studies show that this figure in some groups of patients with immunodeficiency can even reach 30-36%. It has been noted that drug resistance to acyclovir develops more often in patients with weakened immune systems (who have taken repeated courses of acyclovir), as well as in patients with the herpes simplex virus type HSV-2.

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

an 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 [1].

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 [1].

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). It causes various diseases of the 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.

Herpes 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) [3]. 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 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 (abundant vascularization, high levels 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. During the acute period of stomatitis, viremia is observed in children.

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 of clinical signs of stomatitis. The appearance of lesions on the oral mucosa is preceded by lymphadenitis of varying severity. 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 suppress natural immunity, which is restored 7-14 days after the child’s clinical recovery [1].

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 suffering a herpetic infection in one clinical form or another.

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 gray bottom with a rim of hyperemia around it.

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, the protective mechanisms of saliva are well expressed: 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, moodiness, loss of appetite appear, catarrhal sore throat or symptoms of acute respiratory disease are observed. 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 the highest normal limits; 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, skin-muscular hyperesthesia and arthralgia, etc. Symptoms of damage to the cardiovascular system are often observed: 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 odor from the mouth, profuse salivation 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 condition, 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 a clinical blood test and 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 for determining the infectious agent, starting from the earliest stages of the 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 elevated - 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 putrefactive odor [5].

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 eruptions 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 other antiviral agents [1 ].

These medications are recommended to be used 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 on both the affected areas of the mucous membrane and areas without rash elements, since they have a greater preventive effect 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 provide comprehensive treatment, eliminate contact of a sick child with healthy children, and carry out preventive measures for 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 [3].

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, the following groups of drugs are recommended:

• 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.

During the period of rashes, antiviral gels, ointments and solutions are recommended 3-4 times a day:

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 [4].

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. [4].

General treatment

V.M. Elizarova recommends the following general treatment regimen [5]:

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. Antihistamines are recommended - mebhydrolin (Diazolin), hifenadine (Fenkarol), loratadine (Claritin), clemastine (Tavegil), suprastin [1].

Among the antiviral drugs prescribed are 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 of allergic reactions to antibiotics, creams with glucocorticoids (fluorocort, flucinar, lorinden hyoxysone, etc.) are added to antibacterial ointments [5].

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, and boiled vegetables are added. Warm low-fat milk and fermented milk products, soft-boiled eggs are beneficial. 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 [5].

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.

Herpetic stomatitis: treatment in children and adults

It usually takes about 1 week to fully recover from herpetic stomatitis, but complete healing of ulcers (erosions) can last up to 12-14 days. During this time, the patient is recommended a liquid diet consisting of slightly chilled liquid foods, which should also not contain acid. As we said above, the treatment provided will depend on the severity of the clinical manifestations.

• In adults (especially mild forms of the disease), you can generally do without any specific treatment, i.e.
  without taking tableted antiviral drugs. In this case, you can limit yourself to rinsing your mouth using antiseptic solutions with an antiviral effect (for example, Miramistin or Hexoral), and in the presence of herpetic rashes, including on the lips and skin around the mouth, use Zovirax Duo-Active cream, Fenistil cream -Pentsivir" or any cream based on 5% acyclovir. In case of elevated temperature or muscle pain, you can additionally take symptomatic NSAIDs (ibuprofen). Usually, such therapy is quite sufficient, but in case of severe manifestations, immediate prescription of antiviral drugs (Acyclovir, Valaciclovir, Famciclovir), as well as antihistamines, is necessary.

• In children the presence of pronounced symptoms of intoxication (fever, etc.) means bed rest, and the need to start immediately taking the antiviral drug “Acyclovir” in tablets. Some doctors recommend taking tableted antiviral drugs for herpetic stomatitis - even in cases of mild disease, others - only in cases of moderate and severe disease.
  In addition to Acyclovir, the following are prescribed: some kind of NSAID based on ibuprofen - to relieve pain and fever, as well as one of the 2nd generation antihistamines (Erius, Xyzal, Claritin and their analogues). The biggest mistake you can make in this case is to delay taking acyclovir until “until things get really bad.” Remember that antiviral drugs help only if they are taken as early as possible.

  Also remember that in case of moderate and severe cases, you should not rely solely on products for topical use in the oral cavity (for example, Viferon gel) or on Viferon in the form of rectal suppositories. In young children, you should not rely too much on irrigating lesions on the mucous membrane with Miramistin spray, because Unlike traditional rinsing, irrigation will not be very effective, and below we will tell you why.

The choice of antiseptic for herpetic stomatitis -

The drug Miramistin is effective against herpes simplex viruses, both HSV-1 and HSV-2. This drug has only 1 minus - after rinsing with miramistin, an indelible layer of the drug does NOT form on the mucous membrane, which would act for another 5-12 hours. It is this layer that forms after the use of many other antiseptics (for example, hexitidine). In general, Miramistin works only at the moment of rinsing, and it is precisely because of this that you need to rinse your mouth with this drug more often and for longer.

The optimal frequency of use of miramistin is 3-4 times a day, each time rinse your mouth for 2-3 minutes (preferably three). For example, with the drug Hexoral based on hexitidine, you only need to rinse your mouth 2 times a day for 1 minute, which is associated with the formation of an indelible layer of hexitidine on the surface of the mucosa, which will be effective for at least another 12 hours. Therefore, Miramistin is a good drug for patients who, due to their age, are already able to thoroughly rinse their mouths for 2-3 minutes 4 times a day.

Irrigation of foci of herpetic stomatitis in children with Miramistin spray is not very effective, because... the drug is immediately washed off with saliva. Although sometimes we simply have no other choice (especially in children from 0 to 3 years old) but to prescribe irrigation with Miramistin. The disadvantage of Miramistin is the lack of analgesic effect, but the advantage is that it has a slight immunostimulating effect on the mucous membrane, thereby reducing the risk of repeated cases of infection. In children over 3 years of age and adults, Hexoral may be an alternative to Miramistin.

Hexoral is available in the form of a solution or an aerosol, both forms are approved for use from 3 years of age. This drug is effective against the herpes simplex virus HSV-1 (this is about 90% of patients), but is ineffective against HSV-2. We have already said above that the HSV-2 type can cause herpetic stomatitis only in patients who engage in oral sex (according to statistics, only 10% of patients have herpetic stomatitis caused by the herpes virus type HSV-2).

The drug Hexoral contains not only the antiseptic hexitidine (sometimes written as hexetidine or hexetidine), but also anti-inflammatory components - methyl salicylate, peppermint oil, anise oil, clove oil, eucalyptus oil. Therefore, it also has an anti-inflammatory, as well as a slight analgesic effect on ulcerations of the oral mucosa.

Conclusions: in children under 3 years of age, we can only use Miramistin - in the form of irrigation of the oral mucosa from a spray. In children over 3 years old, in our opinion, it is optimal to use the drug Hexoral aerosol, which contains 0.2% hexitidine as the main component (after spraying, an indelible layer of the drug is formed on the mucous membrane, effective for at least another 12 hours). At the age when the child is already able to rinse his mouth independently for at least 1 minute, and preferably for 2-3 minutes, it is better to use Miramistin again (the same applies to adults).

Forms of disease severity

Depending on the severity of toxicosis and the area of ​​damage to the surface of the mouth, the disease is divided into the following forms:

• incubation period;
• light;
• average;
• heavy.

Incubation period

The incubation stage lasts about a week. The disease develops rapidly, often with a temperature reaching 39 degrees and severe malaise. After two days, discomfort occurs in the mouth, increasing while eating and when talking. Rashes occur on the edematous mucosa, single or in quantities from 2 to several dozen. It is not difficult to notice them, as they quickly turn into ulcers that appear on the tongue, palate and face. The gums are affected from the inside, becoming covered with purulent plaque. Salivation is viscous, increasing over time. This process lasts another 5-10 days after inflammation of the ulcers.

Mild form of the disease

It is difficult to notice the mild stage of the pathological process due to the mild symptoms of the course.

There are either no rashes, or there are 1-2 flat ulcers that appear as a painless small spot on the inner surface of the mouth.

After a few hours, the inflammatory process intensifies, and the ulcers become painful and fill with fluid inside. At the same time, the lymph nodes become enlarged. After 2-3 days, the stage of healing of ulcers-erosions begins. Relapses of this form of the disease depend entirely on the human immune system.

Medium severity

It is characterized by prolonged healing of ulcers up to 2-3 weeks, and especially deep erosions disappear in a month or more. With this form, patients still suffer from regular relapses every month. Erosion ulcers go deep into the mucous membrane, causing severe pain upon contact. Exacerbations of the moderate form occur immediately - the ulcers become denser, corroding the mucous surface of the erosion, and then deepen. Later, the ulcers heal with the formation of scars.

Severe illness

Severe disease is less common than others, but is characterized by the sudden formation of several ulcers on the oral mucosa. Patients suffering from allergies, gastrointestinal diseases, rheumatism, and viral infections are susceptible to such manifestations. The primary symptoms are:

• lethargic state;
• heat;
• headache;
• joint pain;
• pain in the mouth;
• poor appetite;
• apathy and depression;
• sleep disturbance.

A blood test diagnoses an increase in leukocytes and an increase in the erythrocyte sedimentation rate, which clearly indicates a pronounced inflammatory process. Upon examination, newly formed foci of ulcers of various sizes are noticeable.

Antiviral drugs for stomatitis -

In severe cases of herpetic stomatitis, the clear use of antiviral drugs is indicated. This is usually either acyclovir or famciclovir. Clinical studies have shown that it makes sense to prescribe these drugs only in the first 72 hours (from the moment the first symptoms appear). Moreover, there is a clear dependence - the closer to the end of this period the drug is prescribed, the less effective it will be.

Please note that all antiviral drugs are prescription drugs and should be used only as prescribed by a doctor!

1) Acyclovir –

The drug Acyclovir is used in adults and children over 2 years of age in the same dosages (400 mg each). For children under 2 years of age, half this dosage is used. Let us say right away that you should not take it if you have already taken several courses of it before and have not noticed any improvement from use. Previous lack of effect may indicate that you either started using it too late, or that you are resistant to this drug, or that the dosage is insufficient.

Speaking about dosages for Acyclovir in this article, we rely not so much on the manufacturer’s instructions, but on randomized clinical trials (at this link you can read the review, which is devoted to the analysis of most clinical studies on this topic). For example, one clinical study showed that acyclovir tablets (200 mg - 5 times a day, for 5 days) did NOT affect either the duration of pain or the healing time of ulcers.

Another study (174 patients) reported a decrease in symptom duration (8.1 vs 12.5 days) when a higher dose of Acyclovir was used (400 mg - 5 times a day, for 5 days). Therefore, in adults and children over 2 years of age, the single dosage should be exactly 400 mg. The drug is well tolerated even by children, and short-term side effects may include nausea, diarrhea, dyspepsia, and headache. Below we provide acyclovir treatment regimens recommended by the Department of Infectious Diseases (source).

In severe cases - when the patient’s condition is serious and it is impossible to take the drug in tablets - acyclovir is prescribed intravenously at a dose of 15 mg/kg/day, which should be divided into 3 administrations (every 8 hours). The drug is administered intravenously as an infusion, which lasts 1-2 hours. The course of treatment with acyclovir (regardless of the route of administration) is 5-7 days.

Acyclovir for the prevention of relapses - if a child has frequent severe attacks of herpes infection, then acyclovir tablets can be used not only for treatment, but also for the prevention of relapses. In this case, the dosage in children under 12 years of age is calculated based on 20 mg/kg/day (but not more than 400 mg per day), which should be divided into 2-3 doses. The course of therapy is from 6 to 12 months.

For adults and children over 12 years of age (or more than > 42 kg) - to prevent relapses of herpetic stomatitis, acyclovir is prescribed in a dosage of 400 mg - 2 times a day. Also in this age category, more serious antiviral drugs can be used - 1) famciclovir 250 mg 2 times a day (strictly every 12 hours), 2) valacyclovir 500 mg (if less than 9 relapses during the year) and 1 g / day in one dose (if more than 9 episodes per year). The duration of taking these drugs is from 6 to 12 months.

Important: the original drugs containing acyclovir are drugs under the Zovirax brand (UK). Zovirax is available in the form of 2 types of cream, and in the form of tablets, as well as a solution for intravenous administration. Other drugs containing acyclovir are generics. By the way, it should be noted that the cost of the original drug Zovirax is not too much higher than the cost of Russian generics, and we always, if financially possible, recommend using the original drugs.

2) Valacyclovir –

This drug is used in a short one-day course. The dosage of Valacyclovir in adults, 2000 mg 2 times a day (for 1 day), reduced the duration of pain compared to the placebo group by only 1 day (4 days versus 5 days in the placebo group). This result was recorded in a clinical study in which 1524 patients took part. An important point is that the effectiveness of such a course can be high only if we are talking about early start of taking the drug.

Important: i.e. a short one-day course is optimal if you start taking the drug - either in the prodromal period of the disease (when you only feel bloating, itching or burning, but there are no rashes yet), or no later than 6-12 hours from the moment the rash appears. If more than 12 hours have passed since the rash, then not a short one-day course, but a full 5-7 day course of taking the drug in standard dosages will be more effective.

3) Famciclovir –

According to clinical studies, famciclovir at a dosage of 500 mg 3 times a day for 5 days reduces the duration of pain (4 days versus 6 days in the placebo group). It has been noted that famciclovir also reduces the size of lesions, and this effect is dose-dependent, i.e. when using dosages of 125 and 250 mg, this effect was significantly less pronounced, and when using a dosage of 500 mg, the effect was significantly higher.

Treatment of herpetic stomatitis in adults with the use of famciclovir can also be carried out in a short course according to the regimen of 750 mg 2 times a day (for only 1 day). This regimen also resulted in a reduction in symptom duration of up to 4.0 days, compared with 6.2 days for the placebo group. Speaking about such results, it should be noted that in all the reported clinical studies, the use of the antiviral drug began either at the stage of prodromal symptoms, or in the first 12 hours after the appearance of the rash.

It should be noted that short-term, high-dose antiviral therapy with valacyclovir and famciclovir offers greater comfort for patients and doctors (with the same efficacy rates). This therapy does not require long-term use of the drug, and it is a good choice for patients with previous severe cases of herpetic stomatitis - especially if the drug is started no later than 6 hours from the onset of herpetic rashes.

Treatment methods for different forms of the disease

When you first identify symptoms of herpetic gingivitis or stomatitis, you should seek help from a qualified specialist: an infectious disease specialist and a dentist. The doctor diagnoses the disease through a survey and visual examination of the patient. Assess the nature of the rash and prescribe treatment.

Therapy is reduced to the use of the following medications:

• antipyretic and painkillers;
• antiseptics;
• antiviral ointments and gels;
• decoctions of medicinal herbs for treating wounds.

At the moment of extinction of the disease, it is recommended to regularly treat the ulcers with an antiseptic solution, then with an oil solution (vitamin A). Be sure to adhere to proper nutrition, feed the patient soft foods, and give plenty of fluids. The sick person should be restricted from visiting institutions and crowded places due to the contagiousness of the disease. Those caring for the patient should follow basic hygiene rules.

Treatment for mild forms

To stop the process of inflammation in the body, antiviral drugs are prescribed at the initial stage of the disease, namely:

• tablets Acyclovir, Zovirax, Biocyclovir, Acik, Gerpevir are prescribed in the first week of illness, 1 piece each. 5 times a day for 5 days;
• drugs Interferon, Acyclovir, Acyclostad in the form of applications of solutions, creams or ointments for 20 minutes 5-7 times a day.

Traditional medicine methods can also be used in parallel with drug treatment. Folk remedies provide a mild effect in the form of preparing decoctions and infusions of medicinal herbs (yarrow, sage, St. John's wort, chamomile and calendula).

The method for preparing a decoction of the above herbs is 1 tablespoon of dry herbs per glass of boiling water. Pour and cover the container with a towel for 10 minutes, then strain. Rinse your mouth before and after meals.

The following folk methods are also used to help with mild forms of the disease:

• propolis infusion to relieve pain in the mouth;
• lemon juice for swelling of the mucous membrane;
• flaxseed or sea buckthorn oil at the stage of ulcer healing.

Treatment for moderate severity of the disease

There is general and local therapy to eliminate the moderate form of the disease. General therapy is aimed at preventing the spread of the virus and improving the general immunity of the patient. The following drugs are prescribed:

• painkillers and antipyretics: Paracetamol for children, Efferalgan, Nurofen, Tylenol;
• antiviral drugs: Acyclovir, Zovirax, Biocyclovir, Virolex, Herperax;
• antihistamines: Claritin, Tavegil, Suprastin, Fenkorol;
• vitamins: Ascorbic acid and Ascorutin;
• immunomodulators: IRS-19, Viferon, Anaferon, Arbidol, Imudon;
• drink plenty of fluids and eat a healthy diet;

Local therapy is aimed at reducing pain and healing of erosive ulcers. The most commonly prescribed topical medications are:

• antiseptics: weak solutions of Furacilin, Miramistin after each meal;
• antiviral and healing ointments and oils: Interferon, Acyclovir, Acyclostad, Socloseryl, Carotolin, oil solution of vitamin A, rosehip and sea buckthorn oils;
• painkillers in the form of lotions and ointments: solution of Lidocaine and Pyromecaine, Cholisal, Mundizal-gel;
• alcohol solution of brilliant green, Fukortsin (“red brilliant green”), hydrogen peroxide for treating ulcers on the skin of the face and hands.

Treatment of a serious illness

In case of severe disease, antibacterial drugs (broad-spectrum antibiotics) are prescribed as the main method of treatment to prevent further development of the disease.

Treatment of herpetic stomatitis with interferon -

In Russia, drugs from the Viferon line, based on interferon, are sometimes recommended for the treatment of herpetic stomatitis in children. For very young children, a suppository form is used for this (with interferon dosages of 150,000, 500,000 or 1,000,000 IU), and for older children and adults, a gel form is used. Although some Russian clinical studies indicate the effectiveness of such therapy, many immunologists and virologists are doubtful about the results of these studies (including our editors).

Release forms of the drug Viferon -

It should be noted that in Europe and the United States, which in principle can be considered leaders in the quality of medical care, as well as in the quality of the medications being developed, in these countries such interferon replacement therapy has long been recognized as not very effective. Those. in developed countries, interferons are not used at all as a method of treating herpetic stomatitis/gingivostomatitis.

Instead, immunostimulating drugs are often used, which are a lifesaver in patients with frequent relapses of herpetic stomatitis (or infrequent, but with a severe course). Frequent relapses and severe stomatitis certainly indicate problems with the immune system.

Immunomodulators for the treatment of stomatitis –

The following over-the-counter medications may be used in children. Firstly, in children over 1 year old it can be Thymogen, which comes in the form of a nasal spray. Secondly, in children over 4 years old, this can be the drug Cycloferon, which is taken once a day (half an hour before meals, washed down with plenty of water). A single dosage for children 4-6 years old is 150 mg, for children 7-11 years old - 300-450 mg, for adults and children over 12 years old - 450-600 mg.

As immunomodulators in adults - intramuscular injections of the drug Thymogen, or drugs such as Levamisole or Methyluracil (in tablets). But all of these are prescription drugs that should be used only as prescribed by a doctor!

Vaccination against stomatitis (Vitagerpavak vaccine) –

You may be surprised, but in Russia a vaccine against herpetic stomatitis has been developed, and, by the way, it works. This vaccine is called Vitagerpavak, and it is intended to prevent relapses of herpetic infections caused by herpes simplex virus types I and II (HSV-1 and HSV-2) - these are the types of viruses that cause herpetic stomatitis. The author of the article tested this vaccine on her patients, and below is what results were achieved.

The primary course of vaccination consists of 5 injections (carried out intradermally) - with an interval of 7 days, and after six months a repeat course is prescribed. Personal experience in administering the vaccine has shown that in patients who often suffer from both herpetic stomatitis and herpes of the lips, the frequency of relapses has significantly decreased (by about 2-3 times), which is a very good indicator. In principle, all of our patients noted a positive effect from this treatment.

Vaccination against herpetic stomatitis (Vitagerpavak) –

→ Vaccine Vitagerpavak – instructions for use (download in PDF)

Important: unfortunately, there are several “buts” - 1) the vaccine is intended for adults and children over 15 years of age, although, in consultation with the doctor, earlier use is possible, for example, when it comes to frequent severe outbreaks of herpetic stomatitis, 2) In the last six months, this vaccine has been quite difficult to find in pharmacies and medical centers. In our opinion, this is due to the fact that the vaccine does not have a very long shelf life, and therefore medical organizations purchase it without enthusiasm.

What else is very important for children -

When the blisters burst, very painful ulcers can form, so drinking and eating can cause a lot of pain for the child (causing children to refuse to drink and become dehydrated). Under these conditions, it is important to numb the ulcers 2-3 times a day, for example, use special gels to numb the ulcers 10-15 minutes before feeding. In addition, be sure to drink plenty of fluids, as well as take symptomatic medications with ibuprofen (for example, children's Nurofen syrup) for fever, muscle pain and headaches.

As an anesthetic gel, it is better to use the drug Cholisal (there is no age limit), which is rubbed into the lesions 2-3 times a day using light massaging movements with the index finger. The advantage of this drug is that it has not only an analgesic, but also a pronounced anti-inflammatory effect. But it is better not to use various sprays and gels with lidocaine such as Kamistad, because when mixed with saliva, lidocaine can cause numbness of the entire oral cavity (this can lead to impaired swallowing of saliva and choking on saliva in small children).

Special nutrition and feeding for stomatitis -

Be sure to drink plenty of fluids! Food should be such that it does not irritate the oral mucosa (ulcers). These can be fresh vegetable broths, fish or meat broth; after cooking, you can add ground boiled meat to the latter. These can be non-irritating juices and purees from vegetables and fruits, for example, carrots or apples, and rosehip decoction is also recommended. It is recommended to give fermented milk products (kefir, cottage cheese), low-fat warm milk, as well as boiled and pureed chicken eggs mixed with broth.

Oral hygiene for stomatitis –

If brushing your teeth causes pain, then buy a toothbrush with soft bristles. To clean your teeth, you can use special toothpastes with licorice extract and a whole complex of lactic enzymes (24stoma.ru). These components improve the local immunity of the oral mucosa and, therefore, reduce the risk of developing new cases of herpetic stomatitis.

If we are talking about very young children who have not yet erupted teeth, or only a few teeth have erupted, hygienic care in this case is no less important. Because very often there are situations when, against the background of insufficient hygiene, a bacterial infection is also added to the herpetic infection, and then the disease develops according to an extremely negative scenario - with massive necrotic lesions of the oral mucosa.

Important: if your child often experiences herpetic or aphthous stomatitis, you should not use toothpastes containing sodium lauryl sulfate (SLS). This component has the property of stimulating desquamation (sloughing) of epithelial cells of the oral mucosa (source). Accordingly, as a result of using toothpastes with SLS, the oral mucosa becomes thinner, which increases the impact of damaging factors on it, including infectious agents (bacteria and viruses).

In addition, it would be logical to assume that since SLS accelerates the desquamation of epithelial cells, it will also inhibit the epithelization of ulcerations, i.e. their healing. By the way, data on this were published in the medical journal “Oral Diseases” (Jurge S, Kuffer R, Scully C, Porter SR. 2006). Thus, toothpastes without SLS will reduce the risk of recurrent cases of any form of stomatitis.

What consequences and complications can there be?

It is important to remember that gingivostomatitis is the most popular form of the disease, caused by staphylococci, streptococci and diplococci. Most often, the disease is observed in children's educational institutions. Inappropriate and untimely treatment leads to tooth loss.

If recovery is not complete, the disease may become chronic. The danger of the disease is that inflammation slowly affects the deep tissue layers, resulting in an increased likelihood of developing periodontal disease, the manifestations of which can be seen in the photo on the left. In this case, partial damage or complete destruction of the ligamentous dental apparatus occurs.

Delaying treatment can lead to more serious viral infections such as diphtheria, measles and influenza. Failure to comply with hygiene and safety rules in the event of illness can reach epidemic proportions.

Differential diagnosis –

Before starting treatment, it is necessary to distinguish herpetic stomatitis from other forms of stomatitis and diseases of the oral mucosa, because their treatment is carried out with completely different drugs. Firstly, you need to exclude the occurrence of aphthous stomatitis, which is usually quite easy to do (follow the link you can familiarize yourself with the symptoms of this form of stomatitis and its treatment regimen).

Secondly, it is necessary to distinguish herpetic stomatitis from enteroviral vesicular stomatitis (EVS), in which antiviral drugs such as Acyclovir will no longer be effective (source). With EVS, approximately 2-3 days after the development of the disease, rashes appear not only on the mucous membrane of the oral cavity, but also on the palms and soles (these can be spots or blisters with transparent contents ranging in size from 1 to 3 mm). EVS is caused by enteroviruses - most often the Coxsackie virus-A16 or Enterovirus-71. The disease usually occurs in the autumn-summer period in children's groups.

Thirdly, it is necessary to distinguish herpetic stomatitis from the so-called “herpetic sore throat”. The latter is characterized by very painful small rashes (up to 1 mm) - no more than 5-6 pieces, which are located on the border of the hard and soft palate, as well as the back wall of the pharynx. Against the background of local manifestations, symptoms of general intoxication are usually always present - fever, headache (increased salivation is absent).

First symptoms of the disease

From the 1st to the 8th day of the presence of the virus in the blood, it is difficult to recognize the disease due to the appearance of common symptoms: weakness, lethargy, headaches, drowsiness. Later, other symptoms are felt that most clearly indicate acute gingivostomatitis, such as:

• pain when swallowing;
• a sharp increase in temperature up to 40 degrees;
• vomiting and seizures;
• swelling of the oral mucosa;
• white coating on the tongue and cheeks;
• poor sleep, lethargy, decreased appetite;
• enlarged lymph nodes.

The main indicator of the disease is damage to the surface of the tongue by erosions along the gum edge and on the oral mucosa. After the first day, this manifestation can be distinguished by the following symptoms of an extensive process:

• rashes of the mouth, cheeks and palate;
• plaque on the tonsils;
• painful ulcers;
• bubbles with liquid;
• viscous saliva.

Manifestations of the disease last for 5-10 days. During this period, the face and sometimes the hands may be affected. Other mucous membranes, located, for example, in the gastrointestinal tract, may also be affected. Painful sensations occur along the intestines. Later, the pharynx, larynx, urethra, female genital organs, and cornea are involved.

Hospitalization for “herpes stomatitis” –

Hospitalization may be required for severe cases when the patient is dehydrated (this is especially common in infants), when there are severe symptoms of intoxication, against the background of a weakened immune system, and in cases where there are signs of spread of herpetic infection to the tonsils, pharynx, eye area, etc. .d. We hope that our article on the topic: Viral stomatitis in children and adults was useful to you!

Sources:

1. Dental education of the author of the article, 2. National Library of Medicine (USA), 3. PubMed.gov scientific research base, 4. “Diseases of the oral mucosa” (Danilevsky N.), 5. “Acute and recurrent herpetic stomatitis in children" (Kazantseva I.A.).