Stomatitis in children: what it is, why it occurs, symptoms. Types of stomatitis, treatment methods. Prevention of stomatitis, care for children with illness.

Small “ulcers” and inflammations may appear in the oral cavity, causing discomfort, especially when chewing food. These are signs of stomatitis, which is an inflammation of the oral mucosa.

According to scientists, the most common are viral stomatitis.

Of the above types of disease, patients most often consult a doctor with herpetic stomatitis, which is caused by the common herpes virus. There are the following forms of this disease: acute herpetic gingivostomatitis and recurrent chronic herpes.

Let's take a closer look at these diseases.

What is stomatitis and what types exist?

The name of the disease indicates its exact location; translated from Latin “stoma” means mouth. Stomatitis is an inflammatory lesion of the oral mucosa (most often ulcerative). Both adults and children can get sick. But the disease affects children more often. This is due to the fact that the mucous membrane at this age is easily infected by pathogenic microflora, because the child’s body is not yet perfect, local and general protective reactions are not sufficiently developed. Statistics show that almost 80% of young children have suffered from this disease at least once.

Stomatitis is the general name for a whole group of diseases of the oral mucosa. Therefore, each of them has its own symptoms and its own treatment methods. Depending on the etiology, stomatitis is divided into several types:

viral, including herpes - has a viral nature, infection occurs by airborne droplets. The virus can exist on objects (clothing, toys, etc.) for some time. The initial symptoms are similar to those of ARVI: lethargy, fever, runny nose, cough (not always). On the second or third day, light ulcers with a red border appear on the tongue, mucous membranes of the cheeks and lips;
traumatic - inflammation is provoked by mechanical damage to the inner surface of the mouth, for example, a burn from a hot drink or food, a scratch from a toy stuck in the mouth, biting if the child has an incorrect bite;
allergic – the inflammatory process is provoked by the entry into the body of a substance that causes an allergic reaction. Most often caused by drugs;
candidiasis (fungal) - begins when the mucous membrane is infected with the fungus Candida (“thrush”). A striking symptom is a dense white coating on the tongue.

Clinic, diagnosis and treatment of acute herpetic stomatitis in children

What is the clinical picture of acute herpetic stomatitis?
What are the new treatment regimens?

The problem of diseases of the oral mucosa is one of the most important in dentistry.
Acute herpetic stomatitis occupies a special place here, primarily because it accounts for more than 80% of all diseases of the oral mucosa in children. The combined use of virological, serological and immunofluorescence research methods confirms that acute herpetic stomatitis is one of the clinical forms of primary herpetic infection.

The spread of the disease in 71% of cases among children aged 1 to 3 years is explained by the fact that at this age, 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.

Great importance in the pathogenesis of the disease is attached to the lymph nodes and elements of the reticuloendothelial system, 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. Most often they are observed in severe and moderate stomatitis. As a rule, lymphadenitis is bilateral, submandibular. However, with moderate and severe forms of the disease, simultaneous involvement of the cervical lymph nodes in the process is also possible. Lymphadenitis accompanies the entire period of the disease and persists for 7-10 days after complete epithelization of the elements.

The body's resistance to the disease is determined by its immunological defense. Both specific and nonspecific immune factors play a role in immunological reactivity. Violation of nonspecific immunological reactivity determines the severity of the disease and the periods of its development. Moderate and severe forms of stomatitis led to a sharp suppression of natural immunity, which was restored 7-14 days after the child’s clinical recovery.

The severity of acute herpetic stomatitis is assessed by the severity and nature of toxicosis and damage to the oral mucosa. The development of the disease goes through five periods: incubation, prodromal, period of disease development, extinction and clinical recovery.

Elements of herpetic stomatitis

The mild form of acute herpetic stomatitis is characterized by an external absence of symptoms of intoxication; the prodromal period is clinically absent.
The disease begins suddenly with an increase in temperature to 37-37.5°C. The general condition of the child is quite satisfactory. In the oral cavity there are signs of hyperemia and slight swelling, mainly in the area of the gingival margin (catarrhal gingivitis). 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 six. 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 epithelialization 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 jaw.

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 children 1-3 years old, the number of lymphocytes is normally up to 50%). Herpetic complement-fixing antibodies are not often detected during convalescence. In this form, the protective mechanisms of saliva are well expressed: pH 7.4±0.04, which corresponds to the optimal state. At the height of the disease, the antiviral factor interferon appears in saliva from 8 to 12 units/ml. The decrease in lysozyme in saliva is not pronounced.

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, loss of appetite appear, the child is capricious, there may be catarrhal tonsillitis or symptoms of an acute respiratory disease. The submandibular lymph nodes enlarge and become painful. The temperature rises to 37-37.5°C.

As the disease progresses (catarrhal phase), the temperature reaches 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 the lesion appear both in the oral cavity and on the skin of the face in the perioral area. In the oral cavity there are usually from 10 to 20-25 lesions. During this period, salivation increases, saliva becomes viscous and viscous. Severe gingivitis and bleeding 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 ESR of up to 20 mm/hour is observed in the blood, often leukopenia, sometimes slight leukocytosis. Band and monocytes within the higher limits of normal, lymphocytosis and plasmacytosis. An increase in the titer of herpetic complement-fixing antibodies is detected more often than after suffering 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 therapy. 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 and lymphadenitis last the longest.

With a moderate course of the disease, the pH of saliva becomes more acidic, reaching 6.96 ± 0.07 during rashes. The amount of interferon is less than in children with a mild course of the disease, but does not exceed 8 units/ml and is not detected in everyone. The content of lysozyme in saliva decreases more than in mild forms of stomatitis. The temperature of the unchanged oral mucosa is in accordance with the child’s body temperature, while the temperature of the affected elements in the degeneration stage is 1.0-1.2°C lower than the temperature of the unchanged mucosa. With the beginning of regeneration and during the period of epithelization, the temperature of the affected elements rises to 1.80 and remains at a higher level until complete epithelization of the affected mucosa.

The severe form of acute herpetic stomatitis is much less common than the moderate and mild form.

During the prodromal period, all the signs of an incipient acute infectious disease occur: apathy, adynamia, headache, musculocutaneous 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 has a mournful expression on his lips and painfully sunken eyes. There may be a mild runny nose, coughing, and the conjunctivae of the eyes are somewhat swollen and hyperemic. Lips are dry, bright, parched. In the oral cavity, the mucous membrane is swollen, clearly hyperemic, with pronounced gingivitis.

After 1-2 days, lesions up to 20-25 begin to appear in the oral cavity. Often, rashes in the form of typical herpetic blisters form on the skin of the perioral area, the skin of the eyelids and conjunctiva of the eyes, the lobes of the ears, 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 extensive areas of mucosal necrosis. Not only the lips, cheeks, tongue, soft and hard palate are affected, but also the gingival margin. Catarrhal gingivitis turns into ulcerative-necrotic. A sharp putrid odor from the mouth, profuse salivation mixed with blood. Inflammation in the mucous membranes 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 observed. In this condition, children need active treatment from a pediatrician and dentist, and therefore it is advisable to hospitalize the child in a boxed ward of a children's or infectious diseases hospital.

In the blood of children with severe 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.

Saliva has an acidic environment (pH 6.55±0.2), which can then be replaced by more pronounced alkalinity (8.1-8.4). Interferon is usually absent, the content of lysozyme is sharply reduced.

The diagnosis of acute herpetic stomatitis is made based on the clinical picture of the disease. The use of virological and serological diagnostic methods, especially in practical healthcare, is difficult. This is primarily due to the difficulty of conducting special research methods. In addition, with these methods, results can be obtained at best towards the end of the disease or some time after recovery. Such a retrospective diagnosis cannot satisfy the clinician.

It should be emphasized that in recent years the immunofluorescence method has been increasingly used. The high percentage of coincidences (79.0±0.6%) of the diagnosis of acute herpetic stomatitis, according to immunofluorescence data, with the results of virological and serological studies make this method the leading one in diagnosing the disease.

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.

Due to the peculiarities of the 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, that is, contain all the necessary nutrients, as well as vitamins. Therefore, it is necessary to include fresh vegetables, fruits, berries, and juices in your diet. Before feeding, the oral mucosa should be anesthetized with a 2-5% solution of anesthetic emulsion.

The child is fed predominantly liquid or semi-liquid food that does not irritate the inflamed mucous membrane. It is necessary to give the child enough fluids. This is especially important during intoxication. During meals, natural gastric juice or its substitutes should be given, since when there is pain in the mouth, the enzymatic activity of the stomach glands reflexively decreases.

Local therapy for acute herpetic stomatitis has the following objectives:

relieve or reduce painful symptoms in the oral cavity;
prevent repeated eruptions of lesions (reinfection) and promote their epithelization.

From the first days of the disease, given its etiology, in local treatment, serious attention should be paid to antiviral therapy. For this purpose, it is recommended to use 0.25% oxolinic, 0.5% tebrofen ointments, Zovirax, solutions of interferon and neoferon.

It is recommended to use the listed medications repeatedly (3-4 times a day) not only when visiting a dentist, but also at home. It should be borne in mind that antiviral agents must be applied to both the affected areas of the mucosa and areas that do not contain elements of the lesion, since they have more of a preventive effect than a therapeutic one.

During the period of extinction of the disease, antiviral drugs can be discontinued.

Particular importance should be attached to keratoplasty agents at this time. These are primarily oil solutions A and B, sea buckthorn oil, caratoline, rosehip oil, ointments with methyluracil, and an oxygen cocktail.

A study of the state of local immunity in children with acute herpetic stomatitis revealed that it correlates with the nature of the pathological process, therefore we consider it pathogenetically justified to include measures aimed at their elimination in a comprehensive treatment regimen.

At the Department of Pediatric Therapeutic Dentistry of the Moscow State Medical University, the drug imudon from Solvay pharma was prescribed to 80 children aged 2 to 4.5 years in the complex treatment of acute herpetic stomatitis. 40 children were diagnosed with mild, 38 children with moderate and 2 with severe forms of stomatitis.

Imudon is a mixture of lysates: 0.050 g (dry product) Lactobassillus acidophilus, fermentatum, helveticus, lactis Streptococcus pyogenes (2 var.), faecalis, faecium, sanguinis Staphilococcus aureus Klebsiella pneumoniae, Corynebacterium pseudodiphteriticum, Fusiformis fusiformis, Candida albicans.

Preservative: Sodium mercurothiolate: 0.0125 mg.

Excipients: lactose, mannitol, saccharin, sodium bicarbonate, anhydrous citric acid, precirol fine, magnesium stearate, polyvinylpyrrolidone.

pharmachologic effect

Imudon is intended for local specific immunotherapy of diseases of the oral cavity and pharynx. The effect of the drug on the immune system is expressed in an increase in the phagocytic activity of macrophages, an increase in the content of lysozyme in saliva, as well as an increase in the number of immunocompetent cells and the content of local antibodies (class A immunoglobulins). Thus, imudon has a therapeutic specific antimicrobial and anti-inflammatory effect, and also, by increasing the immune local protective barrier, ensures the prevention of relapses.

The first group consisted of children treated with 0.5% tebrofen ointment, the second group included children treated with interferon solution. In the third group, on the day of treatment, in addition to 0.5% tebrofen, imudon was prescribed, and in the fourth group, imudon + interferon. Children took Imudon tablets 5-6 times a day, no earlier than 30-40 minutes after treating the oral cavity with antiviral ointment, and dissolved it in the oral cavity.

Criteria for clinical and laboratory assessment of the therapeutic effectiveness of the drug imudon:

The therapeutic effect is the average recovery time.
Analgesic effect.
General and local reactions to the drug.
Influence on the state of local immunity.

Recovery was considered to be the epithelization of the lesion elements without a complete cure of the child from acute herpetic stomatitis, the duration of which is determined not only by the end of the epithelization of the lesion elements, but also by the duration of gingivitis and lymphadenitis, as well as deviations in the general well-being of the child.

As can be seen from table. 1, timely correction of local immunity increases the effectiveness of ongoing treatment measures and allows for faster recovery of children with AHS.

The effectiveness of the drug was manifested in groups 3 and 4 on the second day in case of contacting a doctor on the first day of the disease: erosions did not develop into aphthae, and the surrounding mucous membrane was not infiltrated.

Table data 1 indicate the advantage of complex therapy for OGS over generally accepted methods of treatment, its high efficiency, confirmed by a reliable reduction in the time of epithelization of elements and recovery of children.

The more effectively the drug stops the disease, the faster it normalizes the pathological infectious process, the more actively the factors of local immunological defense are restored. (Table 2).

We have given a high assessment of the effectiveness of the new regimen of complex therapy for AHS using stimulating immunotherapy, in particular imudon; It was concluded that there is a fundamental need for an integrated approach to the treatment of acute herpetic stomatitis with the mandatory inclusion of imudon, both a stimulating and a replacement agent for the correction of local immunity.

Thus, the high effectiveness of imudon in the treatment of AHS due to the immune correction of saliva has been established. Imudon has a therapeutic, anti-inflammatory effect, reduces the time for epithelization of lesions. There were no complications or side effects when using the drug imudon. Children used the drug with pleasure, as it has a pleasant, minty taste that does not irritate the mucous membrane. Apparently due to the mint aroma there is a weak analgesic effect.

All this allows us to recommend imudon in the complex therapy of acute herpetic stomatitis in children.

In conclusion, it should be noted that acute herpetic stomatitis, occurring in any form, is an acute infectious disease and requires in all cases the attention of a pediatrician and dentist in order to provide comprehensive treatment, eliminate contact of a sick child with healthy children, and take measures to prevent this diseases in children's groups.

Symptoms

Signs indicating that a baby is suffering from stomatitis are divided into two types: local and general. It is not difficult to recognize them, especially if the baby already knows how to speak and can tell where he feels discomfort. If a baby is sick, the main symptom is general restlessness and crying. Parents should carefully examine his mouth and make sure that there is (or is not) an inflammatory process on the mucous membrane.

Local symptoms:

blisters, sores or plaque on the inner surface of the lips, cheeks and/or tongue, pharynx;
marks from biting, burns or scratches;
swelling and redness of the mucous membrane next to the lesions;
bad breath.

Are common:

increase in body temperature (from slight to critical);
increased size of lymph nodes;
refusal to eat;
lethargy;
moodiness;
nervousness.

Note to parents: symptoms can manifest themselves both complexly and individually. But the presence of even one of the listed manifestations of the disease is a reason to visit a doctor.

Causes and risk factors

The mucous membrane of the child's oral cavity is often injured. The appearance of ulcers can be caused by temperature effects (hot food and drinks), biting the inner surface of the cheeks or lips; damage by sharp edges of the filling, braces or the tooth’s own tissues in case of chipped enamel. Normally, the immune response allows the pathological process to be quickly eliminated, the mucous membrane heals, and bacteria do not have time to cause severe inflammation and ulceration.

Weakened children's immunity cannot cope with this task, which leads to the development of aphthous stomatitis. A small number of opportunistic bacteria that populate the oral cavity begin to actively multiply. Often the disease occurs against the background or as a result of a severe infection: influenza, ARVI, acute tonsillitis, infectious mononucleosis, etc.

Main risk factors:

food allergies, allergic reactions to hygiene products, such as toothpaste;
deficiency of vitamins and microelements due to a strict diet or impaired digestion of food;
hereditary predisposition;
foci of infection in the oral cavity: caries, chronic periodontitis, periodontitis, gingivitis;
frequent respiratory diseases;
severe systemic diseases: pathologies of the endocrine system, blood vessels, metabolic disorders, etc.

Ask a Question

What happens if stomatitis is not treated?

Some parents do not take their child’s stomatitis seriously, they say, “it will go away on its own.” Such an attitude towards the baby’s health can lead to serious consequences. Without treatment, the infection can spread to the skin of the face. There is also a high risk of secondary infection. And this already threatens general intoxication of the body, damage to the nervous system, etc., even death. Therefore, doctors strongly recommend that if symptoms of the disease are detected, show the child to a specialist in order to avoid negative health consequences.

Treatment methods

Due to the fact that the etiology of each type of stomatitis is different, the approaches to treatment are also different. For example, a fungus needs to be fought with an antifungal drug, herpes with an antiherpes drug, allergies with an antihistamine, etc. Therefore, the main task of a doctor is to diagnose stomatitis, identify the cause of the disease and prescribe appropriate treatment. Therapy is carried out in two directions: relief of general symptoms and local effects on mucosal lesions. As a rule, the doctor prescribes medications and antiseptic treatment of the oral cavity in the form of applications and rinses.

Diagnosis of the disease and its differences from other pathologies

The doctor receives the first data after examining the patient’s mouth. Next, the doctor collects an anamnesis of the disease and the patient must answer when the first symptoms appeared, how quickly the disease developed, whether there were injuries (including burns) to the oral cavity, allergies to foods and medications, whether close relatives suffered from stomatitis.

To identify the causative agent of the disease, you will need to take a smear on the flora and exclude manifestations of herpes and candidiasis. For this purpose, laboratory tests are used - bacterial culture and PCR smear.

For persistent stomatitis, you should check your blood glucose level.

What do doctors advise for home care?

The specialist makes a diagnosis and prescribes treatment, and the implementation of all instructions falls entirely on the shoulders of the parents. Caring for a small child with stomatitis contains many nuances. For example, during this period you should feed your baby only warm food with a mushy consistency, excluding citrus, sour and spicy foods. After eating, be sure to rinse your mouth. If the baby is still very small, then after eating you should give him a little boiled water to drink. Treatment of the oral cavity and application of gels prescribed by a doctor should be done with a special fabric fingertip or a finger wrapped in a bandage (the bandage should then be thrown away).

Important: self-medication is dangerous. Only a doctor can correctly diagnose and give the correct therapeutic recommendations.

Methods for preventing stomatitis

Preventative visits to the dentist (twice a year), if necessary, dental treatment
Strengthening the immune system (regime, good nutrition, hardening)
Maintaining oral hygiene
Getting rid of bad habits (finger sucking, toys, pencils, etc.)
Maintaining household hygiene (thorough cleaning of premises, washing toys)
Timely treatment of gastrointestinal diseases

The dental network offers services for the treatment of stomatitis in children. Our specialists are highly qualified and regularly improve their skills in leading clinics in Russia and Europe. The pediatric dentist will diagnose and prescribe effective treatment. We have a system of family and cumulative discounts.

You can contact any of the branches of our center in Moscow within walking distance from metro stations:

Art. Alekseevskaya (VDNKh district, etc. Mira), address: st. 3rd Mytishchiskaya house 3, building 2;
Art. Shelepikha, address: Shelepikhinskaya embankment, address: building 34, building 1.

Stomatitis is a serious disease; do not expect that it will go away on its own without consequences. Remember that your child's health depends only on you. If you notice the symptoms described in the article, sign up for “Smile” dentistry and get qualified help. We are waiting for you every day without breaks and weekends.