Clinic, diagnosis and treatment of acute herpetic stomatitis in children

Are you familiar with the feeling of burning and itching on your lips? Or the unexpected appearance of bubbles on the skin of the face and lips? 95% of the people on the planet know what I'm talking about. True, not everyone pays due attention to these things. Let's start with the fact that any inflammation of the oral mucosa is called STOMATITIS. But in this article we will talk about the most common disease in the world as a whole, popularly called HERPES. Namely, we will consider herpetic stomatitis, etiology, pathogenesis, clinic and treatment of this disease.

It's all the virus's fault!

The term "stomatitis" is derived from the merger of two Greek words: stoma (mouth) and itis (inflammation). There are a great variety of different types of disease - serous, aphthous, allergic, etc. The most dangerous is herpetic, or cold sore, stomatitis caused by a virus. Its main manifestations are painful ulcers covering the oral mucosa. The trigger mechanism of the disease is the activation of herpes simplex virus types 1 and 2. First of all, the disease threatens those who have a weakened immune system and, as a result, the body simply does not have the strength to give a worthy rebuff to viruses.

Causes

The cause of the development of the pathology is the herpes simplex virus type 1. It belongs to DNA viruses belonging to the Herpesviridae viral family. The pathogen multiplies rapidly in the epithelial cells of the oral mucosa. Then it enters nearby lymph nodes (submandibular) and continues to reproduce in them. Then it enters the blood and migrates to the parenchymal organs (spleen, liver, kidneys). There it multiplies and enters the bloodstream again. As a result, it again appears in large quantities in the epithelial cells of the skin and mucous membranes. They are massively defeated. It is localized in the oropharynx, oral cavity, nose, lips, and nearby skin. Stomatitis and herpes of the skin and mucous membranes develop when the infection generalizes simultaneously.

Children become infected with it as follows:

• through contact and everyday life (using shared utensils, toys, through kissing);
• airborne (coughing, sneezing);
• from a sick mother to the fetus through the placenta or during childbirth.

A baby can become infected from sick adults, children, and carriers.

The following factors contribute to the development of the disease:

• previously suffered inflammatory processes;
• previous antibiotic therapy;
• deficiency of microelements and vitamins in the body;
• mechanical damage to the skin and mucous membranes;
• insufficient fluid intake;
• poor oral hygiene.

In children, the virus is especially easily transmitted through contact. The infectious process quickly spreads to healthy areas.

Forms of the disease

Lightweight

It is considered the most beneficial for the body. In this form, people with high immunity suffer from herpes stomatitis. It flows without temperature. It is distinguished by single rashes that do not cause discomfort and disappear on their own without consequences.

Average

General disorders are added: weakness, drowsiness, fatigue, loss of appetite. Rashes appear in several places at the same time. The temperature rises to 37-37.6°C.

Heavy

This form of stomatitis indicates extremely low immunity. The rashes are multiple and painful. Severe headache, chills, and vomiting appear. The temperature exceeds 38oC.

If the disease is mild, the patient may not notice any external signs!

How to distinguish herpes from stomatitis?

Many patients try to find an answer on the Internet to the question: “Do I have stomatitis or herpes? How to recognize? Herpes stomatitis can be easily distinguished from ordinary stomatitis by 3 key signs.

1. With herpes infection, the rash is localized in the gum area. Whereas with stomatitis - on the soft tissues of the oral cavity (tongue, cheeks).
2. A herpes rash first appears as blisters, which then ulcerate, while stomatitis begins with the appearance of ulcers.
3. Herpetic stomatitis is characterized by a stable appearance of the rash in the same places, and with ordinary stomatitis its location often changes.

Herpetic or aphthous?

It will be somewhat more difficult to distinguish between herpetic and aphthous stomatitis. The latter got its name from the Greek term “aftha”, which means “ulcer”.

If with herpetic stomatitis there are many ulcers, but they are small, then with aphthous stomatitis there are few of them, and the size can reach 7–8 mm.

The second important distinguishing feature is the absence of swelling of the gums with aphthous stomatitis.

If you are looking for differences between herpetic and aphthous stomatitis, then the third thing you should pay attention to is the localization of the rash. Aphthous is characterized by the appearance of ulcers in the oral cavity, while herpes infection can spread to the border of the lips.

Classification

According to the flow, acute, chronic, and wave-like variants of the pathology are distinguished. The following degrees of severity of the pathological process are distinguished:

1. Mild - it is typically characterized by a slight increase in body temperature, moderate inflammation of the mucous membrane in the mouth, and enlargement of regional lymph nodes. Rashes form on the mucous membrane and skin.
2. Medium – high temperature rises. Severe weakness and sudden deterioration in health. The baby begins to vomit and the pain in the mouth increases. Significant rashes appear in the mouth and the skin around it.
3. Severe - a severe headache is added to the pathological process. High temperature rises, severe muscle pain. Not only regional but also distant lymph nodes enlarge. The rashes are located not only in the oral cavity, but on the skin next to it. They appear on the mucous membrane of the eye, on the eyelids, and on other parts of the face.

The severity of the pathology depends on the viral load (the amount of virus in the body) and the general reactivity of the body.

How to distinguish herpes sore throat from stomatitis?

Despite the fact that these medical terms have the same grammatical root, herpetic sore throat and herpetic stomatitis are two different diseases. Unlike stomatitis, herpes sore throat occurs not due to the penetration of the herpes virus, but as a result of an adenovirus infection (in particular, the Coxsackie A virus). Children are more likely to suffer from this disease than adults. The rashes are localized, for the most part, on the soft palate and tonsils. Typical symptoms of stomatitis include pain in the abdomen and abnormal bowel movements.

Attention!

The disease begins acutely, with a jump in temperature to 40 degrees, and is severe, so differential diagnosis should only be carried out by a doctor.

What contributes to the exacerbation of chronic stomatitis?

A patient with a chronic form of herpetic stomatitis is a carrier of the herpes virus, the activation of which is facilitated by the following factors:

• decreased immunity;

• exacerbation of infectious diseases;
• thermal, mechanical injuries of the oral mucosa;
• constant stress;
• contact with a patient with acute herpetic infection;
• avitaminosis;
• exacerbation of allergic diseases;
• the presence of a chronic focus of infection in the oral cavity (carious teeth, enlarged tonsils);
• prolonged insolation, general overheating of the body;
• antibiotic treatment;
• decrease in the amount of saliva produced;
• hypothermia.

Relapses of the disease occur mainly in the autumn-winter period. Along with viral infections, symptoms of stomatitis appear and treatment usually takes several weeks. The disease is especially difficult for young children.

Bacterial or viral?

In addition to viral origin, the disease can be caused by bacteria: streptococci and staphylococci are normally present in the microflora of the oral cavity and begin to multiply uncontrollably during the inflammatory process. The latter may be caused by caries or periodontitis (read more about the disease in the article).

How to distinguish viral stomatitis from bacterial one? It is extremely difficult to do this at home, so it is better to consult a doctor. The main differential feature is the localization of the rash. With viral herpetic stomatitis, vesicles with transparent contents first appear on the tongue (its tip, along the side surfaces and under it), and then can even spread to the pharynx and tonsils.

For bacterial stomatitis, the location of the rash on the gums and those areas where the skin borders the mucous membrane (for example, on the red border of the lips) is more common. Also, with a disease caused by streptococci, “jams” are often observed - pustules on the corners of the mouth, which quickly begin to bleed, become covered with a crust, crack and cause constant discomfort while eating and talking.

Types of diagnostics

An experienced doctor can identify herpetic stomatitis in adults during an initial examination, relying on only two methods.

• Clinical picture.
  Based on the totality of the patient’s specific complaints and distinctive external signs, the dentist will not only assess the severity of the disease, but also differentiate it from ordinary stomatitis, candidiasis, etc.
• Immunofluorescence.
  Express microscopy method, the most accurate for diagnosing acute herpetic stomatitis.

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.

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:

1. The therapeutic effect is the average recovery time.
2. Analgesic effect.
3. General and local reactions to the drug.
4. 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.

Causes of herpes stomatitis

There are two types of herpetic stomatitis: acute and chronic. Acute herpetic stomatitis, according to Dr. Komarovsky, occurs only in children under 3 years of age, when for the first time the child’s body, already deprived of antibodies to the herpes virus received from the mother, is first exposed to a viral attack from the outside. Moreover, the source of infection, as a rule, is the parents themselves - carriers of the virus, who kiss the baby or lick his pacifier or feeding spoon.

Recurrent or chronic stomatitis is already the lot of adults. The disease is recurrent in nature as soon as the body’s immune forces are weakened. In this case, primary infection can occur either through airborne droplets (sneezing), or through household contact (for example, through the use of the same dishes with a virus carrier) or hematogenous (through blood during injections, etc.). The incubation period of the disease can last up to two weeks depending on the state of the immune system.

Attention!

The pathogenesis of the disease in dentistry is still unknown. But if the body is weakened, any injury to the palate or gums can provoke activation of the herpes virus types 1 and 2!

What is this disease?

Herpetic stomatitis is a pathological process that develops in the mucous membrane lining the oral cavity. The causative agent of this disease is herpes simplex virus type 1. In children under the age of five, this virus is detected in 60% of all cases. By adolescence, it is detected in the vast majority of people. Herpes stomatitis in children develops during the baby’s first contact with the virus. This occurs most often before the age of three.

The high incidence is explained by:

• low level of production of own antibodies;
• immaturity of cellular immunity;
• the fact that the baby does not receive antibodies from mother's milk;
• high reactivity of the child's body.

If the baby is bottle-fed, he may get sick in the first months of life. Viral infection often goes into a latent state. It persists in the nerve ganglia.

Treatment of herpetic stomatitis

How to treat herpes stomatitis? Unfortunately, the herpes virus, once entered into a person’s blood, remains in a “dormant” state for the rest of his life. But treatment of viral stomatitis is possible provided that you do not delay visiting the dentist when the first signs of the disease are detected. During the period of therapy, in order to avoid infecting loved ones, you should eat and drink from separate containers and avoid kissing. The patient is recommended a diet that excludes spicy, smoked, sour and salty foods, which can irritate the damaged oral mucosa, and an increased drinking regimen (up to 2.5 liters per day), aimed at combating the manifestations of general intoxication of the body.

Drug therapy

Rinse

To stop the spread of infection throughout the oral cavity, as well as to prevent the occurrence of sore throat, anti-inflammatory drugs such as Stomatidine and Miramistin are prescribed. The greatest effect is achieved by repeating the rinsing procedure every 3 hours, strictly adhering to the instructions for medicinal solutions.

Antiviral drugs

To suppress the reproduction of the herpes virus, the patient is advised to take “Immudon” and “Acyclovir” orally according to the scheme, and for external use - “Viferon” ointment or “Silicea” gel.

Vitamin therapy

Tablet vitamin complexes such as “Complivit” help improve immunity.

Attention!

Before use, consultation with a specialist is recommended!

Treatment at home with folk remedies

On the Internet you can often come across the question: “How to treat herpetic stomatitis with folk remedies?” Let’s make a reservation right away: when treating this disease, you cannot rely solely on traditional medicine methods. Therapy must be comprehensive, and only a doctor can choose it correctly.

An effective folk remedy for rinsing the mouth is propolis tincture diluted with boiled water 1:3. In case of pronounced “jams” in the corners of the mouth and painful ulcers inside, applications with natural sea buckthorn oil have an analgesic and wound-healing effect.

Treatment

Treatment of herpetic stomatitis in children with mild and moderate forms is carried out on an outpatient basis. In severe cases and the development of complications, the baby is hospitalized. Treatment is carried out under the supervision of a pediatric dentist or periodontist.

Children are prescribed bed rest and a diet with pureed, non-irritating food. He is given separate hygiene items and dishes. Plenty of warm fluids are recommended.

The following drugs are prescribed:

1. Non-steroidal anti-inflammatory drugs (Nise, Paracetamol, Nurofen) are used to relieve temperature and inflammatory reactions.
2. Antihistamines (Clemastine, Loratadine) are used to relieve swelling of the mucous membranes.
3. Antiviral drugs (Famciclovir, Acyclovir, Zovirax) are used at the beginning of treatment or in severe cases.
4. Immunomodulators (Lysozyme, Gamma globulin, Thymogen) are used to enhance immunity.

During treatment, vitamin-mineral complexes and fish oil are used in monthly courses.

Local drugs that act directly on the mucous membrane are widely used.

For local treatment of herpetic stomatitis the following are used:

• antiseptics (Hexoral, Miramistin) - they are used to rinse the mouth every four hours for two weeks;
• ointments and gels with anesthetics (Kamistad, Lidochlor gel) are used for pain relief, they are lubricated with mucous membranes three times a day for up to two weeks;
• antiviral agents (Ganciclovir, Acicovir) - destroy the viral cell, gums are treated with these ointments five times a day, two weeks;
• proteolytic enzymes (Trepsin, Chymotrypsin) are used to cleanse the necrotic surfaces of ulcers; they are washed with these solutions twice a day.
• rinsing with decoctions of medicinal herbs (calendula, chamomile, sage) is carried out after each meal for up to two weeks;
• epithelializing ointments (Solcoseryl, Methyluracil) are used to enhance the healing of erosions and ulcers, used in the recovery stage, used up to four times a day for ten days.

Physiotherapy is applied locally. Irradiation of affected mucous membranes with ultraviolet and infrared rays is used.

Prevention measures

1. Strengthening the immune system.
   Avoid excessive exercise and stress. Take a multivitamin in the fall and spring. Regular exercise and hardening increase the vitality of the body.
2. Healthy lifestyle.
   Get rid of bad habits: scientists have proven that excessive smoking and alcoholic beverages can become a catalyst for the activation of the herpes virus in the body.
3. Timely treatment of chronic diseases.
   Do not forget that simple stomatitis, if you do not seek medical help in a timely manner, can develop into herpetic stomatitis. Chronic caries and acute respiratory viral diseases suffered “on the legs” also seriously undermine the body’s immune defense.
4. Maintain personal hygiene.
   According to statistics, it is poor oral hygiene that most often opens the way for herpes infection.
5. Avoid oral trauma.
   Even a minor microcrack from a prick with a fish bone or careless use of a toothpick can become an “entry gate” for the herpes virus.

Attention!

With reduced immunity, herpes stomatitis becomes chronic and relapsing: the disease can recur 2-6 months after recovery.