Symptoms and treatment of acute herpetic stomatitis. List of dental materials, tools and equipment necessary for the work of a doctor

Treatment should be comprehensive, taking into account the degree of local changes and disturbances general condition(severity), age of the child. Depending on the severity, treatment is carried out on an outpatient basis or in a hospital. Conventionally, it is customary to divide therapeutic measures into local (local) and general (systemic) treatment.

Goals local treatment are: anesthesia of the affected mucous membrane;

prevention of new rashes;

prevention of secondary invasion and relapses;

acceleration of epithelization of lesion elements.

Local treatment scheme

Anesthesia of the mucous membranes.
Antiseptic treatment.
Antiviral etiotropic therapy.
Immunocorrective drugs.
Agents that stimulate epithelialization.

For pain relief use: 3% oil solution of anesthesin, 10% lidocaine gel, Kamistad gel, Baby-Dent, etc. Apply for 3-5 minutes. before treatment of mucous membranes or feeding.

Antiseptic treatment carry out: 0.02% furacillin solution, herbal remedies - decoctions and infusions of chamomile, sage, yarrow, eucalyptus, etc. These products also have anti-inflammatory effect. They are used as irrigations, rinses, and in young children they are carefully wiped with a cotton swab. In case of severe AGS and the development of necrotizing ulcerative gingivitis, previously, after anesthesia, foci of necrosis on the oral mucosa are treated with proteolytic enzymes once a day. Of the enzymes, 0.2% deoxyribonuclease solution is especially recommended, as it has, in addition to a cleansing (necrolytic) and antiviral effect.

For local etiotropic therapy OGS use mainly antiviral drugs of groups 2, 3, 4: most often acyclovir (3rd group) - 3% cream or ointment "Zovirax", ointment "Gerpevir", cream "Acic", 5% ointment "Virolex" and etc. Indicated in the incubation period (history of contact with a patient with AHS), prodromal periods, and during the peak period. Duration of use - up to clinical recovery (complete epithelization of rashes on the mucous membranes) - not earlier! In addition, they are often combined with drugs of the 2nd group: 0.5% riodoxole, 0.25% oxolinic, 0.55% tebrofen, 0.5% florenal ointment. The drugs are carefully applied to the ENTIRE musculoskeletal system, starting from unaffected areas, to reduce the likelihood of secondary invasion of the virus into the oral mucosa. The frequency of treatments depends on the severity: for mild - 3-4 times a day, and for severe - 5-6 times. For older and calmer children, applications are carried out, for younger age, with restless behavior - careful lubrication.

Our department has developed a technique using it as an antiviral agent. 2% copper sulfate solution, possessing other healing effects:

antiviral for HSV;
antimicrobial against strepto- and staphylococci;
antifungal against fungi of the genus Candida;
promotes the rejection of necrosis and cleansing of the mucous membranes;
anti-inflammatory;
analgesic and keratoplasty due to the formation of a film of copper albuminate on the surface of erosions (aphthae), which creates protective barrier from external irritants.

The technique involves repeated (taking into account the severity), gentle lubrication of the oral mucosa with a swab moistened with 2% copper sulfate solution and carefully wrung out. In older children, applications to lesions of the oral mucosa are possible. It is necessary to avoid swallowing the solution: carefully wring out the tampon, slightly tilt your head forward when processing, spit out saliva if it accumulates in the oral cavity.

In the local immunomodulatory therapy OGS are used: interferon preparations (human leukocyte interferon, Laferon, etc.), immunomodulators (Dekaris, Imudon, Laferobion, lysozyme solution or "Lizobakt", etc.). Preparations of interferon and its inducers are often prescribed in the form of intranasal drops or inhalations; applications into the nasal passages are possible. Imudon, "Lizobakt" are produced in the form of tablets for resorption in the oral cavity. For irrigation and aerosol inhalation, 0.01-0.05% decaris solution (levamisole) can be used. The frequency of procedures is determined individually, based on the severity and age of the child, on average 3-8 times a day.

For stimulation of epithelialization During the period of extinction of the disease, it is advisable to use applications of keratoplastics: oil solutions Vit. A, E, vinylin, rosehip oil, sea buckthorn, carotoline, Solcoseryl jelly, etc.

Goals general treatment with AHS: reduction of symptoms of intoxication;

impact on HSV circulating in the blood;

reduction of hyperergic inflammatory reaction;

correction of immunity, support of general resistance.

General treatment plan

Correction of nutrition, drinking plenty of fluids.
Prescription of NSAIDs.
Antiviral drugs orally or intramuscularly for moderate and severe cases;
Detoxification therapy for severe cases.
Immunomodulatory drugs.
General strengthening (vitamin) therapy.

Nutrition correction carried out taking into account the area affected by the mucous membrane (number of rashes) and the presence of intoxication. It is recommended to relieve pain in the mucous membranes before eating and to eat non-irritating foods: berry-milk jelly, warm milk, kefir, meat and fish broths, vegetable and fruit purees, boiled eggs and poultry, etc., drink plenty of fluids to reduce intoxication. After eating - rinse the mouth.

Anti-inflammatory therapy (NSAIDs) prescribed for hyperergic reactions, high temperature body (more than 38-38.5ºС). NSAIDs are taken in an age-specific dose; they have analgesic and antipyretic effects.

Etiotropic antiviral drugs prescribed for moderate and severe forms of AGS orally or parenterally along with their local application. Many antiviral drugs are produced in two forms - for local and general treatment: acyclovir (tablets, cream), herpevir (tablets, ointment), Zovirax (cream and solution for injection), etc. Interferons and their inducers, as a rule, , are produced in ampoules and can be used for systemic therapy in the form of intramuscular injections together with their local use (intranasal, inhalation). Representatives: laferon, laferobion, proteflazid, cycloferon, etc. Antiherpetic agents are highly effective plant origin: alpizarin, gossypol, helepin, flakozid. Alpizarin is used in the form of tablets and ointments (2% and 5%), has bacteriostatic, immunomodulating effects, and is an interferon inducer.

Detoxification therapy involves the introduction of salt and plasma-substituting solutions in a hospital setting parenterally: physiological solution, Ringer-Locke solution, hemodez, neohemodez, etc. - in severe cases of the process.

Specific immunotherapy (immunocorrection) is carried out with immunoglobulin with a high content of antiherpetic antibodies, which is administered intramuscularly according to a certain scheme. The immunomodulator "Polyoxidonium" can also be used for this purpose. Immunocorrection is especially indicated for frequent relapses herpetic infection.

It should also be emphasized Features of the treatment of OHS are different age periods:

in the chest: pay attention to the prevention of thrush and herpes

paronychia, active antiviral and anti-inflammatory therapy

skin rashes;

in the nursery: timely and thorough treatment of gingivitis and lymphadenitis;
in preschool: prevention of allergic reactions;
at school: prevention and treatment of gingivitis in the region. removable and teething

permanent teeth.

Anti-epidemic measures include isolation of sick people, treatment of household items (1-2% chloramine solution, alcohol, ether, etc.), disinfection of the premises, regular examinations of children during an outbreak of AHS in an organized group (kindergarten, school) in order to identify again sick, preventive treatment with antiviral drugs for children who were in contact with patients (topically for 5 days, 3-4 times a day).

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 more short time restore normal immunity.

Acute herpetic gingivostomatitis in children

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

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

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

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

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

Herpes simplex virus is a DNA virus. The size of the vibrio is 100-160 nm. Develops intracellularly. The virus is thermolabile and is inactivated at a temperature of 50-52°C for 30 minutes. At a temperature of 37°C, inactivation of the virus occurs within 10 hours. The virus persists for a long time at low temperatures (-70°C). 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.

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

In the development of herpes infection great importance have the structure of the oral mucosa in children in early childhood and the activity of local tissue immunity. The highest prevalence of acute herpetic stomatitis in the period up to 3 years may be due to age-morphological indicators indicating high permeability during this period histohematic barriers and a decrease in the morphological reactions of the immune system: thin epithelial cover with low levels of glycogen and ribonucleic acids, friability and low differentiation 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 viral infection begins with a violation of the integrity of the mucous membranes and skin, adsorption of viral particles and penetration of the virus into the cell. Further ways of spreading the introduced virus throughout the body are complex and poorly understood. There are a number of provisions indicating the spread of the virus by hematogenous and neural routes. IN acute period stomatitis in children, viremia is noted.

Of great importance in the pathogenesis of the disease are The lymph nodes and elements of the reticuloendothelial system, which is quite consistent with the pathogenesis of sequential development clinical signs 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.

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 decreases sharply, amounting to 1-2 cases per 1000 in schoolchildren. 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. So, highest prevalence OGS in the period up to 3 years may be due to high permeability of histological barriers during this period and a decrease in morphological immune responses, thin epithelial cover with low levels of glycogen and ribonucleic acids, friability and low differentiation of the basement membrane and fibrous structures of connective tissue.

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

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

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

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

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

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

In children suffering from this form of the disease, as a rule, there are no changes in the blood, sometimes only towards the end of the disease a slight lymphocytosis appears. In this form of the disease, 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 impaired protective forces body.

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 higher boundaries norms; lymphocytosis and plasmacytosis are observed. An increase in the titer of herpetic complement-fixing antibodies is detected more often than after a mild form of stomatitis.

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

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

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

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

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

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

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

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

The diagnosis of acute herpetic stomatitis is established on the basis of anamnestic, epidemiological data, characteristic clinical symptoms, as well as cytomorphological data. Cytologically clinical diagnosis confirmed by the presence in smears of fingerprints characteristic of herpetic infection 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, we are studying the state local immunity oral mucosa: lysozyme content, 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 development 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 last years Schoolchildren and teenagers also rarely get sick. The causative agents are saprophytes of the oral cavity: fusiform bacillus and spirochetes, which under certain conditions become pathogenic; they large quantities are found in the discharge from the surface of the ulcers.

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

The goals of treatment of acute herpetic stomatitis are:

— elimination of the cause of the disease;

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

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

Indications for hospitalization:

- prolonged dehydration and intoxication;

- severe and complicated course of the disease.

Complex therapy for acute herpetic stomatitis includes general and local treatment. For moderate to severe disease general treatment It is advisable to do this together with a pediatrician. Due to the peculiarities of the clinical course of acute herpetic stomatitis, rational nutrition and proper organization feeding the patient occupy an important place in the complex 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 pay attention to the introduction of a sufficient amount of fluid. This is especially important during intoxication.

Local treatment for acute herpetic stomatitis requires the following tasks:

Remove or loosen painful symptoms in the oral cavity;

Prevent repeated rashes of lesions (reinfection);

Promote the acceleration of epithelization of lesion elements.

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

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 oil solution vitamin A, sea buckthorn oil, Vitaon oil, rosehip seed oil, ointments with methyluracil, solcoseryl, Actovegin (gel, ointment, cream, dental adhesive paste). The drugs are applied to the treated wound surface until complete epithelialization.

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

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

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

Treatment algorithm for children with acute herpetic stomatitis

Local treatment:

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

human leukocyte interferon;
meglumine acridone acetate (cycloferon).

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

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

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

With the aim of antiseptic treatment oral cavity recommended the following groups drugs:

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

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

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

General treatment

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

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

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

Treatment of complications of acute herpetic stomatitis

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

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 the illness must be reported to childcare facility if the child visits it.

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 should lubricate the mucous membranes of the nose and mouth with 0.25% oxolinic ointment or instill a solution of human leukocyte interferon into the nose, and also give ascorbic acid orally for 5 days.

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

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

Kazan State Medical University

Dental clinic No. 9, Kazan

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

Literature:

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

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

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

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

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

According to WHO, among viral infections, diseases caused by the herpes simplex virus (HSV) rank second after influenza. The total infection of the population with HSV ranges from 50 to 100%, which allows us to consider diseases caused by this infection as socially significant. In terms of frequency of occurrence among all lesions of the oral mucosa in children (OSM), acute herpetic stomatitis (AHS) ranks first.

Primary infection is observed mainly in children under 5 years of age, which is explained by their lack of appropriate antibodies. In 90% of children, primary infection occurs asymptomatically, and only in 10% of cases does the clinical manifestations manifest in the form of AHS. The share of this disease is 80% of the number of lesions of the oral mucosa in children of this age group. In adults, primary infection occurs much less frequently.

After primary infection in early childhood, up to 70% of the population become lifelong carriers of HSV. The virus becomes inactive and remains in the sensory nerve ganglia. In conditions of immune deficiency and other unfavorable factors, HSV is able to be activated, the body reacts to this with the manifestation of various clinical variants of secondary herpetic infection, that is, the pathology is considered as a manifestation of recurrent herpetic infection. Recurrences of herpes infection may be due to repeated infection.

Clinically, herpes occurs as a diverse, complex and often severe disease affecting many organs and tissues, which makes it necessary to consider it as a general systemic disease of the body. Thus, HSV can affect the central and peripheral nervous system, liver, skin, mucous membranes of the eyes, gastrointestinal tract, genitals.

The herpes simplex virus causes both inflammatory diseases (meningoencephalitis, hepatitis, keratoconjunctivitis, gingivostomatitis, etc.) and degenerative-dystrophic and tumor diseases (Alzheimer's disease - senile dementia, Kaposi's sarcoma, Burkitt's lymphoma, cervical cancer, lip cancer and others pathological conditions). Herpes simplex virus is causative factor intrauterine pathology of the fetus. Often in the clinic there is a combination of various clinical forms of herpetic infection.

Treatment tactics for patients with AGS should be determined by the severity of the disease and the period of its development. Complex therapy for acute syndrome includes general and local treatment. In case of moderate and severe disease, general treatment must be carried out together with a pediatrician, often in a hospital setting. Children are advised to remain on bed rest and should be isolated.

The goals of treatment for AHS are:

bringing the child's body into adequate condition(identical to the state of the body of a healthy child);
fight against intoxication of the child’s body;
ridding the child of manifestations of the disease on the face, lips and oral cavity;
prevention of complications and, first of all, streptostaphyllococcal pyoderma;
improving the hygienic condition of the oral cavity.

Caring for a sick child is very important. Children infected with HSV and having an OHS clinic should receive local and general therapy. Local therapy for OGS solves the following problems:

cleansing the oral cavity and teeth from food debris, plaque, necrotic tissue;
relieve or reduce painful symptoms in the oral cavity;
prevent recurrence of lesions;
eliminate inflammation of the mucous membranes;
promote the acceleration of epithelization of lesion elements.

The implementation of these tasks can be represented by the following algorithm for providing medical care to children with acute herpetic stomatitis.

Local treatment algorithm

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

human leukocyte interferon;
cycloferon;
Viferon;
reaferon.

Painkillers are used before eating and before treating the mucous membranes:

5-10% suspension of anesthesin in peach oil;
lidochlorgel (lidocaine + chlorhexidine);
Cholisal gel;
tantum verde spray;
stomatophyte A.

Enzyme solutions for lysis of necrotic tissue and cleansing the mucous membrane of fibrin deposits:

trypsin;
chymotrypsin;
chymopsin.

Antiseptic treatment:

hexoral or 0.05% chlorhexidine solution;
miramistin solution;
Cholisal gel;
stomatophyte A;
tantum verde.

Antiviral gels, ointments, solutions 5-6 times a day:

cytovir 3;
acyclovir;
alpizarin;
florenal, tebrofen, bonafton, etc.

During the period of extinction of the disease, anti-inflammatory and keratoplasty agents are used:

Cholisal gel;
stomatophyte A;
SDAP;
vegetable oils;
vitaon oil

Physiotherapy:

ozone therapy
laser treatment

To be more effective, drugs for local (local) therapy should combine several effects: antiviral, immunomodulating, symptomatic and preventive action. Most drugs have one or two of these effects.

A new step has been taken in the treatment of manifestations of herpetic infection - the company "Diarsi" (Russia) has developed a new formula in the drug "Gerpenox". It is based on a chelate complex of germanium-organic compound with guanine, alginates and xylitol. The drug has complex impact on the course of the pathological process in the treatment of herpetic infection.

General treatment is carried out for any severity of the disease and includes:

organization of rational therapeutic nutrition; food should be complete, liquid or semi-liquid, not irritating the inflamed mucus; When eating, it is advisable to prescribe natural gastric juice or its substitutes, because with pain in the mouth, the secretory activity of the gastric glands reflexively decreases;
nonspecific detoxification therapy - administration of a sufficient amount of fluid to relieve intoxication, ascorbic acid and other vitamins;
taking hyposensitizing drugs;
taking antiviral drugs orally;
It is advisable to prescribe immunostimulants and immunocorrectors, in consultation with a pediatrician, for children at risk of developing RHS and herpetic hepatitis.

The implementation of these tasks can be represented by the following algorithm for providing medical care to children with acute herpetic stomatitis.

General treatment algorithm

Bed rest, isolation of a sick child.

Non-irritating crushed protein foods, plenty of drink (fruit drinks, natural juices).

Hyposensitizing therapy (antihistamines):

diazolin 0.02-0.05 g per night, fenkarol - 0.02-0.05 g per night, tavegil (syrup) - up to 1 g, 2.5 ml per dose;
calcium preparations (calcium gluconate for children over 6 years old, 1 tablet, 4-6 years old - 1/2 tablet; up to 4 years old - 1/4 tablet).

Antipyretics, painkillers:

paracetamol, Efferalgan (tablets, syrup), Panadol (syrup), Calpol (syrup) or Tylenol (syrup, tablets); analgin (suppositories) - (5-10 mg/kg 3-4 times a day).

Antiviral drugs:

acyclovir;
alpizarin;
cycloferon;
Viferon.

Immunomodulatory drugs:

imudon;
lycopid;
polyoxidonium;
lysobacter.

Pharmaceutical industry for children early age produces immunomodulatory, antiviral and other drugs for ease of use in the form of ointments, gels and suspensions. This is how viferon, raeferon, polyoxidonium, etc. are produced, used in the treatment of acute hepatitis.

Forecast favorable. At the same time, with inactive treatment and untimely prescription of antiviral drugs, as well as other treatments, especially those that increase the resistance of the child’s body, the disease becomes chronic or often recurs.

Yanovsky L.M., Kovtonyuk P.A.

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 depression natural immunity, which recovered 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 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.

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 lesion elements rises to 1.80 and remains for more high 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. Pungent putrid odor from the mouth, profuse drooling 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. A 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 leading 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. Must be given to child sufficient quantity liquids. 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, taking into account its etiology, in local treatment serious attention should be paid antiviral therapy. For this purpose, it is recommended to use 0.25% oxolinic, 0.5% tebrofen ointments, Zovirax, solutions of interferon and neoferon.

Listed medications It is recommended to use it 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 children's department therapeutic dentistry MGMSU 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 lemon acid, precirol finely divided, 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 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 treatment of the oral cavity 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 for the drug.
Influence on the state of local immunity.

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

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 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 it is installed high efficiency imudon in the treatment of AGS due to immune correction of saliva. Imudon has a therapeutic, anti-inflammatory effect, reduces the time of 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.

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.

Reading time: 10 minutes

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

What it is

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

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

Causes and symptoms of herpetic stomatitis

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

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

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

Mild symptoms:

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

In cases of moderate severity, the following is noted:

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

A severe form of the disease is characterized by:

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

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

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

Treatment of herpetic stomatitis in children

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

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

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

How and with what to treat

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

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

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

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

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

Review of pharmaceutical drugs

Holisal

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

Viferon

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

Oxolinic ointment 0.25%

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

Acyclovir

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

Zovirax

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

Immunal

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

Oil solutions A and E

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

Folk remedies

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

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

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

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

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

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

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

Prevention of herpetic stomatitis in children

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

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

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

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