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

Treatment should be complex, take into account the degree of local changes and violations 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 subdivide therapeutic measures into local (local) and general (systemic) treatment.

Goals local treatment are: anesthesia of the affected oral mucosa;

prevention of new rashes;

prevention of secondary invasion and recurrence;

acceleration of epithelialization of the elements of the lesion.

Scheme of local treatment

Anesthesia SOPR.
antiseptic treatment.
Antiviral etiotropic therapy.
Immunocorrective drugs.
Means that stimulate epithelialization.

For anesthesia apply: 3% oil solution of anesthesin, 10% lidocaine gel, gel "Kamistad", "Baby-Dent", etc. Apply for 3-5 minutes. before treatment with ORM or feeding.

antiseptic treatment carry out: 0.02% solution of furacillin, vegetable media - decoctions and infusions of chamomile, sage, yarrow, eucalyptus, etc. These funds also have anti-inflammatory effect. Apply in the form of irrigation, rinsing, and in young children gently wipe with a cotton swab. In severe acute hepatitis C and the development of ulcerative necrotic gingivitis, after anesthesia, foci of necrosis on the oral cavity are treated with proteolytic enzymes 1 time per day. Of the enzymes, a 0.2% solution of deoxyribonuclease is especially recommended, which, in addition to having a cleansing (necrolytic) and antiviral effect, is especially recommended.

For local etiotropic therapy OGS mainly use antiviral drugs of groups 2, 3, 4: most often acyclovirs (3rd gr.) - 3% cream or ointment "Zovirax", ointment "Gerpevir", cream "Atsik", 5% ointment "Virolex" and etc. Shown in the incubation (in history - contact with a patient with acute hepatitis C), prodromal periods, during the peak. Duration of application - up to clinical recovery (complete epithelialization of rashes on the mucous membrane) - not earlier! In addition, they are often combined with drugs of the 2nd group: 0.5% rhyodoxol, 0.25% oxolinic, 0.55% tebrofen, 0.5% florenal ointment. The preparations are carefully applied to the ALL OM, starting from the unaffected areas, to reduce the likelihood of secondary infection of the virus in the OM. The frequency of treatments depends on the form of severity: with mild - 3-4 times a day, and with severe - 5-6 times. In older and calm children, applications are carried out, in younger age, with restless behavior - careful lubrication.

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

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

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

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

For stimulation of epithelialization in the period of extinction of obstruction, it is advisable to use applications of keratoplastic agents: oil solutions of vit. A, E, vinylin, rosehip oil, sea buckthorn, carotenoline, Solcoseryl jelly, etc.

Goals general treatment with OGS: a decrease in the symptoms of intoxication;

impact on HSV circulating in the blood;

reduction of hyperergic inflammatory response;

correction of immunity, support of general resistance.

General Treatment Scheme

Correction of food, plentiful drink.
Appointment of NSAIDs.
Antiviral drugs orally or intramuscularly in moderate and severe cases;
Detoxification therapy in severe cases.
Immunomodulatory drugs.
General strengthening (vitamins) therapy.

Power correction carried out taking into account the area of damage to the oral mucosa (number of rashes) and the presence of intoxication. Recommended analgesia of oral mucosa before meals and non-irritating food: berry-milk jelly, warm milk, kefir, meat and fish broths, vegetable and fruit purees, boiled eggs and poultry, etc., drinking plenty of water - to reduce intoxication. After eating - rinsing the mouth.

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

Etiotropic antiviral drugs prescribed for moderate and severe forms of acute hepatitis C 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 injection solution) and others. Interferons and their inducers, as a rule , produced in ampoules and can be used for systemic therapy in the form of intramuscular injections along with their local use (intranasal, inhalation). Representatives: laferon, laferobion, proteflazid, cycloferon, etc. Highly effective antiherpetic drugs plant origin: alpizarin, gossypol, helepin, flacoside. Alpizarin is used in the form of tablets and ointments (2% and 5%), it has a bacteriostatic, immunomodulatory effect, an interferon inducer.

Detoxification therapy involves the introduction of saline and plasma-substituting solutions in a hospital, parenterally: physiological solution, Ringer-Locke solution, gemodez, neogemodez, etc. - in case of severe process.

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

It should also be emphasized features of the treatment of OHSv are various age periods:

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

paronychia, active antiviral and anti-inflammatory therapy

skin rashes;

in 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. replaceable and erupting

permanent teeth.

Anti-epidemic measures include isolation of sick people, treatment of household items (1-2% solution of chloramine, alcohol, ether, etc.), disinfection of the premises, regular examinations of children during an outbreak of ACS in an organized number (kindergarten, school) in order to identify newly sick, prophylactic treatments with antiviral drugs for children who have been in contact with patients (locally for 5 days, 3-4 rubles / day).

The present review considers 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 time of treatment of acute herpetic stomatitis, reduce the severity of the 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 virus 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, due to primary contact with the herpes simplex virus, characterized by inflammation of the oral mucosa with the manifestation of bubble rashes, fever and decreased immunity.

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

For the first time, the role of the herpes simplex virus in diseases of the oral mucosa was pointed out at the beginning of the 20th century. N.F. Filatov (1902). He suggested the possible herpetic nature of the most common acute among children. aphthous stomatitis. This evidence was obtained later, when antigens of the herpes simplex virus were found 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 childhood infectious diseases. At the same time, in every 7-10th child, acute herpetic stomatitis very early turns into a chronic form with periodic relapses.

Herpes simplex virus is a DNA-containing virus. Vibrio dimensions - 100-160 nm. Develops intracellularly. The virus is thermolabile, 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 intrauterine fetal pathology. A combination of various clinical forms of herpes 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 obtained from the mother interplacentally disappear in children, as well as the lack of mature systems of specific immunity. Among older children, the incidence is much 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 by airborne, contact-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 morphological reactions of immunity: a thin epithelial cover with a low level of glycogen and ribonucleic acids, friability and low differentiation basement membrane and fibrous structures of the connective tissue (abundant vascularization, high levels of mast cells with their low functional activity, etc.).

The pathogenesis of acute herpetic stomatitis is currently not fully understood. 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 pathways. IN acute period stomatitis in children noted viremia.

important in the pathogenesis of the disease are The lymph nodes and elements of the reticuloendothelial system, which is 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 also 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 epithelialization of the elements of the rash.

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

Primary infection usually occurs after 6 months of life, since before that, the blood of most newborns contains antibodies to the herpes simplex virus obtained from the mother by the transplacental route. Most often, the disease occurs at the age of 1 to 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 schoolchildren. High incidence in children from 6 months to 3 years is explained by the fact that at this age the 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 a herpes infection in one or another clinical form.

For the development of a herpetic infection that affects mainly the oral cavity, the structure of the oral mucosa is of great importance. So, highest prevalence ACS in the period up to 3 years may be due to the high permeability of histological barriers during this period and a decrease in morphological immunity reactions, a thin epithelial cover with a low level of glycogen and ribonucleic acids, looseness and low differentiation of the basement membrane and fibrous structures of the 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, development of the disease, extinction and clinical recovery. In the period of development of the disease, two phases can be distinguished - catarrhal and rashes of the elements of the lesion.

Symptoms of damage to the oral mucosa appear in the third period of the development of the disease. Intense hyperemia of the entire oral mucosa is observed, after a day, less often two, elements of the lesion 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 inflammation of the nasal mucosa, upper respiratory tract may be detected. Sometimes in the oral cavity there is hyperemia, slight swelling, 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 the doctor, as the bubble quickly bursts and turns into an erosion-aphtha. Aphtha-erosion rounded or oval with smooth edges and a smooth bottom gray color 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. Rashes are disposable. The duration of the period of development of the disease is 1-2 days.

The period of extinction of the disease is longer. Within 1-2 days, the elements acquire a kind of marble 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 region 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 a slight lymphocytosis appears only towards the end of the disease. With 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 appears in saliva - interferon (from 8 to 12 units / ml). The decrease in lysozyme in saliva is not expressed.

Natural immunity with a mild form of stomatitis suffers slightly, and during the period of clinical recovery, the defenses of the child's body are almost at the level of healthy children, i.e. with a mild form of acute herpetic stomatitis, clinical recovery means a complete restoration of the disturbed defensive forces organism.

The moderate form of acute herpetic stomatitis is characterized quite clearly severe symptoms toxicosis and lesions of the oral mucosa during all periods of the disease. Already in the prodromal period, the child's well-being worsens, weakness, whims, loss of appetite appear, catarrhal tonsillitis or symptoms of acute respiratory disease are observed. Submandibular lymph nodes increase, become painful. The temperature rises to 37-37.5°C.

As the disease progresses during the development of the disease (the phase of catarrh), the temperature rises to 38-39 ° C, headache, nausea, and pallor of the 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 elements of the lesion are usually noted. During this period, salivation increases, saliva becomes viscous, viscous. Marked pronounced inflammation and bleeding of the gums.

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 rash of elements of the lesion, the body temperature usually drops to 37-37.5 ° C. However, subsequent rashes, as a rule, are accompanied by a rise in temperature to the previous figures. The child does not eat, sleeps poorly, symptoms of secondary toxicosis increase.

In the blood, an increase in ESR up to 20 mm / h is noted, more often leukopenia, sometimes slight leukocytosis; stab leukocytes and monocytes are within higher limits norms; observed lymphocytosis and plasmacytosis. 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 decayed teeth in the oral cavity, and irrational treatment. The latter factors contribute to the fusion of the elements of the lesion, their subsequent ulceration, the appearance of ulcerative gingivitis. Epithelialization of the elements of the lesion is delayed up to 4-5 days. Gingivitis, sharp bleeding of the gums and lymphadenitis persist the longest.

With a moderate course of the 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 with a mild form of stomatitis.

The severe form of acute herpetic stomatitis is much less common than moderate and mild. In the prodromal period, the child has all the signs of an incipient acute infectious disease: apathy, adynamia, headache, cutaneous muscle hyperesthesia and arthralgia, etc. Often, symptoms of a lesion are observed. of cardio-vascular system: brady- and tachycardia, muffled heart sounds, arterial hypotension. In some children, nosebleeds, nausea, vomiting, and pronounced lymphadenitis are noted not only in the submandibular, but also in the cervical lymph nodes.

During the development of the disease, the temperature rises to 39-40 ° C. The child has a mournful expression, suffering sunken eyes are characteristic. Observe unsharply pronounced runny nose, coughing; conjunctiva somewhat edematous and hyperemic. Lips dry, bright, parched. The mucous membrane of the oral cavity is edematous, brightly hyperemic, acute catarrhal gingivitis is pronounced. After 1-2 days, elements of a rash begin to appear in the oral cavity (up to 20-25). Often, rashes in the form of typical herpetic vesicles appear on the skin in the oral region, the skin of the eyelids and the conjunctiva of the eyes, the lobes of the ears, on the fingers, like 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 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. Inflammatory phenomena on the mucous membrane of the nose, respiratory tract, and eyes are aggravated. In the secret from the nose and larynx, streaks of blood are also found, and sometimes nosebleeds are noted. In this state, children need active treatment at the pediatrician and dentist, in connection with which 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 stab shift to the left, eosinophilia, single plasma cells, and young forms of neutrophils are found. In the latter, toxic granularity is very rarely observed. Herpetic complement-fixing antibodies during the period of convalescence are usually always determined.

The reaction of saliva is acidic (pH 6.55 ± 0.2), but after a while 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 the timely and correctly prescribed treatment and on the presence of concomitant diseases in the child's history.

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

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

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

It is known that immunosuppression is one of the main factors in the implementation of herpes virus infection. In this regard, the study of the state local immunity oral mucosa: the content of lysozyme, the level of immunoglobulins (in particular, secretory IgA) in mixed saliva. The material for the study are smears-imprints from the oral mucosa. Tests are considered positive for herpetic antigen, in which cell nuclei are stained with fluorescein and polymorphonuclear neutrophils and macrophages are observed, which are specifically stained with herpetic antiserum; 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 by indicating specific regions of the genome. The method provides high sensitivity and specificity for the determination of an infectious agent, starting from the earliest stages of development. infectious process. The material for the study are scrapings from the oral mucosa.

Strepto-staphylococcal lesions (pyoderma)

The leading symptoms of the disease are due to the addition of pyogenic microflora. The body temperature is elevated - in severe cases up to 38-39°C, there are signs of intoxication and lymphadenitis of regional nodes, prone to abscess formation. 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, infiltrated. The anterior sections of the oral mucosa may also be affected: lips, gums, tip of the tongue. At the same time, on a hyperemic background, separate and merging erosions covered with a loose coating are revealed.

Ulcerative gingivostomatitis Vincent

Rarely seen in young children. IN last years schoolchildren and adolescents are also rarely ill. The causative agents are saprophytes of the oral cavity: fusiform bacillus and spirochetes, which under certain conditions become pathogenic, they are in in large numbers are found in the discharge from the surface of ulcers.

The general condition of the child is severe, 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 enhanced. Gums swollen, dark red; in the area of ulceration, the interdental papillae are, as it were, cut off due to the decay of the tissue at their top and are covered with a dirty, easily 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 necrotic gingivostomatitis).

The doctor's tactics in the treatment of 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 carry out together with a pediatrician. In connection with 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 medical measures. Food should be complete, i.e. contain all the necessary nutrients as well as vitamins. Given that the pain factor often makes the child refuse food, first of all, before feeding, it is necessary to treat the oral mucosa with cholisal gel, which provides a quick analgesic effect, application anesthetics, a 5-10% benzocaine oil solution or a gel containing lidocaine + chlorhexidine (lidochlor).

The child is fed mainly liquid or semi-liquid food that does not irritate the inflamed mucous membrane. great attention give the introduction of a sufficient amount of liquid. This is especially important for intoxication.

Local treatment for acute herpetic stomatitis requires the following tasks:

Remove or loosen painful symptoms in the oral cavity;

Prevent repeated rashes of elements of the lesion (reinfection);

Contribute to the acceleration of the epithelization of the elements of the lesion.

From the first days of the period of development of acute herpetic stomatitis, given the etiology of the disease, serious attention should be paid to antiviral treatment. For this purpose, it is recommended to use an ointment with bromnaphthoquinone (bonafton ointment), tebrofen ointment, acyclovir ointment, interferon alpha-2 (viferon), herpferon, alpizarin ointment (0.5-2%), a solution of leukocyte human interferon and other antivirals.

These medicines 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 desirable to act with antiviral agents both on the affected areas of the mucous membrane and on areas without elements of the rash, since they have a more prophylactic effect than a therapeutic one. During the period of extinction of the disease, antiviral agents and their inducers are replaced by anti-inflammatory and keratoplastic drugs.

Weak antiseptics and keratoplastic agents play a leading role in 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.

The 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 in this disease. Thus, the content of IgA, which plays a major role in protecting the oral mucosa, correlates with the severity and nature of the course. pathological process. The content of lysozyme in saliva in patients with acute herpetic stomatitis depends on the severity of stomatitis and gingivitis. The revealed regularities in the dynamics of indicators of local immunity of the oral cavity make it possible to consider the inclusion of drugs aimed at their correction into the complex treatment regimen for acute herpetic stomatitis as pathogenetically justified. These drugs include immunomodulating agents: imudon, glucosaminyl muramyl dipeptide (lycopid), azoxymer bromide (polyoxidonium), lysobact, etc.

With a severe degree of damage, the elements of rashes on the skin are smeared 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.

Algorithm for the treatment of children with acute herpetic stomatitis

Local treatment:

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

human leukocyte interferon;
meglumine acridonacetate (cycloferon).

As painkillers (before eating and before treating the oral mucosa) are used:

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

To remove necrotic tissues 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 mouth recommended following groups drugs:

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

0.25% oxolinic, 0.25-1% tebrofen, 2% alpizarin, 0.25-0.5% florenal, 1% bonafton, 0.25% adima, 5% helepin liniment or alpizarin, Viferon, solutions of interferon and reaferon.

During the period of extinction of the disease, anti-inflammatory and keratoplastic agents are prescribed: solcoseryl jelly, actovegin, cholisal gel, vitaon oil, aekol, sea buckthorn oil, rosehip oil, etc.

General treatment

As an antipyretic, pain reliever, prescribe the following drugs: paracetamol (tablets, syrup), efferalgan (tablets, syrup), panadol (syrup), calpol (syrup), cefecon suppositories (5-10 mg / kg body weight 3-4 times a day), Tylenol (syrup , tablets), nurofen (syrup), etc. Recommended antihistamines- mebhydrolin (diazolin), hifenadine (fencarol), loratadine (claritin), clemastine (tavegil), suprastin.

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

Immunomodulatory drugs used in this treatment regimen are imunal, licopid, polyoxidonium, lysobact, immunobears. In addition, plentiful drinking and non-irritating food are recommended.

Treatment of complications of acute herpetic stomatitis

Treatment of pyoderma includes the removal of purulent crusts and the treatment of the mucous membrane. The crusts are removed after application anesthesia, after softening them with a 1% hydrogen peroxide solution. The mucous membrane of the mouth, 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 IU 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 reported to the children's institution if the child attends.

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

All children who have been in contact with sick people are lubricated with 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, bedding, towels. He needs to observe bed rest, follow all the doctor's orders. Get special meals. Fresh vegetable broths are recommended in meat or fish broth, to which chopped boiled meat or fish or fish are added. chicken fillet, boiled vegetables. Warm non-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). Plentiful drink, chemically and mechanically sparing food is recommended. Before eating, the oral mucosa should be anesthetized. To do this, carefully lubricate the lips first, and then the affected areas of the oral mucosa with an anesthesin emulsion. The emulsion is applied to the lips with the index finger wrapped in cotton. 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 down and the mouth is washed from a rubber spray.

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

Kazan State Medical University

Dental polyclinic No. 9, Kazan

Tidgen Kristina Vladimirovna — post-graduate student of the Department of Pediatric Dentistry

Literature:

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

2. Persin L.S. Dentistry of children's age. - Ed. 5th, revised. and additional / L.S. Persin, V.M. Elizarova, S.V. Dyakova. - M.: Medicine, 2003. - 640 p.: ill. (Study literature for students of medical universities).

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

4. Vinogradova T.F. Diseases of the periodontium 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 / Enter. Art. acad. RAMN E.I. Sokolov. - M.: MEDpress, 2000. - 140 p.

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

Primary infection is observed mainly in children under 5 years of age, due to the lack of appropriate antibodies in them. In 90% of children, primary infection occurs asymptomatically, and only in 10% of cases is the clinic expressed in the form of acute hepatitis C. The proportion of this disease is 80% of the number of lesions of the oral mucosa in children of this age group. In adults, primary infection is realized 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 persists in sensitive nerve ganglia. Under conditions of immune deficiency and other adverse factors, HSV is able to activate, the body reacts to this by manifesting various clinical variants of a secondary herpes infection, that is, the pathology is considered as a manifestation of a recurrent herpes infection. Relapses of herpes infection may be due to re-infection.

Clinically, herpes proceeds as a diverse, complex and often severe disease with damage to 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.

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

The tactics of treating patients with acute hepatitis C should be determined by the severity of the disease and the period of its development. Complex therapy for ACS includes general and local treatment. In moderate and severe cases of the disease, general treatment should be carried out together with a pediatrician, often in a hospital setting. Children are advised to do bed rest and need to be isolated.

The objectives of the treatment of ACS are:

bringing the child's body into adequate condition(identical to the state of the body of a healthy child);
struggle and intoxication of the child's body;
getting rid of the child from the manifestations of the disease on the face, lips and mouth;
prevention of complications and, first of all, streptostaphylococcal pyoderma;
improvement of the hygienic condition of the oral cavity.

It is very important to take care of a sick child. Children infected with HSV and having an AHC clinic should receive local and general therapy. Local therapy of OGS solves the following tasks:

cleansing the oral cavity and teeth from food debris, plaque, necrotic tissues;
relieve or relieve painful symptoms in the oral cavity;
prevent repeated rashes of elements of the lesion;
eliminate inflammation of the oral mucosa;
contribute to the acceleration of epithelialization of the elements of the lesion.

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, apply: 3-4 drops in the nose and under the tongue every 4 hours:

human leukocyte interferon;
cycloferon;
viferon;
reaferon.

Painkillers are used before meals and before the treatment of oral mucosa:

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

Enzyme solutions for lysis of necrotic tissues and cleansing of the mucous membrane from fibrin plaque:

trypsin;
chymotrypsin;
chymopsin.

Antiseptic treatment:

hexoral or 0.05% chlorhexidine solution;
miramistin solution;
holisal 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 keratoplastic agents are used:

holisal gel;
stomatophyte A;
SDAP;
vegetable oils;
vitaon oil.

Physiotherapy:

ozone therapy
laser treatment

Preparations of local (local) therapy in order to be more effective should combine several effects: antiviral, immunomodulatory, 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 preparation "Gerpenox". It is based on a chelate complex of an organic germanium compound with guanine, alginates and xylitol. The drug has complex impact on the course of the pathological process in the treatment of herpes 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 mucosa; when eating, it is advisable to prescribe natural gastric juice or its substitutes, tk. with pain in the mouth, the secretory activity of the stomach glands reflexively decreases;
non-specific detoxification therapy - the introduction of a sufficient amount of liquid to relieve intoxication, ascorbic acid and other vitamins;
taking hyposensitizing drugs;
taking antiviral drugs inside;
the appointment of immunostimulants and immunocorrectors, in agreement with the pediatrician, is advisable for children at risk of developing CHD, 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 food, plentiful drink (fruit drinks, natural juices).

Hyposensitizing therapy (antihistamines):

diazolin 0.02-0.05 g at night, fenkarol - 0.02-0.05 g at 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 each; up to 4 years old - 1/4 tablet each).

Antipyretics, painkillers:

paracetamol, efferalgan (tablets, syrup), Panadol (syrup), calpol (syrup), or Tylenol (syrup, tablets); analgin (candles) - (5-10 mg / kg 3-4 times a day).

Antiviral drugs:

acyclovir;
alpizarin;
cycloferon;
viferon.

Immunomodulatory drugs:

imudon;
licopid;
polyoxidonium;
lysobact.

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

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 methods of virological, serological and immunofluorescent studies confirms that acute herpetic stomatitis is one of the clinical forms of primary herpes 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 the antibodies obtained from the mother interplacentally disappear in children, as well as the lack of mature systems of specific immunity. Among older children, the incidence is much 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 consistent with the pathogenesis of the consistent 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, in 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 epithelialization of the elements.

The resistance of an organism to a disease is determined by its immunological defense. Both specific and non-specific 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 clinical recovery of the child.

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, prodrome, the period of development of the disease, extinction and clinical recovery.

The mild form of acute herpetic stomatitis is characterized by the 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, the phenomena of hyperemia, slight edema, 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. Rashes are disposable. The duration of the period of development of the disease is 1-2 days.

The period of extinction of the disease is longer. Within 1-2 days, the elements acquire a kind of marble 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 jaws.

In children suffering from this form of the disease, as a rule, there are no changes in the blood, sometimes a slight lymphocytosis appears only towards the end of the disease (in children 1-3 years old, the number of lymphocytes is normally up to 50%). Herpetic complement-fixing antibodies during convalescence are not often determined. With 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 expressed.

The moderate form of acute herpetic stomatitis is characterized by fairly pronounced symptoms of toxicosis and lesions of 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 naughty, there may be catarrhal tonsillitis or symptoms of acute respiratory disease. Submandibular lymph nodes increase, become painful. The temperature rises to 37-37.5°C.

As the disease progresses (the phase of catarrh), the temperature reaches 38-39 ° C, headache, nausea, and pallor of the skin appear. At the peak of the rise in temperature, increased hyperemia and severe swelling of the mucosa, elements of the lesion pour out both in the oral cavity and on the skin of the face near the mouth. In the oral cavity, usually from 10 to 20-25 elements of the lesion. During this period, salivation intensifies, saliva becomes viscous, viscous. Pronounced gingivitis and bleeding gums are noted.

In the blood, ESR up to 20 mm / h is noted, more often leukopenia, sometimes slight leukocytosis. Band and monocytes within the upper limits of the norm, 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 decayed teeth in the oral cavity, and irrational therapy. The latter factors contribute to the fusion of the elements of the lesion, their subsequent ulceration, the appearance of ulcerative gingivitis. Epithelialization of the elements of the lesion is delayed up to 4-5 days. Gingivitis, severe bleeding and lymphadenitis persist the longest.

In the moderate course of the disease, saliva pH 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 found in everyone. The content of lysozyme in saliva decreases more than with a mild form of stomatitis. The temperature of the unchanged oral mucosa is in accordance with the temperature of the child's body, while the temperature of the elements of the lesion in the stage of degeneration is 1.0-1.2°C lower than the temperature of the unchanged mucosa. With the onset of regeneration and during the period of epithelialization, the temperature of the elements of the lesion rises to 1.80 and stays for more than high level until complete epithelialization of the affected mucosa.

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

In the prodromal period, all signs of an acute infectious disease begin: apathy, weakness, headache, musculoskeletal hyperesthesia and arthralgia, etc. Often there are symptoms of damage to the cardiovascular system: bradycardia and tachycardia, muffled heart sounds, arterial hypotension. Some children have nosebleeds, nausea, vomiting, and pronounced lymphadenitis not only of the submandibular, but also of the cervical lymph nodes.

During the development of the disease, the temperature rises to 39-40 ° C. The child has a mournful expression of lips, suffering sunken eyes. There may be a mildly pronounced runny nose, coughing, and the conjunctiva of the eyes are somewhat swollen and hyperemic. Lips dry, bright, parched. In the oral cavity, the mucosa is edematous, brightly hyperemic, pronounced gingivitis.

After 1-2 days, elements of damage up to 20-25 begin to appear in the oral cavity. Often, rashes in the form of typical herpetic vesicles form on the skin of the oral region, the skin of the eyelids and the conjunctiva of the eyes, the earlobe, 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 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 salivation mixed with blood. Inflammatory phenomena on the mucous membrane of the nose, respiratory tract, and eyes are aggravated. In the secret from the nose and larynx, streaks of blood are also found, and sometimes nosebleeds are noted. In this state, children need active treatment by a pediatrician and a dentist, and therefore it is advisable to hospitalize the child in a boxed department of a children's or infectious diseases hospital.

In the blood of children with severe stomatitis, leukopenia, a stab shift to the left, eosinophilia, single plasma cells, and young forms of neutrophils are found. In the latter, toxic granularity is very rarely observed. Herpetic complement-fixing antibodies during the period of convalescence are usually always determined.

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 on the basis of 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, you can get results at best by 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 method of immunofluorescence has been increasingly used. A high percentage of coincidences (79.0±0.6%) of the diagnosis of acute herpetic stomatitis, according to immunofluorescence, with the results of virological and serological studies make this method leading in the diagnosis of the disease.

The doctor's tactics in the treatment of patients with acute herpetic stomatitis should be determined by the severity of the disease and the period of its development.

In connection with the peculiarities of the course of acute herpetic stomatitis, rational nutrition and the proper organization of feeding the patient occupy an important place in the complex of therapeutic measures. Food should be complete, that is, contain all the necessary nutrients, as well as vitamins. Therefore, it is necessary to include fresh vegetables, fruits, berries, juices in the diet. Before feeding, the oral mucosa should be anesthetized with a 2-5% solution of anesthetic emulsion.

The child is fed mainly liquid or semi-liquid food that does not irritate the inflamed mucous membrane. Should be given to the child enough liquids. This is especially important for intoxication. In the process of eating, natural gastric juice or its substitutes should be given, since with pain in the mouth, the enzymatic activity of the stomach glands reflexively decreases.

Local therapy for acute herpetic stomatitis sets itself the following tasks:

relieve or relieve painful symptoms in the oral cavity;
prevent repeated rashes of the elements of the lesion (reinfection) and promote their epithelialization.

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 ointment, zovirax, solutions of interferon and neoferon.

Listed medications it is recommended to apply 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 both to the affected areas of the mucosa and to areas that do not contain elements of the lesion, since they have a more preventive effect than a therapeutic one.

During the period of extinction of the disease, antiviral agents can be canceled.

Particular importance at this time should be given to keratoplastic agents. First of all, these are oil solutions A and B, sea buckthorn oil, caratoline, rosehip oil, ointments with methyluracil, 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 course of the pathological process, so we consider it pathogenetically justified to include measures aimed at eliminating them in the complex 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 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.

Fillers: lactose, mannitol, saccharin, sodium bicarbonate, anhydrous lemon acid, finely dispersed precirol, 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 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 consisted of 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 a tablet of imudon 5-6 times a day, not earlier than 30-40 minutes after treatment of the oral cavity. antiviral ointment and dissolve it in the oral cavity.

Criteria for clinical and laboratory evaluation of the therapeutic efficacy of the drug imudon:

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

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

We have given a high assessment of the effectiveness of the new scheme of complex therapy of acute hepatitis C with the use of stimulating immunotherapy, in particular imudon; concluded that it is essential integrated approach to the treatment of acute herpetic stomatitis with the obligatory inclusion of imudon, both a stimulating and a substitution agent for the correction of local immunity.

Thus, set high efficiency imudon in the treatment of acute hepatitis C due to the immune correction of saliva. Imudon has a therapeutic, anti-inflammatory effect, reduces the time of epithelialization of the elements of the lesion. Complications and side effects when using the drug imudon were not observed. Children used the drug with pleasure, as it has a pleasant, minty taste that does not irritate the mucous membrane. Apparently due to the aroma of mint there is a weak analgesic effect.

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

Reading time: 10 minutes

Your child began to act up and eat poorly, and a rash in the form of small bubbles appeared in the mouth? It is highly likely that this is a viral infection, which causes not only inflammation in the oral cavity, but also general intoxication of the body. Herpetic stomatitis in children is a common disease that requires timely diagnosis, proper complex treatment.

What it is

Herpetic stomatitis is an infectious lesion of the oral cavity that occurs when the child's body first comes into contact with the herpes simplex virus of the first type. This infection develops in children with weakened or unformed cellular and specific immunity, therefore 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 illness may become an asymptomatic virus carrier or have a chronic form of this infection. To understand in more detail the features of the course, as well as the treatment of herpetic stomatitis in childhood, watch a video with Professor of the Department of Therapeutic Dentistry S.Yu. Stakhova.

Causes and symptoms of herpetic stomatitis

Herpes simplex virus type 1 (HSV-1) - the causative agent of the disease, enters the child's body mainly through the skin, mucous membranes upon contact with a sick person or virus carrier, by household or airborne droplets. After entering the body, it begins to function inside the cells, actively multiply, using the resources and components of the cells. The activation of the manifestations of symptoms is associated with intensive reproduction of the virus, which is manifested by 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 immunity;
sudden change in temperature, overheating or hypothermia;
injuries of the oral cavity, lips;
non-compliance with sanitary and hygienic rules;
stress, nervous strain.

Mild symptoms:

the child becomes lethargic, capricious, 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 vesicles, sores in the oral cavity.

In a state of moderate severity, it is noted:

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

The 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;
downgrade blood pressure, cardiac arrhythmias;
lymphadenitis of the cervical, submandibular lymph nodes;
multiple painful rashes in the form of vesicles, erosions that spread to the area around the mouth, wings of the nose, eyelids, conjunctiva of the eyes.

Bubbles, characteristic of stomatitis, appear in a group, tend to merge. After the herpetic vesicle bursts, a focus of painful erosion is formed. If there are no complications, then scars at the site of the affected areas of the skin do not form. 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 the analysis of symptoms, clinical manifestations, and cytological examination scrapings of the contents of the bubble or erosion. The duration of the active phase of the disease depends on the general condition of the child, the timeliness of therapeutic measures and the severity of the course of the disease. With a mild form of herpetic stomatitis, treatment takes up to 7 days, with an average form - several weeks, and a severe form requires immediate hospitalization. The duration of the child's symptomatic period will depend on the effectiveness of treatment measures.

Treatment of herpetic stomatitis in children

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

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

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

How and what to treat

With herpetic stomatitis in children drug therapy prescribed by the attending physician, taking into account the severity of the disease, condition, age of the child. Parents are advised to:

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

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

Rinsing. Toddlers do not know how to rinse their mouths on their own, so the mouth is irrigated by gently tilting their heads over the basin. Older children can rinse their mouth herbal decoctions, water-salt solution or medicines that were prescribed by a 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 with a cotton swab. It is necessary to carefully lubricate the affected areas, trying to do it carefully so that the child does not hurt.
Gadgets. Applications and lotions for stomatitis can be done if herpetic crusts form, and also to prolong the effect of the drug. Procedures with herbal remedies, analgesic drugs help relieve pain, inflammation. At the healing stage, it is recommended to use sea buckthorn oil, rosehip oil, oil solutions of vitamins A and E to speed up healing.

During the period of the disease, it is necessary to follow the appointments, the rules for caring for a sick child, because the herpes simplex virus is highly contagious and can actively spread. With herpetic stomatitis, drugs of various forms of release, pharmaceutical action are prescribed. The sooner treatment is started, 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 recommended by experts.

Review of pharmaceutical preparations

Holisal

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

Viferon

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

Oxolinic ointment 0.25%

Ingredients: active substance 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 on the affected areas of the mouth, 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

Composition: active substance acyclovir.
Action: antiviral.
Application: for herpetic stomatitis, children over 2 years of age are prescribed one tablet (200 mg) 4 times a day or two tablets 2 times a day, children under 2 years of age receive a half dose. Intravenous injections used at a dosage of 10 mg / kg with an interval of 8 hours. 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 substance - plant extract of Echinacea purpurea.
Action: stimulator 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 the 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 of 50 ml - from 220 rubles.

Oil solutions A and E

Ingredients: vitamins A (retinol), E (tocopherol).
Action: keratoplastic, accelerate the regeneration and epithelialization of tissues.
Application: local. The areas affected by herpetic stomatitis are lubricated with an oily 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.

Decoction of chamomile. It has anti-inflammatory and analgesic action. To prepare a decoction 4 tbsp. chamomile flowers are poured with 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, oral mucosa.

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

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

Vegetable oils of wild rose and sea buckthorn. They include unsaturated fatty acids, complexes of vitamins and trace elements. These natural oils relieve pain, inflammation, irritation and promote regeneration and healing. The keratoplastic effect of sea buckthorn and wild rose is especially important, therefore, at the stage of recovery, it is recommended to lubricate herpetic erosions or apply in the form of applications to the affected areas 1-2 times a day.

Solution chicken protein and water. crude protein mixed with 0.5 l boiled water, mix thoroughly and use for rinsing. Helps with a deficiency of lysozyme in the saliva of a sick child and has an analgesic effect. Use several times a day as a 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 there is swelling and redness of the oral mucosa. It is recommended to rinse the mouth with it 3-4 times a day or irrigate the inflamed areas with this liquid.

Prevention of herpetic stomatitis in children

Preventive measures are to avoid contact of the child with patients and virus carriers in active phase diseases. Also, doctors recommend observing the rules of oral hygiene and, if there are traumatic factors, eliminate them in a timely manner. Good nutrition and increased body resistance can minimize the risks of complications.

If your child has been ill with herpetic stomatitis, he becomes a virus carrier, so relapses are not ruled out. To avoid the transition of the disease into a chronic form, 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 offer you to watch the recording of the program “School of Doctor Komarovsky”, dedicated to the topic stomatitis. A well-known pediatrician will teach you to recognize the signs of the disease and give you recommendations for treatment.