The Herpetic stomatitis, acute herpetic stomatitis in children: treatment
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Herpetic stomatitis


Herpetic stomatitis

Herpetic stomatitis

Previously, the disease was called "acute stomatitis, aphthous", but with a detailed study of all signs of the pathological process, specialists came to the conclusion that acute herpetic stomatitis is the true name of this form of the disease.

The disease is quite complex in order to express several symptoms and even flow.

Depending on how strongly the signs of a violation of the general state of the organism and the extent of the spread of vesicular eruptions on the oral mucosa are singled out, the following forms of acute herpetic stomatitis are distinguished:

  • Lightweight
  • Average
  • Heavy

The disease also has periods:

  • Incubation
  • Catarrhal (or prodromal)
  • The period of formation of vesicles (development of the disease)
  • Fading
  • Reconvalescence (recovery).
  • Primary infection with herpetic stomatitis always proceeds hard, especially if the disease has affected a newborn or an infant.

Depending on the nature of the current, they distinguish:

  • Acute stage
  • The chronic phase.

A doctor-periodontist can determine the form, nature and period of the disease reliably. Self-diagnosis is likely to be incorrect.

Acute herpetic stomatitis


After infection of a person, signs do not appear immediately. Herpetic stomatitis has an incubation period that can last several days. Without knowing it, the patient becomes an unwitting carrier of viruses. But even in this "preparatory" already there are changes in the body. When palpating the lymph nodes of the neck or under the lower jaw, you can be sure that they are enlarged.

Herpetic stomatitis begins acutely:

  • Increases body temperature above subfebrile values.
  • Infected feels a general decline in strength, it is tormented by headaches, a feeling of nausea and vomiting, increased sensitivity of the skin and muscles.

When examining the oral cavity, you can see:

  • The entire surface of the oral mucosa is captured by hyperemia.
  • Vesicles are found (small blisters on the mucous membrane), which are localized everywhere individually or in small groups, not more than 20-30 in one place.
  • The patient feels burning and tingling when the vesicles appear.
  • Selectively, in some places, there is swelling.
  • Vesicles remain intact for quite some time. When they are destroyed, erosions of a round shape appear, covered with a whitish-gray coating. These erosions resemble aphthae, which is why the disease was once called "aphthous" instead of "herpetic".
  • Erosions that have arisen on the site of bursted vesicles merge, forming polycyclic, irregular contours in the hard palate, on the back of the tongue, on the cheeks, lips and gums.
  • In some cases, even the red border of the lips and skin areas near the lips are affected.
  • The patient feels pain throughout the course of the process and is troubled by excessive salivation.
  • Bubbles of herpetic stomatitis appear gradually, therefore, with an objective examination of the oral cavity, both vesicles and erosive formations are visible at different stages of development.
  • Sometimes the disease is burdened with the addition of symptoms of catarrhal gingivitis, which can quickly transform into ulcerative if the patient does not observe the thorough oral hygiene.

Lymphadenitis , which occurs even in the prodromal period, disappears only after a week or two after the final recovery.

Methods for diagnosis of acute herpetic stomatitis

In order to clarify the diagnosis, specialists apply the cytological method. It is carried out when the patient calls for help in a medical institution in the first days of illness, after the appearance of rashes.

The material for the studies is obtained by scouring the scrapes from the vesicles or from the surface of the erosions. The resulting preparation is stained using the Romanovsky-Giemsa method to identify giant multinucleated cells, macrophages, polymorphonuclear neutrophils and epithelial cells. In the first 2-3 days after the appearance of signs of herpetic stomatitis and during periods of recurrence in the contents of the blisters, it is possible to detect herpes viruses.

To diagnose acute herpetic stomatitis, fluorescence methods, serological reactions and skin tests using specific antigens can also be used.

Differential diagnosis with other diseases

With some types of diseases, herpetic stomatitis has common symptoms. For greater confidence in the formulation of a final diagnosis, their differences should be carefully studied.

Diffodiagnosis of herpetic stomatitis is carried out with:

  • Erythema multiforme exudative type
  • Viral lesions of the body (herpetic sore throat, vesicular stomatitis and foot and mouth disease)
  • Allergic reactions of the body.

Herpengu gives out its localization. It affects the zone of the oropharynx, because of what myalgia and dysphagia develop, and with herpes vesicles are within the oral mucosa, without affecting the oropharynx. If there is any doubt, you can refer to laboratory diagnostic methods.

Foot and mouth disease can be detected with the help of virological studies, serological or biological tests. Diphdiagnostics with herpetic stomatitis should be carried out taking into account the situation of epidemiology and cutaneous manifestations of foot and mouth disease.

Erythema multiforme appears during seasonal exacerbations, and not spontaneously, as herpetic stomatitis. Pathology is accompanied by the formation of erythema on the skin and in the oral cavity, the formation of extensive erosions and large subepithelial blisters.

Differences in acute herpetic stomatitis with allergic reactions can be different, depending on the type of allergy and the form of its manifestation.

Differential diagnosis can not be completely based on a visual examination, so virological and allergic tests are attached to it.

Treatment of acute herpetic stomatitis

The disease can be severe, leading the patient into a state of weakness and helplessness, and can pass in an easy form and disappear on their own. Symptoms of herpes are kept for two or three weeks, and the tactics of treatment are based on the severity and period of the pathological process.

The treatment process is divided into:

  • Local Therapy
  • General therapy

General Therapy

In the early days, with a severe course of the disease, antiviral medications are prescribed:

  • Cycles
  • Bonaphoton
  • Acyclovir (or Zovirax)
  • DNase (deoxyribonuclease) for intramuscular injection.

Antihistamines (tavegil, suprastin, phencarol), which are included in the treatment plan along with antiviral drugs, relieve possible allergic symptoms. Herpes to allergies does not apply, but the weakened organism can "respond" to the receipt of products or the use of chemicals that previously tolerated normally.

To restore the immune system the doctor appoints groups of vitamins P and C. If you do not want to take them separately, you can take a course of taking multivitamins.

Possible development of complications in the presence of herpetic stomatitis. Thus, the attachment of fusospirochete suggests the need to begin treatment with metronidzol.

If you have heart problems, take additional medications, but only with the approval of a doctor.

The state of the body as a whole can be improved if you include in your diet foods rich in vitamins and minerals.

Local Therapy

Methods of local effects in acute herpetic stomatitis are quite diverse.

1. At the very beginning of the disease, antiviral drugs give a very good therapeutic effect. More often leukocyte interferon is used in the form of a solution. Wet a piece of cotton wool or gauze and apply to the affected surface at least 5-6 times during the day.

2. Ointments with antiviral effect also successfully alleviate the symptoms of herpetic stomatitis. From the spectrum of ointments apply:

  • Tebrofen 2%
  • Florenal 1-2%
  • Helepinovy ​​1-5%
  • Gossypol liniment 3%.

It should not be limited to applying antiviral drugs to restricted areas. It is important to distribute solutions and ointments throughout the surface of the oral mucosa for prevention.

3. The patient may have difficulty eating, as the mechanical effect on any areas of the mouth is accompanied by pain. It is recommended to perform an easy procedure of anesthesia before eating with anesthetic solutions of lidocaine, pyromecaine and trimecaine and special aerosols.

4. The use of enzymes has a proteolytic or antiviral effect, so the treatment is mandatory for the plan:

  • Deoxyribonuclease 0.2%
  • Lysomidase 1%.

Enzymes are used topically, in the form of solutions.

5. Antiseptic treatment of the oral cavity is carried out to eliminate the bacterial agent. The patient should make oral baths with hydrogen peroxide, furacilin, chloramine and ethonium.

6. It is equally important to take care of accelerating the regeneration of the damaged mucous membrane. Oily solutions of vitamins A and E in the form of applications, carotolin, solcoseryl, dogrose oil and Aerosols "Spedian", "Hypozole", "Livian" stimulate the healing process of erosion.

7. Physiotherapeutic treatment is recommended for use during the entire period of the disease, until the mucosa in the oral cavity is completely healed. KUF irradiation, laser therapy and other methods contribute to the removal of severe symptomatic manifestations of herpetic stomatitis.

It should be remembered that the treatment plan can be made up and assigned to the patient only by a qualified specialist. Self-treatment or the use of third-party advice in practice can lead to various complications of an irreversible nature.


Acute herpetic stomatitis, with adequate treatment, completely cured after 2-3 weeks. On the site of the former erosions of scars does not remain, the marginal gum remains without pathological changes in its shape. A dangerous moment occurs when in the absence of proper hygiene fuzospirochetes join the underlying disease. Such a combination of herpes and fusospirochete leads to the occurrence of ulcerative necrotic gingivitis of Vincent.

The overall outlook is favorable. It is only in time to seek help and carefully monitor the cleanliness of the oral cavity.

Preventive actions

There are no measures that could prevent infection with herpetic stomatitis. There is no vaccine for the disease, it is enough to get the infection on the mucous membrane, so that the person gets sick. But, you can prevent infection from a known sick other people. The carrier of herpes infection should be isolated in a separate room and contacts with healthy adults and children should be excluded. The severity of the course and the localization of the symptoms do not affect the risk of infection.

Chronic herpetic stomatitis

The chronic form of herpes can only bother those who have already suffered an acute form of the disease.

Causes of recurrence of herpetic stomatitis

The re-occurrence of herpetic stomatitis is always associated with a decrease in the body's immune forces. Relapse provoked by hypothermia, overfatigue, the introduction of viral infections into the body, regularly occurring stressful situations and obscheomaticheskimi diseases. Such common causes contribute to the weakening of immunity and contribute to the activation of herpes viruses, which continue to live in body fluids.

Local aggravators provoke injury, drying the mucous membrane of the red border and increased insolation. The frequency of relapse is different for everyone and depends on the lifestyle, health status, diet and many other factors that can affect the activity of viruses to some extent. Proceeding from this, exacerbations can occur both twice a year, and several times within one month.

The clinical picture of chronic herpetic stomatitis is similar to the signs of acute, but the severity of the symptoms is somewhat more flattened. Symptoms of recurrence are characterized by the appearance of single rashes or the formation of small groups of herpetic vesicles.

The beginning of the process is signaled by the itching and burning of the oral mucosa, sometimes a slight feeling of soreness is added to the places where the blisters should appear. After a while the mucous membrane swells and hyperemia appears. Next there are vesicles, which burst very quickly and turn into painful, bright red erosions. On the surface of erosions appears yellowish fibrinous plaque, if they are localized on the mucous surface. On the red border of the lips and on the skin around the mouth of the erosion are covered with hemorrhagic crusts. After 9-10 days, healing takes place, but there are no charms and scarring in the end. If herpetic manifestations are constantly localized in one place, this form of the disease is called fixed.

Differences in chronic herpetic stomatitis from typical diseases

Diffiagnosis of recurrent herpes is carried out with:

  • Allergic stomatitis
  • Recurrent aphthous stomatitis
  • Streptococcal impetigo.

Differences between these diseases are revealed with a careful study of the clinical picture and the results of cytological examination of scraping, as well as fluid from the vesicles.

Virological method, as well, is a sufficiently informative study in the process of differential diagnosis of chronic herpetic stomatitis.

Treatment of chronic herpetic stomatitis

The purpose of treatment of recurrent herpes is to increase the level of nonspecific and specific protection of the patient's body so that it can suppress the actions of the virus.

The use of levamisole can significantly increase the period of remission and shorten the duration of relapse. In addition, the symptomatic manifestation of the disease proceeds in a more facilitated version. During an exacerbation, it is necessary to carefully check all the organ systems for the presence of a hotbed of chronic infection. If so, immediately proceed with the liquidation process. Use of a specific herpes vaccine gives good results. But it is used during the period of symptoms subsidence. Deoxyribonuclease may also be useful, but to a lesser extent than the vaccine. The intake of ascorbic acid, dibazole and the injection of gamma globulin, the application of methods of physiotherapy are mandatory items of the medical process. For home use, the patient is prescribed antiviral ointments and a leukocyte interferon for applications.

Treatment of herpetic stomatitis should be carried out under the supervision of a specialist doctor. Independent measures, in the presence of disease, should not be taken.

| 28 December 2014 | | 3 093 | Stomatology