Herpetic Stomatitis-Etiology Pathogenesis Clinic

One of the most common childhood diseases is stomatitis: according to statistics, more than 80% of parents experience it.

This is not as harmless a disease as it may seem, because if the disease is ignored and left untreated, the infection can lead to complications that will require much more time and effort to combat. Therefore, it is extremely important to know what childhood stomatitis looks like, as well as how to treat it.

What is this disease?

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

The high incidence is explained by:

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

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

ETIOLOGY OF HERPETIC STOMATITIS

The etiology of herpetic stomatitis is simple. If there is a virus, there are diseases. The virus that causes herpetic stomatitis belongs to the HERPES VIRIDAE family. This family includes about 80 different viruses, and, note, 8 of which cause human illness. Herpetic stomatitis is caused by the herpes simplex virus type 1 (HSV-1), and if it was a congenital or intrauterine (neonatal) infection, then this infection occurred with the herpes simplex virus type 2 (HSV-2).

It would seem that the virus is simple - the infection is simple. But the herpes simplex virus itself is very cunning and insidious. This virus, the herpes simplex virus, has come up with 4 ways of entering the human body:

• Airborne (therefore, it is recommended to avoid people with visible manifestations of the virus);
• Contact (lips affected by herpes are unlikely to give pleasant kisses);
• Transplacental (that is, from mother to child);
• Transfusion (with blood transfusion).

Causes

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

Children become infected with it as follows:

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

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

The following factors contribute to the development of the disease:

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

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

Preventive measures to prevent stomatitis in children

To minimize the risk of developing stomatitis you need to:

• wash the child’s toys, bottles and other things regularly, and do not forget to thoroughly wash the baby’s hands;
• strengthen the child’s immunity;
• do not let your child bite his nails;
• create a balanced menu containing all the necessary minerals and vitamins. The diet should be followed;
• promptly treat diseases such as tonsillitis, gastritis and other gastrointestinal diseases. If you extinguish the outbreak in time, this will prevent stomatitis from developing;
• At least once a year, and preferably twice, visit the dentist for a detailed examination of the oral cavity.

All these simple recommendations will help avoid the occurrence of stomatitis, because any disease is much easier and cheaper to prevent than to treat it later. If it was not possible to avoid the disease, at the first signs of it, you must consult a doctor to prescribe effective treatment. If stomatitis appears again and again, a thorough immunological examination is required. The child should be examined by a pediatrician and an immunologist; it is also advisable to contact an endocrinologist and gastroenterologist (perhaps they will identify a chronic disease leading to relapse of the disease).

It is equally important to teach your child proper oral hygiene. If the teeth are affected by caries and covered with plaque, and there are fistulas on the gums, the fight against stomatitis will not be successful. A child must be taught how to properly brush his teeth and gums by buying him a brush and toothpaste appropriate for his age.

Classification

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

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

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

PATHOGENESIS OF HERPETIC STOMATITIS

The pathogenesis of herpetic stomatitis is quite complex and not fully understood. It is not fully explained by what factors the inner shell of the virus is dissolved, what viral factors allow it to penetrate DNA - human cells, and why the virus, when it is inactive (that is, there are no clinical manifestations) cannot be treated.

However, scientists believe that at the time of infection, the herpes simplex virus attaches to specific receptors on the cell membrane (cells that are sensitive to HSV). Then the fusion of the cell membrane and the outer shell of the virus occurs. At the moment of such penetration, the cell membrane of the cell is not damaged, but the virus seems to bud inside. Then cellular enzymes work, those that dissolve the inner shell of the virus and the “naked” virus penetrates the DNA of the host cell. And the herpes simplex virus can remain in this state for a long time until the provoking factors work.

FACTORS PROVOKING RECURRENCE OF HERPETIC STOMATITIS

Factors that provoke relapse of herpetic stomatitis represent a large group. In principle, herpes can be triggered by anything, from climate change and time zone to ARVI and other infections. And so, the group of factors that provoke a relapse of herpetic stomatitis includes:

• Any change in body temperature (hypothermia is more favored by the herpetic stomatitis virus);
• Decreased immunity (any infection, etc.);
• Trauma to mucous membranes and skin;
• Stress, overwork or overexertion;
• Consumption of alcoholic beverages;
• Smoking;
• Menstruation;
• Change of climate and time zone;
• Taking medications.

As you can see from the lists, there are many factors, and the virus is just waiting for the body to give up. Children from 6 months to one year get sick due to the cessation of protective proteins from the mother. Therefore, let's talk about the prevention of herpetic stomatitis.

Clinical manifestations

Stomatitis in children is characterized by a gradual onset of the disease. Clinical signs of the disease do not appear immediately after infection. The incubation period is typical for this pathology; it lasts from two days to three weeks.

Symptoms of herpetic stomatitis in children appear starting from the prodromal period.

Each period has its own clinic:

1. Latent – ​​lasts up to two weeks. The child's sleep is disturbed and he refuses to eat. The baby becomes restless and whiny. He has increased salivation, possible nausea and vomiting. The lymph nodes are enlarged and painful on palpation.
2. The height of the disease - at this time rashes appear on the skin and mucous membranes. They are located on the soft, hard palate, gums, cheeks, lips and tongue. They are group or single, up to three millimeters in size. They are thin-walled bubbles filled with a clear liquid. Their formation lasts up to four days. The vesicles quickly open, then erosions and painful aphthae form. They are shallow ulcers covered with a white coating. The mucous membrane in the mouth is swollen and bleeding. The child develops a high temperature of up to 40 degrees. A runny nose, cough, and conjunctivitis occur.
3. Fading - aphthae, erosions gradually heal and epithelialize. These formations heal without scarring. Often there is a wavy course of the disease. The periods of appearance of rashes alternate with rises in temperature.

The illness usually lasts up to two weeks. In children under one year of age, generalization of the process is possible. The development of sepsis, damage to all internal organs and meninges is likely.

Forms of the disease

Lightweight

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

Average

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

Heavy

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

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

Diagnostics

A patient suspected of having this disease is examined by a dentist. He asks the child’s parents about how the disease progressed. The diagnosis is established on the basis of the characteristic clinical picture of stomatitis, revealed during examination, anamnesis and characteristic complaints. Upon examination, typical mucosal lesions are revealed.

To confirm the diagnosis, laboratory testing of scrapings of the oral mucosa, the contents of ulcers, the patient’s saliva and blood is used.

The following are used for research:

• cytopolymerase chain reaction;
• immunofluorescence method;
• serological blood tests (RSC, ELISA, immunoglobulin M test);
• HSV test for the detection of immunodot G-specific glycoprotein.

These methods are used only for severe infections, as they are quite expensive.

Bacterial or viral?

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

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

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

Types of diagnostics

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

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

Treatment

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

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

The following drugs are prescribed:

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

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

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

For local treatment of herpetic stomatitis the following are used:

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

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

Aphthous stomatitis in children

Manifests itself in the form of small individual ulcers on the lips and oral mucosa. Its appearance is provoked by:

• allergic reactions of various types (to food, medications, etc.);
• staphylococci (there are many of these bacteria in carious formations and dental plaque);
• immunity disorders;
• liver diseases.

Aphthous stomatitis in children: symptoms and treatment

Exacerbation occurs mainly in autumn and spring. Ulcerations most often form on the lips, tongue and inside the cheeks (in these places the mucous membrane comes into contact with food and can be injured by the teeth).

Sometimes weakness in the body and fever appear, but often the general condition of the body remains normal.

The size of the ulcers (ulcers) is 5-10 mm. They are covered with a grayish coating and are surrounded by a red, inflamed rim of mucous membrane. There is pain when touching them. It happens that only 1 ulcer forms.

Aphthous stomatitis in children: treatment

The causes of stomatitis in children will influence the nature of treatment. Immediately after the first symptoms appear, it is necessary to adjust the child’s menu, completely eliminating the main allergens (chocolate, honey, berries, citrus fruits, etc.). During illness, you should also not eat spicy foods with added spices.

Often, aphthous stomatitis becomes a reaction of the body to medications, so if a child is taking medications, it would be a good idea to consult a doctor.

Treatment methods:

• Antiallergic drugs. The most frequently prescribed are Suprastin, Diazolin and many others like them.
• Treatment of ulcerations. At the initial stage of the disease, “Miramistin” (they are recommended to spray the aphras using a special sprayer that comes with the drug) and “Cholisal” (ulcers are treated with gel at least 3 times a day) perform well. When the acute symptoms of the disease pass, you can use Solcoseryl, a gel that accelerates the healing of mucosal defects and has an analgesic effect.
• Exposure to UV rays in a physiotherapy room.
• Use of immunomodulators. Firstly, it is worth purchasing a special toothpaste based on lactoferrin, and secondly, you can take a course of Imudon.
• Sanitation of the oral cavity. Since one of the causes of stomatitis is microorganisms, all carious formations must be cured and plaque removed.

Prevention

Preventive measures are aimed at preventing infection. This presents certain difficulties, since the vast majority of the population is infected with it. It is better if the child gets sick from it at an older age.

For this it is recommended:

• avoid contact with infected people;
• will provide personal utensils and personal hygiene products for the child;
• Kissing people with herpetic rashes is prohibited;
• strengthening the baby's immune system.

It is recommended that the child be provided with adequate nutrition and regularly given vitamin and mineral complexes.

Treatment at home with folk remedies

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

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

Possible complications

Primary infection with herpetic stomatitis is highly treatable. Within 7-10 days, with proper treatment, the child can fully recover. Without appropriate drug therapy, the following complications may develop:

• herpetic keratoconjunctivitis (a dangerous herpetic eye infection that leads to blindness);
• dehydration (due to refusal to eat and drink).

To avoid undesirable consequences, it is necessary to consult a doctor at the first symptoms of the disease, strictly adhere to all instructions, give the baby plenty of fluids, monitor oral hygiene, and wash your hands after each treatment of a surface affected by herpes.

How to treat stomatitis during pregnancy

During pregnancy, a weakened immune system coupled with hormonal changes can lead to the formation of ulcers or white plaque in the mouth. This fate awaits almost every second expectant mother.

Major stomatitis can be cured during pregnancy only under the supervision of a specialist. Rinsing your mouth with folk remedies with an antiseptic and anti-inflammatory effect will help cure a fungal infection. Regular chamomile gives a good result (it is enough to infuse one spoonful of the herb in a glass of boiling water).

Do not thoughtlessly use rinsing for healing. It is also important to establish the root cause of the disease and, if possible, eliminate it.