The manifestation of infectious diseases in the oral cavity in children. Disease of the oral mucosa in children

The likelihood of mucosal damage oral cavity, pharynx and tongue are higher in families where the simplex virus (HSV) circulates. This pathogen in adults often causes a "cold" on the lips. Herpes in the mouth of a child is associated with the same types of viruses - HSV-I and HSV-II. Painful places lesions of the mucous membranes heal within a few days, but the disease is characterized by a relapsing course. Proper Treatment helps to significantly reduce the risk of herpes returning.

Sometimes, without special knowledge and equipment, it is difficult to determine the cause of lesions of the oral mucosa. Stomatitis can be caused by microbes and viruses, microtrauma and vitamin deficiency lead to lesions. The mucosa lining the tongue, pharynx, surface of the cheeks and lips from the inside becomes inflamed. Small blisters appear, then rounded, painful sores.

Herpes simplex is transmitted to children from sick people and carriers of the pathogen through household contact. Primary infection in the mother increases the likelihood of developing herpes sores in the newborn up to 50%. If a pregnant woman has previously suffered from this disease, then the baby becomes infected with a probability of about 5%. The period from infection to the onset of symptoms takes 2–12 days. Painful blisters and sores heal in about a week. All this time children early age are restless and refuse to eat.

Infection of pregnant women with HSV-II during the first trimester of pregnancy can lead to miscarriage or premature birth, birth premature baby with damage to the brain or other organs.

The disease manifests differently in infants and older children. The most common cases are mild mucosal lesions (vesicles, small ulcers). Herpetic infection in babies is accompanied by fever, profuse salivation. Young children have difficulty chewing and swallowing, especially after eating sour and rough foods. The most serious manifestations are accompanied by fever, vomiting, respiratory arrest, severe inflammatory response of the whole body (sepsis).

A feature of a viral infection is a recurrent course, the appearance of small vesicles on the same areas, which then open. Breastfeeding women with cold sores are advised to use a mask to avoid direct contact of their saliva with the baby's skin. Infection occurs in 80–90% of cases, but infection occurs much less frequently.

Complex therapy of herpes in the oral cavity in children

Herpetic stomatitis is more common in children under 5 years of age. A viral infection spreads to the inside of the lips and cheeks, on the gums, tongue. If vesicles and ulcers form only in the pharynx and on the tonsils, then the disease is considered herpetic sore throat. Complete healing of the mucosa in this case occurs within a week (up to 10 days).

Antiviral drugs for the treatment of herpes in the mouth in a child are more effective within 72 hours from the onset active phase infections. Prevention of relapses is carried out with smaller doses of antiherpetic drugs. Locally used medicines with antiseptic analgesics, astringent, cooling properties. They dry herpetic vesicles, reduce inflammation and discomfort, and improve healing.

How to treat herpes in the mouth of a child:

Most often, children with a herpes infection in the oral cavity are prescribed to take tablets with the virostatic substance acyclovir for 5 days.
In the case of a febrile condition, medical care consists in the use of antipyretic drugs, which simultaneously act as an analgesic (Ibufen syrup, Cefekon rectal suppositories).
Antimicrobial, antiseptic gels, balms and solutions are used to treat the oral mucosa - vinylin, cholisal, miramistin.
Vinilin and cholisal are approved for the treatment of children older than 1 year, miramistin - from 3 years.
Weakened babies are prescribed antibiotics to prevent a secondary infection.
Used to treat herpes on the tongue of a child, irrigation with chamomile infusion and other anti-inflammatory herbs that are not allergic.
Food must be high-calorie, containing vitamins B and C.
Small patients are given food in liquid and pasty form.

To reduce the pain caused by herpes in the throat, to speed up the healing of ulcers, it is recommended to take several primary measures. Children are given an antipyretic with paracetamol or ibuprofen if the temperature rises. Wounds in the throat are lubricated with lidocaine-based products. Sick babies are not recommended to give fruit juices and other sour-tasting foods.

Herpes recurrences in the oral cavity

20-30 days after infection with HSV-I and HSV-II, the human body develops immunity that protects against severe recurrences of the infection in the future. The causative agent, even in the absence of symptoms, remains in an inactive form. The re-development of rashes in the baby's oral cavity is possible with weakened immunity, hypothermia, stress, physical or mental stress. Bubbles can appear on the lips, oral mucosa, tongue and pharynx.

Strong immunity does not eliminate, but suppresses the virus in the tissues. In a latent state, the infection "sleeps" in individual cells human body. Periodically, herpes is activated, the virus multiplies again. Blisters and ulcers appear, but develops mild form disease compared to primary infection. Only in children with a weakened immune system, recurrences of herpes are difficult, with the spread of a rash to the skin and internal organs.

The boy is 6 years old. Body temperature 39°C, sore throat, headache, nausea. Objectively: the mucous membrane of the soft palate and palatine arches is brightly hyperemic. The tongue is dry, edematous, its lateral surfaces are free from plaque, bright red. Fungiform papillae of the tongue are enlarged. The skin of the face and body is hyperemic, covered with small spotted rashes. The nasolabial triangle is pale, free from rashes. Determined submandibular lymphadenitis. What is the most likely diagnosis?

A. Herpetic infection

B. chickenpox

C. Infectious mononucleosis

D. Scarlet fever +

E. Diphtheria

A 3-year-old child refuses to eat, body temperature is 38.5°C, rashes appear in the oral cavity. Got sick 3 days ago. On examination: there are single vesicles with hemorrhagic contents on the skin of the perioral region. In the oral cavity: on the mucous membrane of the tongue, lips, cheeks, single erosions, 2-3 mm in diameter, are covered with a whitish coating with a halo of hyperemia. The gums are edematous, hyperemic. Submandibular lymph nodes are painful. What is the preliminary diagnosis?

A. Erythema multiforme exudative

B. Stevens-Johnson syndrome

C. Acute herpetic stomatitis +

D. Stomatitis in infectious mononucleosis

E. Stomatitis with chickenpox

The mother of a 5-year-old child complains of a violation general condition, vomiting, diarrhea and pain when swallowing in a child. Objectively: the general condition of the child is moderate, the temperature is 38.2°C. On the tonsils, soft palate and palatine arches, against the background of hyperemia, erosions of 1-3 mm in diameter are determined, having a bright red bottom. Submandibular lymph nodes are enlarged, slightly painful on palpation. What is the preliminary diagnosis?

A. Herpangina +

B. Acute herpetic stomatitis

C. Stomatitis with chicken pox

D. Stomatitis with diphtheria

E. Infectious mononucleosis

The boy is 7 years old. Body temperature 38.5°C, sore throat, headache, nausea. Objectively: the mucous membrane of the soft palate and palatine arches is brightly hyperemic. The tongue is dry, edematous, its lateral surfaces are free from plaque, bright red. Fungiform papillae of the tongue are enlarged. The skin of the face and body is hyperemic, covered with small spotted rashes. The nasolabial triangle is pale, free from rashes. Submandibular lymphadenitis is determined. Determine the causative agent of the disease?

A. Lefleur's wand

B. Coxsackie virus

C. Herpes virus

E. Bordet-Jangu wand

The patient is 15 years old. Complaints: general malaise, fever up to 39°C, pain when swallowing. Objectively: inflammation of the mucous membrane in the area of the pharynx, palatine arches and uvula, swelling of the tonsils. On the tonsils, a massive fibrinous film plaque is determined, tightly soldered to the underlying tissues, spreading to the soft and hard palate. Films are also located on the gums and tongue. Submandibular and cervical lymphadenitis are determined. What is the most likely diagnosis?

A. Gonorrheal stomatitis

B. Diphtheria stomatitis +

C. Vincent's stomatitis

D. Agranulocytosis

E. Stomatitis with scarlet fever

A 14-year-old girl complains of pain while eating, headache, weakness, fever up to 380C, the presence of rashes. Objectively: there are erythematous spots, papules with double contour coloration on the skin of the face and hands. The red border of the lips is edematous, covered with bloody crusts. The mucous membrane of the oral cavity is edematous, hyperemic, with multiple erosions covered with a grayish coating. Submandibular lymphadenitis is determined. Which one is the most probable cause development of the disease in the patient?

A. Viral infection

B. Staphylococcal infection

C. Streptococcal infection

D. Allergic reaction +

E. Mechanical injury

A 4.5-year-old child has a rash in the mouth and on the skin that appeared the night before. On examination: general condition of moderate severity, body temperature 38.3°C. On the scalp, on the skin of the trunk and extremities, there are multiple vesicles with transparent contents. In the oral cavity: on the mucous membrane of the cheeks, tongue, hard and soft palate, round-shaped erosions covered with fibrinous plaque. Submandibular lymph nodes are enlarged. What is the preliminary diagnosis?

A. Stomatitis in scarlet fever

B. Acute herpetic stomatitis

C. Erythema multiforme exudative

D. Measles stomatitis

E. Stomatitis with chickenpox +

A 13-year-old child complains of fever up to 39.5 °C, vomiting, sore throat. Objectively: the oral mucosa is edematous, hyperemic. The tonsils are hypertrophied, covered with a yellowish-gray coating, which is easily removed. Submandibular, cervical lymph nodes are enlarged, painful. The liver and spleen are enlarged. What is the preliminary diagnosis?

B. Diphtheria

C. Scarlet fever

D. Infectious mononucleosis +

E. Gerpangina

A 2-year-old girl has been sick for the 4th day. Increased body temperature - 38°C, naughty, refuses to eat. On the 3rd day, rashes appeared in the oral cavity. Objectively: the submandibular lymph nodes are painful, enlarged. In the oral cavity on the mucous membrane of the soft palate - numerous erosions, covered with a whitish coating, acute catarrhal gingivitis. What ointment should be used for etiotropic local treatment?

A. Clotrimazole

B. Solcoseryl

C. Aciclovir +

D. Hydrocortisone

E. Flucinar

A 5-year-old child has a rash in the mouth and on the skin that appeared the night before. On examination: general condition of moderate severity, body temperature 38.5°C. On the scalp, on the skin of the trunk and extremities, there are multiple vesicles with transparent contents. In the oral cavity: on the mucous membrane of the cheeks, tongue, hard and soft palate, round-shaped erosions covered with fibrinous plaque. The gum is not changed. Submandibular lymph nodes are enlarged. What is the causative agent of the disease?

A. Lefleur's wand

B. Coxsackie virus

D. Hemolytic streptococcus

A. Lefleur's wand

B. Coxsackie virus

C. Herpes virus

D. Hemolytic streptococcus

E. Epstein-Barr virus +

A 16-year-old patient was hospitalized in the infectious department of the hospital. 2 days ago I used dairy products bought at the market. Temperature 39 °C, severe headache, muscle pain, nausea, dyspepsia. Complains of burning and pain in the mouth. The mucous membrane of the oral cavity is hyperemic. Numerous, painful erosions are determined. The patient has severe hypersalivation. Vesicular eruptions on the skin between the fingers. What is the preliminary diagnosis?

B. Shingles

C. Acute herpetic stomatitis

D. Dühring's dermatitis

E. Chronic herpetic stomatitis

A 10-year-old child complains of sore throat, cough and fever up to 38°C. for 2 days. Objectively: acute catarrhal stomatitis. The tonsils are edematous, hyperemic, covered with a yellow-gray coating, which is easily removed and has a crumbly character. Submandibular, cervical lymph nodes are significantly enlarged, painful on palpation. At laboratory research revealed leuko- and monocytosis. What is the most likely diagnosis?

A. Diphtheria

B. Scarlet fever

C. Infectious mononucleosis +

D. rubella

A 1.5-year-old child is restless, refuses to eat. Got sick 2 days ago. She is being treated by a pediatrician for pneumonia and receiving antibiotics. Objectively: the oral mucosa is hyperemic, edematous. On the mucous membrane of the cheeks, lips, soft palate, a whitish, easily removable plaque is determined. After removing plaque, erosion forms in some areas. Submandibular lymph nodes are enlarged. What is the most likely cause of the patient's disease?

A. Viral infection

B. Staphylococcal infection

C. Streptococcal infection

D. Allergic reaction

E. Fungal infection +

The child is 11 years old. Complains of fever up to 39°C, cough, runny nose, lacrimation and photophobia. Objectively: signs of conjunctivitis. Enlarged submandibular lymph nodes. There is a pale red enanthema on the soft palate, Belsky-Filatov-Koplik spots on the cheeks in the area of the molars. What is the preliminary diagnosis?

A. Stomatitis with scarlet fever

B. Stomatitis with measles +

C. Herpangina

D. Stomatitis with chickenpox

E. Infectious mononucleosis

Parents of an 8-month-old child complain about the child's refusal to eat, the presence of an ulcer in the palate. The child is on artificial feeding. Objectively: on the border of the hard and soft palate there is an oval-shaped ulcerative depression with clear edges, covered with a yellow-gray coating and limited by an inflammatory ridge. What is the most likely cause of the patient's disease?

A. Viral infection

B. Streptococcal infection

C. Allergic reaction

D. Fungal infection

E. Mechanical injury +

A 15-year-old child complains of fever up to 40°C, vomiting, headache and sore throat when swallowing. Objectively: the oral mucosa is edematous, hyperemic. The tonsils are hypertrophied, covered with a yellow-gray coating, which does not extend beyond the lymphoid tissue and is easily removed. Submandibular, cervical, occipital lymph nodes are enlarged, painful on palpation. The liver and spleen are enlarged. What is the most likely diagnosis?

A. Stomatitis with scarlet fever

B. Infectious mononucleosis +

C. Stomatitis with measles

D. Stomatitis with diphtheria

E. Herpangina

The patient is 16 years old. Complaints: general malaise, fever up to 39°C, pain when swallowing. Objectively: inflammation of the mucous membrane in the area of the pharynx, palatine arches and uvula, swelling of the tonsils. On the tonsils, a massive fibrinous film plaque is determined, tightly soldered to the underlying tissues, spreading to the soft and hard palate. Films are also located on the gums and tongue. Submandibular and cervical lymphadenitis are determined. What is the causative agent of the disease?

A. Lefleur's wand +

B. Coxsackie virus

C. Herpes virus

D. Hemolytic streptococcus

E. Bordet-Jangu wand

An 11-year-old child complains of sore throat, cough and fever up to 38.5°C. for 2 days. Objectively: acute catarrhal stomatitis. The tonsils are edematous, hyperemic, covered with a yellow-gray coating, which is easily removed and has a crumbly character. Submandibular, cervical lymph nodes are significantly enlarged, painful on palpation. Laboratory examination revealed leuko- and monocytosis. What is the causative agent of the disease?

A. Lefleur's wand

B. Coxsackie virus

C. Herpes virus

D. Hemolytic streptococcus

E. Epstein-Barr virus +

A. Lefleur's wand

B. Coxsackie virus

D. Hemolytic streptococcus

A 3-year-old child had a fever up to 390C the night before and rashes appeared in the mouth. Objectively: on the hyperemic mucous membrane of the tongue, lips and cheeks there are about 20 rounded erosions, 2-3 mm in diameter, covered with a gray-white coating. Revealed acute catarrhal gingivitis, submandibular lymphadenitis. What drugs should be prescribed for the purpose of etiotropic treatment?

A. Antiviral +

B. Antiseptics

C. Anti-inflammatory

D. Painkillers

E. Keratolytics

A 2.5-year-old child had a fever up to 380C the night before and rashes appeared in the mouth and on the skin. Objectively: on the hyperemic mucous membrane of the tongue, lips and cheeks there are about 15 rounded erosions, 2-3 mm in diameter, covered with a gray-white coating. Revealed acute catarrhal gingivitis, submandibular lymphadenitis. Vesicles with serous contents are determined on the skin of the perioral region and wings of the nose. What is the causative agent of the disease?

A. Staphylococcus aureus

B. Streptococcus

C. Herpes simplex virus +

D. Virus chicken pox

E. Epstein-Barr virus

A 4-year-old child had a fever up to 380C the night before and rashes appeared in the mouth and on the skin. Objectively: on the hyperemic mucous membrane of the tongue, lips and cheeks there are about 20 rounded erosions, 2-3 mm in diameter, covered with a gray-white coating. Submandibular lymphadenitis was diagnosed. On the border of the skin of the forehead and the scalp, vesicles with serous contents are determined. What is the causative agent of the disease?

A. Staphylococcus aureus

B. Streptococcus

C. Herpes simplex virus

D. Varicella zoster virus +

E. Epstein-Barr virus

The parents of a 5-year-old child complain about the appearance of edema in both parotid-masticatory areas, an increase in temperature up to 38.5°C. Objectively: in the parotid-masticatory areas, the infiltrate is painful, soft. The skin is pale, tense. From the ducts parotid glands a small amount of clear, viscous saliva is secreted. On palpation, painful points in the area of \u200b\u200bthe corners are determined mandible, semilunar notches of the lower jaw, on the tops mastoid processes and in front of the tragus of the ears. What is the preliminary diagnosis?

A. Bacterial parotitis

B. Pseudoparotitis Herzenberg

C. Parotid lymphadenitis

D. Parotid abscess

E. Epidemic parotitis +

The parents of a 7-year-old boy complain about the appearance of edema in both parotid-masticatory areas, an increase in temperature up to 38.5°C. Initially, swelling appeared on the right, the next day - on the left. The child has orchitis. Objectively: in the parotid-masticatory areas, the infiltrate is painful, soft. The skin is pale, tense. A small amount of clear, viscous saliva is secreted from the ducts of the parotid glands. On palpation, painful points are determined in the region of the angles of the lower jaw, semilunar notches of the lower jaw, on the tops of the mastoid processes and in front of the tragus of the ears. What is the etiology of this disease?

A. Staphylococcus aureus

B. Streptococcus

E. Reduced immunity

A 6-month-old girl was referred for a consultation about a palate ulcer that appeared 3.5 months ago. From the anamnesis: she was born prematurely, artificial feeding. Objectively: on the hard palate on the left, when moving to the soft palate, there is an oval ulcer 1.3x0.8 cm in size, covered with a yellow-gray coating with a pronounced infiltration shaft. What disease can we talk about in the first place?

A. Recurrent aphtha

B. Tuberculous ulcer

C. Congenital syphilis

D. Afta Bednara +

E. Setton's stomatitis

At preventive examination schoolchildren lower grades in a 7-year-old boy on the buccal mucosa along the line of teeth closure, non-removable layers of gray-white color were revealed. The mucosa is slightly hyperemic, painless on palpation. The boy is emotionally unbalanced, biting his cheeks. What is your diagnosis?

A. Chronic recurrent aphthous stomatitis

B. Lichen planus

WITH. soft form leukoplakia +

D. Chronic candidal stomatitis

E. Erythema multiforme exudative

A 15-year-old patient complains of pain when eating and talking. The pain appeared 3 weeks ago. Objectively: there is an ulcer on the mucous membrane of the tongue on the right polygonal shape 1.0x0.5 cm, covered with necrotic plaque, the edges are hyperemic, painful. Crowns of 46, 47 teeth are destroyed, have sharp edges. What is the preliminary diagnosis?

A. Hard chancre

B. Traumatic ulcer +

C. Trophic ulcer

D. Tuberculosis ulcer

E. Cancer ulcer

A 9-month-old girl was referred for a consultation about a palate ulcer that appeared 3.5 months ago. From the anamnesis: often more respiratory infections, artificial feeding. Objectively: on the hard palate on the left, when moving to the soft palate, there is an oval ulcer 1.2x1.0 cm in size, covered with a yellow-gray coating with a pronounced infiltration shaft. Which etiological factor this disease?

A. Mycobacterium tuberculosis

B. Herpes virus

C. Mechanical injury +

D. Allergic reaction

E. Circulatory disorders

A 16-year-old patient complains of pain when eating and talking. The pain appeared 2 weeks ago. Objectively: on the mucous membrane of the tongue on the right is a polygonal ulcer 1.0x0.5 cm, covered with necrotic plaque, the edges are hyperemic, painful. The crown of the 46 tooth has sharp edges. Which medical event is leading?

A. Antiviral drug

B. Pain medication

C. Antiseptics

D. Keratoplasty

E. Elimination of injury +

Inflammatory disease of the oral mucosa, often of infectious or allergic origin. Stomatitis in children is manifested by local symptoms (hyperemia, edema, rashes, plaque, sores on the mucous membrane) and a violation of the general condition (fever, refusal to eat, weakness, adynamia, etc.). Recognition of stomatitis in children and its etiology is carried out by a pediatric dentist on the basis of an examination of the oral cavity, additional laboratory tests. Treatment of stomatitis in children includes local treatment of the oral cavity and systemic etiotropic therapy.

Causes of stomatitis in children

The state of the oral mucosa depends on the impact of external (infectious, mechanical, chemical, physical agents) and internal factors (genetic and age features, the state of immunity, concomitant diseases).

In the first place in terms of frequency of distribution are viral stomatitis; of these, at least 80% of cases occur in herpetic stomatitis in children. Less often stomatitis viral etiology develop in children against the background of chickenpox, measles, influenza, rubella, infectious mononucleosis, adenovirus, human papillomavirus, enterovirus, HIV infection, etc.

Stomatitis of bacterial etiology in children can be caused by staphylococcus, streptococcus, as well as pathogens specific infections- diphtheria, gonorrhea, tuberculosis, syphilis. Symptomatic stomatitis in children develop against the background of diseases of the gastrointestinal tract (gastritis, duodenitis, enteritis, colitis, intestinal dysbiosis), blood system, endocrine, nervous system, helminthic invasions.

Traumatic stomatitis in children occurs due to mechanical trauma of the oral mucosa with a nipple, a toy; teething or biting teeth lips, cheeks, tongue; brushing teeth; burns of the oral cavity with hot food (tea, soup, jelly, milk), damage to the mucous membrane during dental procedures.

Allergic stomatitis in children can develop as a reaction to local exposure to an allergen (ingredients of toothpaste, lozenges or chewing gum with artificial colors and flavors, medicines, etc.).

Prematurity, poor oral hygiene, plaque accumulation, caries, wearing braces, frequent general morbidity, deficiency of vitamins and microelements (B vitamins, folic acid, zinc, selenium, etc.), application medicines that change the microflora of the oral cavity and intestines (antibiotics, hormones, chemotherapy drugs).

The mucous membrane of the oral cavity in children is thin and vulnerable, so it can be injured even with a slight impact on it. The microflora of the oral cavity is very heterogeneous and is subject to significant fluctuations depending on the characteristics of nutrition, the state of immunity and concomitant diseases. When weakened defensive forces even representatives normal microflora oral cavity (fusobacteria, bacteroids, streptococci, etc.) can cause inflammation. The barrier properties of saliva in children are poorly expressed due to the insufficient functioning of local immunity factors (enzymes, immunoglobulins, T-lymphocytes and other physiologically active substances). All these circumstances cause the frequent incidence of stomatitis in children.

Symptoms of stomatitis in children

Viral stomatitis in children

The course and features of herpetic stomatitis in children are discussed in detail in the corresponding article, therefore, in this review let's look at the common features viral infection oral cavity, characteristic of various infections.

The main symptom of viral stomatitis in children is the appearance of rapidly opening vesicles on the oral mucosa, in place of which small round or oval erosions are then formed, covered with a fibrinous coating. Vesicles and erosions can look like separate elements or have the character of defects that merge with each other.

They are extremely painful and, as a rule, are located against the background of a brightly hyperemic mucous membrane of the palate, tongue, cheeks, lips, and larynx. Local manifestations of viral stomatitis in children are combined with other signs of infection caused by this virus (skin rash, fever, intoxication, lymphadenitis, conjunctivitis, runny nose, diarrhea, vomiting, etc.) Erosions are epithelialized without a scar.

Candidal stomatitis in children

Development of specific local symptoms candidal stomatitis in children precedes excessive dryness mucous, burning sensation and bad taste in the mouth, bad breath. Babies are naughty during meals, refuse breasts or bottles, behave restlessly, sleep poorly. Soon on inside small white dots appear on the cheeks, lips, tongue and gums, which, merging, form a plentiful white, cheesy consistency plaque.

In severe candidal stomatitis in children, plaque acquires a dirty gray tint, is poorly removed from the mucous membrane, exposing the edematous surface, which bleeds at the slightest touch.

In addition to the pseudomembranous candidal stomatitis described above, atrophic candidal stomatitis occurs in children. It usually develops in children wearing orthodontic appliances, and proceeds with poor symptoms: redness, burning, dryness of the mucous membrane. Plaque is found only in the folds of the cheeks and lips.

Repeated episodes of candidal stomatitis in children may indicate the presence of other serious diseases - diabetes, leukemia, HIV. Complications of fungal stomatitis in children can be genital candidiasis (vulvitis in girls, balanoposthitis in boys), visceral candidiasis (esophagitis, enterocolitis, pneumonia, cystitis, arthritis, osteomyelitis, meningitis, ventriculitis, encephalitis, brain microabscesses), candidosepsis.

Bacterial stomatitis in children

The most common type of bacterial stomatitis in childhood serves as impetiginous stomatitis. It is indicated by the combination of the following local and common features: dark red color of the oral mucosa with confluent superficial erosions; the formation of yellow crusts that stick together the lips; increased salivation; unpleasant putrid odor from the mouth; subfebrile or febrile temperature.

With diphtheria stomatitis in children, fibrinous films are formed in the oral cavity, after the removal of which an inflamed, bleeding surface is exposed. With scarlet fever, the tongue is covered with a dense whitish coating; after its removal, the tongue becomes a bright crimson color.

Gonorrheal stomatitis in children is usually combined with gonorrheal conjunctivitis, in rare cases, with arthritis of the temporomandibular joint. Infection of the child occurs when passing through the infected genital tract of the mother during childbirth. The mucous membrane of the palate, back of the tongue, and lips is bright red, sometimes lilac-red, with limited erosions, from which a yellowish exudate is released.

Aphthous stomatitis in children

Prevention of stomatitis in children

Prevention of stomatitis in children consists in the exclusion of any microtrauma, careful hygienic care of the oral cavity, and the treatment of concomitant pathology. To reduce the risk of stomatitis in children infancy it is important to regularly disinfect nipples, bottles, toys; to treat the mother's breast before each feeding. Adults should not lick a baby's nipple or spoon.

Starting from the moment of eruption of the first teeth, regular visits to the dentist are necessary for preventive measures. For cleaning children's teeth, it is recommended to use special toothpastes that increase local immunity of the oral mucosa.

The child's body is a perfect system in which everything works like a clock, if at least one insignificant mechanism is violated, the work of the entire system collapses. Of course, not literally, the processes of adaptation and correction of the situation are launched, but sometimes the body needs outside help. And he signals this - this is how various symptoms e.g. fever, feeling unwell, etc. Often, the first signals, requests for help appear precisely in the oral cavity, especially with infectious diseases, which we will talk about in detail today. Even with numerous acute respiratory viral infections, the first symptoms appear in the oral cavity even before the formation of poor health, the onset of symptoms of intoxication, to say nothing of more serious infections, such as herpes, chickenpox, mumps, measles, etc.

How do respiratory infections manifest in the mouth?
ARVI is one of the most common infectious diseases among the general population, especially children. This is the combined name for a whole group of viral infections, but today we will talk more about influenza, parainfluenza, adenovirus infection. As mentioned above, the first signs of an incipient disease appear in the oral cavity on the eve of an increase in temperature and the development of symptoms of intoxication. According to the medical dictionary, influenza is defined as a respiratory viral disease with pronounced symptoms of intoxication and damage to the organs of the respiratory tract. The causative agents of the disease will be specific viruses, and outbreaks are most often characteristic of the disease.

Parainfluenza is an acute respiratory viral infection, in which the symptoms of intoxication are moderate, and the larynx is predominantly affected. Most often, the disease is recorded in children 3-4 years old. The most interesting in terms of symptoms will be adenovirus infection, its manifestations are diverse, so it is often called many-sided. AT clinical practice many forms of infection are released, and the disease can affect the respiratory system, eyes, nasopharynx, sometimes adenovirus proceeds as intestinal infection. This pathology is recorded in children of any age, but most often, babies in age group from one year to 4 years.

In the oral cavity, even before the appearance specific symptoms, you can see an increase in the vascular pattern. The entire mucosa becomes red, edema appears, the tongue is covered with plaque. With many-sided adenovirus infection, the mucosa becomes granular. For any respiratory infection, a few days or hours before the appearance of common clinical symptoms, there is an increase in regional lymph nodes. Against the background of a viral infection, the child registers various stomatitis, fungal, microbial or viral etiology - swelling, redness, plaque, sores on the mucous membrane of the cheeks, palate, gums. The severity will depend on the pathogen, age and condition of the child.

Manifestation of an enteroviral infection in the oral cavity
The mechanism of transmission of this infection is airborne, or with dirty hands. The susceptibility of babies to this infection is extremely high, and is most often recorded in the age group under 10 years old, and the pathology is characterized by seasonality, most often it is spring-summer. When the disease affects the mucous membrane of the oropharynx and the central nervous system. And it is this infection that can provoke serous meningitis, fever, herpangina. The onset of herpangina is acute, the body temperature immediately rises to 39 - 40, with symptoms of severe intoxication. In the oral cavity of the child - red nodules appear on the mucous membrane, palatine arches, soft and hard palate small size- just a couple of millimeters. They quickly transform into bubbles, surrounded by a red halo. After 2 - 4 days, the bubbles break through, and erosions remain under them, covered with a gray-white coating. They can merge with each other and form large elements of the lesion. At first, the elements of the rash bring great inconvenience to the child - pain, aggravated by swallowing.

How does scarlet fever manifest itself in the oral cavity?
Scarlet fever is an acute disease of a microbial nature, and its causative agent will be group A hemolytic streptococcus. Its toxins have a complex toxic, septic and allergic effect on the child's body. The first symptoms of the disease appear at the site of infection, usually the mucous membrane of the pharynx and pharynx. The first manifestations of the disease are acute, and are formed precisely in the oral cavity, and they are so specific that doctors can make a diagnosis only on these symptoms, but still, for complete certainty, it is necessary to conduct additional research. In the first few days of the disease, the child's tongue becomes coated - covered with a dense white coating that resembles curdled. But after a few days, it is cleared, the cells of the tongue are exfoliated, and it becomes bright red, raspberry. The gradual shedding of epithelial cells on the surface of the tongue makes the tongue polished, or, as they say in medicine, a varnished tongue. It is the crimson, varnished tongue that is a diagnostically significant symptom.

How does measles appear in the mouth?
Measles is a disease that can be registered all year round, but the rise of the disease is recorded in autumn and winter. The source of infection will be a sick child, so outbreaks are often recorded. As a rule, children older than a year are sick, and children 3-10 years old. The pathogen is transmitted through the air. The first signs of the disease are an increase in temperature to 38-39, a dry, barking cough, a runny nose, eye damage in the form of conjunctivitis. In the oral cavity, the mucous membrane becomes red, loose and rough. The main manifestation of measles is skin rashes, but a couple of days before they appear in the child's mouth, several specific symptoms appear. A rash appears on the soft and hard palate - pink-red small spots. After in projection chewing teeth grayish-whitish dots appear, small and surrounded by a red corolla.

Diphtheria in the oral cavity - features of the manifestation
With the disease, the tonsils are primarily affected, and only after the mucous membrane in the mouth. When examining a child, a bright red mucosa is noticeable, edema is pronounced, and in the area of \u200b\u200bthe tonsils and pharynx it is covered with dirty gray films. Can join bad smell out of the mouth, hard to disguise. After the film is rejected, the eroded mucosa is exposed, bleeding even with a slight mechanical impact. In addition to the erosions themselves, ulcers often form in the oral cavity. Often there is a secondary infection, and the ulcers and erosions themselves heal for a long time and are extremely difficult, bringing a lot of inconvenience to the child.

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Viral warts

Benign neoplasms viral origin. In the oral cavity, two types of warts are found on the mucous membrane: flat and pointed.

Clinic of viral warts

A flat wart has the appearance of a flattened papule, slightly protruding above the level of a healthy mucosa. The outlines of the wart are clear, rounded, the color is somewhat brighter than the surrounding mucous membrane.
The pointed wart has the appearance of a pointed papilla of a pale pink color. Single elements can merge and form vegetations that resemble cauliflower in appearance.
Most frequent localization wart is the anterior part of the mouth, especially the corners of the mouth and lateral surfaces anterior section language. Much less frequently, warts are found on the gums and on the red border of the lips or in the corners of the mouth (outer surface).
Viral warts on the mucous membrane of the oral cavity are often combined with those on the skin of the hands and on the mucous membrane of the external genital organs. When diagnosing diseases, one should remember about papillomas of the oral mucosa and other neoplasms.

Treatment of viral warts

Treatment involves the local use of 3% oxolinic ointment, 0.5% bonafton ointment, 0.5% florenal, 0.5% tebrofen and others. antiviral drugs. In this case, the use of ointments must be combined with a thorough sanitation of the oral cavity and hygienic treatment of all surfaces of the teeth. The ointment must be treated with the oral cavity 3-4 times a day after brushing and toothpaste.
In the presence of warts on the skin and mucous membrane of the genital organs, treatment should be combined.
Success is achieved by long-term (at least 3-4 weeks), persistent and careful implementation of the doctor's recommendations.

Gerpangina

A disease caused by Coxsackie group A and B enteroviruses and ECHO viruses.

Clinic of herpangina

The disease begins acutely: fever, general malaise. In the back of the mouth on the soft palate, anterior arches and back wall pharynx vesicles appear, grouped and solitary, filled with serous contents, painful. With the development of the disease, some of the vesicles are eliminated, others are opened, forming erosions. Small erosions merge to form larger ones. Some of them resemble aphthae. Erosions are not painful, slowly epithelialize, sometimes within 2-3 weeks. Cases of illness of members of the same family and even epidemic outbreaks are described.

Herpangina treatment

Treatment consists of symptomatic general therapy and topical application in the first 2-3 days of antiviral agents, and later on keratoplastic. Frequent rinsing and lubrication slow down the process of erosion epithelialization.

Thrush (candidiasis)

Etiology The causative agent is a yeast fungus from the genus Candida. Usually young children, weakened, often premature, with severe and protracted diseases are affected.
The occurrence of thrush contributes to poor hygiene care behind the oral cavity, and mechanical injury mucous membrane due to careless manipulations in the oral cavity during processing.

Thrush Clinic

It is characterized by the appearance of a loose white, easily removable plaque, scattered at the onset of the disease on an unchanged mucous membrane in the form of separate dotted foci, resembling curdled milk. Then, merging, these foci can spread throughout the oral mucosa in the form of a continuous plaque, which consists of mycelium and spores of the fungus, torn epithelium, leukocytes and bacteria.
In advanced cases, the removal of plaque is associated with trauma to the mucous membrane, since the mycelium germinating the surface layers of the epithelium subsequently penetrates into the deeper layers.
Without treatment, a fungal infection can become generalized, spread to the internal organs, which is associated with a poor prognosis.
The most important in the fight against candidomycosis are preventive actions strengthening strength, raising the body's resistance rational nutrition(according to age), vitamin therapy. In addition to treating the underlying disease, careful oral hygiene and antiseptic treatment of all objects that come into contact with the child's oral cavity are necessary.
Candidiasis often occurs when long-term treatment of a disease with broad-spectrum antibiotics, especially antibiotic complexes. According to a number of authors, as a result of this, the growth of microbial flora antagonistic to fungi is suppressed. The latter grow unhindered, which leads to candidomycosis.

Treatment of thrush

The treatment consists in energetic actions in order to increase the strength and resistance of the body by enhanced nutrition, taking doses of vitamins K, C and group B.
Treatment with antibiotics, if it was carried out for any disease, must be stopped, switching to other drugs if necessary. Inside appoint nystatin:
children under 3 years old in the amount of 100,000 IU, and over 3 years old up to
1,000,000 IU/day in fractional doses.
All items in contact with the child's oral cavity, as well as the mother's breasts and the hands of caregivers, must be thoroughly washed and treated with baking soda.
To treat the patient's oral cavity, a 2% solution of boric acid is recommended (1 teaspoon of dry boric acid per 1 cup warm water) or 1-2% soda solution (1/2 teaspoon of soda to 1 cup of water). During the day, treatment with these solutions is performed 5-6 times.
A protracted course and relapses are possible in cases where the treatment is not completed and with insufficient measures to strengthen the body and raise its resistance. With a long and persistent illness, the child should be referred to an endocrinologist and examined for the presence of Candida-endocrine syndrome.

Acute herpetic stomatitis

Until recently, two independent diseases were described in the literature: acute aphthous and acute herpetic stomatitis.
Clinical and laboratory study of a large group of patients using the arsenal of modern virological, serological, cytological and immunofluorescent research methods convincingly showed the clinical and etiological unity of acute herpetic and acute aphthous stomatitis.
The data obtained allowed us to recommend calling the disease acute. herpetic stomatitis based on the etiology of the disease.

Etiology of acute herpetic stomatitis

Acute herpetic stomatitis is one of the clinical forms manifestations of primary herpetic infection. The causative agent is the herpes simplex virus. In children's preschool institutions and in hospital wards during an epidemic outbreak, up to 1/3 of the children's team can get sick. Transmission of infection occurs by contact and airborne droplets.
The highest prevalence of the disease in children aged 6 months to 3 years is explained by the fact that at this age the antibodies obtained from the mother interplacentally disappear, as well as by the insufficient maturity of the specific immunity system.

Clinic of acute herpetic stomatitis

Acute herpetic stomatitis has five periods of development: incubation, prodromal (catarrhal), period of disease development (rashes), extinction and clinical recovery (or convalescence). Depending on the severity of general toxicosis and local manifestations in the oral cavity, the disease can occur in mild, moderate and severe forms.
From common symptoms characteristic hyperthermic reaction with a rise in temperature to 41 ° C or more in a severe form of the disease, general malaise, weakness, headaches, skin and muscle hyperesthesia, lack of appetite, pallor skin, nausea and vomiting of central origin, since the herpes simplex virus is an encephalotropic virus. Already in the incubation and especially in the prodromal period, lymphadenitis of the submandibular, and in severe cases, cervical lymph nodes is clearly diagnosed.
At the peak of the rise in temperature, hyperemia and swelling of the oral mucosa increase, lesions appear on the lips, cheeks and tongue (from 2-3 to several tens, depending on the severity of stomatitis). In the moderate and especially severe form of the disease, the elements of the lesion are localized not only in the oral cavity, but also on the skin of the face near the mouth, earlobes and eyelids. In these forms of the disease, rashes, as a rule, recur, due to which, during examinations, you can see the elements of the lesion located on different stages clinical and cytological development. The next recurrence of the rash is accompanied by a deterioration in the general condition of the child, anxiety or adynamia, and a rise in temperature by 1-2 ° C.
An obligatory symptom is hypersalivation. Saliva becomes viscous and viscous, there is an unpleasant, putrid smell from the mouth.
Already in the catarrhal period of the disease, pronounced gingivitis is detected, which later, especially in severe form, acquires an ulcerative-necrotic character and is accompanied by severe bleeding of the gums.
The lips of patients are dry, cracked, covered with crusts, maceration in the corners of the mouth. Sometimes nosebleeds are observed, as the herpes virus disrupts the blood coagulation system.
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 detected. Very rarely, toxic granularity of the latter is observed. Protein and traces of it are noted in the urine. Saliva has a low pH, which is then replaced by a more pronounced alkalinity. It usually lacks interferon, the content of lysozyme is markedly reduced.
Humoral factors of the body's natural defenses during the height of the disease are also sharply reduced.
In patients with severe stomatitis, the onset of the disease is characterized by a sharp decrease in all indicators of phagocytosis. This is evidenced by the fact that pathogenic forms of colonies of microorganisms are observed in almost half of the cases from total number bacteria during the Klemparskaya test (bactericidal activity of the skin).
Despite the clinical recovery of a patient with a severe form of acute herpetic stomatitis, deep changes in homeostasis persist during the convalescence period: a decrease in bactericidal and lysozyme activity.
Restoration of the phagocytic function of neutrophils begins with the period of extinction of the disease.
Diagnosis placed on the basis clinical picture and epidemiology of the disease. The use of virological and serological methods in practical public health is difficult due to their laboriousness.

Treatment of acute herpetic stomatitis

Treatment of patients should be determined by the severity of the disease and the period of its development.
Complex therapy of the disease includes general and local treatment. With moderate and severe course disease, it is advisable to treat a child together with a pediatrician. Since these forms of the disease develop against the background of a significant decrease in the body's defenses, it is advisable to complex therapy include agents that stimulate the immune system (lysozyme, prodigiosan, parenteral gamma globulin, methyluracil, pentoxyl, sodium nucleonate, herpetic immunoglobulin, etc.).
Prodigiosan is administered intramuscularly at a dose of 25 mcg once every 3-4 days. Course of treatment 2 3 injections. Lysozyme is administered daily at 75-100 mcg for 6-9 days. Immunoglobulin - 1.5-3.0 ml 1 time in 3-4 days, 2-3 injections per course of treatment.
Methyluracil (methocil), pentoxyl, sodium nucleonate are prescribed in powders (2 times a day). Single doses of drugs depend on age: methyluracil - 0.15-0.25; pentoxyl-0.05-0.1; sodium nucleonate - 0.001-0.002.
With the introduction or intake of these funds, there is a positive trend in the course of the disease, expressed in an improvement in the general condition of patients, a decrease in body temperature. There is an activation of the processes of regeneration of the elements of the lesion, as a result of which the soreness in the oral cavity decreases in the child, and appetite appears.
As general treatment hyposensitizing therapy is prescribed for all forms of stomatitis (diphenhydramine, suprastin, pipolfen, calcium gluconate, etc.) in age-appropriate doses.
Local therapy should pursue the following tasks:
1) remove or reduce painful symptoms in the oral cavity;
2) to prevent repeated rashes of elements of the lesion;
3) promote their epithelialization.
From the first days of the development of the disease resort to antiviral therapy. It is recommended to use one of the following ointments: 0.25-0.5% oxolinic ointment, 1-2% florenal, 5% tebroenic, 5% interferon, 4% heliomycin, 1% deoxyribonuclease solution, helenin liniment, a mixture of interferon with prodigiosan and other interferonogens, ointments containing interferon, etc.
These drugs are recommended to be used 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 should act not only on the affected areas of the mucous membrane, but also on the area where there are no elements of the lesion, since ointments have preventive properties. When visiting a doctor, the child's oral cavity is recommended to be treated with a 0.1 - 0.5% solution of proteolytic enzymes (trypsin, chymopsin, pancreatin, etc.), which contribute to the dissolution of necrotic tissues.
During the period of extinction of the disease, antiviral agents can be canceled or reduced to a single dose in the first days of the extinction of the disease. Leading value during this period of the disease, weak antiseptics and keratoplastic agents should be given. From the group of the latter, good results are given oil solutions vitamin A, rosehip oil, caratolin, solcoseryl ointment and jelly, methyluracil ointment, livian, levomisol. As antimicrobial agents you can use solutions of furacilin, ethacridine, ethonium, etc.
The child is fed mainly liquid or semi-liquid food that does not irritate the inflamed mucous membrane. In connection with the intoxication of the body, it is necessary to enter enough liquids (tea, fruit juices, fruit decoctions). Before feeding, the oral mucosa is anesthetized with a 5% anesthetic emulsion. After eating, be sure to rinse or rinse your mouth with strong tea.

Prevention of acute herpetic stomatitis

Acute herpetic stomatitis (in any form) is a contagious disease and requires the exclusion of patient contacts with healthy children, the implementation of preventive measures for this disease in children's groups.
Employees should not be allowed to work with children during the period of recurrence of chronic herpetic lesion skin, eyes, mouth and other organs.
In children's dental clinics or departments, it is necessary to allocate a specialized office (and, if possible, a special doctor) for the treatment of diseases of the oral mucosa. It is advisable to choose the location of the office so that the children visiting it are, if possible, isolated from other visitors.
A child with acute herpetic stomatitis is not allowed to visit a children's institution, even if the disease is very mild.
Medical personnel of kindergartens, nurseries, orphanages and other institutions are recommended to conduct daily examinations of children to identify signs of the prodromal period of the disease (lymphadenitis, hyperemia of the oral mucosa, etc.). These measures have great importance, since the treatment carried out at this moment (interferon, interferonogens, antiviral ointments, UV therapy, multivitamins, hyposensitizing and restorative agents) in most cases prevents the further development of the disease or contributes to its easier course.
Adults who brought the child to the group should inform about any changes in the state of his health, complaints, rashes on the skin and oral mucosa.
In the conditions of an outbreak of the disease, it is recommended to use a 0.2% solution of lime chloride, 1-2% solution of chloramine for disinfection. It is necessary to thoroughly ventilate the room, create conditions for penetration into the room sun rays and others. The use of ultraviolet rays.

Acute catarrhal stomatitis

Etiology of acute catarrhal stomatitis

Often associated with childhood acute infections: measles, scarlet fever, dysentery, influenza, etc., especially in cases where oral hygiene is not provided during illness. Often the cause is the presence of carious teeth, roots, traumatic and infecting the edge of the gums and the mucous membrane of the cheeks and tongue. In addition, catarrhal stomatitis occurs during the eruption of milk teeth, especially in weakened children. oh with the simultaneous eruption of several teeth.

Clinic of acute catarrhal stomatitis

The disease is characterized by diffuse hyperemia and swelling of the oral mucosa, especially pronounced redness and swelling of the gums and gingival papillae.
On the mucous membrane of the cheeks along the line of closure of the teeth and on the lateral surfaces of the tongue, there are imprints of the contours of the teeth due to swelling of the soft tissues. Bleeding gums and soreness of the affected mucous membrane appear when eating. This causes the child to become restless and refuse to eat.
Salivation usually increases, but in some cases dryness of the oral cavity is noted, while the mucous membrane is covered with a sticky coating consisting of leukocytes, mucus, mucin, bacteria and exfoliated epithelium.
The submandibular lymph nodes react weakly at first. Body temperature often remains within low-grade.
With a decrease in the body's resistance, the absence of appropriate treatment, the process can be complicated by ulcerative necrotic lesions of the gingival margin, as well as the appearance of ulcers in other parts of the oral mucosa, especially in places of injury. This is accompanied by an increase and soreness of the submandibular lymph nodes, an increase in temperature to 38 ° C and above, and a deterioration in the patient's well-being. The edge of the gums is covered with a dirty gray coating due to gangrenous tissue decay, a characteristic bad breath appears. Plaque can be removed relatively easily. Under it, an eroded, bleeding, painful surface is found. Due to tissue necrosis, the tops of the gingival papillae become, as it were, cut off.
Ulcers elsewhere in the mucosa usually have irregular shape and uneven edges, covered with the same coating, very painful when talking and eating. All this is accompanied by significant salivation. The child does not eat, is restless, does not sleep well.
The further condition of the patient indicates an increase in the general intoxication of the body.

Treatment of acute catarrhal stomatitis

Treatment consists in treating the oral cavity with solutions of potassium permanganate. In the presence of carious teeth, it is desirable to close the carious cavities with at least temporary fillings. It is necessary to refrain from removing the roots in the acute period in order to avoid complications. Dental deposits should be removed with care, avoiding soft tissue injury. This should be preceded by a thorough cleaning of the oral cavity. antiseptic solutions. For the purpose of anesthesia, before removing dental plaque, the gums can be lubricated with a 2% solution of anesthesin.
Inside, the patient is prescribed vitamins Bb, B: and C, and in order to reduce edema, a 1-5% solution of calcium chloride is prescribed in accordance with the age of the patient (a teaspoon or dessert spoon 3 times a day after meals). For the same purposes, calcium gluconate powder can be recommended from 0.25 to 1.0 per dose, depending on age.
The food of the child should be varied, high-calorie, having a sufficient amount of proteins, fats and vitamins and not irritating the mucous membrane. Soft-boiled eggs, mashed cottage cheese, twisted meat, meat broth, kefir, vegetable and fruit purees and mild fruit and vegetable soups are recommended.
Thus, the treatment of acute catarrhal stomatitis has three goals: it contributes to the elimination inflammatory process in the oral cavity, prevents the development of complications, and also increases the body's resistance through enhanced nutrition and vitamin therapy.
In case of complications for oral administration, in addition to vitamins and calcium chloride, it is possible to recommend general disinfectants - urotropin and streptocid in doses corresponding to the age of the patient. It also requires plenty of fluids.