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Abstract: The child developed swollen and painful gums and bleeding gums after a high fever, accompanied by mouth ulcers, and the parents initially thought it was a fire and did not seek treatment, but only used “fire-removing” medication. After treatment, the child’s swollen and painful gums gradually resolved and the parents learned about the manifestations and precautions of this infectious disease.
Basic information】Female, 6 years old
Disease Type】Herpetic gingivostomatitis
Hospital】The First Hospital of Harbin Medical University
Date of Consultation】January 2022
Treatment plan】Oral medication (acyclovir granules, ibuprofen granules) + topical medication (iodine glycerin, stomatitis spray)
Treatment period】7 days of medication
Effect】The child’s gum swelling and pain were eliminated and the condition was cured.
I. Initial consultation
The child was brought to the clinic by his parents because of gum swelling and pain, crying, and not liking to eat. The parents initially thought it was a fire and asked the child to drink Pancreatin and Dandelion water, but they had no significant effect, so they came to the clinic.
I checked the child’s oral cavity and found that red and swollen gums were clearly visible within it, bleeding when touched, and no rash was found on the hands and feet. The child’s typical symptoms led to the initial diagnosis of herpetic gingivostomatitis. To further diagnose, a routine blood test was performed, which showed a normal number of white blood cells, an increased percentage of lymphocytes and a decreased percentage of neutrophils, suggesting a viral infection, thus confirming the diagnosis of herpetogingival stomatitis.
II. Treatment history
Herpes gingivostomatitis is a self-limiting disease that usually heals on its own because the child is usually healthy and has no chronic or major illnesses. However, medication is recommended for symptomatic support to relieve pain, and parents are willing to choose medication. Because of the low acceptance of tablet medications in children, oral acyclovir pellets were given for antiviral treatment, along with topical iodoglycerin to slow down gingival inflammation and stomatitis sprays to promote ulcer healing. In addition, considering that the child’s gingival pain significantly affected his life, oral ibuprofen granules were recommended for pain relief, but care should be taken not to administer the drug more than four times every 24 hours.
III. Treatment effect
Because herpes gingivostomatitis is contagious, the child’s family should be informed that the child should be isolated at home throughout the treatment period until the disease is cured, and that the child should share meals and sleep with his family during this period. In addition, the child should take the medication as required and parents should not increase or decrease the dosage on their own.
After 1 week of taking the medication as required, the child came to the follow-up clinic and the swollen and painful gum symptoms were eliminated and the mouth ulcer was healed. When the routine blood test was performed again, all indicators were normal and met the criteria for discontinuing the medication, so permission was granted to discontinue the medication. Since herpetic gingivostomatitis does not leave sequelae, the child does not need regular follow-up after healing.
IV. Notes
I was happy to see that the child recovered and was no longer suffering from gum swelling and pain. However, since herpes gingivostomatitis does not provide lifelong immunity, it is possible for the child to get sick again after recovery. Therefore, while I am happy for the child’s recovery, I also remind parents to pay more attention to ventilation at home and keep other children away from infectious children to reduce the possibility of future illness. In addition, during the period of herpes gingivostomatitis, the child should eat a warm and cool liquid diet to avoid aggravating the pain in the mouth, but after recovery, he should return to a normal diet, as eating too soft and fine food for a long time is not good for dental health. If you find symptoms similar to this fever with swollen and painful bleeding gums, do not use medication on your own, but come to the clinic promptly.
V. Personal insight
Swollen and sore gums are a common symptom, and many people treat it as a “fire”, just like the parents in this case. In fact, there is no definition of fire in formal modern medicine, and simply attributing the disease to fire in general is not conducive to treatment and recovery. Gum swelling and pain can be a manifestation of many diseases, but in herpetic gingivostomatitis, the main characteristic of gum swelling and pain is a fever, and after the fever subsides, the gum swelling and pain is often accompanied by oral ulcers, and the gum swelling and pain is mostly overall, and herpes may also appear around the lips of the child.