Recently, many cases of “recurrent fever, refusal to eat, crying, irritability ……” have been seen in the specialist outpatient clinic and ward. Parents and friends, this is a small disease called “herpetic gingivostomatitis”, which is a crossover disease between pediatrics and stomatology, and many pediatricians do not recognize or understand this disease. Therefore, it is necessary to do a little popularization, in addition to this disease is also the Chinese medicine is more good at the efficacy of the disease. Next, let’s understand this disease from different perspectives of Chinese and Western medicine.
Herpes gingivostomatitis is an infection caused by the herpes simplex virus, which involves the mouth, throat and face. It is a common childhood disease, most commonly affecting young children between the ages of 6 months and 5 years, but adults and older children can also contract the disease. Once infected, children become carriers, with the virus lurking in their bodies and occasionally appearing in their mouths and lips.
What is herpes stomatitis?
Herpes stomatitis is a disease caused by the herpes virus. It is more common in infants and young children, is highly contagious, spreads by droplets, and is not seasonal in onset.
Herpes stomatitis can be divided into two categories.
(1), herpetic stomatitis
The child has a high fever, often lasting 5-7 days, the oral mucosa is congested, and several or dozens of rice-sized or even mung bean-sized herpes appear on the anterior oral mucosa (including the tongue and inner lips) and the buccal mucosa, the skin around the herpes is red and soon ruptures into an irregularly shaped ulcer covered with a white film. The child is irritable, has localized pain, salivates, and does not want to eat. If bacterial infection is combined, swollen submandibular lymph nodes may be seen.
The disease is different from herpes pharyngitis, which is caused by coxsackievirus and has a high incidence in the summer and autumn, with herpes occurring in the pharyngeal isthmus and soft palate.
(2) Herpes labialis
This type is lighter, herpes can be seen on the lips, perioral skin, or the junction of the lips and skin begin to feel itchy, red, with a burning sensation; later appear more or less pinpoint or small rice-sized blisters, soon the blisters become cloudy, and then rupture and crust, a few days or 1 to 2 weeks scabs fall off, no scars remain after decabbing. Something like a pimple grows around the mouth.
How can herpes stomatitis be treated?
There are no specific medications for herpetic stomatitis, and the following treatments are commonly used.
(1) Anti-viral drugs, which have a limited effect and have certain side effects. In case of combined bacterial infection, oral antibiotics are also required.
(2) Oral vitamin B1, vitamin B2, vitamin C.
(3) To reduce the pain of eating, local application of 2% procaine solution or ice borax (G-6-PD deficiency is prohibited), open throat sword spray, rehabilitation new liquid topical application, gargle.
(4) Eat less and more meals, eat light and semi-liquid food, drink more water and eat more vegetables and fruits.
What is the manifestation of herpes simplex virus infection in the oral cavity?
Herpes simplex virus (HSV) infection is common in humans. It is a deoxyribonucleic acid virus. The virus that forms small pox blisters is called herpes simplex virus type I; the virus that forms larger pox blisters is called herpes simplex virus type II. Herpes simplex virus infections that occur in the oral cavity are called oral herpes simplex.
Primary herpetic stomatitis is an oral lesion caused by the most common type of herpes simplex virus, type I. It can present as a more severe form of gingivostomatitis, acute herpetic gingivostomatitis, and is more common in children under 6 years of age, especially in those between 6 months and 2 years of age, and not infrequently in adults. The onset is often preceded by a history of exposure and an incubation period of 4 to 7 days. Acute symptoms such as fever, headache, fatigue, generalized muscle pain, and even sore throat, swollen submandibular and supra-cervical lymph nodes, tenderness, salivation, refusal to eat, and restlessness are then seen.
After a prodromal period of 1 to 2 days, the oral mucosa becomes extensively congested and edematous, and there is also obvious acute inflammatory damage to the attached gingiva and gingival margin. Clusters of small, thin-walled, transparent blisters are seen on any part of the oral mucosa and soon break down to form superficial ulcers, which can cause large areas of erosion and secondary infection.
Similar lesions are seen on the lip and perioral skin, where the herpes breaks down and forms a scab. In rare cases, the infection can spread so widely in the body that it causes encephalitis, meningitis, and other life-threatening complications. In most untreated cases, recovery is slow and can take more than 10 days. In the outpatient clinic I have seen many cases with children who had fevers for more than 10 days due to this disease.
After the primary herpes infection has healed, recurrent damage can occur in 30% to 50% of cases, called recurrent herpetic stomatitis, also known as recurrent herpes labialis. It is characterized by clusters of blisters and the lesions always recur at or near the site of the original attack. There are many triggers for recurrence, such as sunlight, local mechanical injury, and irritants such as a mild fever from a cold, and emotional factors may also be triggering factors.
The prodromal phase of recurrent mouth sores may be characterized by mild fatigue and discomfort, followed soon by tingling, burning, itching, and increased tension in the localized area. Within about 10 hours, blisters appear in the area, surrounded by mild erythema. 24 hours later, they break down, erupt, and crust over. Healing is usually delayed for about 10 days. In cases of secondary infection, small pustules appear on the lesion. No scars are left after healing, but pigmentation may be present. Recurrence can occur after a few days to a few months.
To diagnose oral herpes simplex, direct smears of the herpes substrate or HSV-DNA-PCR can be done, which can reveal cells damaged by the virus, such as ballooning degeneration and edematous cells, as well as multinucleated giant cells and intranuclear inclusion bodies, indicating a viral infection. Within the patient’s serum, the potency of antibodies against herpes simplex virus can be significantly increased.
How to prevent and treat oral herpes simplex?
The main prevention of primary oral herpes simplex is to avoid contact with infected or asymptomatic detoxified persons. Because the virus is present in their saliva and feces, herpes simplex virus can be transmitted through the respiratory tract and also through herpes lesions on the skin, mucous membranes, and cornea. Recurrent herpes simplex infections are caused by the activation of latent herpes simplex virus in the body. There is no ideal method to prevent recurrence, but mainly to eliminate the triggering stimuli.
To date, there is still no specific treatment for oral herpes simplex virus infection, mainly due to the lack of ideal antiviral drugs. Interferon is effective, but difficult and expensive to prepare. Topical dimethyl sulfoxide solution of 5% iodoside (herpes net) or 5% acyclic guanosine ointment can be used 4-6 times daily. In case of secondary infection of herpes, the affected area should be moistened with saline or 0.01% zinc sulfate twice a day; in the case of antibiotic preparations and neomycin application.
The use of adrenal cortical steroids is absolutely prohibited. Because acute herpetic gingivostomatitis is a systemic disease, supportive therapy and symptomatic management are important. If necessary, bed rest and adequate nutrition should be provided. Gargle with 2% tetracycline solution 4 times a day; in case of high fever or severe secondary infection, systemic antibacterial therapy should be administered.
Understanding of herpetic gingivostomatitis in Chinese medicine
In Chinese medicine, this disease belongs to the category of “mouth sores and tooth declarations”. In the diagnosis method of Chinese medicine, there is a method of “inspecting the tongue and examining the teeth to identify the rash”, and the condition of the teeth and gums will be noted during oral examination, which is helpful in identifying the disease and evidence in Chinese medicine. This disease can be definitely treated through TCM diagnosis, and infusion is not necessary.
At-home care
Once herpes stomatitis appears in infants and children, at this time, parental care is especially important!
1, the acute phase is mostly symptomatic treatment, such as antipyretic, to the baby with warm water to rub the arms and legs at the large blood vessels, which is conducive to cooling the baby.
2, keep the mouth clean, feed water regularly, prohibit irritating drugs and food, diet with slightly warm or cool liquid or semi-liquid is appropriate to reduce stimulation.
3, local can be coated with herpes net to inhibit the virus, can also spray watermelon cream, tin type dispersion, etc.. To prevent secondary infection, apply 2.5%-5% aureomycin cod liver oil once every 1-2 hours.
4.If this disease occurs repeatedly, it is recommended to give your baby more zinc-rich foods, such as oysters and nuts, when it does not occur. Or supplement with trace elements of zinc under the guidance of a doctor, which can play a role in preventing recurrence.