“Mom, my mouth hurts!” We talk about stomatitis in children

Causes of stomatitis

Inflammation of the oral mucosa can be caused by various reasons.

1. Mucosal injury6.
2. Viral, bacterial or fungal infection6.
3. Allergy2.
4. Immunity disorders (autoallergy, that is, a reaction to one’s own altered tissues2).
5. Diseases of the blood, digestive, cardiovascular, nervous and endocrine systems2.
6. Hypovitaminosis - lack of vitamins C, B1, B12, E, D32.
7. Common infectious processes: measles, rubella, scarlet fever and diphtheria, infectious mononucleosis, tuberculosis and others1.

Only a specialist can understand the causes of stomatitis. Therefore, if symptoms of the disease appear, you should definitely contact your dentist.

Inflammatory diseases of the oral cavity can occur in a child of any age6. Immaturity of the body is the primary factor predisposing to the occurrence of stomatitis in children under one year of age. The mucous membrane of the oral cavity during this period of a child’s life is very vulnerable, its natural protective properties are reduced. The immunity received from the mother during fetal development and which protected the baby immediately after birth weakens every day. Therefore, the infection easily penetrates the mucous membrane and causes its inflammation. Most often at this age, candidal stomatitis occurs, commonly called thrush1,6.

From the age of one to 3 years, children actively develop immune mechanisms to protect the oral mucosa (local immunity), but its permeability to viruses remains extremely high. Therefore, in a 2-3 year old child, stomatitis is more likely to be viral, in the vast majority of cases - herpetic1,3,4.

From 4 to 12 years of age, stomatitis in children is more often caused by allergic and autoimmune reactions. In particular, chronic aphthous forms of the disease occur during this period1.

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Traumatic stomatitis

Inflammation of the mucous membrane in the mouth can be preceded by trauma: mechanical, thermal, chemical, radiation1,6.

Small children who put everything in their mouths can injure the mucous membranes with the sharp edges of toys or household items. Injuries often occur due to inept use of cutlery as a result of falls. In older children, stomatitis may be associated with a thermal burn, blows to the teeth, or the bad habit of chewing a pencil or pen. Sometimes the cause of inflammation is dental diseases and their treatment: sharp edges of damaged teeth and fillings, braces and aligners1.

When stomatitis develops in a child on the gum, on the inner surface of the cheek or in another place, the mucous membrane becomes red and swollen, and a painful erosion or ulcer may appear in the area of ​​damage. Since there are many microorganisms in the mouth, there is always a risk of a bacterial or fungal infection1.

If the mucous membrane is constantly injured, painless whitish or whitish-gray layers may form on it.

In children under 1 year of age, stomatitis can be the result of using the wrong nipples: long, tight, irregularly shaped. The resulting Bednar aphthae are located in the area of ​​the transition of the soft palate to the hard palate and are round erosions or ulcers1.

Treatment of traumatic stomatitis in children includes:

• elimination of traumatic factors;
• rinsing the mouth, irrigating the mucous membranes and treating wounds with drugs with an analgesic and antiseptic effect1.

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Symptoms

Signs indicating that a baby is suffering from stomatitis are divided into two types: local and general. It is not difficult to recognize them, especially if the baby already knows how to speak and can tell where he feels discomfort. If a baby is sick, the main symptom is general restlessness and crying. Parents should carefully examine his mouth and make sure that there is (or is not) an inflammatory process on the mucous membrane.

Local symptoms:

• blisters, sores or plaque on the inner surface of the lips, cheeks and/or tongue, pharynx;
• marks from biting, burns or scratches;
• swelling and redness of the mucous membrane next to the lesions;
• bad breath.

Are common:

• increase in body temperature (from slight to critical);
• increased size of lymph nodes;
• refusal to eat;
• lethargy;
• moodiness;
• nervousness.

Note to parents: symptoms can manifest themselves both complexly and individually. But the presence of even one of the listed manifestations of the disease is a reason to visit a doctor.

Viral stomatitis

About 80% of all stomatitis in children is caused by herpes viruses3,5. In approximately 70% of cases, the disease develops in children aged 1 to 3 years3,4.

The disease can occur in mild, moderate and severe forms.

With mild herpetic stomatitis, the general condition is practically not disturbed. Body temperature does not exceed 37-37.50 C. Symptoms of inflammation are limited to swelling of the gums and usually the simultaneous appearance of single painful herpetic blisters and erosions on the mucous membrane (no more than 6). After 1-2 days, the contours of the lesions are blurred, the rashes turn pale, and the erosions heal without scarring3.

With moderate stomatitis, the child’s temperature reaches 38-390 C and lasts until rashes continue to appear. General intoxication manifests itself in the form of weakness, headache, nausea. The child becomes capricious, lethargic, refuses to eat and play3.

As the temperature rises, the oral mucosa becomes red and swollen, and the gums begin to bleed. The number of herpetic elements reaches 20-25, repeated rashes are accompanied by fever3.

Severe stomatitis in children looks like a common acute infectious disease and is accompanied by severe intoxication: fever 39-400 C, chills, headache, aching muscles and joints, heart rhythm disturbances, nosebleeds, nausea and vomiting. The number of herpetic elements can reach 100; they are located not only in the mouth, but also on the skin of the face, on the eyelids and conjunctiva of the eyes, and earlobes. In addition, upper respiratory tract symptoms may be present.3

Treatment includes treating the affected area with painkillers and antiseptic drugs, antiviral therapy, drinking plenty of fluids, a balanced diet and proper nutrition3,5.

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How long does the disease last and how many days is the child contagious?

Depending on the complexity of the form, herpes stomatitis in children lasts from several days to 2-3 weeks. With a mild form, the main symptoms disappear on the third or fourth day, treatment of a moderate form takes one to two weeks. The severe form is the most dangerous; healing lasts for weeks and requires mandatory hospitalization of the baby.

The disease is characterized by a high degree of contagiousness precisely during the period of exacerbation.

The infection is transmitted by airborne droplets (including through kissing), when using shared dishes, cutlery, toys, and hygiene items.

Herpes is contagious and can easily be transferred to healthy parts of your own body.

It is necessary to wash your hands thoroughly after treating the surface affected by the sores with medications to prevent the spread of the virus.

Candidal stomatitis

In 80% of healthy children, Candida fungi can be found in the oral cavity. They get there during childbirth, from nipples and pacifiers, from care products, in contact with the mother's skin, with food during eating and usually do not cause any problems. Candidal stomatitis, or thrush, occurs when immunity decreases1.

Predispose to the disease:

• prematurity and postmaturity;
• developmental defects and concomitant diseases;
• treatment with antibiotics and hormones;
• artificial feeding;
• poor care and poor feeding hygiene;
• Using the wrong nipples1.

What does candidal stomatitis look like? In children's mouths, whitish or whitish-gray dotted formations appear on the reddened mucous membrane. They merge into films of a cheesy nature; when the films are rejected, bright red painful erosions are formed. Because of the pain, the baby becomes restless, cries often, sleeps poorly, and refuses to eat1.

In severe cases of candidiasis, a cheesy coating may appear on the palate and on the lateral surfaces of the tongue, on the tonsils and the back wall of the pharynx - candidal tonsillitis and pharyngitis develop1.

If your child has a fungal infection, you should always consult a doctor; he will tell you how and what to treat the mucous membrane with candidal stomatitis, so that the child does not have complications and recovers faster. Treatment, as a rule, involves treating the oral cavity with drugs with antifungal activity (chlorhexidine, hexethidine). In severe cases of the disease, antifungal agents, probiotics and immunomodulators are prescribed1.

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How and with what to treat herpetic stomatitis in children

As Dr. Komarovsky notes, treatment of herpetic stomatitis in children, regardless of age, depends on the severity of the disease, the general condition of the patient’s immune system, and the presence or absence of concomitant diseases.

The main question that interests young parents is which doctor should they contact if they suspect herpetic stomatitis. Both a qualified pediatrician and a dentist can advise the child.

Therapeutic methods include both general and local treatment. Common activities include:

• prescription of antiviral drugs (acyclovir, Zovirax, Herpevir, Virolex);
• taking antipyretic and painkillers (paracetamol, Panadol, Eferalgan, Tylenol);
• prescription of antihistamines (diazolin, claritin, erius, fenistil);
• correction of the immune system (immudon, sodium nucleinate);
• vitamin therapy (vitamin C, ascorutin, multivitamins, B vitamins).

Children of older preschool and school age are recommended to be treated with broad-spectrum antibiotics to avoid possible complications.

For newborns and infants, antibiotic therapy is prescribed only as a last resort, with preference given to local therapy:

• applications of painkillers (solution of lidocaine, trimecaine, pyromecaine);
• treating the baby’s oral cavity with antiseptics (solutions of furatsilin, potassium permanganate, brilliant green, blue);
• Treatment of aphthae with iodine should be avoided, as it causes a burn to the mucous membrane;
• the use of antiviral medications in the form of ointments, lotions, solutions (interferon, acyclovir);
• applying an oil solution of vitamin A, sea buckthorn or rosehip oil, solcoseryl to the mucous membrane of the baby’s mouth).

If the symptoms of the disease do not disappear on the 3-4th day of treatment, but only intensify, the child is indicated for treatment in a hospital setting, otherwise stomatitis will become chronic, from which it is impossible to get rid of it.

Allergic stomatitis

Allergic damage to the mucous membrane most often occurs in the form of contact stomatitis and chronic aphthous form of the disease1.

Allergens can include medications, food products, varnishes and paints that coat toys, toothpastes, mouth rinses, chewing gum, and dental metals included in braces1,2.

With allergic stomatitis in children, erosions and ulcers may appear in the mouth, but more often the matter is limited to redness and swelling of the mucous membrane1.

Treatment is avoiding contact with the allergen, rinsing or irrigating the mouth with antiseptic solutions to prevent infection. If necessary, doctors recommend taking antihistamines1,2.

Chronic recurrent aphthous stomatitis often occurs in schoolchildren and adolescents due to allergies2. In addition, its development can be provoked by diseases of the gastrointestinal tract, upper respiratory tract infections, disorders of the nervous system, and hypovitaminosis1,2.

With aphthous stomatitis in children, itching and burning first appear in the oral cavity. The mucous membrane at the site of the lesion becomes red and swollen, then an aphtha forms on it - a round or oval erosion 0.5-1 cm in diameter rising above the surrounding tissues with a red rim along the periphery and a bottom covered with a grayish-white coating. Aphthae are extremely painful, and if many of them form, they cause significant distress to the child1,2.

How many days does aphthous stomatitis last in children? With a mild course of the disease, the elements of inflammation persist for up to 5-7 days, then they heal without scar formation2 and do not appear for quite a long time. However, in severe cases, aphthae can occur constantly, and then many elements of inflammation can be found on the mucosa at different stages of development1,2.

To treat aphthous stomatitis, doctors use:

• antihistamines;
• immunomodulatory drugs;
• vitamins;
• probiotics2.

As a local therapy, it is recommended to treat the mucous membrane with drugs with analgesic, antiseptic, proteolytic (protein-breaking), anti-inflammatory and regenerating effects2.

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Prevention in children

Preventing infection with the herpes virus is extremely difficult, since 90% of the population are carriers of it. It is important to delay infection as much as possible; the younger the child, the more difficult the disease is to tolerate. It is necessary to avoid contact with people who have an acute herpes virus. From infancy, the baby should be taught to use personal hygiene products, not allowed to drink from someone else’s mug after someone else, or to use used spoons, forks, and plates. You should not kiss someone who has a herpetic sore on their lips.

To prevent herpetic stomatitis, you need to do general strengthening of the child’s immune system, systematically give him B vitamins, multivitamin complexes, and carry out hardening procedures.

Hexoral in the treatment of stomatitis

For local treatment of stomatitis in children, drugs from the HEXORAL® line can be used.

For irrigation of the oral cavity, the doctor may recommend aerosol HEXORAL® based on hexethidine, which has antiseptic properties7. Thanks to the fine spray, the drug is evenly distributed over the entire surface of the mucosa7. A solution of HEXORAL®8, similar in composition, is intended for rinsing the mouth. Both medications can be used to treat children 3 years of age and older.

Mint-flavored lozenges HEXORAL® TABS based on chlorhexidine and benzocaine may be suitable for boys and girls over 4 years of age9.

For patients with stomatitis over 6 years of age - HEXORAL® TABS CLASSIC based on the antiseptic amylmetacresol. The assortment includes tablets with lemon, orange, black currant, lemon and honey flavors10.

HEXORAL® TABS EXTRA may be suitable for adolescents aged 12 years and older. The lidocaine it contains can relieve even severe pain11.

The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

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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.

Literature

1. Khomenko L. A. Therapeutic dentistry of children. Textbook for university / ed. 2007 – pp. 643-722.
2. Ismailova G. T. Chronic recurrent aphthous stomatitis // Bulletin of surgery of Kazakhstan. - 2011. - No. 4. — P. 124-125.
3. Drobotko L.N., Strakhova S.Yu. Acute stomatitis in children // Issues of modern pediatrics. - 2010. - T. 9. - No. 2. - P. 146-149.
4. Suerkulov E. S., Yuldashev I. M., Mamyraliev A. B., Toktosunova S. A., Tsepeleva A. S., Sooronbaev A. A. Prevalence and structure of the incidence of stomatitis in children // Bulletin of Science and Practice. 2022. T. 4. No. 11. — P. 91-96.
5. Suerkulov E. S., Yuldashev I. M., Mamyraliev A. B., Zhumashova N. K., Yuldasheva G. I. Complex therapy of inflammatory diseases of the oral mucosa in children // Bulletin of Science and Practice. 2022. T. 5. No. 5. — P. 96-104.
6. Pankrusheva T.A., Maravina I.N., Chekmareva M.S. Research on the development of the composition and technology of tablets for the treatment of stomatitis // Scientific result. Medicine and pharmacy. – T.4, No. 1, 2022. – P. 78-87.
7. Instructions for medical use of the drug HEXORAL® aerosol: , .
8. Instructions for medical use of the drug HEXORAL® solution: , .
9. Instructions for medical use of the drug HEXORAL® TABS: , .
10. Instructions for medical use of the drug HEXORAL® TABS CLASSIC: , ​​.
11. Instructions for medical use of the drug HEXORAL® TABS EXTRA: , .

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