Inflammatory gum disease in adults and children is called gingivitis. It is most often observed in children a few months from birth to 13 years of age, which is explained by the characteristics of the child’s body and poor oral hygiene.
According to statistics, in a child from 2 to 4 years old, gum inflammation occurs in 2% of cases, and by the age of 13, the proportion of this disease in children reaches 80%. Gingivitis cured in time does not become chronic, but if left untreated it can cause the development of periodontitis.
Causes of herpangina
Herpangina can be caused by about 70 serotypes of enteroviruses. Most often these are Coxsackie B, Coxsackie A17 viruses and enterovirus 711.
Since the only carrier of enteroviruses is humans, you can become infected through contact with a sick person or with a virus carrier who has no symptoms of the disease1. According to the literature, the number of virus carriers can be up to 46% of people2.
The virus is released into the external environment with feces and droplets of saliva. It is also contained in bubbles that appear in the patient’s throat. Enterovirus infections most often affect children, although the disease also occurs in adults5.
The patient or virus carrier excretes viruses from the upper respiratory tract within 3 weeks after infection, and with feces - up to 8 weeks. In the first two weeks, herpetic sore throat is most contagious1.
You can become infected in the following ways:
- through dirty hands, objects and food if they are exposed to the virus;
- drinking contaminated water from a reservoir;
- upon contact with a patient or virus carrier.
The herpangina virus is also transmitted transplacentally - from mother to fetus3.
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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.
Symptoms of herpetic sore throat
The disease begins acutely. From the moment of infection to the first symptoms, it takes from 2 to 14 days3. The temperature rises to 38-39°C. The patient feels weakness, headache, chills, less often nausea, possible vomiting and enlargement of the submandibular lymph nodes, 1,2,3.
Herpangina goes through several stages2:
- The day before the rash appears in the throat, the patient feels a mild pain. On examination, you may notice redness of the palatine arches and the back wall of the pharynx.
- Then, rashes appear on the mucous membrane of the soft palate, palatine arches, tonsils and uvula - small papules (nodules) up to 5 mm in diameter with a red rim.
- The nodules turn into vesicles, which open after 1-2 days.
- In their place, painful erosions with a gray-white coating form.
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Herpetic sore throat in children
Children usually become infected at school or kindergartens2,3. Due to pain and fever, they are restless, tearful, and often refuse to eat and drink because food irritates erosions on the mucous membrane and causes discomfort. But due to refusal to drink water or juices, children often develop dehydration. At the same time, the child’s tongue becomes dry, and the elasticity of the skin decreases1. Convulsions may occur due to high temperature1.
Blistering rashes in children can appear not only on the mucous membrane of the throat, but also on the hands and feet, and even on the buttocks and forearms. This manifestation of enterovirus infection is called viral pemphigus of the oral cavity and extremities or mouth-hand-foot syndrome. The disease is contagious in 100% of cases, is often mild, and can affect nails3.
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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.
Course of herpetic sore throat
The diagnosis of herpetic sore throat can be made by an otolaryngologist, therapist or pediatrician after examining the patient and clarifying his complaints. To monitor changes characteristic of a viral infection, the doctor may prescribe a general blood test, and to confirm enteroviral sore throat, a specialist may prescribe a pharyngeal smear and a blood test for specific antibodies. The pathogen can also be detected in stool or inflammatory fluid that is released from vesicles1,4.
Manifestations of herpetic sore throat can go away on their own in less than 10 days. But in any case, at the first symptoms of the disease, you should definitely consult a doctor. You cannot self-medicate2,3.
In some cases, herpetic sore throat can cause complications from the nervous system. In this case, 1 appears:
- severe spasm of the neck muscles, due to which the child cannot bend his head;
- weakness of the muscles of the limbs;
- disturbance of consciousness.
A severe complication of herpetic sore throat is damage to the soft membranes of the brain, brain and spinal cord1,3.
Newborns are at highest risk of developing complications, so they need careful treatment and care3. It is important to maintain hydration and give your child enough fluids1.
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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.
Treatment of herpetic sore throat
Patients with complications require hospitalization in an infectious diseases hospital and treatment under the supervision of specialized specialists - a neurologist and a cardiologist. If the doctor has recommended treatment at home, it is necessary to closely monitor the patient's condition2.
The sick person should be isolated and stay in a clean, well-ventilated area so as not to infect other family members. Quarantine must be observed until symptoms subside1.
For herpangina you should 1,3,4:
- Wash your hands as often as possible, including after feeding and changing a sick child’s diaper.
- Disinfect surfaces and objects with which the patient has been in contact.
- Drink enough fluids to avoid dehydration. At the same time, pay attention to the temperature of the drink: hot, warm drinks irritate the mucous membranes and cause additional discomfort. You can drink cool drinks.
- Consume food in liquid or mushy form. Spicy, salty, sour foods, including fresh fruits even in the form of puree, are not suitable for a patient with herpetic sore throat.
- Rinse your mouth with a saline solution after every meal to maintain oral hygiene and prevent bacterial infections from erosions.
- Use a soft toothbrush to reduce trauma to the mucous membrane.
Currently, there is no proven antiviral drug to treat herpangina by acting on its causative agent. Sometimes a doctor may prescribe medications that support local immunity of the pharyngeal mucosa1. Antibiotics are not prescribed for herpangina6.
The goal of treatment for herpangina is to relieve the symptoms of the disease4.
If the body temperature is above 38.5°C, physical methods such as cold compresses and ice packs may be used. Your doctor may also recommend anti-inflammatory and antipyretic medications1. Local treatment includes agents with anti-inflammatory, analgesic, enveloping and antiseptic effects1.
For the symptomatic treatment of herpetic sore throat, the doctor may prescribe the drugs HEXORAL®7,8,9,10,11. It is convenient to use HEXORAL® spray to irrigate the pharyngeal mucosa. The active substance of the spray is hexethidine. It acts against the main bacteria found in the oral cavity and pharyngeal mucosa8. The drug is also active against some viruses and fungi of the genus Candida8. Thanks to the local anesthetic effect of hexethidine, HEXORAL ® spray helps reduce pain8. HEXORAL®7 solution is suitable for rinsing. The use of HEXORAL ® spray and solution is allowed in children over 3 years of age7,8.
If herpangina causes severe pain and discomfort, adolescents over 12 years of age and adults can benefit from HEXORAL ® TABS EXTRA lozenges, which contain the anesthetic lidocaine10. For children over 4 years of age, HEXORAL ® TABS lozenges may be suitable. The anesthetic benzocaine in their composition helps reduce pain in the throat and mouth9.
All medications for herpetic sore throat should be used only after consultation with a doctor. In case of severe erosions, HEXORAL ® solution and spray are contraindicated7,8, and lozenges can only be prescribed by a specialist after examining the pharynx9,10.
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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.
How to deal with tongue coating
Thorough cleaning of the tongue is the main hygienic measure aimed at eliminating plaque. Clinical trials have shown that regular tongue cleaning reduces bacteria and bad odor by 75%.
How to get rid of dry mouth and white coating on the tongue:
- use a special scraper - effective tongue cleaning reduces plaque by 40%;
- drink enough water;
- eat foods containing coarse fiber (for example, apples, carrots);
- quit smoking;
- do not abuse alcoholic beverages;
- Healthy food;
- rinse your mouth after eating.
By following these simple rules, you can forever “say goodbye” to the coating on your tongue and forget about bad breath.
Related services: Pediatrician consultation
Sources
- Corsino CB, Ali R, Linklater DR. Herpangina. 2022 Jun 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29939569. https://www.ncbi.nlm.nih.gov/books/NBK507792/
- Ter-Baghdasaryan L.V., Ratnikova L.I., Stenko E.A. Clinical and epidemiological aspects of enterovirus infection // Infectious diseases: news, opinions, training. 2022. T. 9, No. 1. P. 88-93. doi: 10.33029/2305-3496-2020-9-1-88-93 https://infect-dis-journal.ru/ru/jarticles_infection/672.html?SSr=2601343bdb01ffffffff27c__07e4040b011a36-9772
- Alacheva Z. A., Rybalka O. B., Kulichenko T. V. Should everyone escape from Coxsackie?! Or fear has big eyes. Issues of modern pediatrics. 2017; 16 (4): 286–290. doi: 10.15690/vsp.v16i4.1774) https://vsp.spr-journal.ru/jour/article/viewFile/1787/713
- Herpangina Brenda L. Tesini. University of Rochester School of Medicine and Dentistry // MSD Handbook - 2019 https://www.msdmanuals.com/ru/professional/infectious-diseases/enteroviruses/herpangina
- Kozlovskaya O.V., Katanakhova L.L., Kamka N.N., Evseeva A.N. Epidemiological, clinical and diagnostic features of enterovirus infection in children and adults. Bulletin of Surgu State University. Medicine. 2018;(2):56-60. https://surgumed.elpub.ru/jour/article/view/140/141
- Kuo KC, Yeh YC, Huang YH, Chen IL, Lee CH. Understanding physician antibiotic prescribing behavior for children with enterovirus infection. PLoS One. 2022 Sep 7;13(9):e0202316. doi: 10.1371/journal.pone.0202316. PMID: 30192893; PMCID: PMC6128467. https://pubmed.ncbi.nlm.nih.gov/30192893/
- Instructions for use of the drug HEXORAL® SOLUTION:
- Instructions for use of the drug HEXORAL® AEROSOL:
- Instructions for use of the drug HEXORAL® TABS:
- Instructions for use of the drug HEXORAL® TABS EXTRA:
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