A record of clinical treatment experience in 206 cases of infantile herpetic stomatitis is provided. Herpetic stomatitis is induced by herpes simplex virus type I, clinically termed primary herpes simplex, and generally occurs in children under the age of 6, especially in infants and young children aged 6 months to 2 years. It is often a contact or respiratory infectious disease with an incubation period of about one week. The onset is sudden, presenting prodromal symptoms such as increased saliva, irritability, refusal to feed, and fever. The course of the disease is about 7-14 days, during which oral impairment may be evident while systemic symptoms can be alleviated.
1. Early symptoms of infantile herpetic stomatitis are similar to influenza. Children usually start at the pediatric clinic for cold treatment. When oral herpes, ulcers, or exacerbations occur, they seek treatment from oral specialists. In this paper, there were 25 cases of early misdiagnosis, leading to prolonged treatment.
2. In 20 patients with herpetic gingivostomatitis, herpes simplex virus (HSV) was isolated, cultured, and analyzed using restriction enzyme analysis. Among these, 9 cases involved HSV-L infection. Scott's [3] study revealed that herpes simplex virus type II (HSV-2) is also involved in oral ulcers, accounting for approximately 10% to 15% of herpes oral ulcers caused by HSV-2. Herpes simplex virus likely plays a priming role in oral ulcers by inhibiting cellular immune function. On the other hand, the herpes virus may be involved in the vasculitic process of oral cavity ulcers. Virus gene fragments or infected cells after vascular endothelial injury directly enter the blood, acting as antigenic components that prime a vasculitic process. Polyinosinic solution, a sterile water solution of double poly acid polymer, can enhance antibody formation and has broad-spectrum antiviral effects. Wang Bing and others' experiments showed that polyinosinic solution is effective in treating recurrent oral ulcers. Ribavirin, a broad-spectrum antiviral drug, inhibits nucleic acid synthesis. The authors used polyinosinic and ribavirin solutions applied to wounds, favorably reducing simplexes and promoting ulcer healing. This group of 206 cases was treated according to the above theory and achieved good results.
3. Cleaning gums with 3% hydrogen peroxide favors the fading of gingival congestive redness. As an oxidant, 3% hydrogen peroxide has sterilizing, antiseptic, and deodorizing effects. It meets catalase in gingival exudate, breaking down with the release of free oxygen, forming bubbles in the gum, separating and discharging surface secretions and pus necrosis tissue.
4. A characteristic of the disease is significant oral pain. Before meals or before treatment, pain relief can be applied, while simultaneously consuming a nutrient-rich soft diet to reduce local stimulation. For herpes simplex, only local application is needed. If accompanied by systemic symptoms like fever, antibiotics, ribavirin, vitamin B, C, and other systemic medications can be administered to prevent complications of infection.
5. Differential diagnosis should be made between recurrent oral ulcers and herpangina in children. Recurrent oral ulcers in children are rare, causing single scattered small ulcers, not plexus integrated clusters, and not complicated by gingival damage. Herpes zoster vesicles are larger than those in herpetic stomatitis, some arranged linearly along the branches of the trigeminal nerve, accompanied by severe pain.
6. In general, corticosteroid drugs should not be applied for systemic or local treatment in patients with herpetic stomatitis. In case of high fever and other symptoms, a small application can be considered for anti-inflammatory therapy.