Mouth rot
| Classification according to ICD-10 | |
|---|---|
| B00.2 | Herpetic gingivostomatitis and herpetic pharyngotonsillitis |
| ICD-10 online (WHO version 2019) | |
The mouth ulcers or aphthous stomatitis ( Latin aphthous stomatitis , herpetic stomatitis , or more precisely herpetic gingivostomatitis , and acute infectious Gingivostomatitis ) is a by the herpes virus "herpes simplex type 1" (HSV-1) induced disease of the oral mucosa and gums . It usually occurs in children between 10 months and 3 years of age as the first infection of the virus, but occasionally also in adulthood. In the current classification of periodontal diseases , it is assigned to gingival diseases that are not induced by plaque. The clinical picture can correspond to that of aphthe .
Transmission path
The infection usually takes place via the saliva of infected people through the sharing of cutlery and the like. Ä. Or through physical contact. Around 90% of people carry the virus, although only around a third of infected people get it. The virus usually becomes active when the immune system is weakened by other illnesses or psychological factors. Cold sores can then appear on the lip or in the mouth.
In children, in whom the virus becomes active for the first time, it can appear as typical mouth rot. Later illnesses occur elsewhere, e.g. B. as lip vesicles or in the mouth and nasal mucosa.
Clinical picture
The disease usually begins with a very high fever that lasts up to five days . After two to three days, the gums begin to swell, but initially there is no pain. Later the inflammation usually spreads to the inside of the oral cavity , mainly affecting the palate , tongue and possibly the lips . In addition, the papillae of the tongue (tongue papillae, Latin papillae linguales ) become inflamed and appear as small, white dots. This is associated with severe burning pain, so that food intake is only possible to a limited extent. The swollen gums are blood red in color and may bleed easily. The cervical lymph nodes are swollen, the flow of saliva increased; typical is a strong, sour halitosis. After about a week, the blisters dry up and the sores heal without scarring. Only then can the virus no longer be transmitted.
The numerous blisters, the inflamed inside of the mouth and the swollen gums cause persistent, severe pain. Contact with abrasive, hard materials (e.g. dry baked goods) as well as spicy, hot or sour food causes particularly severe, acute pain. Salt also burns in the open wounds. This makes it much more difficult to consume food, which can lead to refusal to eat and drink. The pain makes speaking difficult because the affected areas have to be struck with the tongue when speaking.
Complications are rare; in newborns in the first two weeks, however, the initial infection with the herpes virus can be more severe and lead to herpes encephalitis (hemorrhagic, necrotizing inflammation of the brain). In the eye, the virus can damage the cornea.
Differential diagnosis
- If the pharynx is not affected, it is bacterial gingivo stomatitis .
- Habitual aphthous ulcers usually do not require treatment. Symptomatic therapy is only indicated if the subjective symptoms are severe.
- Plaut-Vincenti stomatitis (also: Stomatitis ulceromembranacea; acute necrotizing ulcerative gingivitis (ANUG)) is a bacterial inflammation of the gums, the treatment of which is treated with penicillin or a penicillin derivative, similar to Plaut-Vincent's angina .
- Behçet's disease , an immunological disease whose symptoms include oral aphthae among many others.
treatment
In the vast majority of cases, the therapy is purely symptomatic; That is, you fight the symptoms, not the cause.
The pain can be eliminated with locally effective painkillers , such as numbing gels / creams with the active ingredient lidocaine or a glucose solution. Existing fever can be reduced symptomatically with paracetamol or ibuprofen , usually in the form of suppositories , which also have an analgesic effect.
The drug therapy can be supplemented by giving chilled beverages such as chamomile tea, clear water or milk. The food should also be chilled, mild and soft. Ice cream, pudding or yogurt, pasta, rice, milk or vegetable porridges are ideal here. Spicy, hot or sour foods such as tomato sauce, fruit juices and the like are unsuitable. Ä. Very dry foods such as biscuits, rusks or bread rolls rub painfully on sore gums and inflamed areas.
A therapy with the antiviral drug acyclovir can accelerate the healing success in individual cases, but is not recommended for all sick children in the DGPI manual.
A sick child should stay in the house until it has healed completely.
prevention
Because the virus is so widespread, there is no real chance of avoiding the pathogen. Parents suffering from acute herpes should use pacifiers etc. Ä. do not put in your mouth. There is no vaccination.
There are no special rules for kindergartens and schools; However, especially in day nurseries, it is recommended to leave the child at home during the illness.
literature
- German Society for Pediatric Infectious Diseases eV (DGPI) (Hrsg.): Handbook of infections in children and adolescents. 4th edition Futuramed, Munich 2003, ISBN 3-923599-90-0 .
Web links
Individual evidence
- ↑ Herpes. Retrieved October 8, 2019 .
- ↑ Peter Cichon: Clinic of tooth, mouth and jaw diseases in disabled patients . Schlütersche, January 1999, ISBN 978-3-87706-482-5 , p. 77–.
