Characteristics of recurrent chronic herpetic stomatitis

Abstract

Introduction. One of the current challenges in contemporary clinical medicine is infectious diseases. According to WHO data, herpes simplex virus (HSV) infection ranks second among human viral illnesses. Herpes simplex virus, an obligate intracellular parasite, belongs to the alpha subfamily of Herpesviridae. The virus cannot replicate outside living cells. There are two types of HSV: HSV-1, which is involved in oral mucosal conditions, and HSV-2, the causative agent of genital herpes and occasionally oral herpes. Literature data suggests that almost 90% of the population is infected and carriers of the virus. Clinical manifestations differentiate between primary (acute) herpetic gingivostomatitis and secondary (recurrent) herpetic stomatitis. Objective of the study: To examine the cause of herpetic infection in the oral cavity, clinical symptoms of the condition depending on the affected region of the oral mucosa, and determine the correct treatment approach. Materials and Methods. Nineteen patients with manifestations of chronic herpetic stomatitis in the oral cavity sought treatment at Dental Clinic of the State University of Medicine and Pharmacy „N. Testemițanu”. Subjective complaints included pain upon touching the affected region and difficulty in food consumption. From the medical history, all patients reported the frequent recurrence of chronic herpes elements, ranging from 1-2 times per year. The general condition of the patients was satisfactory without fever. Clinically, mild congestion and edema of the vermillion border and surrounding skin were observed, followed by vesicular eruption in clusters. Ulcerations appearing after vesicle rupture formed crusts within the next 2 days. Oral lesions were located on the attached gingiva, hard palate, and lateral surfaces of the tongue. They started as vesicles that rapidly ruptured, resulting in erythematous ulcers with a tendency to coalesce. Oral hygiene in patients was unsatisfactory (II OHI-S 3.0 and above). There was an abundance of soft and hard deposits, moderately hyperemic and edematous free gingival margin, with preserved integrity of the dentogingival junction. Oral sanitation was necessary in 11 clinical cases. All patients underwent both general and local treatment. General treatment included antiviral drugs, desensitizing agents, immunomodulatory therapy, and vitamin C. Local treatment aimed at topical applications of analgesics, proteolytic enzymes, antivirals (aerosol, ointment), and immunomodulatory preparations. At the end of the treatment, all patients underwent professional dental hygiene. Results and Conclusions. The applied treatment approaches were classified as etiotropic, pathogenetic, and symptomatic. Etiotropic treatment was based on the use of specific antiviral drugs targeting HSV, medication inhibiting DNA and RNA replication in HSV-infected cells. Pathogenetic treatment involved the use of immunomodulators to normalize the immune system function. Symptomatic treatment included the use of antiseptic substances to establish an analgesic and antiseptic therapeutic effect. All patients showed improvement and a reduced recurrence period against the applied treatment. Our experience confirms that comprehensive treatment with antiviral drugs, combined with keratoplastic substances, reduces the duration of chronic herpetic stomatitis treatment. Strict local hygiene implementation and clinical case monitoring contribute to the reduction of disease recurrence.