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2COMPLEX TREATMENT OF HERPETIC STOMATITIS WITH MEDICAL REMEDY BASED ON PLANTS OF LOCAL ORIGIN
N.M. AZIMBAEV
Senior lecturer of the Department of Surgical Dentistry with a course of pediatric surgical dentistry of the Medical Faculty of Osh State University, Candidate of Medical Sciences.
A.M. ESHIEV
Professor of the Department of Surgical Dentistry with a course of pediatric surgical dentistry of the Medical Faculty of Osh State University, Doctor of Medical Sciences, Professor.
N.O. KURMANBEKOV Senior lecturer of the Department of Surgical Dentistry with a course of pediatric surgical dentistry of the Medical Faculty of Osh State University, Candidate of Medical Sciences.
Abstract: This article reflects clinical and archival studies of3350 patients with oral mucosa diseases, including 1200 patients with various forms of stomatitis; outpatient examination and treatment of 268 patients on the basis of maxillofacial surgery of Osh interregional united clinical hospital was prospectively conducted. Herpes-virus infection is the most frequent and widespread infection all over the world. In this regard, we set goals and objectives, differentiated principles of treatment of patients with chronic herpetic stomatitis of various degrees of severity, aimed at the correction of the identified disorders based on the results of the study of the peculiarities of the clinical course of the disease. The state of local immunity in oral stomatitis was investigated. As a result of the study high efficiency depends on the applied tactics of treatment ofpatients with herpetic stomatitis. Complex therapy at HS includes general, local treatment and rational nutrition of patients, combined application of new antiviral and immunomodulating drugs, in particular Leukinferon with Timalin, local application of the drug "Stomat" allowed to increase the effectiveness of treatment of patients with recurrent stomatitis.
Keywords: dentistry, maxillofacial surgery, herpetic stomatitis, diagnosis, treatment, drugs.
Introduction. Based on data from the World Health Organization (WHO), herpes-virus infection affects about 20% of the world's population. About 95% of the population are direct carriers of herpes-virus infection. Among viral infections - diseases caused by herpes simplex virus occupy the second place (15.8%) after influenza (35.8%) [N. V. Tiunova et al. V. Tiunova et al., 2018; E. S. Suerkulov, 2020; N. A. Yudina et al., 2021].
Currently, one of the most frequent diseases is herpetic infection, which is explained not only by the wide prevalence of herpes simplex virus, but also by the peculiarities of the formation of the immune system in the developing body [V. Yu. Klenina, 2015; A. I. Kuselman et al., 2017].
Herpes infection caused by herpes simplex virus occurs in all countries and different climatogeographic zones, the incidence of which varies widely among populations with different standards of living. Herpes simplex virus, being in a latent state, under certain conditions causes an exacerbation of the disease, manifested as herpetic stomatitis [E. V. Simonova et al. V. Simonova et al., 2016; Y. N. Kuznetsova, 2017; E. V. Luzganova, 2017; A. V. Bagrii, 2018].
Stomatitis in general, having a wide variety of symptoms and causes of occurrence are among the most common, poorly controlled pathology, with a complicated course, especially in patients with general medical conditions, against the background of increased allergization of the body [E. V. Borovsky et al., 2018; N. A. Yudina et al., 2021].
During the last decade, the problem of prevention and treatment of acute and chronic diseases of the oral mucosa has received considerable attention from domestic and foreign researchers [I. K. Lutskaya, 2016; A. I. Kaspina et al., 2018; E. O. Isakov et al., 2019; E. S. Suerkulov, 2020; E. T. Stoopler, 2016; I. Amin, 2019; R. Reddy, 2019]. This is primarily due to the increasing negative
impact of immunosuppressive environmental factors on the human body, the widespread and not always justified use of medications with antibacterial properties [M. A. Dolgikh et al., 2017; E. V. Borovsky et al., 2018; E. S. Suerkulov, 2020].
Therefore, despite certain results achieved in addressing the issue of improving the effectiveness of complex treatment of patients with HS using new drugs in combination with immunomodulators remains relevant in addressing the above problems, which was the subject of this scientific study in this area.
Aim of the study: to improve the treatment of herpetic stomatitis with the development of an improved treatment technique.
Materials and methods of research
Object of the study: analysis of archival data of 3350 patients with diseases of the oral mucosa, including 1200 patients with various forms of stomatitis; outpatient examination and treatment of 268 patients were prospectively performed.
The subject of the study: determination of the frequency, structure, clinical and diagnostic features, evaluation of the effectiveness of complex treatment of acute and chronic herpetic stomatitis.
General characteristics of the studied patients. We retrospectively analyzed archival data of case histories, outpatient records, logbooks to study the prevalence, frequency and structure of stomatitis according to the data of the City Dental Polyclinics (CDP) No. 1, No. 2 and Osh Interregional Dental Center (OMOSC) for the period from the beginning of 2013 to the end of 2015 of 3350 patients with various diseases of the oral mucosa.
To realize the set objectives, we conducted an outpatient examination and treatment of referred 268 patients with various forms of stomatitis in the clinical and diagnostic department of Osh Interregional United Clinical Hospital (OMOCH) for the period from 2015 to 2018. The prevalence, incidence, structure and significant factors of development of various forms of stomatitis depending on the place of residence, sex and age were analyzed.
Research Methods. Clinical research methods were carried out: clinical manifestations of stomatitis and severity degree were determined and evaluated, caries intensity index, oral hygiene index were determined; laboratory tests were studied: polymerase chain reaction, immunogram, pH-metry of oral fluid, as well as statistical methods of research.
Assessment of the state of local immunity of the oral cavity and specific humoral immunity. Laboratory diagnostics of quantitative determination of IgA, IgG, IgM, slgA content in oral fluid with calculation of the coefficient of balance of local immunity factors in patients before and after treatment according to the selected schemes was carried out.
Laboratory diagnostics of herpetic infection by polymerase chain reaction (PCR) method. The method is the most sensitive and fastest method of detecting the infectious agent. Material is collected by the working part of a sterile disposable applicator from the affected areas and around them. After material collection, the applicator was placed in a sterile disposable tube and sent to the laboratory.
pH - oral fluid metrics. Litmus paper was used to measure the pH of oral fluid, which provides a quick and inexpensive way to obtain the results. Estimation of pH on an indicator scale using pH-metric strips. On this basis, we used pH-metry as an indicator of the effectiveness of the phytopreparation "Stomat". The pH level was evaluated according to the reference scale using pH-metric strips.
Methods of treatment of herpetic stomatitis. When planning therapy for patients with herpetic stomatitis, we were guided by two main principles: pathogenetic validity of a particular method of treatment in each case and gradual transition, in the absence of effect, from simpler to complex.
Before treatment of the patients of the main and control groups, complete sanation of the oral cavity was performed. Treatment of the oral cavity, cleaning of plaque with 1% hydrogen peroxide solution with rinsing with antiseptic solutions. To remove necrotized tissues were used - solutions of enzymes: trypsin, chymotrypsin, etc. In the control group, the treatment was carried out by the
traditional method with the use of antiviral drug "Acyclovir" and keratoplastic means (sea buckthorn oil). In the main group additionally rinsing with phytopreparation "Stomat". Irradiation with blue light with a wavelength of 450 nm, was carried out for 10 minutes, 7-8 days in the oral cavity 2 times a day. For the purpose of immunocorrective therapy we used "Timalin", in the treatment of chronic herpetic stomatitis in adults we used antiviral drug "Leukinferon". We recommended a rational sparing diet, abundant drinking and explained the principles of child care at home and the technique of oral cavity treatment with this drug to patients of both groups.
Blue light irradiation. The patients under our observation (175 patients) received complex treatment. In this case, in the control group of patients was carried out complex therapy, standard treatment. In the main group, blue light phototherapy was additionally carried out. During 7-8 days the oral cavity was irradiated with blue light with a wavelength of 450 nm 2 times a day for 10 minutes.
Methods of preparation of complex phytopreparation "Stomat" for external application in pharmacy № 5 of LLC "Prius" of Osh city. Ingredients: chamomile flowers 13 g.; sage leaf 13 g.; calendula flowers 6.5 g.; peppermint herb 6.5 g.; common thyme herb 6.5 g.; aira rhizomes 6.5 g.; oak bark 13 g.; purified water up to 650 ml. Preparation requires a different mode of extraction, two infundibles and standard pharmacy LRS (medicinal plant material) are used. Calculations: the volume of water purified for 1g of LRS is 650/65=10ml. Volumes of extractions:
a) (13+13+6,5x4)x10=520ml;
b) 13x10=130 ml (for oak bark).
Volumes of water for extraction taking into account water-absorption coefficients (820,3 ml).
Methods of statistical processing of the obtained data.
Reliability of the obtained data was evaluated by paired method using Student's t test (t). Reliability index: at p = 95.0% or p<0.01(**), at p = 99.9% or p<0.001(***).
Variation-statistical processing of the study results in combination with correlation and regression analysis was performed on a personal computer "Acer intel CORE i5" in the programs MS "Word" and "Excel" in the Windows 2007 environment, using the data analysis package in the program "Microsoft Excel" with the use of standard statistical analysis "Statistica 6.0", with calculation of the arithmetic mean and its standard error (M±m).
Results of the study and their discussion Retrospective analysis of archival material. We analyzed archival data of outpatient charts, registers of patients who applied to GSP № 1 and № 2, OMOSC for the period from 2013 to 2015 with various diseases of SOPR, which amounted to 3350 patients, of which stomatitis was detected in 1200 (35.8%). Acute stomatitis was detected in preschool children, which amounted to - 63.4%, in adolescence - 25.7%, in this case the cause may be local factors. In adults - 10.9%, the cause of development is gastrointestinal tract diseases, general weakening of immunity, avitaminosis, anemia and traumas of SOPR. However, according to the results of analyzing the archival data of outpatient records, in the majority of cases there was no full-fledged examination and laboratory tests, the diagnosis was established on the basis of clinical manifestations, in this connection the diagnosis was not reasonable. Due to the above, we set the task to study the peculiarities of stomatitis diagnostics. Based on the laboratory data of 268 patients followed prospectively, it was found that the main, frequently occurring disease is herpetic stomatitis in 175 (65.2%) patients, and the remaining 93 (34.7%) patients had other types of stomatitis. Therefore, we set the task to study this type of stomatitis (seasonal manifestations, age and gender).
Urban residents accounted for 39.1% and rural residents for 60.9%. We also noted the sex and age of the patients, from a total of 84 (41.3%) patients aged from 6 months to 5 years. Of these 84 patients under 3 years of age - 16 (19%), from 3 to 5 years of age - 68 patients (81%). In school-adolescent age stomatitis occurred in 121 patients (45,1%). According to the severity of the disease: mild form was detected in 34 (20%); medium form - 107 (60%) patients; severe form - 34 (20%). form - 34 (20%).
Stomatitis of non-viral etiology was detected in 93 patients, of which 34 (36.5%) had catarrhal stomatitis, chronic aphthous stomatitis was detected in 34 (36.5%) patients, and chronic aphthous stomatitis was noted.
aphthous stomatitis was found in only 29 (31.1%) patients. Other types of stomatitis (bacterial, allergic, traumatic) were noted in 30 (32.2%) patients.
Clinical characterization of patients with acute herpetic stomatitis. Seventy-five patients with acute herpetic stomatitis (AHS) were examined, which were divided by severity into three stages:
18 (24%) patients with a mild degree of severity were examined, whose general condition was characterized by the absence of signs of general intoxication. Examination of the oral mucosa revealed: slight hyperemia, against which there were single herpetic rashes (from 2 to 5 elements) with serous content; on the mucous membrane of the gingival margin, lips and on the tip of the tongue there were small-point erosions of polygonal shape, covered with fibrinous plaque, slightly painful on palpation. In this form of the disease course, saliva defense mechanisms are well expressed: pH 7.4±0.04, which corresponds to the optimal state (Fig. 1. A).
IS. Iii
1 1
A Б В 1
Fig.1 - Clinical picture of acute herpetic stomatitis:
A) mild degree; B) medium degree; C) severe degree.
Twenty-five (33.3%) patients with a moderate degree of severity were examined; they had: malaise, weakness, headaches, slight increase in body temperature from 37.5 to 38° C. The clinical picture on the mucous membrane of the oral cavity was characterized by the presence of diffuse hyperemia, against which there were polygonal erosions of 10-15 elements, sometimes merging into large erosive areas, painful on palpation. Most often pathological elements were localized on different surfaces of the tongue, lips, floor of the mouth, mucous membrane of the hard palate. At moderately severe course of the disease salivary pH became more acidic pH 7,9±0,04 (Fig.1. B).
With severe severity of stomatitis 32 (42,7%) patients came to us, who had pronounced symptoms of general intoxication: body temperature up to 390 C and higher, head, muscle and joint pains, enlargement of regional lymph nodes, lack of appetite, abundant salivation and inability to eat because of the painfulness of the affected areas of the mucous membrane of the oral cavity.
There was marked hyperemia of the mucous membrane of the mouth, hard and soft palate, cheeks, lips, dorsal and inner surfaces of the tongue, vestibule and floor of the mouth, as well as on the mucous membrane of the posterior pharyngeal wall, palatine glands and retromolar area. Multiple painful elements in the form of erosions were found on the sharply hyperemic background, where as a consequence of merging erosions formed extensive lesions, which makes it difficult to open the mouth and take food (even liquid). Saliva reaction is acidic pH 6.55±0.2, but after some time it changes to alkaline pH 8.1-8.4 (Fig.1. B).
The most frequent clinical manifestations of acute stomatitis of moderate and severe degree were observed, which amounted to 76%. The age of patients with moderate and severe degree of severity varied from 3 to 5 years. As the results showed in the majority of cases, boys (68%) had the disease 2 times more often than girls (32%) (p<0.05).
The analysis of the dental status of children with acute stomatitis showed that 60% of patients had carious lesions of teeth, which corresponds to the average caries prevalence rate. Along with caries, periodontitis, pulpitis, gingivitis, and dental deposits were present. In 65 (37.1%) patients inflammatory diseases of the mucous membrane were found. Caries intensity in patients with mild and moderate severity was 3.0, which corresponds to the average level.
In patients with severe degree the intensity was much higher and amounted to 6.5, which is a very high index of CP, CPP. Oral hygiene in the majority of children was in unsatisfactory condition. OHI-S index in children with mild form was 1.2, with moderate degree 1.9, and with severe degree of severity 2.5 and more. These high indices of individual oral hygiene were one of the triggering factors of acute stomatitis.
The results of the analysis showed that the children suffering from acute stomatitis have mainly severe degree and amounted to 47.2%, followed by medium degree - 33%, and light degree -24%.
In the examined children, the acute form of stomatitis at the age of 3 to 5 years - 64%, occurs more often than in children from 6 to 14 years - 36% (p<0,05).
Analysis of humoral immunity in saliva of patients with acute and chronic herpetic stomatitis. The analysis of the humoral link revealed that the content of serum immunoglobulins IgM and IgG in 90.0% of patients with mild and moderate severity of herpetic stomatitis was slightly increased.
was slightly increased. In patients with severe course there was proved an increase in the level of IgG and M when comparing the data of patients with mild and moderate severity of herpetic stomatitis, indicating polyclonal activation of B - immunity system, which was the result of acute or chronic course caused by infection of viral genesis.
When the pathologic process intensified, the level of immunoglobulin A decreased in 87.5% (p<0.5), which proves the decrease of humoral immunity in the oral cavity.
The protective mechanism of immunity was reduced in 95.0% of patients with moderate and severe course of the disease, which is shown in Table 3.1 and proved by comparison with the data of the control group. It is known that, the protective barrier is created from the mucosal immune system, while IgA causes tolerance, which in turn contributes to the neutralization of immune pathological complex antigens, providing preservation at the level of mucosal surfaces, at the same moment participating in the active neutralization of viral pathogen.
It is now proven that the same elements are present in saliva, denoted SIgA, where these elements block the adhesion of microorganisms to adjacent cells of mucosal surfaces.
It was determined that the level of IgA and SIgA in salivary fluid, with a mild degree of severity is reduced in 73.8% of patients, and more pronounced in the medium degree in 88.6% of patients. In severe course of herpetic stomatitis, the same level of IgA was reduced in 91.2% of patients, which proved the disorder of defense mechanism against viral pathogen of SOPR (Table 1).
Table 1 - Level of immunoglobulins (mg %) in saliva of patients with herpetic stomatitis
Immunoglobulin Comparative Level of severity of the disease
s group mild moderate severe
n=30 n=35 n=30 n=10
IaG 3,6±0,7 5,9±0,5* 6,7±0,3** 8,11±0,6***
IgM 9,8±0,5 11,7±0,4 12,4±0,6** 12,8±1,7***
IgA 14,9±1,1 12,1±0,6* 8,1±0,5** 7 9±0 7***
SIgA 37,0±1,5 24,0±0,3* 14,9±0,4** 9,0±0,4***
Note:
* - proven difference in relation to the control group (p<0.01), ** - proven difference in relation to mild degree of HS (p<0.05),
*** - proven difference in relation to the average degree of HS (p<0.001).
The level of IgG and IgM in saliva increased at mild and moderate severity in patients with herpetic stomatitis 85,3%. With increasing severity of the disease there was an increase in 2.5 times as well as in 1.4 times. The proof of acute inflammatory course of the disease was the increase of IgG and IgM in 97,7% of patients.
Based on the obtained data, the dynamics of Ig changes in saliva showed a disorder of humoral immunity with a decrease in immune response at the level of PWS in patients with acute and chronic herpetic stomatitis, so they need to correct the immune system by including immunomodulators in the treatment complex.
Results of treatment of patients with acute herpetic stomatitis. In the results of treatment of patients with a mild degree of severity of AHS, where subjectively noted a decrease in pain in the main group on 2,5±0,22 day, in the control group on 3,5±0,21 day. Objectively: in the main group on 3,6±0,14 day the area of lesions decreased: hyperemia completely disappeared, erosions significantly decreased in size and were in the stage of epithelization, and in the control group on 5,0±0,12 day. On day 7,5±,25 the oral mucosa was of normal color, without pathological elements in the main group, similar treatment results were observed in the control group on day 10±0,15 (p<0,05). At average severity of AHS patients on 3,6±0,23 day subjectively noted decrease of pain syndrome (insignificant pains remained when eating), body temperature normalized, patients became more active, and in control group the same picture was noted on 5,6±0,16 day.
In the main group on 5,6±0,23 day the general condition of patients normalized, decrease of intoxication symptoms was observed (weakness and malaise disappeared, headaches decreased), and in the control group on 6,4±0,24 day. Erosions significantly decreased in size, the initial stage of epithelization was observed along the periphery, slight swelling and hyperemia of the mucous membrane remained, no new erosions appeared. In the main group 8,5±0,13 days the patients felt well, swelling and hyperemia of the oral mucosa completely disappeared. Erosions in the oral cavity epithelialized, patients could take any food in the control group on 12,9±0,35 day (p<0,001).
At severe degree of severity of OGS in the main group 2,5±0,25 days patients subjectively noted improvement of general condition, symptoms of intoxication decreased (body temperature increased 38° C, significantly head, joint and muscle pains decreased), in the control group on 6.5±0.20 days.
Slight soreness was noted when opening the mouth. Objectively: in the main group on day 4,5±0,31, erosions were cleared from fibrinous plaque, swelling and hyperemia of the oral mucosa decreased, free mouth opening was observed in patients, and in the control group 7,5±0,10 day. In the main group on 7,9±0,32 day the general condition completely normalized, temperature was within the normal range, erosions significantly decreased in size, from the periphery to the center of erosions the process of neovascularization began, the same result was observed in the control group on 9,6±0,20 day. Full epithelization of erosions occurred in the main group by 11.5±0.23 day, and in the control group there was no full epithelization of erosions, in the stage of active epithelization there were 1-2 erosions on slightly hyperemic background, clearly delimited from healthy tissue by 13.5±0.35 day (p<0.05).
In the main group with acute herpetic stomatitis the therapy according to our method proved the effectiveness of treatment (p<0,05). Studies have shown that the inclusion in the complex of therapeutic measures immunostimulating drug "Timalin", which normalizes the quantitative and functional indicators of the T-system of immunity, increased the effectiveness of treatment of patients suffering from acute herpetic stomatitis. And local application of phytopreparation "Stomat" along with the described pharmacological properties and irradiation with blue light, clearly accelerates the process of epithelization and reduces the time of treatment (p<0,05).
Results of treatment of chronic herpetic stomatitis. To evaluate the effectiveness of our proposed therapy we proposed the following scheme of treatment of the examined patients: in the control group, consisting of 50 patients, traditional therapy was carried out; in the main group, including 50 patients were treated according to our proposed complex scheme.
According to the results of treatment in the main group at a mild degree of severity of chronic herpetic stomatitis on 2,3±0,25 day pain decreased and free mouth opening was observed, and in the control group on 4,5±0,12 day. Hyperemia of the oral mucosa in the main group completely disappeared by 3.4±0.36 days, and in the control group by 6.7±0.34 days. Erosions were in the stage of epithelization in the main group on day 7,1±0,18, the oral mucosa was pale pink, without pathological elements, and in the control group on day 10,0±0,38 (p<0,05).
At the average degree of severity of chronic herpetic stomatitis in the main group on 3,4±0,23, in the control group on 6,2±0,17 days the patients noted a decrease in pain syndrome; slight pain remained at meal intake; body temperature normalized; the patients became more active. In the main group on day 5,7±0,17 erosions significantly decreased in size, the initial stage of epithelization was observed along the periphery, slight swelling and hyperemia of the mucous membrane remained, no new erosions appeared. And in the control group the general condition of patients normalized on 9,1±0,61 days; decrease of symptoms of intoxication was observed (weakness and malaise disappeared, headaches decreased), the process of epithelization of erosions began; oral mucosa remained slightly hyperemic; new erosions did not appear. In the control group on day 14,5±0,25 patients felt well, erosions in the oral cavity epithelialized, freely took food, while in the main group on day 8,1±0,14 this symptomatology was observed (p<0,001).
At a severe degree of chronic herpetic stomatitis in the main group on 2,3±0,25 day the general condition of patients improved, symptoms of intoxication decreased (body temperature increased to 37,5 ° C, slightly decreased head, joint and muscle pain), when opening the mouth was painful, while in the control group these symptoms were noted on 2,3±0,25 day.
head, joint and muscle pains decreased), there was soreness when opening the mouth, and in the control group these symptoms were noted on 5,1±0,25 days. On 4,5±0,35 day in the main group the general condition completely normalized, the temperature was within the normal range, erosions significantly decreased in size, from the periphery to the center of erosions the process of neovascularization began, in the control group on 8,5±0,19 day the body temperature increased only in the evening up to 37,2-37,5 ° C; erosions were cleared from plaque, hyperemia of the oral mucosa decreased in size; opening of the mouth was slightly difficult in patients. On 12,4±0,12 day in the control group the body temperature normalized, there was still pain when eating; the beginning of the process of epithelization of erosions was observed, such clinic was observed in the main group on 8,8±0,10 day. By 13,1±0,33 day there was a complete epithelization of erosions in the main group, and in the control group - 17,1±0,36 day the general condition was completely normalized, temperature was within normal limits; there was no complete epithelization of erosions, in the stage of active epithelization there were 1-2 erosions on insignificantly hyperemic background, clearly delimited from healthy tissue (p<0,001).
On the basis of the conducted treatment it was found that the remission period in the patients of the main group in comparison with the control group (11,5±0,24 months, for mild severity; 10,5±0,25 months, for moderate severity; 7,5±0,36 months, for severe severity) increased up to 2,6±0,34 times for mild severity, up to 2,1±0,22 times for moderate severity and up to 0,95±0,25 times for severe severity. Accordingly, the frequency of recurrence of chronic herpetic stomatitis within a year was significantly decreased (p<0,05).
Duration of remission stage at application of traditional method of treatment of patients of control group was (at mild severity 6,8±0,17 months, at medium - 5,2±0,25 months, at severe -4,3±0,75 months), which accordingly remains unchanged. When comparing the data of control and main groups, there are reliable differences (p<0.05) in the terms of treatment and in the terms of recurrences. During the treatment of oral stomatitis our observations in the main group allowed us to establish that the degree of objectivity of the survey data was confirmed by the results of special functional studies. The use of blue light in the complex treatment of acute and chronic recurrent stomatitis of the oral mucosa is more effective compared to predominantly drug therapy due to rapid stabilization of microcirculation and keeping it longer within normal values. In addition, the use of
blue light along with other known means of physiotherapy expands the arsenal of pathogenetic means in the treatment of oral mucosa pathology.
Comparative aspects of the main and control groups of patients with chronic herpetic stomatitis. One of the components of complex treatment of acute and chronic herpetic stomatitis is local application of phytopreparation "Stomat" in the oral cavity, as well as irradiation with blue light of 450 nm wavelength, immunocorregulating drug "Timalin" in combination with antiviral drug "Leukinferon" helped to achieve good treatment results. The results of the study of immunoglobulin levels in saliva: the levels of IgA and secretory SIgA increased (p<0.05), with the use of these components, which contributes to bacteriocidal, analgesic, as well as immunocorregulatory action. Phytopreparation "Stomat" normalized the pH of saliva, thereby blocking the adhesion of microorganisms to epithelial cells of mucosal surfaces. "Timalin" as an immunomodulator contributed to the restoration of impaired immunological reactivity, regulating the number and ratio of T and B-lymphocytes and their subpopulations, accelerating the process of phagocytosis and increasing the immune reserves of the body, the effect on metabolism at the cellular level, which in turn contributed to an increase in antiviral protection of the macroorganism.
The analysis of distant results after the proposed complex method of treatment of the main group of patients with chronic stomatitis contained the period of remission duration, as well as the nature of the course of recurrence of the disease and healing time of newly appeared foci. The results of the study of saliva pH in adults and children suffering from herpetic stomatitis before treatment, as the severity of the pathological process increased, marked a shift to the alkaline side.
Observation of patients during 3 years revealed positive results in treatment with our proposed method in comparison with the traditional method of treatment. Stable clinical recovery was noted in 25% of people with chronic stomatitis. The rest had longer remission periods. Long remissions for the period from 12 to 36 months were observed in more than half of patients (61,5%). In 5% of patients, which included two patients with severe forms of chronic stomatitis and with concomitant autoimmune disease, remission increased up to 6 months, and permanent course in a patient with deforming form was interrupted for 5 months. Repeated exacerbations in patients proceeded in a lighter form: aphthae became smaller, their number decreased. In the comparison group, where only traditional therapy was used, the anti-relapse effect of treatment was not as pronounced as in the main group.
The combined use of new antiviral and immunomodulatory drugs, in particular "Leukinferon" and "Timalin", allowed to increase the effectiveness of treatment of patients with AHS. Also complex application of phytopreparation "Stomat" with blue light radiation allows to eliminate pain in the area of aphthae at once, to accelerate epithelization terms and to increase local resistance of oral mucosa pathology to repeated rashes, and also allows to increase duration of remissions, to change the nature of the course of relapses and to increase the percentage of clinically recovered patients with chronic stomatitis (p<0,05). On the basis of the conducted treatment it was found that the remission period in patients suffering from chronic herpetic stomatitis at different degrees of severity in 1.5 times increased (p<0,05). Accordingly, the frequency of recurrences within a year significantly decreased (p<0.05).
Conclusion: 1. Frequency of stomatitis according to the archival material of diagnostic centers of Osh city is 1200 out of 3350 or 35.8%. Acute stomatitis was detected in 63.4% of preschool children, in adolescence - 25.7%, and in adults - 10.9%.
2. In PCR study of 268 patients, herpetic form of stomatitis was diagnosed in 175 (65.2%), other forms of stomatitis were detected in 93 (34.8%), herpetic form of stomatitis was 1.8 times more common (p<0.05). According to gender, female patients were 123 (45.8%), male patients 145 (54.1%). Children under 14 years of age were 121 (45,1%), adults - 147 (54,8%) of the studied patients (p<0,05). According to the seasonality of the disease, herpetic form of stomatitis occurred in spring and fall period in 167 (62.3%) patients (p<0.05).
3. The method of complex treatment of herpetic stomatitis with the use of immunomodulator, phytopreparation "Stomat" and radiation with blue light of 450 nm wavelength was developed and introduced into clinical practice.
4. Clinical and laboratory studies show the effectiveness of complex treatment of stomatitis, which accelerates the epithelization time (in the main group 4,9±0,25 days against 6,8±0,30 in the control group), reduces 1,5 times the frequency of recurrences (p<0,05), reduces an average of 3 bed-days of treatment.
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