Ozonoterapia en el tratamiento de la Gingivo estomatitis herpética aguda. Presentación de caso / Ozone therapy in the treatment of acute herpetic gingivo stomatitis. Case presentation

El ozono presenta actividad antiparasitaria por su potente acción bactericida. En el presente estudio experimental se evaluó la efectividad del ozono en el tratamiento de la gingivoestomatitis herpética aguda (GEHA) en una paciente diagnosticada con esta enfermedad. La paciente recibió dos curas de OLEOZON® oral diaria, en toda la cavidad oral y en sus labios donde se extendía la enfermedad. Los resultados muestran que la aplicación de oleozón oral logró la sanación completa de la zona donde apareció la lesión sin dejar huellas en un periodo de 3-7 días, el dolor alivió aproximadamente a los tres minutos de aplicado el medicamento y desapareció a las 24 horas., mejorando las condiciones de la cavidad bucal y facilitando su alimentación. Se pudo comprobar el efecto antiparasitario, fungicida y virucida del Ozono ante la presencia de las lesiones herpéticas, así como cicatrizante y estimulante de la circulación mejorando la llegada de elementos nutritivos y oxígeno a la mucosa bucal y encía, contribuyendo a la mejoría de la paciente ya que el dolor se alivió aproximadamente a los tres minutos de aplicado el medicamento y desapareció a las 24 horas.

[Development of a method for evaluating the effectiveness of treatment of children with herpetic stomatitis.]

The high frequency of herpes infection in children determines the need to search for new diagnostic markers, evaluate treatment efficacy and predict relapse of the disease. The purpose of the work is to assess the possibility of using biochemical analysis of oral fluid to assess the effectiveness of treatment of children with acute herpetic stomatitis. In the oral fluid and blood plasma of 28 children of patients with acute herpetic stomatitis in the dynamics of the disease, the content of total protein, proteins of the acute phase of inflammation, as well as the concentrations of calcium, magnesium, copper and zinc was determined spectrophotometrically. Oral fluid and blood plasma of 45 practically healthy children were used as a control. In acute herpetic stomatitis, the content of C-reactive protein, orosomucoid, α1-antitrypsin, ceruloplasmin, prealbumin and microalbumin, as well as magnesium, calcium and zinc, increases in the oral fluid of children, but the level of total protein and transferrin decreases. In this blood plasma, the level of ceruloplasmin, orosomucoid, C-reactive protein, α1-antitrypsin is higher, and zinc is lower than in healthy children. The copper content in the oral fluid and blood plasma of children increases with moderate herpetic stomatitis, and significantly decreases with severe herpetic stomatitis. The degree of changes in the content of the proteins of acute phase of inflammation and indicators of mineral metabolism of the oral fluid and blood plasma of children with a herpetic infection of the oral cavity correlates with the severity of the disease. Highly significant correlations were revealed when comparing the concentrations of proteins of the acute phase of inflammation, electrolytes between the oral fluid and the blood plasma of children with acute herpetic stomatitis. After treatment of children with acute herpetic stomatitis, the content of minerals and proteins of the acute phase of inflammation in the oral fluid returned to normal only with a mild disease severity. A method has been developed for evaluating the effectiveness of treatment of children with acute herpetic stomatitis by determining the content of minerals in the oral fluid. The ratio of copper to calcium in the oral fluid of children more than 45 should be considered an indicator of effective treatment of children with herpetic stomatitis.

Honey can help in herpes simplex gingivostomatitis in children: Prospective randomized double blind placebo controlled clinical trial.

PURPOSE: Herpes simplex gingivostomatitis (HSGS) in children is a common painful infectious disease. This study aims to examine the combined efficacy of honey with acyclovir suspension compared to acyclovir alone for treating HSGS in young children. MATERIAL AND METHODS: This Randomized double blind placebo controlled study was conducted from June 2015 to September 2017 in a tertiary referral hospital. One hundred children aged 2-8 years with HSGS were randomly classified into 2 groups; study group: treated with honey plus oral acyclovir and control group: treated with oral acyclovir alone. Severity of oral lesions, Fever, eating and drinking ability, pain scores and need for analgesics were compared between 2 groups on day 3, 5 and 7 after starting treatment. RESULTS: Children receiving honey plus acyclovir (i.e. study group) had significantly earlier disappearance of herpetic oral lesions; median 3 days vs. 6 days in control group (P = 0.022), drooling; 2 days vs. 4 days (P = 0.030) and eating difficulty; 3 days vs. 8 days (P = 0.001). Study group also had significantly lower pain scores, better eating and drinking ability and significantly less need for analgesics at 3 time-points of assessment. Fever disappeared in both groups with no statistically significant difference. CONCLUSIONS: The combined use of honey with oral acyclovir can produce favorable outcome than acyclovir alone in children with Primary herpetic gingivostomatitis.

[Complex treatment of recurrent herpetic stomatitis in employees of industrial enterprises]. / Kompleksnoe lechenie retsidiviruiushchego gerpeticheskogo stomatita u rabotnikov promyshlennykh predpriiatii.

Research ebjective was to study assessment of quality organization of work treatment recurrent herpetic stomatitis in patients of industrial enterprises from employees.172 patients on the industrial enterprises from 25 to 54 year were treated recurrent herpetic stomatitis. Clinical efficiency of immunomodulator quality therapy of recurrent herpetic stomatitis for assessment organization of work in employees industrial is proved by estimation of oral cavity local immunity (SIgA, lisozyme). After treatment of recurrent herpetic stomatitis in employees signifie and (p<0,005) inerease of lisozyme and SIgA. The obtaiquality of treatment of recurrent herpetic stomatitis et employees of industrial enterprises.

Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis.

Mesenchymal stem cells (MSCs) have potent immunomodulatory functions and are a promising therapy for immune-mediated inflammatory disorders. We previously demonstrated the efficacy of fresh, autologous, adipose-derived MSCs (ASCs) to treat feline chronic gingivostomatitis (FCGS), a chronic oral mucosal inflammatory disease similar to human oral lichen planus. Here, we investigate the use of fresh allogeneic ASCs for treatment of FCGS in seven cats. Radiolabeled ASCs were also tracked systemically. Each cat received two intravenous injections of 20 million ASCs, 1 month apart. Oral inflammation, blood lymphocyte subsets, anti-fetal bovine serum antibody levels, ASC crossmatching and serum proteins and cytokine concentrations were determined. Four of the 7 cats (57%) responded to treatment [complete clinical remission (n = 2) or substantial clinical improvement (n = 2)]. Three cats were nonresponders. Prior to therapy, most cats had increased circulating CD8+ T cells, decreased CD8lo cells, and a decreased CD4/CD8 ratio, however clinical resolution was not associated with normalization of these parameters. Nonresponders showed more severe systemic inflammation (neutrophilia, hyperglobulinemia and increased interferon gamma and tumor necrosis factor alpha concentration) prior to ASC therapy. Clinical remission took up to 20 months and no clinical relapse has occurred. A higher fraction of radiolabeled ASCs were identified in the oral cavity of FCGS affected cats than the control cat. The administration of fresh, allogenic ASCs appeared to have lower clinical efficacy with a delayed response as compared to the fresh, autologous ASCs. In addition, the mechanism(s) of action for autologous and allogenic ASCs may differ in this model of oral inflammation. Stem Cells Translational Medicine 2017;6:1710-1722.

Recurrent Herpes Labialis in Adults: New Tricks for an Old Dog.

Herpes labialis remains a common worldwide affliction. Recent advances in understanding the basic pathogenesis have led to new therapeutic intervention, both on-label and off-label. Aside from reducing the duration and symptomatology of acute outbreaks, another goal of treatment is to decrease the frequency of future episodes. Oral and topical acyclovir and its analogues are the mainstay of both chronic suppressive and episodic therapy. A new muco-adhesive formulation of acyclovir provides a decrease in outbreaks, probably due to a diminution of herpesvirus load in all reservoir sites. Acyclovir-resistant strains are rare in immunocompetent hosts; parenteral foscarnet and cidofovir are administered in this situation. Parenteral acyclovir is the drug of choice for eczema herpeticum, which may begin as herpes labialis in an atopic dermatitis patient. Thermotherapy may be beneficial, and a certified device to deliver heat is available outside the United States.

J Drugs Dermatol. 2017;16(3 Suppl):s49-53.

Intervención educativa sobre gingivoestomatitis herpética aguda, dirigida a médicos de la atención primaria / Educational Intervention on Herpetic Gingivostomatitis for Family Physicians in Primary Health Care

Introducción: es insuficiente el conocimiento de los médicos de familia sobre la gingivoestomatitis herpética aguda, una urgencia dentro de las normas estomatológicas.Objetivo: evaluar la efectividad de una intervención educativa sobre gingivoestomatitis herpética aguda, dirigida a médicos de familia que laboran en consultorios pertenecientes al área de salud.Métodos: estudio cuasi experimental comparativo en el período comprendido de enero a junio de 2013 en 25 médicos de familia y 13 internos de los consultorios pertenecientes al área de salud de la clínica Manuel Angulo Farrán, de las policlínicas Julio Grave de Peralta, Pedro del Toro y Alex Urquiola. En la etapa de diagnóstico se determinaron las necesidades de aprendizaje por medio de encuestas. Luego se distribuyeron folletos educativos sobre el tema y finalmente se realizó la evaluación bajo los mismos criterios que en la etapa diagnóstica.Resultados: se obtuvieron diferencias significativas entre el estado inicial y final de los conocimientos ya que al comienzo de la investigación el 64 por ciento de los médicos y el 70,6 por ciento de los internos poseían insuficientes conocimientos sobre esta enfermedad y el 100 por ciento no había recibido información sobre la misma, mientras que al finalizar el estudio el 100 por ciento de los médicos y el 92,3 por ciento de los internos mostraron buenos conocimientos sobre el tema.Conclusiones: la aplicación de la intervención educativa permitió motivar a los médicos y elevar sus conocimientos acerca de esta enfermedad, de manera que puede efectuarse en otras instituciones en el territorio.(AU)

Introduction: the family doctors´ knowledge on acute herpetic gingivostomatitis is insufficient, an urgency within the stomatologic standars.Objective: to assess the effectiveness of an educational intervention on acute herpetic gingivostomatitis, for family physicians working in health areas.Method: a comparative quasi-experimental study from January to June 2013 in 25 family physicians and 13 internal doctors from Manuel Angulo Farrán health area, Julio Grave de Peralta, Pedro del Toro and Alex Urquiola polyclinics. At the stage of diagnosis, learning needs were determined by surveys. Then they were distributed in educational brochures on the subject and finally, the evaluation was performed under the same criteria of diagnostic stage.Results: significant differences between the initial and final state of knowledge obtained since the beginning of the investigation, 64 percent of physicians and 70.6 percent of the patients had insufficient knowledge about the disease and had not received 100 percent about this, while at the end of the study 100 percent of physicians and 92.3 percent of the patients showed good knowledge on the subject.Conclusions: the application of educational intervention allowed doctors to motivate and increase their knowledge about this disease, so that could take place in other institutions in the territory.(AU)

Efecto terapéutico de las aguas mineromedicinales en el tratamiento de la gingivoestomatitis herpética aguda / Therapeutic effect of medicinal mineral needles in the treatment of acute herpetic gingivostomatitis

Introducción: el empleo de las aguas con fines curativos, se remonta a épocas tempranas en la evolución del hombre.Objetivo: determinar el efecto terapéutico de aguas mineromedicinales en el tratamiento de gingivoestomatitis herpética aguda. Métodos: estudio analítico cuasiexperimental, en el Policlínico Gilberto Marquetty, Candelaria, Artemisa, en el periodo de octubre de 2011 a octubre de 2012, con un universo de 110 niños de 1 a 14 años diagnosticados con gingivoestomatítis herpética aguda. Por muestreo aleatorio simple se dividieron en dos grupos, Grupo 1 (Control) 55 pacientes, se aplicó tratamiento convencional con antihistamínico y analgésicos, prescripto por el facultativo. Grupo 2 (Estudio): 55 pacientes, se aplicó tratamiento con aguas mineromedicinales. Las variables estudiadas fueron edad, sexo, zona de residencia, síntomas colaterales, zonas anatómicas afectadas y evolución. Se consideró favorable cuando curó o mejoró y desfavorable cuando siguió igual o empeoró. La información se obtuvo por examen físico evolutivo al tercer, quinto y décimo día de tratamiento, evaluando sintomatología y cuadro clínico. Para el análisis de la información se utilizó distribución de frecuencias absolutas y porcentaje. Resultados: evolución satisfactoria, en menos días de tratamiento y con ausencia de reacciones adversas en los pacientes tratados con aguas mineromedicinales; el 50,90 por ciento de niños al tercer día de tratamiento estaban curados y el 96,36 por ciento, al décimo día. Conclusiones: las aguas mineromedicinales del manantial El Templado de San Diego de los Baños tiene efectos terapéuticos favorables en el tratamiento de las gingivoestomatitis herpética aguda en niños; se logró una evolución clínica favorable en menor tiempo que en el tratamiento convencional(AU)

Introduction: The use of needles with therapeutic aims dates back to early ages in humankind evolution. Objective: To determine the therapeutic effect of medicinal mineral needles in the treatment of acute herpetic gingivostomatitis. Methods: Quasi-experimental analytical study, in Gilberto Marquetty Polyclinic of Candelaria, Artemisa Province, from October 2011 to October 2012, with a target group of 110 children at ages 1-14 years diagnosed with acute herpetic gingivostomatitis. By random sampling, they were divided into two groups: 1 (control group, 55 patients), to which conventional treatment with antihistaminic and analgesics, prescribed by the doctor; 2 (study group, 55 patients), to which treatment was applied with medicinal mineral needles. The variables studied were age, sex, dwelling area, side symptoms, affected anatomical areas and natural history. It was considered favorable when healed or ameliorated; and unfavorable when remained the same or worsened. The information was obtained by followed-up physical examination after three, four and five days of treatment, evaluating symptoms and clinical frame. For information analysis, distribution of absolute frequencies and percentages were used. Results: Satisfactory natural history, in less than ten days of treatment and without side effects in patients treated with medicinal mineral needles. 50.90 percent of children were healed after three days of treatment and 96.36 percent after ten days. Conclusions: medicinal mineral needles from El Templado springs of San Diego de los Baños have favorable therapeutic effects in the treatment of acute herpetic gingivostomatitis in less time than the conventional treatments(AU)

Efecto terapéutico de las aguas mineromedicinales en el tratamiento de la gingivoestomatitis herpética aguda / Therapeutic effect of medicinal mineral needles in the treatment of acute herpetic gingivostomatitis

Introducción: el empleo de las aguas con fines curativos, se remonta a épocas tempranas en la evolución del hombre. Objetivo: determinar el efecto terapéutico de aguas mineromedicinales en el tratamiento de gingivoestomatitis herpética aguda. Métodos: estudio analítico cuasiexperimental, en el Policlínico Gilberto Marquetty, Candelaria, Artemisa, en el periodo de octubre de 2011 a octubre de 2012, con un universo de 110 niños de 1 a 14 años diagnosticados con gingivoestomatítis herpética aguda. Por muestreo aleatorio simple se dividieron en dos grupos, Grupo 1 (Control) 55 pacientes, se aplicó tratamiento convencional con antihistamínico y analgésicos, prescripto por el facultativo. Grupo 2 (Estudio): 55 pacientes, se aplicó tratamiento con aguas mineromedicinales. Las variables estudiadas fueron edad, sexo, zona de residencia, síntomas colaterales, zonas anatómicas afectadas y evolución. Se consideró favorable cuando curó o mejoró y desfavorable cuando siguió igual o empeoró. La información se obtuvo por examen físico evolutivo al tercer, quinto y décimo día de tratamiento, evaluando sintomatología y cuadro clínico. Para el análisis de la información se utilizó distribución de frecuencias absolutas y porcentaje. Resultados: evolución satisfactoria, en menos días de tratamiento y con ausencia de reacciones adversas en los pacientes tratados con aguas mineromedicinales; el 50,90 por ciento de niños al tercer día de tratamiento estaban curados y el 96,36 por ciento, al décimo día. Conclusiones: las aguas mineromedicinales del manantial El Templado de San Diego de los Baños tiene efectos terapéuticos favorables en el tratamiento de las gingivoestomatitis herpética aguda en niños; se logró una evolución clínica favorable en menor tiempo que en el tratamiento convencional(AU)

Introduction: The use of needles with therapeutic aims dates back to early ages in humankind evolution. Objective: To determine the therapeutic effect of medicinal mineral needles in the treatment of acute herpetic gingivostomatitis. Methods: Quasi-experimental analytical study, in Gilberto Marquetty Polyclinic of Candelaria, Artemisa Province, from October 2011 to October 2012, with a target group of 110 children at ages 1-14 years diagnosed with acute herpetic gingivostomatitis. By random sampling, they were divided into two groups: 1 (control group, 55 patients), to which conventional treatment with antihistaminic and analgesics, prescribed by the doctor; 2 (study group, 55 patients), to which treatment was applied with medicinal mineral needles. The variables studied were age, sex, dwelling area, side symptoms, affected anatomical areas and natural history. It was considered favorable when healed or ameliorated; and unfavorable when remained the same or worsened. The information was obtained by followed-up physical examination after three, four and five days of treatment, evaluating symptoms and clinical frame. For information analysis, distribution of absolute frequencies and percentages were used. Results: Satisfactory natural history, in less than ten days of treatment and without side effects in patients treated with medicinal mineral needles. 50.90 percent of children were healed after three days of treatment and 96.36 percent after ten days. Conclusions: medicinal mineral needles from El Templado springs of San Diego de los Baños have favorable therapeutic effects in the treatment of acute herpetic gingivostomatitis in less time than the conventional treatments(AU)

Congenital disseminated HSV-1 infection in preterm twins after primary gingivostomatitis of the mother: case report and review of the literature.

Transplacental transmission of HSV infection is rare, typically associated with Herpes Simplex Virus 2 (HSV-2) and often reported in term infants, whereas only a few cases of preterm infants with Herpes Simplex Virus 1 (HSV-1) infection are found in the literature. We report the case of a transplacental HSV-1 infection in preterm twins born at 27 weeks gestation. At 23 weeks gestation the mother had experienced primary gingivostomatitis and "flu-like" symptoms, which healed without specific treatment. At birth both infants presented disseminated ulcerated skin lesions at the head, trunk and extremities. Soon after birth, the infants required mechanical ventilation and showed multiple organ involvement. On the basis of the mother's positive HSV-1 serology, treatment was established before the Tzanck test, serological findings and polymerase chain reaction of the skin and blood had confirmed the neonatal infection. In spite of the early diagnosis within hours after birth and immediate treatment, the extensive skin involvement associated with rapidly progressing multiorgan failure resulted in death of both infants within 3 days. Although a primary HSV-1 infection during pregnancy is extremely rare, gingivostomatitis with general symptoms can lead to transplacental infection and should therefore be taken seriously. Prompt recognition and treatment in the mother are paramount and might be life-saving for the infants.

Update on oral herpes virus infections.

Oral herpes virus infections (OHVIs) are among the most common mucosal disorders encountered by oral health care providers. These infections can affect individuals at any age, from infants to the elderly, and may cause significant pain and dysfunction. Immunosuppressed patients may be at increased risk for serious and potential life-threatening complications caused by OHVIs. Clinicians may have difficulty in diagnosing these infections because they can mimic other conditions of the oral mucosa. This article provides oral health care providers with clinically relevant information regarding etiopathogenesis, diagnosis, and management of OHVIs.

La gingivoestomatitis herpética aguda: actualización / Acute herpetic stomatitis: update study

Con la finalidad de realizar una actualización de los conocimientos sobre la gingivoestomatitis herpética aguda (GEHA), se realiza una revisión bibliográfica sobre este tema basado en la información obtenida de textos y revistas consultada en centros de referencia y a través de localizadores electrónicos como Pubmed, Medline y Google de los últimos años. Según se pudo constatar la GEHA es de alta incidencia y transmisibilidad, frecuente en las edades tempranas de la vida, se manifiesta con lesiones orales y extraorales molestas para el paciente. Durante la fase aguda de la GEHA muchos niños pueden negarse a comer o beber debido al malestar y el dolor por estas lesiones y, en consecuencia, deshidratarse rápidamente, el diagnóstico es por el cuadro clínico y los antecedentes, además de los exámenes complementarios. El tratamiento de esta patología por lo general es paliativo y adquieren vital importancia las medidas preventivas(AU)

In order to perform an update of knowledge on acute herpetic stomatitis (GEHA), a literature review is done on this topic based on information from texts and journals as references in centers, through data bases as Pubmed, Medline and Google in recent years. GEHAs high incidence and transmissibility are studied, common in the early stages of life, manifested by oral and extraoral lesions annoying to the patient. During the acute phase of the GEHA many children may refuse to eat or drink due to discomfort and pain from these injuries and therefore become dehydrated quickly, the diagnosis is by the clinical manifestations and history, plus supplementary examinations. Treatments of this disease are usually palliative and acquire vital preventive measures

Dental and related infections.

Emergency physicians should be comfortable treating most dental and related infections. In this article, we outline recommended techniques to perform a dental examination, explore common pathologies, recommend pain and antibiotic management strategies and review common pitfalls. How to avoid overprescribing opioid analgesics is discussed in depth, along with recent studies to support this strategy.

Laringitis herpética. A propósito de un caso clínico / Herpetic laryngitis. Apropos of a clinical case

La laringitis aguda en niños es una patología frecuente, autolimitada, de breve duración: 2 a 7 días, causada por virus como influenza A y B, parainfluenza 1, 2 y 3, virus respiratorio sincitial (VRS) y adenovirus.Las infecciones prolongadas pueden involucrar otros patógenos; han sido reportados algunos casos de laringitis causadas por infecciones herpéticas, sobre todo por el virus herpes simple tipo 1 (VHS-1).Se sugiere la evaluación endoscópica de la vía aérea en casos de laringitis prolongadas para el diagnóstico e implementar medidas terapéuticas específicas para evitar complicaciones potencialmente graves. El uso de aciclovir ha demostrado ser efectivo en el tratamiento, siendo controvertido el uso de corticoides y antibióticos.Se presenta el caso de una niña de 7 meses con laringitis por Herpes virus, tratado con aciclovir...

Hospital-based emergency department visits with herpetic gingivostomatitis in the United States.

OBJECTIVES: The objectives of this study were to determine the number of hospital emergency department (ED) visits with a diagnosis of herpetic gingivostomatitis (HGS) for 2007 in the United States and to identify the possible comorbid conditions associated with HGS. STUDY DESIGN: The Nationwide Emergency Department Sample for 2007 was used in this study. Patients who visited the ED with a diagnosis of HGS were selected. Estimates were projected to the national levels using the discharge weights. Presence of comorbid conditions in these patients was also analyzed. RESULTS: A total of 23,124 patients had ED visits and received the diagnosis of HGS. Most of the patients were young females and those belonging to the lower socioeconomic strata. All patients with HGS also presented with comorbid conditions. CONCLUSIONS: Physicians should be trained to diagnose, manage, and refer common dental emergencies. In the long term, improving access to dental care for these patients is crucial to managing this problem.

[Infections of the oral mucosa]. / Infektioner i mundslimhinden.

The most common infections of the oral mucosa are those caused by Candida albicans and herpes simplex virus (HSV). Candidosis occurs as pseudomembraneous, erythematous and hyperplastic types with varying symptoms from no to a burning sensation. Treatment most importantly includes elimination of any predisposing factors such as smoking, sub-optimal denture hygiene and hyposalivation. A primary HSV infection results in a life-long latent infection recurring in some infected persons either intraorally or on the lip. If treatment is indicated, topical or systemic aciclovir and related drugs can be used.

Alternative therapies for common dermatologic disorders, part 1.

The exact pathophysiology and curative treatment of many common dermatologic conditions remain unclear. Often conventional treatments are only partially effective, leading patients to look for alternative treatments. Rosacea may be helped by azelaic acid. Seborrheic dermatitis may be helped by tea tree oil. Chronic urticaria may be helped by a focused dietary history and elimination of food additives and salicylates. Although various alternative treatments have been touted as useful in herpes simplex, few have proved efficacious.

Gingivoestomatitis herpetica Aguda en infantes / Herpetic Acute Gingivostomatitis in infants

La gingivoestomatitis herpética aguda constituye una gran preocupación por parte de los estomatólogos a lo largo de la historia en todo el mundo ya que afecta a un grupo muy sensible de la población: lactantes y niños menores de 6 años. Las infecciones virales más importantes son los herpes virus. Estos suelen ingresar en el organismo humano durante la niñez y generar enfermedades con asiento en la mucosa bucal, seguidas por períodos de latencia y algunas veces de reactivación. Por estas razones se realiza una revisión bibliográfica con el objetivo de actualizar la clasificación de gingivoestomatitis herpética aguda, principales factores de riesgo y terapéutica como premisa fundamental para la prevención de complicaciones en infantes (AU)