Diagnosis and treatment for Breakthrough Clinical oral pathology case: No. 29

Stacey L. Simmons, DDS, editorial director of Breakthrough Clinical, offers her diagnosis and treatment for the two-year-old male whose oral pathology case began with a lump on the right side of the neck, and a week later led to fire-engine red gingival tissue with the manifestation of numerous perioral lesions.

Sep 3rd, 2017
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Stacey L. Simmons, DDS, editorial director of Breakthrough Clinical, offers her diagnosis and treatment for the two-year-old male whose oral pathology case began with a lump on the right side of the neck, and a week later led to fire-engine red gingival tissue with the manifestation of numerous perioral lesions.


Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.


LAST MONTH, I presented the following oral pathology case ...

PATIENT HISTORY: A healthy two-year-old male went to his primary care physician for a checkup and to assess a lump on the right side of his neck. During the examination, several ulcer-like lesions on the buccal mucosa were noted intraorally. Appetite, temperature, and overall demeanor were within normal limits. The physician diagnosed the child with hand, foot, and mouth disease.

PRESENTATION A WEEK LATER: Within a week’s time, the gingival tissue became fire-engine red intraorally, and manifestation of numerous perioral lesions became evident. Fever and loss of appetite commenced, myalgia became present in the head and neck area, and overall the child was irritable. The photo below shows how the patient presented. There were no lesions on the hands or feet. It is also worthy to note that the patient's two older siblings began to manifest the same signs and symptoms six days later.


DIFFERENTIALS:

  • Hand, foot, and mouth disease
  • Herpangina
  • Acute primary herpetic gingivostomatitis
  • Varicella (chicken pox)

DEFINITIVE/FINAL DIAGNOSIS: Acute primary herpetic gingivostomatitis

TREATMENT RENDERED:

  • Palliative
  • Liquids with caloric value
  • Prescriptions:
    * Topical oral anesthetics—Orabase with benzocaine or lidocaine HCL 2% viscous solution
    * Acyclovir ointment 5%
    * Acyclovir 5%/lidocaine 2% compounded in a paste for perioral application
  • Must monitor for secondary infections, especially if the patient is young and has a tendency not to leave the area alone
  • The patient and his siblings had a full recovery after three to four weeks


Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about it and subscribe here.


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Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, DE’s Breakthrough Clinical with Stacey Simmons, DDS, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at ssimmonsdds@gmail.com.


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