Editor's note: Originally published March 20, 2018. Formatting updated November 15, 2022.
Presentation and chief complaint
A healthy 16-year-old male presented with this chief complaint: I got my wisdom teeth out five days ago, and I can’t eat or swallow; it hurts. I have bumps all over in my mouth.
Clinical exam
Clinical assessment revealed multiple white lesions with red borders salt-and-peppered in a generalized fashion throughout the entire oral cavity. The gum tissues were swollen and any light palpation/touching of the lesions resulted in bleeding and pain. See clinical photos below.
Differentials
- Hand, foot and mouth disease
- Herpangina
- Acute primary herpetic gingivostomatitis
- Varicella (chicken pox)
Discussion
See table below.1,2
Although there are similarities among the differentials, close assessment, deduction of lesion presentation, and history will render a definitive diagnosis.
Definitive diagnosis: Acute herpetic gingivostomatitis
Treatment rendered/recommendations1,2
The patient in this case was referred to an oral surgeon for follow-up from wisdom teeth extraction. The oral surgeon confirmed the diagnosis of acute primary herpetic gingivostomatitis.
Recommendations for treatment:
- Palliative care
- Liquids with caloric value
- Prescriptions (the patient in this case was given only the compounded acyclovir and a lidocaine Rx)
- Topical oral anesthetics: Orabase (Colgate-Palmolive with benzocaine or lidocaine HCL 2% viscous solution
- Acyclovir ointment 5%
- Acyclovir ointment 5% / lidocaine 2% compounded in a paste for perioral application
- Magic mouthwash (most common ingredients: diphenhydramine, viscous lidocaine, antacid, nystatin, and corticosteroids)
- Monitor for secondary infections; younger patients will exacerbate by picking at the area and not leaving it alone.
References
- Wood NK, Goaz PW. Differential Diagnosis of Oral and Maxillofacial Lesions. 5th ed. St. Louis, MO: Mosby; 1997.
- Sapp JP, Eversole LR, Wysocki GP. Contemporary Oral and Maxillofacial Pathology. St. Louis, MO: Mosby; 1997.
