Diagnosis and treatment for Breakthrough Clinical oral pathology case: No. 34

Dr. Stacey Simmons diagnoses the 16-year-old who presented with multiple, red-bordered white lesions scattered throughout the oral cavity after having his wisdom teeth removed. Although there are similarities among the differentials in this oral pathology case, close assessment, deduction of lesion presentation, and history will render a definitive diagnosis.

Mar 20th, 2018
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Dr. Stacey Simmons diagnoses the 16-year-old who presented with multiple, red-bordered white lesions scattered throughout the oral cavity after having his wisdom teeth removed. Although there are similarities among the differentials, close assessment, deduction of lesion presentation, and history will render a definitive diagnosis.

Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.


This is the COMPLETE ANALYSIS for oral pathology case No. 34


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.


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Definitive diagnosis

Acute primary herpetic gingivostomatitis


◾️FOR FURTHER STUDY : Diagnosis and treatment for Breakthrough Clinical oral pathology case: No. 29

Treatment rendered/recommendations (1, 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

1. Wood NK, Goaz PW. Differential Diagnosis of Oral and Maxillofacial Lesions. 5th ed. St. Louis, MO: Mosby; 1997.

2. Sapp JP, Eversole LR, Wysocki GP. Contemporary Oral and Maxillofacial Pathology. St. Louis, MO: Mosby; 1997.

CALL FOR PATHOLOGY CASES

Do you have an interesting oral pathology case you would like to share with Breakthrough’s readers? If so, submit a clinical radiograph or high-resolution photograph, a patient history, diagnosis, and treatment rendered to DEbreakthrough@pennwell.com.

Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.


For more oral pathology articles, click here.


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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