Content Dam Diq Online Articles 2018 03 18mar22bcpath34dxt

Red-bordered white bumps that hurt

Oct. 31, 2022
A 16-year-old presents with red-bordered white lesions scattered throughout the oral cavity after having his wisdom teeth removed.

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.


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


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.


  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.