OMFS-0130Odontogenic infectionsInfectionbeginnerWhole mouth including gingiva

Febrile child with widespread oral vesicles and bleeding gingiva

4-year-old male

Draft — educational study aid, pending faculty review.

§Chief complaint

Child refusing food, drooling, with fever for 3 days

§Medical & dental history

01Previously well, immunisations up to date
02First dental attendance

§Clinical examination

01Temperature 38.6 C, irritable, drooling
02Fiery red, oedematous marginal gingiva that bleeds on touch
03Multiple small vesicles and coalescing ulcers on the tongue, palate, lips and gingiva
04Bilateral tender cervical lymphadenopathy; early dehydration

§ figuresFigures (2)

Primary Herpetic Gingivostomatitis — clinical image: Herpetic gingivostomatitis. Note ulcers just below the front bottom teeth within the circle. — Fig. 1Herpetic gingivostomatitis. Note ulcers just below the front bottom teeth within the circle.
“Herpesgingiva” · James Heilman, MD · CC BY-SA 3.0 · Wikimedia Commons

Primary Herpetic Gingivostomatitis — clinical image: Herpetic whitlow in a young child who in the previous few days had developed gingivostomatitis — Fig. 2Herpetic whitlow in a young child who in the previous few days had developed gingivostomatitis
“Herpetic whitlow in young child” · James Heilman, MD · CC BY-SA 3.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Primary Herpetic Gingivostomatitis figures pending faculty review.

§Differential diagnosis

Primary herpetic gingivostomatitisFever, gingivitis, vesicles on keratinised and non-keratinised mucosa

Hand, foot and mouth diseaseOral ulcers with palmar and plantar lesions, no marked gingivitis

HerpanginaPosterior oropharyngeal vesicles only

Acute necrotising ulcerative gingivitisPunched-out papillae, halitosis, rare in this age group

§Final diagnosis

Primary herpetic gingivostomatitis (HSV-1)

Generalised acute marginal gingivitis is the key feature that separates primary herpetic gingivostomatitis from herpangina and hand-foot-and-mouth disease, which spare the gingiva. Vesicles on both keratinised and non-keratinised mucosa with fever complete the picture.

§Investigations

01Clinical diagnosis; viral PCR swab only if atypical or immunocompromised
02Assessment of hydration status and urine output

§Treatment plan

01Supportive care is the mainstay: fluids, paracetamol, soft cold diet
02Chlorhexidine swabbing where brushing is impossible
03Aciclovir within 72 hours of onset in severe cases or immunocompromise
04Admission if the child cannot maintain hydration

§Follow-up & outcome

01Oral intake improved by day 5; lesions healed by day 12
02Parents warned about recurrent herpes labialis and autoinoculation to eyes and fingers

§Clinical pearls / learning points

01Do not diagnose 'teething' in a febrile child with widespread oral ulceration.
02Herpetic whitlow and ocular inoculation are real risks — gloves and hand hygiene matter.
03Dehydration, not the ulcers, is what admits these children.

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

L1 · Classification — 1
L6 · Textbook — 3

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

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Current Classification