Febrile child with widespread oral vesicles and bleeding gingiva
4-year-old male
§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)
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
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
§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.
§References
- Neville BW et al. Oral and Maxillofacial Pathology, 5th ed.
§Similar cases
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