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Oral Pathology:  Soft Tissue Case #19

 

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Patient: Young adult, either sex.

Chief Complaint:
The patient complains of a sore mouth of four days duration. The lesions are painful and bleed when the patient eats. The patient has had difficulty eating or drinking for the past two days because of the discomfort.

Medical History:
No abnormalities are identified.

Dental History:
No abnormalities are identified.

Clinical Findings:
The gingival mucosa and soft tissue distal to the mandibular second molars are swollen, erythematous, compressible, and blanch upon pressure. Ulcerations are present on the dorsum of the tongue, soft palate, and soft tissue distal to the mandibular second molars. The ulcerated areas bleed during examination and are tender to palpation. Submandibular and anterior cervical lymph nodes are enlarged bilaterally, tender to palpation and slightly compressible.

Clinical Images
uvula with an ulcer maxillary anterior region, palatal aspect
Uvula with an Ulcer Maxillary Anterior Region, Palatal Aspect
right mandibular second molar region with an ulcer dorsum of the tongue with an ulcer</p>
<p>
Right Mandibular Second Molar Region with an Ulcer Dorsum of the tongue with an ulcer
left mandibular molar region with an ulcer  
Left Mandibular Molar Region with an Ulcer  

 

There are no radiographs available for this case.

There are no lab reports available for this case.

There are no charts available for this case.

Summary:
These lesions are vesicular-ulcerated-erythematous
  ~Acute onset of painful ulcers and erythema throughout oral mucosa
  ~Tender cervical lymphadenopathy

Lesions to Exclude from the Differential Diagnosis:
Hereditary
  ~Epidermolysis Bullosa
       *Blisters and ulcers of the skin are consistently present beginning at birth or early childhood
       *Tender lymphadenopathy not present
Mycotic
  ~Candidosis
       *Does not occur predominantly as ulcers
       *Tender lymphadenopathy not present
Autoimmune Disorders
  ~Lesions have gradual onset and are persistent
  ~Tender lymphadenopathy not present
Viral
  ~Herpangina
       *Limited to posterior oral cavity: soft palate and oropharynx
  ~Varicella (Chicken Pox)
       *Skin rash is most prominent feature of varicella
  ~Infectious Mononucleosis
       *Oral lesions, if present, are usually tonsillitis, pharyngitis, and palatal petechiae, rather than ulcers
  ~Recurrent Herpes
       *Occurs only on keratinized tissues
  ~Varicella Zoster (Shingles)
       *Vesicles and ulcers are unilateral and follow the distribution of a sensory nerve
  ~Hand-foot-and-mouth disease
       *Include vesicles and ulcers on the hands and feet.
Idiopathic lesions
  ~Aphthous Ulcers
       *Occur on non-keratinized mucosa
       *Lymphadenopathy not present
  ~Erythema multiforme
       *Lymphadenopathy not present
  ~Erosive lichen planus
       *Lesions have gradual onset and are persistent
       *Tender lymphadenopathy not present
  ~Erythroplakia
       *Lesions do not occur as discrete ulcers which appear suddenly
       *Tender lymphadenopathy not present
  ~Medication-induced mucositis
       *Tender lymphadenopathy not present
  ~Contact stomatitis
       *Tender lymphadenopathy not present

Lesions to Include in the Differential Diagnosis:
Primary Herpes
  ~Acute onset of ulcers throughout the oral mucosa accompanied by tender cervical lymphadenopathy

Management:
Treatment includes palliative care with an emphasis on maintaining hydration. Systemic antiviral medications such as acyclovir would be of little value since the lesions have been present for four days.  Educate the patient about the viral nature of the disease and the possibility for recurrence.

Final Diagnosis:
Primary Herpetic Gingivostomatitis (Primary Herpes)