Common mouth ulcers in pediatrics

 Acute herpetic gingivostomatitis 

This is the most common cause of stomatitis in children from 1 to 3 years old.

Etiology 

Herpes simplex virus type 1 (HSV 1)

Clinical picture 

1. Abrupt onset of high grade fever,bad mouth odor and salivation 
2. Oral lesions appear 1-2 days after the fever in the form of vesicles which rupture leaving ulcers
3. Ulcers are commonly seen on the tongue and cheeks but can affect all the buccal mucosa 
4. Acute gingivitis that may appear before the vesicles 
5. Sub maxillary lymphadenopathy 

Course

Self limited, usually the acute phase lasts from 4 to 9 days .

Treatment 

No specific treatment,just supportive measurements .

Differential diagnosis 

Herpangina:

Due to coxsackie A,B or Echo virus.
Characterized by:

1. High grade fever may reach 41°c
2. Headache,backpain and vomiting 
3. Small oral ulcers on the pillars, tonsils, pharynx but not on cheeks or gums

Hand,foot and mouth syndrome 

Caused by coxsackie A16 virus Characterized by:

1. Febrile illness mostly during summer and fall
2. Oral ulcers especially on tongue and buccal mucosa
3. Vesicles on hands and feets that usually resolve within one week

Aphthous ulcer

Single or multiple painful mouth ulcers with erythematous borders covered with yellow-white exudates on the floor of the mouth and ventral surfaces of the tongue.

Geographic tongue 

Benign asymptomatic lesions characterized by the presence of multiple patches on the tongue with grayish or white color on the dorsum of the tongue ,with no other symptoms and needs no treatment.