Paeds Vivas · ent-hearing-and-oral-health
Oral ulcers and mucosal disease — branching viva
Branching viva from a febrile drooling two-year-old with diffuse painful anterior gingival ulceration, through the hydration-first assessment and early oral aciclovir within 72 hours, with a pivot to a school-age child with recurrent scarring major aphthae testing the deficiency and coeliac work-up and the differential of systemic aphthosis, and a final stem on an infant with thrush and an oncology child with mucositis.
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Opening — the drooling febrile toddler
Examiner: A two-year-old boy has three days of high fever, drooling and refusal to drink, with a diffusely swollen, bleeding gingiva and shallow vesicles and ulcers across the gingiva, tongue and lips. Talk me through your immediate thoughts and your examination. [1]
Candidate should cover: the diagnosis of primary herpetic gingivostomatitis from the fever, drooling and diffuse anterior gingival vesicles and ulcers; the recognition that dehydration from refusal to drink is the practical threat; and a focused assessment of hydration (moist mucous membranes, capillary refill, urine output) alongside the oral and systemic examination. [1]
References5ShowHide
- [1]Amir J; Harel L; Smetana Z; et al Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. BMJ, 1997.PMID 9224082
- [2]Coppola N; Cantile T; Adamo D; et al Supportive care and antiviral treatments in primary herpetic gingivostomatitis: a systematic review. Clin Oral Investig, 2023.PMID 37733027
- [8]Pankhurst CL Candidiasis (oropharyngeal). BMJ Clin Evid, 2013.PMID 24209593
- [9]Lau CB; Smith GP Recurrent aphthous stomatitis: A comprehensive review and recommendations on therapeutic options. Dermatol Ther, 2022.PMID 35395126
- [10]Barrons RW Treatment strategies for recurrent oral aphthous ulcers. Am J Health Syst Pharm, 2001.PMID 11194135