Oral ulcers

1ry Herpes simplexOnset: after 6 months ,Peak within 2-3 yearsClinical features:Prodrome :1-2 days before appearance of local lesions(fever ,headache ,lymphadenopathy, malaise ,vomiting)-generalized acute marginal gingivitis-multiple vesicles turn to painful, bilateral ulcers surrounded by erythtematous halo-mainly keratinized gingiva-mainly at anterior area of oral cavity

Herpangina By coxsackievirus A4Affect children from 3-10 years ,peak from june to october Clinical picture :-prodrome ,milder than herpes simplex (fever ,anorexia ,malaise)-sore throat ,dysphagia-ulcers mainly at post .area of oral cavity (soft palate ,fauces ,tonsills ,posterior pharynx)Diagnosis: -ulcers smaller than herpes -at post area -no marginal gingivitis -more painfull ,sore throat -milder prodrome -mainly in epidemics

Hand- foot and mouth diseaseCaused by coxsakievirus A16,from 8 months to 33 years ,75%under 4 years.Clinical picture:-low grade fever-oral vesicles and ulcers more extensive than herpes-macules and papules on extensor surface of hand and feet.-stomatitisDiagnosis:-marginal gingivitis(stomatitis)-examine hands and feet for maculopapular lesions and vesicles if there is acute stomatitis and fever

Chicken pox

1ry infection of varicella –zoster infection.Clinical picture:Maculopapular lesion then turn to vesicles on erythematous base

Oral lesions not diagnostic

Herpes zoster (shingles)Prodrome 2-4 days (shooting pain, paresthesia,burning sensation)along the course of the nerveClinical picture:-unilateral vesicles on erythematous base ,appears as clusters along the course of the nerve.Diagnosis :the most diagnostic manifestation is the unilateral appearance of lesions