This document discusses several oral ulcer conditions: 1. Primary herpes simplex causes painful bilateral ulcers surrounded by erythema mainly on the anterior gingiva in children over 6 months. 2. Herpangina, caused by coxsackievirus A4, affects children 3-10 years with ulcers mainly on the soft palate and tonsils and a milder prodrome than herpes. 3. Hand-foot-and-mouth disease caused by coxsackievirus A16 most often affects children under 4 years with oral vesicles/ulcers and maculopapular lesions on the hands and feet along with stomatitis.

1. Oral ulcers

2. 1ry Herpes simplex
Onset: after 6 months ,Peak
within 2-3 years
Clinical 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

4. Herpangina
By coxsackievirus A4
Affect 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

5. Hand- foot and mouth
disease
Caused 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.
-stomatitis
Diagnosis:
-marginal gingivitis(stomatitis)
-examine hands and feet for
maculopapular lesions and
vesicles if there is acute
stomatitis and fever

7. Chicken pox
1ry infection of varicella –
zoster infection.
Clinical picture:
Maculopapular lesion then
turn to vesicles on
erythematous base
Oral lesions not diagnostic

8. Herpes zoster (shingles)
Prodrome 2-4 days
(shooting pain,
paresthesia,burning
sensation)along the course
of the nerve
Clinical 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