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# Childhood infections seen in the mouth

- Mouth and systemic disease

Koplik spots in measles, blisters in hand, foot and mouth disease, a strawberry tongue in Kawasaki disease or scarlet fever: the mouth helps diagnose.

Updated Nov 12, 2026

## Key points

- Koplik spots = measles, before the rash.
- Strawberry tongue: scarlet fever or Kawasaki disease.
- Mouth ulcers in children: hydration first.

## What it is

Several infections of childhood have oral signs that help diagnosis at the bedside. In measles, Koplik spots (tiny white spots on a red background on the buccal mucosa) appear a day or two before the rash. Hand, foot and mouth disease (coxsackievirus or enterovirus) causes painful vesicles and ulcers on the tongue and mucosa with lesions on the palms and soles. Herpangina causes vesicles on the soft palate and tonsillar pillars. Scarlet fever (group A streptococcus) gives a white then red strawberry tongue and a sandpaper rash. Kawasaki disease gives red, cracked lips and strawberry tongue with prolonged fever. Mumps swells the parotids, with a red opening of the parotid duct. Congenital syphilis can cause notched incisors and mulberry molars.

## Oral findings

- Koplik spots: measles, before the rash.
- Hand, foot and mouth disease: oral ulcers plus palm and sole lesions.
- Herpangina: vesicles at the back of the mouth, high fever.
- Strawberry tongue: scarlet fever or Kawasaki disease.
- Hutchinson incisors and mulberry molars: congenital syphilis.

## What the doctor does

- Measles is notifiable and highly contagious; isolate and notify at once.
- Kawasaki disease needs treatment within days of fever to prevent coronary aneurysms.
- Children with painful mouth ulcers mainly need hydration and analgesia.

## Next step / Initial management

- Suspected measles: isolate, notify the public health authority (SIVIGILA in Colombia), test and check vaccination of contacts.
- Fever for five days or more with red lips or strawberry tongue: assess for Kawasaki disease and refer urgently.
- Sore throat with strawberry tongue and rash: test for group A streptococcus and treat if positive.
- Painful oral ulcers: analgesia and fluids; admit if the child cannot drink.

## Test yourself

Think of the answer, then tap the question to see it.

## What are Koplik spots and which disease do they indicate?

Small white spots on the buccal mucosa that appear before the rash of measles.

## Which childhood infection causes oral ulcers with lesions on the palms and soles?

Hand, foot and mouth disease, caused by coxsackievirus or other enteroviruses.

## Which dental anomalies suggest congenital syphilis?

Notched, peg-shaped upper incisors (Hutchinson incisors) and mulberry molars.

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## Connections

## Related 3

- [Herpes in the mouth: primary gingivostomatitis and cold sores](https://durgical.com/en/dentistry/herpes-in-the-mouth-primary-gingivostomatitis-and-cold-sores/)
- [The tongue: geographic tongue, glossitis and what to worry about](https://durgical.com/en/dentistry/the-tongue-geographic-tongue-glossitis-and-what-to-worry-about/)
- [The mouth as a mirror: oral signs of systemic disease](https://durgical.com/en/dentistry/the-mouth-as-a-mirror-oral-signs-of-systemic-disease/)

## Related conditions 6

- [Measles](https://durgical.com/en/conditions/measles/)
- [Hand, foot and mouth disease](https://durgical.com/en/conditions/hand-foot-and-mouth-disease/)
- [Kawasaki disease](https://durgical.com/en/conditions/kawasaki-disease/)
- [Streptococcal pharyngitis](https://durgical.com/en/conditions/streptococcal-pharyngitis/)
- [Mumps](https://durgical.com/en/conditions/mumps/)
- [Syphilis](https://durgical.com/en/conditions/syphilis/)

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Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.

Sources: [Measles](https://www.who.int/news-room/fact-sheets/detail/measles) (World Health Organization, 2026); [About Hand, Foot, and Mouth Disease](https://www.cdc.gov/hand-foot-mouth/about/index.html) (Centers for Disease Control and Prevention, 2024); [Kawasaki Disease](https://www.ncbi.nlm.nih.gov/books/NBK537163/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Mumps](https://medlineplus.gov/ency/article/001557.htm) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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