During a teledentistry consultation, the mother of a 27-month-old reports that the child has fever and multiple painful red lesions throughout the mouth, and has been unable to eat or drink. The child is referred for urgent paediatric care. What is the most likely complication if this is not managed promptly?

Correct answer: C. Dehydration

• A. Ankylosis of primary molars is a developmental or post-traumatic phenomenon in which the root fuses to alveolar bone. It has no relationship to an acute viral stomatitis.
• B. Enamel defects in the successors follow periapical infection or trauma to an overlying primary tooth (Turner's tooth). A self-limiting viral mucosal infection does not damage the developing permanent tooth germs.
• C. CORRECT. The picture is PRIMARY HERPETIC GINGIVOSTOMATITIS (HSV-1), which peaks between 6 months and 5 years. The immediate danger is not the ulceration itself — it is self-limiting over 10–14 days — but the REFUSAL OF FLUIDS that the pain causes. Toddlers dehydrate quickly because of their high surface-area-to-volume ratio and limited fluid reserve, and fever increases losses further. DEHYDRATION is the reason these children are hospitalised, and it is why the correct response to this call is urgent referral rather than reassurance.
• D. Facial cellulitis arises from an odontogenic bacterial source — a necrotic pulp or a periodontal abscess spreading into the fascial spaces. Herpetic gingivostomatitis is a superficial viral mucosal disease and does not track into the facial spaces.

Note: Practical management: supportive care is the whole treatment. Hydration is the priority — cool fluids, avoiding acidic or salty drinks. Antipyretics/analgesics as needed, and systemic aciclovir only if started within roughly the first 72 hours. Watch for the dehydration red flags: reduced urine output, no tears when crying, dry mucous membranes, lethargy. Note also that topical anaesthetics such as viscous lidocaine are avoided in this age group because of the risk of systemic toxicity and impaired swallowing.