Differential Diagnosis for White Spots in the Mouth of a Kid

Single Most Likely Diagnosis

• Thrush (Oral Candidiasis): This is the most common cause of white spots in the mouth, especially in children. It's a fungal infection that can be triggered by various factors, including poor oral hygiene, use of antibiotics, or an immune system that's not fully developed.

Other Likely Diagnoses

• Leukoplakia: Although more common in adults, leukoplakia can occur in children, especially those with a history of chronic irritation or habits like cheek biting. It appears as white patches that cannot be rubbed off and can sometimes be precancerous.
• Lichen Planus: This is an autoimmune condition that can affect the mucous membranes inside the mouth, leading to white, lacy patches. It's less common in children but should be considered, especially if there are skin lesions.
• Fordyce Spots: These are small, white or yellowish spots on the lips, inside of the cheeks, and sometimes on the genitalia. They are benign and represent ectopic sebaceous glands.

Do Not Miss Diagnoses

• Oral Cancer: Although extremely rare in children, any persistent white patch or spot in the mouth that does not resolve with treatment should raise suspicion for oral cancer, especially if there's a history of exposure to carcinogens (e.g., tobacco, areca nut).
• HIV-Related Oral Lesions: Children with HIV/AIDS can present with a variety of oral lesions, including white spots due to opportunistic infections like oral candidiasis, which can be more severe and resistant to treatment.
• Autoimmune Disorders: Certain autoimmune conditions, like pemphigus vulgaris, can cause oral lesions, including white spots or blisters. These conditions are rare but critical to diagnose early due to their potential severity.

Rare Diagnoses

• Darier's Disease: A rare genetic disorder that affects the skin and sometimes the mucous membranes, leading to white or yellowish patches in the mouth.
• White Sponge Nevus: A rare, benign condition that causes white, spongy patches in the mouth, often inherited in an autosomal dominant pattern.
• Oral Histoplasmosis: A fungal infection that can cause oral lesions, including white spots, especially in immunocompromised individuals. It's rare in children but should be considered in those with exposure to contaminated soil or bird droppings.