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Paediatrics > 12. Oral pathology and soft tissue lesions in children > Flashcards

12. Oral pathology and soft tissue lesions in children Flashcards

1
Q

What do you look at extra-orally?

A

– General appearance, do they look well?
– Skull (symmetry), hair, ears, eyes, face
– Lymphadenopathy
- look at growth chart and see what percentile they are in

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2
Q

What do you look at intra-orally?

A

Soft tissues: – mucosa
– inflammation
– red patches, white patches
– swelling
– ulcers
– spontaneous bleeding
– recession
– fraenal attachment
Periodontal tissues Teeth, occlusion Salivary flow rate

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3
Q

How do you describe the lesion?

A
  • Type of lesion
    If they had an ulcer ask was it as small as 5 pence coin, 2 pence, tip of pen lid?
  • Size
    – Measure with a ruler in two dimensions
  • Shape and symmetry
  • Colour and pigmentation of lesion – E.g. red, white, purple, brown, grey
  • Surface features
    – E.g. Smooth, rough
  • Distribution over the tissue
    – Location; diffuse or demarcated
  • Findings of palpation
    – Superficial, deep, movable, fixed, tender
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4
Q

What is a macule?

A

Flat, discoloured spot on skin with sharp borders

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5
Q

What is a papule?

A

Solid elevations without fluid with sharp borders

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6
Q

What is a nodule, tumour?

A

Palpable, solid, elevated mass.
Nodules have distinct borders.
Tumours extend deep into the dermis.
Wart is a nodule.
Large lipoma is a tumour.

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7
Q

What is a pustule?

A

Vesicle or bulla filled with purulent fluid

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8
Q

What is a wheal?

A

Localised area of oedema, often irregular and of variable size and colour

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9
Q

What are the 8 primary lesions?

A

Macule
Papule
Nodule, tumour
Vesicle
Bulla
Pustule
Wheal
Plaque

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10
Q

What are the 4 secondary lesions?

A

Originate from a primary lesion
Scale, crust, fissure, ulcer

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11
Q

What is a scale?

A

Thin or thick flake of skin varying in colour, usually secondary to desquamated, dead epithelium, eg. dandruff

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12
Q

What is a crust?

A

Dried residue of exudates, eg. residue of impetigo

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13
Q

What is a fissure?

A

Linear crack in the skin, eg. athlete’s foot

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14
Q

What is an ulcer?

A

Opening in the skin caused by sloughing of necrotic tissue, extending pass the epidermis.

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15
Q

What is erythema?

A

Redness due to increased blood flow to blood vessels (vasodilatation) in that area

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16
Q

What is purpura?

A

Red/purple discolouration due to extravasation of blood into the skin from a blood vessel

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17
Q

What colour is melanin and lipid deposition?

A

Brown and yellow

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18
Q

How should you document a lesion?

A

With written description, photograph, measurement

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19
Q

What are 3 examples of lesions in the newborn?

A

Keratin cysts
Congenital epulis
Natal/neonatal teeth

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20
Q

What are 2 examples of keratin cysts?

A

Epstein pearls
Bohn’s nodules

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21
Q

What are epstein’s pearls?

A

Hard, raised small nodules
- arise from epithelial remnants trapped along lines of fusion of embryological processes
- appear in midline of hard palate

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22
Q

What are Bohn’s nodules?

A
  • Odontogenic cyst arising from the dental lamina filled with keratin.
  • occur in 80% of infants
  • normally disappear spontaneously
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23
Q

Describe a congenital epulis?

A

Usually firm, pedunculated, pink, smooth, solitary
Present at birth

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24
Q

Where are congenital epulis mostly found?

A

Arise from the crest of the alveolus in the incisor region

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25
Q

What is the cause of congenital epulis?

A

Unknown origin
With proliferation of mesenchymal cells
Affects females more than males

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26
Q

What should you do for congenital epulis?

A

Normally do nothing, unless it is impacting on feeding

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27
Q

When are natal/neonatal teeth seen?

A

Natal teeth are seen at birth
- neonatal teeth are seen within 30 days of birth

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28
Q

What teeth are normally natal/neonatal teeth?

A
  • In almost all cases it is the early eruption of a primary incisor
  • they are mobile due to incomplete root formation
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29
Q

What is the tx for natal/neonatal teeth?

A
  • Smooth sharp edges
  • Extraction
    – If extracting warn likely to have a missing primary tooth
    – Often done with topical LA and gauze – Or if firm LA and forceps
  • No treatment required if no problems experienced.
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30
Q

What 3 syndromes is natal/neonatal teeth associated with?

A
  • pachyonchia congenita
  • ellis van creveld syndrome
  • halermann- strieff syndrome
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31
Q

What are local factors that may cause delayed eruption?

A
  • supernumerary teeth, odontomes
  • thickened overlying mucosa, gingival fibromatosis
  • failure of root to resorb, dilacerated permanent roots
  • ectopic crypt position
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32
Q

What are systemic factors that may cause delayed eruption?

A
  • prematurity/low birth weight- especially if around 28 week mark
  • down syndrome/turner syndrome
  • cleidocranial dysplasia
  • endocrine disorders- hypothyroidism or hypopituitarism
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33
Q

What should you follow if you have delayed eruption?

A
  • know eruption dates
  • wait at least 6 months after the contra lateral side has erupted
  • if still no eruption- take radiograph
  • no obstructions and tooth palpable and present consider excising the gingival margin
  • remove any obstructions like supernumeraries- consider space mainainer
  • refer, address any systemic conditions
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34
Q

What is the differential diagnoses for an eruption cyst?

A
  • amalgam tattoo
  • malignant melanoma
  • freckle
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35
Q

Where does an eruption cyst normally occur?

A

6’s and central incisors

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36
Q

What is the treatment for eruption cyst?

A
  • reassure- often resolve as the tooth erupts
  • sometimes excision required to release pressure and allow the tooth to erupt
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37
Q

What is an extravasation mucocele?

A

Leakage of fluid from the ducts or acini into surrounding tissue

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38
Q

What is a retention mucocele due to?

A

Narrowed ductal opening

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39
Q

What is a mucocele often due to?

A

Trauma to minor salivary glands or ducts often on the lower lip.
- history of going up and down
- if on the upper lip with no clear evidence of trauma, refer

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40
Q

What is a ranula?

A

Fluid collection or cyst that forms in the floor of mouth. Filled with fluid that has leaked out of damaged salivary gland.

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41
Q

Where is ranula often found and what does it look like?

A

Floor of mouth
- blue dome shaped swelling
- lateral to midline
- associated with major salivary glands

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42
Q

What is a plunging ranula?

A

Plunging ranula (PR) otherwise known as cervical ranula is a nonepithelial‐lined salivary gland cyst that forms following mucus escape from sublingual gland and its subsequent herniation via the mylohyoid muscle into submandibular space and beyond.

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43
Q

What are 7 examples of bacterial infections?

A
  • scarlet fever
  • actinomycosis
  • turberculosis
  • atypical mycobacterial infection
  • syphilis
  • impetigo
  • osteomyeleitis
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44
Q

What can TB cause?

A

Lymphadenopathy

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45
Q

What is congenital syphilis and how can it affect teeth?

A
  • infected mother to fetus
  • hutchinsons incisors and mulberry molars
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46
Q

What is impetigo caused by?

A

Bacteria- staphylococcal and streptococcal

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47
Q

What can impetigo cause?

A

Crusting lesions
It is highly contagious
Self limiting

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48
Q

What is acute pseudomembranous candida?

A

– in infants seen as Thrush
– White scrapable plaques that reveal an erythematous base.
– In older children, seen in immunocompromised

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49
Q

What is median rhomboid glossitis?

A
  • seen on dorsal surface of the tongue
  • usually anterior to the vallate papillae
  • normally unpapillated
50
Q

What viral infections are caused by herpesviridae?

A
  • primary herpetic gingivostomatitis HSV1/2
  • chickenpox VZV HHV3
51
Q

What viral infections are caused by coxsackie A virus?

A
  • herpangina
  • hand foot and mouth disease
52
Q

What viral infections are caused by epstein barr virus?

A

infectious mononucleosis

53
Q

What is primary herpetic gingivostomatitis caused by?

A

Herpes simplex virus 1 and 2

54
Q

What age does primary herpetic gingivostomatitis commonly affect?

A

6 months- 5 years

55
Q

What is the incubation period for primary herpetic gingivostomatitis and how long does it last?

A

IP- 3-5 days
- Self limiting- 10-14 days

56
Q

What is the main mode of transmission of primary herpetic gingivostomatitis?

A

saliva

57
Q

What are the features in prodromal phase of primary herpetic gingivostomatitis?

A
  • irritability, cervical lymphadenopathy, pyrexia, malaise, headache, hypersalivation, vesicles rupture to form shallow ulcers
58
Q

What is the tx for primary herpetic gingivostomatitis?

A
  • reassurance, fluids, no hard foods, bed rest, topical anaesthesia like paediatric bonjela
59
Q

What can you prescribe for primary herpetic gingivostomatitis?

A
  • alcohol free CHX
  • systemic aciclovir
    – Child 1–23 months -100 mg 5 times a day usually for 5 days –
  • Child 2–17 years- 200 mg 5 times a day usually for 5 days
60
Q

What are complications of primary herpetic gingivostomatitis?

A
  • ocular transmission
  • herpetic whitlow
61
Q

What is herpes labialis?

A
  • reactivation of HSV in trigeminal ganglion
  • preciptated by UV sun exposure, stress, weather change, immunosuppression
  • prodrome- tingling, burning sensation, itching, mild pain and/or fever
62
Q

Wha is chicken pox caused by and what are the symptoms?

A
  • varicella zoster virus
  • vesicles over face and oral mucosa
  • cutaneous lesions
  • droplet infection from nasopharynx
63
Q

What is the reactivation of varicella zoster?

A
  • lies latent on sensory ganglia
  • reactivation causes shingles (herpes zoster)
  • causes unilateral, distinctive painful rash over a dermatome
64
Q

What are the oral manifestations of shingles?

A

affects opthlamic, maxillary and mandibular nerve distribution

65
Q

When is chicken pox infectious?

A

As soon as they get a temperature.
Stops becoming infectious at around day 15 when lesions start to crust over

66
Q

What is hand foot and mouth disease caused by?

A

Coxsackie strain A16

67
Q

What are the symptoms of hand, foot and mouth disease?

A
  • mild prodrome phase
  • followed by sparse distribution of vesicles with erythematous halo
  • self limiting 5 to 7 days
68
Q

Where do ulcers of hand, foot and mouth disease mostly affect?

A

hard palate, tongue, and buccal mucosa

69
Q

What is the treatment for hand, foot and mouth disease?

A

Self-limiting- 5 to 7 days
- reassure parent, usr topical agents to help child eat or drink, refer if child is really unwell and dehydrate

70
Q

What is the incubation period for herpangina?

A

4 days

71
Q

What is the general symptoms of herpangina?

A

Abrupt onset of fever with malaise, headache, neck or back pain

72
Q

Describe the ulcers in herpangina?

A

1-2mm grey-white papulo-vesicular lesions that progress to ulcers surrounded by erythematous halo

73
Q

Where does the herpangina affect?

A
  • anterior tonsillar pillars
  • soft palate
  • uvula
  • tonsils
  • oropharynx may appear diffusely hyperaemic
74
Q

What is the duration of herpangina?

A

7 days

75
Q

What is infectious mononucleosis caused by?

A
  • epstein barr virus
76
Q

Who does infectious mononucleosis commonly affect?

A

teenagers

77
Q

What is the general symptoms of infectious mononucleosis?

A
  • lymph node enlargement
  • fever, malaise and acute pharyngitis
78
Q

What are the oral symptoms of infective mononucleosis?

A

Oral ulceration and pethecial haemorrhage at junction of hard and soft palate

79
Q

What is the treatment for infectious mononucleosis?

A

Analgesia and fluids

80
Q

Where is HPV most commonly seen?

A

On the lips

81
Q

What is the treatment for human papilloma virus?

A
  • excision
  • cryosurgery
  • laser
  • biopsy- HPV 16 and 18 (both strains have been linked to OSCC)
82
Q

What virus causes MMR?

A

Myxovirus

83
Q

When is MMR vaccine given?

A
  • dose at 12 months then 40 months
84
Q

What are the symptoms of mumps?

A

Painful enlargement of parotid glands
- usually bilateral
- causes headache, vomiting, and fever

85
Q

What is the incubation period for mumps and how long does it last?

A
  • contagious
  • incubation period is 2 to 3 weeks
  • lasts about 7 days
86
Q

What are the symptoms of measles?

A
  • affects buccal mucosa
  • is white speckling surrounded by red margin (Koplick spots)
  • followed by red maculopapular rash
  • fever
  • contagious
87
Q

What is an ulcer?

A

Break in the skin extending through all the layers, discontinuation of the epithelial lining

88
Q

What are 4 related diseases to recurrent oral ulceration?

A
  • Behcet’s disease
  • Sweet’s syndrome
  • MAGIC syndrome
  • HIV
89
Q

What does Behcet’s disease affect?

A

Oral, ocular, genital

90
Q

What does sweets syndrome cause?

A

Acute febrile neutrophilic dermatosis

91
Q

What does MAGIC syndrome cause?

A

mouth and genital ulcers, inflamed cartilage

92
Q

What should you do if someone has RAS?

A
  • ulcer diary
  • do routine full blood count, ferritin, folate and B12 levels
93
Q

What is the preventative treatment for RAS?

A
  • give iron supplements
  • advise benzoate/cinnamon/sls free exclusion, eg. kingfisher or proenamel toothpaste
94
Q

What is the symptomatic relief for RAS?

A

CHX, benzydamine hydrochloride

95
Q

What topical steroids can you give for RAS?

A

Beclomethasone

96
Q

What are the symptoms of orofacial granulomatosis?

A
  • Lip Swelling
  • Linear ulceration
  • Cobble stoning of mucosa
  • Gingivalenlargement
  • Mucosal tags
  • Facial nerve palsy
  • Cervical lymphadenopathy
97
Q

What do you need to exclude if someone has orofacial granulomatosis?

A
  • Crohn’s, sarcoidosis, TB
  • however, 85% of patients with oral crohn like features have no gut problems
98
Q

What allergens is orofacial granulomatosis associated with?

A
  • benzoates, sorbate, cinnamon
99
Q

What is the management for orofacial granulomatosis?

A
  • 3 month empirical exclusion diet
  • topical treatment to angular cheilitis fissures such as hydrocortisone or miconazole
100
Q

What is the topic treatment to lip swellings or facial erythema for orofacial granulomatosis?

A
  • tacrolimus ointments
  • intralesional steroids to lip
101
Q

What do you need to do in crohn’s screening?

A
  • make the parent aware of importance of altered bowel habits or abdominal pain
  • growth monitoring
102
Q

What can you test for in Crohn’s?

A
  • faecal calprotectin assay
  • however, unreliable in younger children
  • screening test for endoscopy
  • good predictor of Crohn’s disease activity
103
Q

What is epiderymolysis bullosa?

A

Rare vesiculobullous lesion
- digits often fuse together
- difficult to treat oral lesions

104
Q

What is the treatment ofr erythema multiforme?

A
  • Minor- symptomatic treatment, possibly aciclovir
  • Major- systemic corticosteroids, immunomodulatory drugs, antiseptic and analgesia
105
Q

What are examples of benign tumours?

A

– Squamous cell papilloma/verruca
– Fibroepithelial polyp
– Fibrous epulis
– Pyogenic granuloma
– Peripheral giant cell granuloma
– haemangiomas

106
Q

What are examples of malignant tumours?

A

– Epithelial tumours eg squamous cell carcinoma
– Lymphomas (Hodgkins, non hodgkins)
– Rhabdomyosarcomas, muscle tumour most common tongue
– Leukaemia- blood cancer often presenting in the oral tissues with gingival bleeding

107
Q

What are differential diagnosis for fibrous lumps in the mouth?

A

– Fibroepithelial polyp
– Fibrous epulis
– Pregnancy epulis
– Pyogenic granuloma
– Denture irritation granuloma and papillary hyperplasia

108
Q

What are neoplastic lesions that present as fibrous lumps?

A

Fibroma, giant cell fibroma, fibrosarcoma, fibrous histiocytoma, malignant fibrous histiocytoma

109
Q

Where is a fibroepithelial polyp found?

A
  • firm pink lump on gingivae
  • usually buccal
  • often same colour as gingivae
  • caused by trauma
  • contains avascular fibrous tissue, scar like
110
Q

What is the tx for fibroepithelial polyp?

A
  • remove trauma/irritation and review
  • excision biopsy
  • can recur
111
Q

What is a cavernous haemangioma?

A

A cavernous hemangioma happens when capillaries – small blood vessels that connect arteries and veins – swell and form a noncancerous mass called an angioma.

112
Q

What is the treatment for cavernous haemangioma?

A
  • establish extent of lesion
  • hazardous in surgery
  • if unsure, refer prior to dental surgery
  • excision, cryotherapy, embolisation, laser therapy
113
Q

What is a capillary haemangioma?

A
  • common
  • benign tumour of vascular origin
  • often presents as facial birth marks that appear in first 6 months of life
  • varies in shape and presentation
  • blanch on pressure
  • can reduce in size as child gets older
114
Q

What is geographic tongue?

A

Common 1-2% population
* Associated with psoriasis
* Usually asymptomatic, occasionally sore with spicy foods/acidic
* Red areas (depapillated areas) change in size and migrate around
* Red areas sometimes surrounded by yellow raised margins

115
Q

What is median rhomboid glossitis and what factors affect it?

A

Candida infection
* Factors – Smoke
– Xerostomia
– Denture wearers – Steroids
– Anaemia

116
Q

What is a fissured tongue?

A

Common
* Often hereditary
* Found in the general population
* Often present in Down syndrome
* Multiple fissures
* Often of no consequence

117
Q

What is ankyloglossia?

A

Tongue tie
* Lingual fraenum anchors the tongue
* Restricts protrusion and lateral movements
* Can make it difficult for oral cleansing
* Differingo pinions on its effect on speech, should always involve speech therapy

118
Q

What are red flags?

A

If the child is systemically unwell
* Lesion rapidly increasing in size
* Spontaneously bleeding gums of no obvious cause

119
Q

What is the age acute lymphoblastic leukaemia affects most?

A

4-5 years

120
Q

What is the cure rate of acute lymphoblastic leukaemia?

A

60% cure rate with chemotherapy in children

121
Q

What may you see in acute lymphoblastic leukaemia?

A
  • infections
  • purpura
  • gingival bleeding
  • lymphadenopathy
  • facial nerve palsy
  • orofacial paraesthesia/anaesthesia
122
Q
A

Paediatrics (8 decks)

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