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My own revision cards > CCD2- Paeds Oral Pathology > Flashcards

CCD2- Paeds Oral Pathology Flashcards

1
Q

What are natal vs neonatal teeth?

A

Natal teeth are seen at birth.
Neonatal teeth are seen within 30 days of birth.

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2
Q

What is the incidence and presentation of natal & neonatal teeth?

A

Incidence: 1 in 2000 to 1 in 3500.
Presentation - Commonly mandible- in the midline.
Only 20% are supernumery

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3
Q

What are the indications for extracting natal / neonatal teeth?

A

If mobile - risk of aspiration
If affecting breastfeeding
Cause trauma - Riga-Fede ulceration [sublingual ulceration]

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4
Q

What is a dental lamina cyst?

A

Oral pathology that can be seen in new borns
Occurs on the crest of Ridge

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5
Q

What are Bohns Nodules?

A
  • Oral pathology that can be seen in new borns
  • remnants of dental lamina.
  • Normally on maxillary alveolar ridge.
  • Salivary Gland remnants
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6
Q

What are Epsteins Pearls?

A
  • Oral pathology that can be seen in new borns
  • On hard palate
  • Epithelial remnants
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7
Q

What is a congenital epulis of a newborn?

A
  • Benign mass
  • Usually on the alveolar ridge (mandible)
    Tx - Simple excision
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8
Q

What is teething?

A

Common pathology that occurs around 9 months
* need to rule out other potential infections - babies also susceptible to other infections at this stage as maternal antibodies are wearing off.

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9
Q

What are the symptoms of teething?

A

Irritability
Disrupted sleep
Rash
Drooling
Systemic upset
Temperature

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10
Q

How can we ease teething symptoms?

A

Teething toys
Analgesics

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11
Q

What is an eruption cyst?

A

Bluish cyst over UE teeth
Fluctuant – fluid filled.
Usually self limiting
Occasionally becomes infected

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12
Q

What is a regional odontodysplasia?

A
  • Ghost teeth (short roots, wide open apical foramen, large pulp chamber, thin and poorly mineralised enamel + dentine = radiolucent image on rads)
  • Affects both dentitions in one area (often quadrants)
  • Gross malformation of enamel and dentine
  • Possibly due to disruption blood supply early in development
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13
Q

Describe the affect of regional odontodysplasia on pt management.

A

Difficult teeth to treat – infected easily.

A lot of micro-channels connecting the enamel to dentine to pulp - easy infection of pulp.

Often requires Xla.

Difficult management of UE teeth.

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14
Q

What causes premature loss of primary teeth?

A

Local factors:
- Infective e.g. caries
- Traumatic e.g. avulsion

  • unusual. Can have significant effects if it goes unnoticed.
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15
Q

Which structural defects cause premature loss of primary teeth?

A
  • Alveolar bone destruction: Langerhans Cell Histiocytosis (genetic mutation), Acrodynia (mercury poisoning)
    • PDL: Ehlers Danlos (genetic – affects connective tissue), Vit C deficiency
  • Cementum: Hypophosphotasia (disruption of phosphorus deposition in teeth/bones)
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16
Q

Which cellular defects cause premature loss of primary teeth?

A
  • Quantitative: cyclic neutropenia, aplastic anaemia
  • Qualitative (impaired function): Chediak higashi syndrome (immune disorder. Link to perio disease, ulceration, abscesses), Papillon lefevre (dry scaly patches on palms of hands and soles of feet, risk of periodontitis), leucocyte adhesiondeficiency (immune compromised).
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17
Q

Describe Papillon-Lefevre syndrome.

A

Inherited as an auto-recessive trait

Classic palmar-plantar keratosis on palm of hands and soles of feet

Aggressive periodontal disease and bone loss.
-Difficult to treat.

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18
Q

What is Chronic neutropenia & the oral manifestations?

A
  • Low neutrophil levels chronically
  • Causes early loss of teeth.
  • Bands of gingivitis
  • Very important to improve OH & plaque control.
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19
Q

What are epulids? & how are they managed?

A

Common lump / swelling on gingiva
Self-limiting
May sometimes require surgical removal

20
Q

What is a Pyogenic granuloma?

A

Very Vascular - overgrowth of tiny blood vessels
Secondary to chronic -> caused by irritation
Wide range of maturity
End stage is probably fibroepithelial polyp
-Pregnancy Epulis

21
Q

What is a Peripheral giant cell granuloma?

A

Overgrowth of tissue due to irritation / trauma.
- Very Haemorrhagic
- Darker colour than pyogenic granuloma

Key: Alveolar bone loss on radiographs**

22
Q

What is a papilloma?

A

Growth similar to a wart.
* Viral Infection- caused by Human Papilloma Virus
* May be associated with lesions (warts) on hands and fingers – spreading into mouth with fingers.

23
Q

What is geographic tongue?

A

Area of erosion, with whitish margins.
- Disappears/reappears
- Occasionally symptomatic to stimulus e.g. spicy foods)
- Benign Migratory Glossitis
- Erythema Migrans (expanding rash)

24
Q

Which drugs commonly cause ‘Drug induced gingival hyperplasia’ ?

A
  • Phenytoin - Anti Convulsant - epilepsy
  • Cyclosporin A - Immunosuppresive - transplants
  • Nifedipine - Anti Hypertensive (kidney disease, kidney transplants)
25
Q

What are the effects of Drug induced gingival hyperplasia?

A

Aesthetics, gingivitis, tenderness (biting on gums), tooth eruption may be affected.

26
Q

How is Drug induced gingival hyperplasia managed?

A
  • Maintain OH (exacerbated response to plaque)
  • Chx m.wash
  • Surgery: gingivectomy
  • Drug choice: high chance of recurrence if meds not changed. (tacrolimus or FK506)
27
Q

What is a mucocele?

A
  • Mucous Extravasation Cyst - swelling that comes and goes, commonly on lower lip.
  • Caused by damage to minor salivary gland (trauma)
  • Leakage of saliva into tissues
  • Fibrous Wall: keratinization on surface if pt keeps biting on area.

*can be removed by excision under LA / GA

28
Q

What is a ranula?

A

Mucous Cyst - Floor of Mouth
Secondary to damage to duct
Appearance: Soft, Bluish Swelling, Usually to one side.
Tx: Marsupialise – expose & allow it to epithelialise over as surgery is difficult

29
Q

Define an oral ulcer

A

Localized defect of the oral mucosa in which the covering epithilium is destroyed leaving an inflamed area of exposed connective tissue

30
Q

List the aetiology of oral ulcers

A
  1. Infective e.g. primary herpes
  2. Traumatic e.g. self mutilation
  3. Neoplastic e.g. langerhans cell histiocytosis
  4. Immunological e.g. recurrent aphthous ulceration
  5. Nutritional e.g. folate deficiency
  6. Inflammatory e.g. Crohn’s disease (IBD)
31
Q

What is recurrent juvenile parotitis?

A

Episodes of painful parotid swelling
- Resolves after puberty
Aetiology - ? Low secretion rate, ? Abnormal ductal system ?, Chronic infection with EBV
- Treated with Amoxycillin

32
Q

How might ulceration / damage to mucosa / gingivae be caused by pt behaviour?

A

Habits: nail picking e.g. stressed
Self harm / mutilation e.g. Lesch-Nyhan syndrome (genetic. Males)

33
Q

What is Orofacial granulomatosis?

A
  • Autoimmune disease
  • Associated with external stimulus e.g. allergic reaction
  • Features: Perioral and gingival swelling, Cobblestone Mucosa, Mucosal tags, Ulceration

*Associated with Crohns disease [liaise with paediatrician – full blood count and ESR, mucosal biopsy, endoscopy]

34
Q

What are the features of Recurrent Aphthous Ulceration?

A

Minor Apthae
Major Apthae
Herpetiform
Increased with Stress
Associated with nutritional deficiency states
Trauma can act as a trigger

35
Q

How are Recurrent Aphthous Ulceration managed?

A

Treatment if symptomatic – difflam spray / oral rinse, Chx m.wash (prevent secondary infection).

Anti inflammatory - Adcortyl in orabase,
Corlan tablets (hydrocortisone - steroid for pain relief and healing)

Address nutritional deficiencies [10-15%] – where there are very recurrent ulcers, clues from history e.g. underlying anaemia.

36
Q

What is Erythema Multiforme?

A
  • Immune mediated skin reaction
  • ? Secondary to infection or drugs
  • Severe oral ulceration
  • Generalised Stomatitis
  • Symptoms: Malaise, fever, dehydration
  • Characteristic target lesions
  • Stevens-Johnson syndrome (skin disorder - reaction to meds).
37
Q

What is the tx of severe odontogenic infections?

A
  • Hospital admission (airway invovlement), IV AB’s, removal of tooth, drainage of pus
38
Q

What is impetigo?

A

Bacterial skin infection: Staph Aureus
* Needs to see paediatrician - Highly infective *

Treated with Flucloxacillin

39
Q

What is Primary Herpetic Gingivostomatitis?

A

Viral infection: caused by herpes simplex type I
Peak incidence 14 months
Incubation 3-5 days
Prodromal period first 48 hours

Symptoms: Fever , Irritability , Malaise, disrupts sleep

40
Q

What are the oral features of Primary Herpetic Gingivostomatitis?

A

Stomatitis – Gingival tissues red and oedematous.

Vesicles occur any part oral mucosa & may rupture to produce ulceration

41
Q

What is the tx for Primary Herpetic Gingivostomatitis?

A

Lasts 7-14 days.

Tx: paracetamol: analgesic, antipyrexic.
Chx m.wash/swabs
Fluids - lots of water.

42
Q

When would acyclovir be used to treat primary herpetic gingivostomatitis

A

Effective in 1st 72 hours

? Use in condition which is self limiting ?

May be indicated in immunocompromised patients

43
Q

Herpes simplex 1 can hide in the trigeminal ganglion and upon reactivation appears as a _______.
List the triggers and tx.

A

___ cold sore.

Triggers – Stress, Illness, Sunlight

Tx: Topical Acyclovir

44
Q

List the common viral infections seen in children

A

Herpangina - fever, painful ulcers.
Hand foot mouth
Chicken pox
Mumps
Measles
Epstein Barr

45
Q

Is a fungal infection common in children?

A

No, this is unusual
May get Acute Pseudomembranous Candidiasis

At risk groups:
- Neonatal [during physiology adapting]
- Immunocompromised pts at risk

Tx - Post antibiotics

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