Infant Oral Pathology and Cysts

Question 1

Neonatal Cysts in the Newborn

Answer 1

Palatal Cysts of the Newborn
◦ Bohn’s Nodules: Buccal and Lingual aspects of MAX alveolar ridge
◦ MUCOUS gland tissue
◦ Epstein’s Pearls: Palatal Midline or Hard/Soft Palate Junction, Epithelial remnants
◦ Found in 65-85% of newborns
◦ Multiple or small (1-3mm)
◦ Palatal midline is most common
Dental Lamina Cyst: Crest of alveolar ridge; remnants of dental lamina
◦ Keratin Filled
◦ 50% of newborns may have these
◦ Maxillary > Mandibular Arch

Question 2

Epstein Pearls (Palatal cyst of the newborn)

Answer 2

◦ 65-85% of infants have these
◦ Seen on hard/soft palate junction typically / MIDLINE palatal raphe
◦ Typically midline
◦ Entrapped epithelium where palatal shelves fuse
◦ 1-3mm white to yellow papules
◦ Can be singular or multiple (2-6)
◦ Keratin filled, spontaneously resolve/rupture

Question 3

Bohn’s Nodules

Answer 3

◦ Whitish papules/cyst like
◦ Typically buccal or lingual to alveolar ridge
◦ 1-3mm in size
◦ Ectopic mucous/salivary glands
◦ Spontaneous resolve in first few months

Question 4

Dental lamina cysts (Gingival cyst of newborns)

Answer 4

◦ Found on alveolar ridge
◦ Derived from the rests of the dental lamina remnants
◦ Maxilla > Mandible
◦ Spontaneously resolve within first 3 months

Question 5

Thrush / Pseudomembranous candidiasis

Answer 5

Caused by candida albicans
Can be result of systemic antibiotics
◦ Clears out good and bad bacteria, opportunistic infection takes over without balance of bacteria
Typically seen with diaper rash and perioral rash
◦ Widespread in mouth, not just tongue
Must rule out milk stained filiform papillae in orally restricted infant with limited tongue
elevation
Could also be materia alba, mucosal sloughing, breastfeeding keratosis
Treatment with nystatin or fluconazole
◦ Must treat mother and child if nursing

Question 6

Congenital Imperforate Submandibular Duct

Answer 6

Blocked Wharton Duct
Duct has no opening and backs up

Question 7

Anomalies of Eruption

Answer 7

Premature Teeth; Eruption prior to 3 months of age
Natal Teeth: Present AT Birth
Neonatal Teeth: Present with 30 Days of Birth
Natal 3 : Neonatal 1
Typically involves only 1-2 teeth
1 : 2,000 – 3,500 births or up to 1:6,000 births
90-95% are true primary teeth
85% are mandibular primary incisors (Centrals)
◦ 20 cases EVER since 1897 of primary molar natal/neonatal teeth
Poorly formed, possible erupt due to superficial position of bud
Hypermobile
Commonly discolored (Yellowish/Tan/Brown)

Question 8

4 Syndromes may have Natal Teeth (POSSIBLE, not absolute)

Answer 8

◦ Ellis-van Creveld Syndrome
◦ Soto Syndrome
◦ Pierre Robin Sequence
◦ Hallerman-Streiff

Question 9

Natal vs. Neonatal: keep or EXT?

Answer 9

Try to maintain: Risk of aspiration vs. Risk of Loss of Perm tooth bud if ext’d
Feeding issues with parent……soft disk tooth to round over
If must extract, NO LOCAL, NO TOPICAL…..immature liver, likely extract after 10 days old, consult with
pediatrician → Confirm Vitamin K shot or oral vitamin K
Poor nerve innervation; minimal pain at young age
Associated with Riga-Fede Disease

Question 10

Riga-Fede Disease

Answer 10

Trauma to ventral side of tongue
Appears as traumatic granuloma
Chronic trauma from natal/neonatal teeth
Determine cause, may be neuropathological in nature

Question 11

Riga-Fede Disease Treatment

Answer 11

◦ Extract (aspiration risk)
◦ Check Vitamin K shot status, Why??
◦ Vit. K needed for prothrombin, Factor VII, IX, X
◦ Smooth with sandpaper disk
◦ Nothing, manage secondary infection

Question 12

Tongue Trauma

Answer 12

Neuropathologic chewing
Seizure disorder
Familial dysautonomia
◦ Lesch-Nyhan Syndrome
◦ Gaucher Disease
◦ Cerebral Palsy
◦ Tourette Syndrome
◦ Autism
◦ Cornelia de Lange Syndrome
◦ Traumatic Brain/Birth Injur

Question 13

Hemangioma

Answer 13

Infantile hemangioma is the most common tumor of infancy
Proliferation phase begins in the first 2 weeks of life and persists for the first year of life
For the following 7-10 years, the proliferation stales and involutes
20% can lead to destruction of normal tissue
Unclear/unknown etiology
Can be treated with beta blockers to reduce proliferation

Question 14

Lymphatic Malformation

Answer 14

Lymphangioma, Cystic hygroma
50-75% in head and neck region
Cystic hygroma have diffuse swelling of cervical region of
neck, parotid gland and tongue
Larger lesions may impinge on airway

Question 15

Neonatal Alveolar Lymphangioma

Answer 15

Occur in roughly 4% of AA infants
POSTERIOR alveolar ridge (Maxillary or Mandibular Arch)
◦ Mandibular is typically bilateral
M&raquo_space; F (2:1)
< 1cm in size
Spontaneously resolve

Question 16

Congenital Epulis of the Newborn

Answer 16

Smooth Surface, Pink to red in Color, Non-tender and Firm.
Pedunculated Tumor of the Newborn
Predominately Granular Cells
◦ Gingival granular cell tumor of the newborn
Maxilla&raquo_space; Mandible
◦ Lateral to canine area mostly involved
Located on anterior ridge almost exclusively
90% in Females
Can be Single or Multiple Lesions
Reoccurrence has not been reported, no need for radical resection
Needs to be excised soon after birth as to not interfere with feeding and/or respiration
< 2cm in size, smooth surfaced mass on alveolar ridge, but can be up to 9 cm

Question 17

The Toma’s

Answer 17

Hamartoma
◦ Excess tissue that is normally found at that site
Choristoma
◦ Anomaly of tissue that is NOT normally found at that site
Tongue and alveolar mucosa most common sites
Teratoma
◦ Neoplasm made up of different tissues that are NOT normally found at that site

Question 18

Melanotic Neuroectodermal Tumor of Infancy

Answer 18

Rare pigmented lesion/neoplasm
Typically benign
Neural Crest origin
61% occur in ANTERIOR MAXILLA, other sites in body can occur
(mandible/brain/skull)
Occurs exclusively in infants younger than 1 year of age
◦ Only 9% after 1st year of life
Rapidly expanding mass of blue/black pigment
Bone destruction and tooth displacement
Elevated Urinary VMA (Vanillylmandelic Acid)
6-20% Recur (High Rate of Recurrence)

Question 19

Primitive Neuroectodermal Tumor (PNET)

Answer 19

Typical in infants under 6 months of age
Maxilla > Mandible (Most often Pre-Maxilla Area)
Radiographically: Poorly circumscribed radiolucency with floating teeth
20% Reoccur

Question 20

Eruption Hematoma:

Answer 20

Dilated follicle becomes filled with fluid and blood
products
Rule out a hemiangioma

Question 21

Primordial Cyst:

Answer 21

Result from stellate reticulum, typically in 3rd molar
region; Pathology report usually reports them to be OKC ( Odontogenic
Keratocyst) or Keratocystic odotongenic tumor (KCOT)

Question 22

Dentigerous Cyst:

Answer 22

Reduced enamel epithelium

Question 23

Macroglossia syndromes

Answer 23

Beckwith-Wiedmann Syndrome
Down Syndrome
Apert Syndrome

Question 24

Macroglossia

Answer 24

Can be detected via ultrasound
Major difficulty with feeding and breathing
Tongue resection and surgery during infancy