Oral Med Paeds Flashcards
(27 cards)
Types of child soft tissue infections
viral
- primary herpes
- herpangina
- hand foot and mouth
- varicella zoster
- epstein barr virus
- mumps
- measles
- rubella
bacterial
- staphylococcal
- streptococcal
- syphillis
- TB
- cat scratch disease
fungal
- candida
What is primary hermetic gingivostomatitis
-caused by herpes simplex virus
-common in children
- then can recur as cold sores when older
-droplet transmission i
Signs and symptoms of primary herpetic gingivostomatitis
- fluid fill vesicles - on gingivae, tongue, lips, buccal and palatal mucosa. rupture to painful ragged ulcers.
- ulceration is commonly seen on presentation
- severe oedematous marginal gingivitis
- fever
- headache
- malaise
- cervical lymphadenopathy
- painful lesions and child may be reluctant to eat or drink - dehydration
Treatment of primary herpetic gingivostomatitis
- bed rest
- soft diet/hydration
- paracetamol
- antimicrobial gel or mouthwash
- aciclovir for immunocompromised patients
- most common complication = dehydration
- lasts 14 days
- heals with no scarring
- can be more serious for immunocompromised
What happens following herpetic gingivostomatitis primary infection
- presents with secondary infection as herpes labialis
- happens in 50-75%
- triggered by:
- sunlight
- stress
- other causes of ill health
- management of herpes labialis is with topical aciclovir cream
What is herpangina
Coxsackie A virus
- mild
-vesicles in tonsilar/pharyngeal region - further back than herpetic gingivostomatitis
Lasts up to 10 days
What is hand foot and mouth
- sore throat , high temp and reluctant to eat
- ulceration on gingivae/cheeks and palate
- maculopapular rash on hands and feet
- lasts 7-10 days
- management same as herpes simplex virus I
What to collect from history about ulceration
- onset
- frequency
- site
- size
- number
- duration
- exacerbating diet factors
- lesions in other areas
- associated medical problems
- treatment so far
Causes of ulceration
- apthous - no cause
-infection
Viral - hand foot and mouth
Bacterial - TB, syphillis - immune mediated - crohns, bechets,
- vesiculobullous disorders
- immunodeficiency
- trauma
-cancer
Aetological factors In recurrent ulceration
- hereditary predisposition (FH in 45%)
- haematological and deficiency disorders (iron def in 20%) - low iron levels and ulceration during growth periods
- gastrointestinal disease (coeliac in 2-4%)
- minor trauma in susceptible individual
- stress
- allergic disorders (toothpaste containing SLS/food containing benzoate or sorbate preservatives)
- hormonal disturbance - menstruation
How to manage low ferritin
3 months iron supplementation
What is average onset of orofacial granulomatosis
11 years old
May predict future crohns
Investigations in OFG
- measure growth
- FBC
- haematinics
- patch testing - ID triggers
- faecal calprotectin
- endoscopy risky in childhood
- serum angiotensin converting enzyme (raised in sarcoidosis)
What is epulides
Common solid swelling of oral mucosa present as gingival enlargements
Benign hyper plastic lesions
3 types
- fibrous expulis
-pyogenic granuloma
-peripheral giant cell granuloma
How does fibrous epulis present
- pedunculated or sessile mass
- firm consistency
- similar colour to surrounding gingivae
- inflammatory cell infiltrate and fibrous tissue
How does pyogenic granuloma present
- also known as pregnancy epulis
- soft deep purple swelling
- often ulcerated
- haemorrhage spontaneously or with mild trauma
- vascular proliferation supported by a delicate fibrous stroma
- probably a reaction to chronic trauma - calculus
- tend to recur
How does peripheral giant cell granuloma present
- pendunculated or sessile swelling
- typically dark red and ulcerated
- usually arise inter-proximally and has hour glass shape
- radiographs may reveal superficial erosion of interdental bone
- distinct from other epulis
- multinucleate giant cells in vascular stroma
- may recur after excision
What is congenital epulis
- rare lesion
- occurs in neonates
- most commonly in anterior maxilla
- F>M
- granular cells covered with epithelium
- benign
-excision curative
What is verruca vulgaris
- solitary or multiple intra-oral lesions
- may be associated with skin warts on finger by autoinoculation
- caused by HPV 2 and 4
- commonly on keratinised tissue - gingivae and palate
- most resolve spontaneously
- can be removed surgically
What is ranula
- mucocele in FOM
- can arise from minor salivary glands or ducts of sublingual/submand gland
- ultrasound or MRI needed to exclude plunging ranula (extend through FOM into submental or submandibular space)
- occasionally found to be lymphangioma - benign tumour of lymphatics
What is squamous cell papilloma
- small pedunculated cauliflower like growths
- benign
- HPV 6 and 11
- vary in colour from pink to white
- usually solitary
- treatment = surgical excision
