Oral pathology in paediatrics part 1 Flashcards
1
Q
List the signs of an acute odontogenic infection (4)
A
- Raised temperature
- Red, facial swelling
- Distressed
- Possible dehydration
2
Q
List the signs of a chronic odontogenic infection (4)
A
• Sinus may be present • Mobile tooth • Discoloured tooth • Halitosis *usually asymptomatic
3
Q
List the criteria for hospitalisation for odontogenic infections (4)
A
- Body temperature >39°C
- Floor of the mouth swelling or swelling that crosses the midline
- Inability to open mouth
- Dehydration
4
Q
List the management of an odontogenic infection
A
- Removal of cause. Extraction of tooth will bring resolution but consider if you can achieve local anaesthetics for the procedure. Extract tooth when swelling subsides. Extract tooth when swelling subsides
- Use of systemic antibiotics – refer to dentist
- Local drainage and debridement
5
Q
Explain why extractions cannot be performed immediately for odontogenic infections
A
- Unable to achieve satisfactory local anaesthetics due to tissue acidosis(local anaesthetic effect decreases in the presence of inflammation)
- Inject into swelling causes infection spread
- Rebook appointments for when swelling subsides
- For a lower D if a patient is unwell, an extraction can be done by using an IAN as this is away from the swelling site. But for a lower E, an IAN will not work, so refer to DO for antibiotics and wait for swelling to subside
6
Q
Define osteomyelitis, including where it commonly occurs, 2 common symptoms, radiographic presentation and treatment
A
- Inflammation of the bone marrow extends to the cortex and periosteum of the infected area
- Odontogenic infection rarely leads to osteomyelitis
- Most commonly involves the mandible
- Symptoms: elevated temperature and pain
- Radiographically the bone has a ‘moth-eaten’ appearance
- Treatment by a dentist involves curettage of the area and IV antibiotics 2 weeks, then oral antibiotics for 4 weeks depending on the results of microbiological culture
7
Q
Describe primary herpetic gingivostomatitis in terms of presentation, age of peak incidence, incubation
A
- Severe oral ulcerations, fever, malaise, lymphadenopathy as well as feeling unwell, difficulty eating and drinking
- Peak incidence around 12- 18 months
- Incubation of 3-5 days
8
Q
Describe the oral presentation of primary herpetic gingivostomatitis
A
- Stomatitis present
- Gingival swelling, redness, pain of the marginal gingiva
- The interdental papillae become bulbous and bleeds easily
- Several oral vesicles develop on any part of the oral mucosa, including the skin around the lips
- Ulcers are usually small 3mm with erythematous margin, may appear as larger ulcers with irregular margins due to coalescence of individual lesions
- Self-limiting, ulcers heal spontaneously without scarring within 10-14 days
- Virus spreads throughout the oral mucosa and invade peripheral nerve endings. The virus travels to the trigeminal ganglion where it enters a latent state
- 30-40% will develop recurrent herpes simplex infections that reappear at sites previously infected
9
Q
Describe the management of primary herpetic gingivostomatitis
A
- Symptomatic care- Encourage oral fluids
- Systemic antiviral medications such as Acyclovir usually recommended by G Pfor immunosuppressed patients. It is only beneficial within the first 72 hours
- Avoid topical anaesthetics - numbness decrease sensation may result in trauma which causes more ulcerations
- Analgesics – paracetamol, 15mg/kg, 4-hourly
- Antimicrobial mouth rinses with Chlorhexidine 0.2% shown beneficial for older children.
- A mouthwash containing benzydamine hydrocholoride 0.15% and chlorhexidine 0.12 % (DifflamC) may offer some advantages over chlorhexidine
- 0.2% Chlorhexidine can be swabbed onto severe ulceration in younger children
- Antibiotics is only necessary if sepsis is present and a consistent high fever
- Severely affected young children usually present dehydrated, hospitalization admission is required for these cases with maintenance intravenous fluids
10
Q
Describe herpes labialis in terms of appearance, associated symptoms, where it resides during latency, triggers and treatment.
A
- Caused by Herpes Simplex virus type 1(HSV-1)
- Highly contagious, characterised by papules, vesicles, burning pain and crust on the lips
- Primary infection occurs before the age of 20 years, young children usually present with herpetic stomatitis characterised by fever and ulcerations
- After primary infection, the virus recedes via the sensory nerve into the trigeminal ganglion where it lies latent throughout the individual’s lifetime
- Stimuli such as fever, sunlight, upper respiratory infection can reactivate virus
- Self limiting, heals spontaneously within 10 days. Over-the counter antiviral cream if necessary
- Appointment should postponed until the vesicles are crusted over.
11
Q
Describe hand, foot and mouth disease in terms of appearance
A
Produces small ulcerative lesions in the mouth together with an erythematous and vascular rash on the dorsal and ventral surface of the hands, fingers, and soles of the feet
12
Q
Describe herpangina in terms of appearance, symptoms and management
A
- Highly contagious coxsackie virus, mainly seen in children during warmer months of summer
- A cluster of 4-5 light grey vesicles and rupture to form shallow ulcers. Ulcers have an erythematous border and are limited to the anterior pillars of the fauces, soft palate, uvula and the tonsils
- Low-grade fever, malaise, sore throat
- Symptomatic care, encourage oral fluids, paracetamol, antimicrobial mouth rinses with Chlorhexidine 0.2% or for older children benzydamine hydrocholoride 0.15% and chlorhexidine 0.12 % ( Difflam C) -0.2% Chlorhexidine can be swabbed
13
Q
Describe haemangioma
A
- It is a blood vessel abnormality which grows by endothelial proliferation. It present as dark reddish-purple, smooth, flat or raised lesions on the mucosa. Bleeds very easily is injured
- Relatively common in children. Most are present at birth or arise in early childhood
- My regress/ disappear by adolescence. May require surgical intervention
- Refer to DO for diagnosis and management
14
Q
Describe eruption cysts and its management
A
- Follicular enlargement appearing just prior to eruption of teeth
- Blue-black in colour as they may contain blood
- Usually require no treatment unless infected
- Parents and child should be reassured and the follicle allowed to rupture spontaneously or it may be surgically opened if infected
15
Q
Describe white sponge nevus, including its inheritance patterns and symptoms
A
- Caused by a non-cancerous (benign) overgrowth of cells. Mucosa is thickened, folded, spongy and white or grey
- Autosomal dominant condition
- Can be present at birth but usually first appears during early childhood
- Symptomless but the folds of extra tissue can promote bacterial growth
- Refer DO for diagnosis and management
