PAEDIATRIC ORAL MEDICINE Flashcards
what are examples of VIRAL oro-facial soft tissue infections?
- primary herpes
- herpangina
- hand foot and mouth disease
- varicella zoster
what are examples of BACTERIAL oro-facial soft tissue infections?
- staphylococcal
- streptococcal
- syphilis
- TB
what is an example of a FUNGAL oro-facial soft tissue infection?
candida
what is primary herpactic gingivostomatitis? what causes it?
ACUTE INFECTIOUS DISEASE
- Herpes Simplex Virus
how is the herpes simplex virus transmitted?
transmission by droplet formation with 7 day incubation period
how does herpes simplex virus present in children?
presents as cold sores
what are the signs and symptoms of primary herpetic gingivostomatitis?
- Fluid filled vesicles which rupture to painful ragged ulcers on gingivae, tongue, lips, buccal & palatal mucosa
- severe oedematous marginal gingivitis
- fever
- headache
- malaise
- cervical lymphadenopathy
what is the treatment for primary herpetic gingivostomatitis?
- bed rest
- soft diet/hydration
- paracetamol
- antimicrobial gel or mouthwash
- aciclovir for immunosuppressed children
how long does primary herpetic gingivostomatitis typically last & what is the most common complication of it?
- Lasts 14 days
- Dehydration most common complication
If primary herpetic gingivostomatitis was to reoccur in adults, how would it present? how common is this? what are the triggers?
- present as herpes labialis (cold sores)
- 50-75% recurrence rate
- triggers = sunlight, stress, ill health
how are cold sores/herpes labialis treated?
topical acyclovir cream
how does herpangina present?
vesicles in the tonsillar/pharyngeal region
how long does herpangina last?
7-10 days
how does hand, foot and mouth disease present?
- first presentation usually sore throat
- followed by ulceration on the gingivae/tongue/cheeks and palate
- maculopapular rash on hands & feet
how long does hand, foot and mouth disease last?
7-10 days
what is the definition of oral ulceration?
a localised defect in the surface oral mucosa where the covering epithelium is destroyed leaving an inflamed area of exposed connective tissue
If oral ulceration in present in a child, what areas of history should be investigated with regards to the lesion?
- onset
- frequency
- number
- size
- site
- duration
- exacerbating dietary factors
- lesions in other areas
- associated medical problems
- treatment so far (helpful or unhelpful?)
what are causes of oral ulceration?
- infection
- immune mediated disorders
- vesticulobullous disorders
- inherited or acquired immunodeficiency disorders
- neoplastic/haematological
- trauma
- vitamin deficiencies
- no apparent cause
what is the most common cause of ulceration in children?
recurrent aphthous ulceration
how does recurrent aphthous ulceration present?
these ulcers are round or ovoid in shape with a grey or yellow base & have a varying degree of perilesional erythema
what are the 3 patters of RAU?
Minor: <10mm
Major: >10mm
Herpetiform: 1-2mm
what are some aetiological factors in RAU?
- hereditary predisposition
- iron deficiency
- coeliac
- stress
- hormonal disturbance
a patient presents with RAU, what would your initial investigations be?
- diet diary
- full blood count
- haematinics (folate/B12/ferritin)
- coeliac screen (anti-transglutaminase antibodies)
a patient presents with RAU, how could you prevent superinfection?
prescribe Corsodyl 0.2% Mouthwash
a patient presents with RAU, how could you protect the healing ulcers?
prescribe:
- gengigel topical gel (hyaluronate)
- gelclair mouthwash (hyaluronate)
a patient presents with RAU, how could you help them with symptomatic relief?
prescribe:
- Difflam spray (0.15% benzydamine hydrochloride)
- local anaesthetic spray
what is orofacial granulomatosis?
Chronic inflammatory disorder that is either idiopathic or associated with systemic granulomatous conditions:
- Crohn’s disease
- Sarcoidosis
what is the average age of onset for orofacial granulomatosis? who is more likely to get this disease?
Average age of onset = 11 years old
Males > Females
what are some clinical features of OFG?
- lip swelling (most common)
- full thickness gingival swelling
- swelling of the non labial facial tissues
- peri-oral erythema
- cobblestone appearance of the buccal mucosa
- linear oral ulceration
- mucosal tags
- lip/tongue fissuring
- angular cheilitis
what are the allergens associated with OFG?
- cinnamon compounds
- benzoates
You suspect a paediatric patient has OFG, what investigations would you carry out in order to diagnose this patient?
- measure growth (paediatric growth chart)
- full blood count
- haematinics
- patch testing (ID triggers)
- diet diary (ID triggers)
- faecal calprotectin
A paediatric patient has OFG, how would you manage their disease?
- oral hygiene support
- symptomatic relief as per oral ulceration
- advise dietary exclusion (no cure but helps with inflammation)
- manage nutritional deficiencies
- topical steroids
what is Geographic Tongue? how does it present?
- an idiopathic and non-contagious mucosal lesion of the tongue
- shiny red areas on the tongue with loss of filiform papillae surrounded by white margins
what are the side effects of geographical tongue?
- discomfort (especially in children)
- discomfort with spicy foods, tomato’s, citrus fruit or juice
how is geographical tongue managed?
bland diet during flare ups
what are examples of solid swellings that may be seen in paediatric patients mouths?
- fibroepithelial polyp
- epulides
- congenital epulis
- HPV-associated mucosal swellings
what is a fibroepithelial polyp?
- firm pink lump
- found mainly in the cheeks, lips or tongue
- constant size (no change)
what is the cause of fibroepithelial polyps?
thought to be initiated by minor trauma
what are epulides?
common solid swellings of the oral mucosa
- benign hyperplastic lesions
what are the main types of epulides?
- fibrous epulis
- pyogenic granuloma
- peripheral giant cell granuloma
how do pyogenic granuloma’s present? what is the cause?
- soft, deep red/purple swelling
- often ulcerated
- haemorrhage spontaneously or with mild trauma
- probably a reaction to chronic trauma?
how do peripheral giant cell granulomas present?
- pedunculated or sessile swelling
- dark red & ulcerated
- usually arises interproximally & has an hour glass shape
what are congenital epulis lesions?
very RARE lesion that occurs in neonates
- most commonly found on anterior maxilla
- granular cells covered with epithelium (large & closely packed)
- benign
what are examples of HPV associated swellings?
- verruca vulgaris
- squamous cell papilloma
what HPV types causes verruca vulgaris?
HPV 2 and 4
what HPV types can cause squamous cell papillomas?
HPV 6 and 11
what are mucoceles? what are the two types?
Benign, mucous containing cystic lesion of salivary glands
- mucous extravasation cyst
- mucous retention cyst
what is a ranula?
Mucocele in the floor of the mouth
what are Bohn’s Nodules?
gingival cysts that are remnants of the dental lamina
- filled with keratin
- occur on alveolar ridge
- found in neonates
what are epstein pearls?
small cystic lesions found along the palatal mid-line
- thought to be trapped epithelium in the palatal raphe
- in 80% of neonates
