paediatric oral medicine

Question 1

primary herpetic gingivostomatitis
- cause
- symptoms
- time
- treatment

Answer 1

caused by herpes simplex virus
prodromal period may see headache, nausea and fever
signs / symptoms : fluid filled vesicles that rupture to form ragged ulcers all over mouth inc lips
oedematous marginal gingivitis
lasts around 2 weeks but can be recurrent disease - herpes labialis (cold sores)
tx - bed rest, soft diet, paracetamol and aciclovir for immunocompromised children

Question 2

what two ways can Coxsackie A virus present

Answer 2

herpangina - vesicles in tonsilar/pharyngeal region
Hand, foot and mouth - maculopapular rash on hands and feet and ulceration on gingiva/tongue/cheeks/palate

Question 3

oral ulcer

Answer 3

A localized defect in the surface oral mucosa where the covering epithelium is destroyed leaving an inflamed area of exposed connective tissue

Question 4

10 key history questions for investigating an ulcer

Answer 4

onset, frequency, number, site, size, duration, exacerbating factors, lesions in other areas, associated medical problems, has treatment so far been helpful or unhelpful

Question 5

name 5 causes of oral ulceration in children

Answer 5

infection - viral (HSV, coxsackie A) or bacterial (TB)
immune mediated disorders (crohns , coeliac)
Trauma
Vitamin deficiencies
immunodeficiency disorders
recurrent apthous stomatitis (ulceration)

Question 6

what is the most common cause of oral ulceration in children

Answer 6

recurrent apthous ulceration

Question 7

what does an apthous ulcer look like
(also known as a canker sore)

Answer 7

round or ovoid in shape with a grey or yellow base
have a varying degree of perilesional erythema

Question 8

aetiology of recurrent apthous ulceration

Answer 8

aetiology is unclear
possibly stress, hereditary predisposition , allergy, haematlogical deficiencies (e.g iron)

Question 9

what investigations would you carry out on a child showing recurrent apthous ulceration

Answer 9

diet diary
full blood count
coeliac screen
haematinic investigation (folate, B12 and ferritin (iron))

Question 10

what pharmalogical management could be provided for a child experiencing recurrent apthous ulceration

Answer 10

chlorhexidine mouthwash - to prevent superinfection
Gengigel - hyaluronic acid containing topical gel to aid healing
Difflam spray - contains benzydamine (NSAID)

Question 11

name 5 clinical features of orofacial granulomatosis

Answer 11

lip swelling, cobblestone buccal mucosa, angular chelitis, full thickness gingival swelling, deep ulceration, mucosal tags, angular chellitis

Question 12

orofacial granulomatosis

Answer 12

uncommon chronic inflammatory disorder
aetiology is unknown
possible predictor of future crohns disease

Question 13

Geographic tongue
- presentation
- symptoms
- management

Answer 13

idiopathic and non contagious mucosal lesion of tongue
appears as shiny red areas with loss of filliform papillae surrounded by white margins
can cause intense discomfort particularly with citrus and spicy foods
managed by a bland diet during flare ups , is likely to become less troublesome with age

Question 14

fibroepithelial polyp

Answer 14

common
firm pink lump initiated by mild trauma
most commonly found on cheeks along occlusal line, tongue or lips
surgical excision is curative

Question 15

epulides
what is it and what are the 3 main types

Answer 15

common solid swellings of oral mucosa
benign hyperplastic lesion
3 main types are fibrous epulis, pyogenic granuloma and peripheral giant cell granuloma

Question 16

fibrous epulis

Answer 16

benign hyperplastic lesion
similar colour to surrounding gingiva and has a firm consistency
made of inflammatory cell infiltrate and fibrous tissue

Question 17

pyogenic granuloma

Answer 17

soft, deep red/purple swelling that is often ulcerated
may haemmorhage spontaneously or in response to mild trauma
usually a reaction to chronic trauma e.g calculus

Question 18

peripheral giant cell granuloma

Answer 18

type of epulide
typically dark red and ulcerated
benign hyperplastic lesion
usually arises interproximally and has hourglass shape
radiographs may reveal superficial erosion of interdental bone

Question 19

congenital epulis

Answer 19

rare lesion that occurs in neonates
most common in anterior maxilla
benign
proliferation of granular cells covered with epithelium

Question 20

name 2 HPV associated swellings

Answer 20

verruca vulgaris
squamous cell papilloma - cauliflower like

Question 21

what are the 2 variants of mucocele

Answer 21

mucous extravasation cyst - normal secretions rupture into adjacent tissue
mucous retention cyst - secretions retained in an expanded duct

Question 22

mucocele

Answer 22

cyst with a connection to a salivary gland
bluish, soft, transparent cystic swelling
most commonly affects minor glands of lower lip
majority rupture spontaneously

Question 23

ranula

Answer 23

mucocele in the floor of the mouth
can arise from minor glands or submandib/subling
requires a MRI or ultrasound to rule out a plunging ranula (extends through floor of mouth into submandibular space)

Question 24

bohns nodules

Answer 24

found in neonates
keratin filled cysts found on alveolar ridge
remnants of dental lamina
usually disappear in early months of life

Question 25

epsteins pearls

Answer 25

small cystic lesions found along palatal midline
disappear in 1st few weeks of life

Question 26

what are the 3 characteristics of temperomandibular joint dysfunction syndrome

Answer 26

pain , masticatory muscle spasm and limited jaw opening

Question 27

what should be included in extra and intra oral examination when investigating TMJDS

Answer 27

palpate MOM at rest and when clenched to assess for tenderness and hypertrophy
asses TMJ when opening for click/ crepitus
assess for deviation of jaw upon opening
assess for normal extent of opening
assess any dental wear facets
look for signs of clenching/grinding -scalloped tongue , buccal mucosal ridges

Question 28

management of TMJDS

Answer 28

reduce exacerbating factors:
- management of stress
- avoid habits such as clenching/grinding/chewing gum/nail biting
- bite raising appliance or mouthguard may be considered if nocturnal grinding/clenching
allow overworked muscles to rest:
- soft diet requiring little chewing
- avoid wide mouth opening , stifle yawns
symptomatic relief:
-ibuprofen
- alternating hot and cold packs