paediatric oral medicine Flashcards
primary herpetic gingivostomatitis
- cause
- symptoms
- time
- treatment
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
what two ways can Coxsackie A virus present
herpangina - vesicles in tonsilar/pharyngeal region
Hand, foot and mouth - maculopapular rash on hands and feet and ulceration on gingiva/tongue/cheeks/palate
oral ulcer
A localized defect in the surface oral mucosa where the covering epithelium is destroyed leaving an inflamed area of exposed connective tissue
10 key history questions for investigating an ulcer
onset, frequency, number, site, size, duration, exacerbating factors, lesions in other areas, associated medical problems, has treatment so far been helpful or unhelpful
name 5 causes of oral ulceration in children
infection - viral (HSV, coxsackie A) or bacterial (TB)
immune mediated disorders (crohns , coeliac)
Trauma
Vitamin deficiencies
immunodeficiency disorders
recurrent apthous stomatitis (ulceration)
what is the most common cause of oral ulceration in children
recurrent apthous ulceration
what does an apthous ulcer look like
(also known as a canker sore)
round or ovoid in shape with a grey or yellow base
have a varying degree of perilesional erythema
aetiology of recurrent apthous ulceration
aetiology is unclear
possibly stress, hereditary predisposition , allergy, haematlogical deficiencies (e.g iron)
what investigations would you carry out on a child showing recurrent apthous ulceration
diet diary
full blood count
coeliac screen
haematinic investigation (folate, B12 and ferritin (iron))
what pharmalogical management could be provided for a child experiencing recurrent apthous ulceration
chlorhexidine mouthwash - to prevent superinfection
Gengigel - hyaluronic acid containing topical gel to aid healing
Difflam spray - contains benzydamine (NSAID)
name 5 clinical features of orofacial granulomatosis
lip swelling, cobblestone buccal mucosa, angular chelitis, full thickness gingival swelling, deep ulceration, mucosal tags, angular chellitis
orofacial granulomatosis
uncommon chronic inflammatory disorder
aetiology is unknown
possible predictor of future crohns disease
Geographic tongue
- presentation
- symptoms
- management
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
fibroepithelial polyp
common
firm pink lump initiated by mild trauma
most commonly found on cheeks along occlusal line, tongue or lips
surgical excision is curative
epulides
what is it and what are the 3 main types
common solid swellings of oral mucosa
benign hyperplastic lesion
3 main types are fibrous epulis, pyogenic granuloma and peripheral giant cell granuloma
fibrous epulis
benign hyperplastic lesion
similar colour to surrounding gingiva and has a firm consistency
made of inflammatory cell infiltrate and fibrous tissue
pyogenic granuloma
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
peripheral giant cell granuloma
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
congenital epulis
rare lesion that occurs in neonates
most common in anterior maxilla
benign
proliferation of granular cells covered with epithelium
name 2 HPV associated swellings
verruca vulgaris
squamous cell papilloma - cauliflower like
what are the 2 variants of mucocele
mucous extravasation cyst - normal secretions rupture into adjacent tissue
mucous retention cyst - secretions retained in an expanded duct
mucocele
cyst with a connection to a salivary gland
bluish, soft, transparent cystic swelling
most commonly affects minor glands of lower lip
majority rupture spontaneously
ranula
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)
bohns nodules
found in neonates
keratin filled cysts found on alveolar ridge
remnants of dental lamina
usually disappear in early months of life
epsteins pearls
small cystic lesions found along palatal midline
disappear in 1st few weeks of life
what are the 3 characteristics of temperomandibular joint dysfunction syndrome
pain , masticatory muscle spasm and limited jaw opening
what should be included in extra and intra oral examination when investigating TMJDS
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
management of TMJDS
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
