Paediatric Oral Medicine Flashcards
1
Q
What can cause oro-facial soft tissue infections?
A
- viral
- primary herpes
- herpangina
- hand, foot and mouth
- varicalla zoster
- bacterial
- staphylococcal
- streptococcal
- syphilis
- tuberculosis
- fungal
- candida
2
Q
What is primary herpetic gingivostomatitis?
A
- acute infectious disease
- herpes simplex virus 1
- primary infection
- common in children
- recurrence as cold sores
- transmission by droplet formation
- 7 day incubation
- signs and symptoms
- fluid filled vesicles
- rupture to ulcers - severe oedematous marginal gingivitis
- fever
- headache
- malaise
- cervical lymphadenopathy
- fluid filled vesicles
- treatment
- usually self limiting after 14 days
- bed rest
- soft diet and hydration (dehydration most common cause)
- paracetamol
- antimicrobial gel or mouthwash
- acyclovir for immunocomprimised children
- virus remains dormant in epithelial cells
- recurrent as herpes labials in 50-75% of cases
- triggered by sunlight, stress or other causes of ill health
- managed by topical acyclovir cream
3
Q
What does coxsackie A virus cause?
A
- herpangina
- hand, foot and mouth disease
4
Q
What is herpangina?
A
- mild condition
- vesicles in the tonsils pharyngeal region
- similar to primary herpetic gingivalvostomatitis
- lasts 7-10 days
- management
- same as that of herpes simplex 1
5
Q
What is hand foot and mouth disease?
A
- ulceration on the gingivae, tongue, palate and cheeks
- maculopapular rash on the hands and feet
- a couple of days after ulceration appears in mouth
- lasts 7-10 days
6
Q
What is oral ulceration?
A
a localised defect in the surface oral mucosal where the covering epithelium is destroyed leaving an inflamed area of exposed connective tissue
7
Q
What 10 key facts must be determined about an ulcer?
A
- onset
- frequency
- number
- site
- size
- duration
- exacerbating dietary factors
- lesions in other areas
- associated medical problems
- treatment attempt so far (success?)
8
Q
What infections can cause oral ulceration?
A
- viral
- hand, foot and mouth
- herpes simplex
- herpez zoster
- bacterial
- tuberculosis
- syphilis
9
Q
What immune mediated disorders can cause oral ulceration?
A
- Crohns
- behcets
- SLE
- coeliac
10
Q
What vesticulobullous disorders can cause oral ulceration?
A
- bulbous or mucous membrane pemphigoid
- pemphigus
- pemphigus vulgaris
- linear IgA disease
11
Q
What are the potential causes of oral ulceration?
A
- infection
- immune mediated disorders
- vesticulobullous disorders
- inherited or acquired immunodeficiency disorders
- neoplastic/haemotalogical
- trauma
- vitamin deficiencies
- recurrent apthous stomatitis
12
Q
What neoplastic/haemotalogical factors can cause oral ulceration?
A
- anaemia
- leukaemia
- agranulocytosis
- cyclic neutropenia
13
Q
What vitamin deficiencies can cause oral ulceration?
A
- iron
- B12
- folate
14
Q
What is recurrent pathos ulceration?
A
- most common cause of ulceration in children
- round or ovoid shaped ulcers
- grey or yellow base
- varying degree of perilesional erythema
- 3 patterns
- minor (<10mm), 10-14 days to heal, only unkeratinised
- major (>10mm), several weeks to heal, also keratinised
- herpetiform (1-2mm), many ulcers at a time
- aetiological factors
- hereditary predisposition
- haemotalogical and deficiency disorders
- GI disease
- minor trauma in susceptible individuals
- stress
- allergic disorders
- hormonal disturbance
- investigations
- diet diary
- FBC
- haematinics
- coeliac screen
- management
- avoid exacerbating food groups
- supplementation
- pharmacological
- corsodyl 0.2% mouthwash (infection prevention)
- gengigel topical gel, gelclair mouthwash (protection)
- difflam, LA spray (symptomatic relief)
15
Q
What is orofacial granulomatosis?
A
- uncommon chronic inflammatory disorder
- associated with systemic granulomatous conditions
- Crohns
- sarcoidosis - average onset at 11 years old
- associated with systemic granulomatous conditions
- non caseating giant cell granulomas
- result in lymphatic obstruction
- can be predictor of future Crohns
- clinical features
- lip swelling
- full thickness gingival swelling
- swelling of other facial tissues
- peri-oral erythema
- cobblestone appearance buccal mucosa
- linear ulceration
- mucosal tags
- lip/tongue fissuring
- angular chelitis
- aetiology
- largely unknown
- potentially genetic
- associated allergens
- cinnamon compounds
- benzoates - higher IgE mediated atopy rates
- diagnosis
- clinical, lip biopsy not essential
- measure facial growth
- FBC
- haematinics
- patch testing to identify triggers
- diet diary to identify triggers
- faecal calprotectin
- management
- oral hygiene support
- symptomatic relief for ulceration
- dietary exclusion
- management of nutritional deficiencies
- topical steroids
- topical tacrolimus
- short course of oral steroids
- intralesional steroids
- surgical intervention
16
Q
What is geographic tongue?
A
- shiny red areas on tongue with loss of filiform papillae surrounded by white margins, migrating over tongue
- benign but can be painful
17
Q
What solid swellings can be seen in the mouth?
A
- fibroepithelial polyp
- epulides
- congenital epulis
- HPV-associated mucosal swellings
- neurofibromas
18
Q
What are fibroepithelial polyps?
A
- firm pink lumps
- pedunculate or sessile
- benign
- mostly found in commonly traumatised areas
- managed by surgical excision under LA
19
Q
What are epulides?
A
- common solid swellings over the oral mucosa
- benign hyperplastic lesions
- inter proximal dental tissues most common
- related to chronic dental irritation (calculus and plaque)
- majority anterior to molars, mostly in maxilla
- 3 main types
- fibrous epulis
- pedunculate or sessile mass
- firm consistency
- similar colour to surrounding gingival
- inflammatory cell infiltrate and fibrous tissue - pyogenic granuloma
- soft, deep, red/pruple swelling
- often ulcerated
- haemorrhage spontaneously or with mild trauma
- vascular proliferation supported by fibrous stroma
- reaction to chronic trauma
- tend to recur after removal - peripheral giant cell granuloma
- pedunculate or sessile swelling
- typically dark red and ulcerated
- interproximally with hourglass shape
- superficial erosion of interdental bone
- multinucleate giant cells in vascular stroma
- may recur after surgical excision
- fibrous epulis
- managed by surgical excision and removal of exacerbating factors
- commonly recur
20
Q
What are congenital epulis?
A
- rare lesion occurring in neonates
- most common in anterior maxilla
- granular cells covered with epithelium
- benign
- simple surgical excision
- does not recur
21
Q
What are HPV associated swellings
A
- verruca vulgaris
- HPV 2 and 4
- solitary or multiple lesions
- keratinised tissue most commonly affected
- spontaneous resolution or surgical removal
- squamous cell papilloma
- HPV 6 and 11
- small pedunculate cauliflower like growths
- benign
- white-pink in colour
- usually solitary
- surgical excision
22
Q
What fluid filled swelling can be seen in the mouth?
A
- mucoceles
- radula
- Bohn’s nodules
- Epstein pearls
- haemangiomas
- vesiculobullous lesions
- primery herpes
- epidermolysis bulls
- erythema multiforme
23
Q
What are mucoceles?
A
- 2 variants
- mucous extravasions cyst
- normal secretions rupture into adjacent tissues - mucous retention cyst
- secretions retained in an expanded duct
- mucous extravasions cyst
- blush, soft, transparent, cystic swelling
- affect minor or major salivary glands
- most affect minor glands of the lower lip
- most rupture spontaneously
- surgery only if lesion fixed in size
- will likely damage adjacent gland
- leads to recurrence
- removal of cyst and adjacent damaged minor salivary gland
24
Q
What are ranula?
A
- mucocele in the floor of the mouth
- minor salivary glands or ducts or sublingual/submandibular
- ultrasound or MRI needed to exclude plunging radula
- extended into submittal or submandibular space
- occasionally found to be lymphangioma
- benign tumour of the lymphatics
25
Q
What are Bohn’s nodules?
A
- gingival cysts
- remnants of the dental lamina
- filled with keratin
- occur on alveolar ridge
- found in neonates
- first 28 days
- disappear in early months of life
26
Q
What are Epstein pearls?
A
- small cystic lesions
- found along palatal midline
- trapped epithelium in palatal raphe
- in around 80% of neonates
- disappear in first few weeks
27
Q
What is temporomandibular joint dysfunction syndrome?
A
- most common condition affecting the temporomandibular region
- characterised by:
- pain
- masticatory muscle spasm
- limited jaw opening
- history
- presenting symptoms
- when discomfort started
- exacerbating factors
- habits
- stress
- examination
- palpation of muscles of mastication
- at rest and on clenching
- assess tenderness or hypertrophy - palpation of TMJ
- at rest
- when opening and closing
- assess tenderness and click/crepitus - assessment of opening
- check for deviation of jaw
- assess extent of opening - intraoral
- assessment of dental wear facets
- signs of clenching or grinding
- scalloped lateral tongue surface
- buccal mucosa ridges
- palpation of muscles of mastication
- symptomatic relief
- ibuprofen
- alternating use of hot and cold packs
