Paediatric Oral Medicine Flashcards
(98 cards)
1
Q
What are viruses that cause oro-facial soft tissue infections
A
primary herpes herpangina hand food and mouth varicella zoster EBV mumps measles rubella
2
Q
What are bacterial ore facial soft tissue infections
A
staphylococcal streptococcal symphilis TB cat scratch disease
3
Q
What is primary herpetic gingivostomatitis
A
acute infectious disease
4
Q
What are fungal causes of facial soft tissue infections
A
candida
5
Q
What is the cause of primary herpetic gingivostomatitis
A
herpes simplex virus I
6
Q
What is the transmission of herpex simplex virus I (PHG)
A
droplet formation with 7 day incubation
7
Q
Why is PHG uncommon in children in their first year of life
A
as they have a degree of immunity from circulating maternal antibodies
8
Q
What is the treatment of PHG
A
bed rest soft diet/hydration paracetamol antimicrobial gel or mouthwash acyclovir for immune compromised children
9
Q
Describe the fluid filled vesicles seen in PHG
A
rupture to painful ragged ulcers on the gingiva, tongue, lips, buccal and palatal mucosa
10
Q
What is the most common complication of PHG
A
dehydration
11
Q
How long does PHG last for
A
14 days
12
Q
How does PHG heal
A
with no scarring
13
Q
What is the recurrent disease of PHG
A
it remains dormant in epithelial cells
recurrent disease is is herpes labials (cold sores)
14
Q
What is recurrent infection of herpes simplex I triggered by
A
sunlight
stress
other causes of ill health
15
Q
How are cold sores managed
A
with topical acyclovir cream
16
Q
What two infections can coxsackie A virus cause
A
herpangina
hand foot and mouth
17
Q
What is the difference between herpangina and PHG
A
the vesicles in the tonsillar pharyngeal region i.e further back
18
Q
How does hand foot and mouth present
A
presents with store throat and high temp initially
then see ulceration on the gingiva/tongue/cheeks and palate
a maculopapular rash is seen on the hands and feet
19
Q
How long does herpangina last for
A
lasts 7-10 days
20
Q
How does hand foot and mouth last for
A
7-10 days
21
Q
What is oral ulceration defined as
A
a localized defect in the surface oral mucosa where covering epithelium is destroyed leaving an inflamed area of exposed connective tissue
22
Q
What are the 10 key facts to ask about when taking a history on an ulcer
A
OFN SS DELAT
onset frequency number site size duration exacerbating dietary factors lesions in other areas associated medical problems treatment so far and if it was helpful or unhelpful
23
Q
What are the causes of oral ulceration
A
infection immune mediated disorders vesiculobullous disorders inherited or acquired immunodeficiency disorders neoplastic/haematological trauma vitamin deficiencies recurrent apthous stomatitis
24
Q
What are viral infections that can cause oral ulceration
A
HFM coxsackie virus herpes simplex herpes zoster CMV EBV HIV
25
What are bacterial infections that cause oral ulceration
TB
| symphilis
26
What are immune mediated disorders that cause oral ulceration
```
crohns
behcets
SLE
coeliac
periodic fever syndromes
```
27
Vesiculobullous disorders
bullous or mucous membrane pemphigoid
pemphigus vulgaris
linear IgA disease erythema multiform
28
What are neoplastic/haematological conditions that cause oral ulceration
anaemia
leukamia
agranulocytosis
cyclic neutropenia
29
What is the most common cause of ulceration in children
recurrent apthous ulceration
30
What are the different types of trauma that can cause ulceration
physical
chemical
thermal
31
What is recurrent apthous stomatitis
it is this when there is no underlying cause identified
32
What are the typical apthous ulcer
round / ovoid in shape
grey or yellow base
have varying degree of perilesional erythema
33
What are the 3 patterns of RAU
minor
major
herpetiform
34
What are minor apthous ulcers
<10mm
35
What are major apthous ulcers
>10mm
36
What are herpetiform ulcers
1-2mm
| can be up to 100 at a time
37
What are the aetilogical factors of recurrent ulceration
```
unclear
hereditary predisposition
haematological and deficiency disorders (iron deficiency)
GI disease (coeliac)
minor trauma in susceptible individuals
stress
allergic disorders (toothpaste containing SLS/foods containing benzoate or sorbete preservatives)
hormonal disturbance: menstruation
```
38
What are initial investigations for recurrent oral ulceration
diet diary
full blood count
haematinics (folate/b12/ferritin)
coeliac screen - anti transglutaminase antibodies
39
What are management of exacerbating factors of RAU
nutritional deficiencies
traumatic factors
avoid sharp or spicy foods
allergic factors
40
What are allergic factors management for RAU
dietary exclusion
| SLS free toothpaste
41
What are pharmacological management of recurrent oral ulcers
prevention of superinfection
protecting healing ulcers
symptomatic relief
42
What do we use to prevent superinfection of RAU
corsodyl 0.2% moutwash
43
What do we use to protect healing ulcers
```
gengigel topical gel (hyaluronate)
geclair mouthwash (hyaluronate)
```
44
What do we use for symptomatic relief
difflam (0.15% benzydamina hydrochloride)
| LA spray
45
What is orofacial granulomatosis
uncommon chronic inflammatory disorder
46
What is the cause of OFG
idiopathic or associated with systemic granulomatous conditions (crohns or sarcoidosis)
47
What gender is OFG more common in
males
48
What is the characteristic pathology of OFG
non caveating giant cell granulomas which then result in lymphatic obstruction
49
What may OFG be a predictor of
future crohn's disease
50
What are the clinical features of OFG/oral crohns
```
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
```
51
What is the etiology of OFG
largely unknown
limited evidence of genetic factors
numerous associated allergens are reported
52
What are the associated allergens with OFG
cinnamon compounds
benzoates
much higher IgE mediated atopy rates compared to the general population
53
How is OFG diagnosed
clinical
| lip biopsy not essential
54
What are the investigations of OFG
```
measure growth
FBC
haematinics
patch testing - identify triggers
dietary diary - identify triggers
faecal calprotectin
endoscopy risky in childhood
serum angiotensin converting enzyme (raised in sarcoidosis)
```
55
What is the management of OFG
can be difficult
OH support
symptomatic relief as per oral ulceration
dietary exclusion (does not cure but reduces inflammation)
manage nutritional deficiencies which may contribute to oral ulceration
topical steroids
topical tacrolimus
short courses of oral steroids (severe or unresponsive to topical)
intralesional corticosteroids
surgical intervention - unresponsive long standing disfigurement
56
What is geographic tongue
idiopathic and non contageous
| shiny red areas on the tongue with loss of filiform papillae are surrounded by white margins
57
Why can geographic tongue cause intense discomfort in children
as they have thinner mucosa and a more intense sense of taste
they may feel discomfort with spicy food, tomato or citrus fruit / juice
need to have a bland diet during flareups
should become less troublesome with age
58
What are the different types of solid swellings
```
fibroepithelial polyp
epulides
congenital epulis
HPV- associated mucous swellings
neurofibromas
```
59
What is fibro-epithelial polyp
common
firm pink lump (pedunculate or sessile)
once established remains constant in size
60
Where are fibroepithelial polyps mostly seen
in the cheeks along the occlusal line, lips and tongue
61
What is the cause fibroepithelial polyps
minor trauma
62
What is the tx of the fibroepithelial polyp
surgical excision
curative
may need to wait until child is cooperative as hard to justify GA when benign
63
What are epulides
common solid swellings of oral mucosa
| benign hyperplastic lesions
64
What are the 3 main types of epulides
fibrous epulis
pyogenic granuloma
peripheral giant cells granuloma
65
What are fibrous epulis
pedunculate or sessile mass
firm consistency
similar color to surrounding ginviae
inflammatory cell infiltrate and fibrous tissue
66
What are pyogenic granuloma/pregnancy epulis
they are soft, deep red/purple swellings
often uclerated
can haemorrhage spontaneously or with mild trauma
vascular proliferation supported by a delicate fibrous storm
probably a reaction to chronic trauma such as calculus
tend to recur
67
When should pregnancy epulis treated
regresses spontaneously after child is born
| excision should be delayed until this time
68
What are peripheral giant cell granulomas
pedunculate or sessile swellings
typically dark, red and ulcerated
usually arises inter proximally and has an hour glass shape
radiographs may reveal superficial erosion of interdental bone
may recur after surgical excision
69
What makes peripheral giant cell granuloma different from other epulis
it is a focal collection of multinucleate giant cells in a rich vascular and cell stroke
70
What are congenital epulis
```
rare
occur in neonates
most common in anterior maxilla
more common in fmelaes
granular cells covered with epithelium
benign
simple excision is curative
```
71
What are HPV associated swellings for
verruca vulgaris
| squamous cell papilloma
72
What is verruca vulgarizes
solitary or multiple intra oral lesions
may be associated with skin warts
most resolve spotnanesouly
can be removed surgically
73
What is the cause of verruca valgarizes
caused by HPV 2 and 4
74
What is verruca vulgarisms most commonly seen
most commonly on keratinsed tissue - gingiva and palate
75
What is squamous cell papilloma
small pedunculate cauliflower like growths
benign
vary in color from pink to white
usually solitary
treatment is surgical excision
76
What are the causes of squamous cell papilloma
HPV 6 & 11
77
What are the fluid swellings
```
mucoceles
ranula
Johns nodules
epstein perals
haemangiomas
vesiculobullous lesions
```
78
What are the vesiculobullous lesions
primary herpes
epidermolysis bullosa
erythema multiform
79
What are the 2 variants of mucocele
mucous extravasion cyst
| mucous retention cyst
80
What is a mucous extraversion cyst
normal secretions rupture into adjacent tissue
81
What is a mucous retention cyst
secretions retained in an expanded duct
82
What are mucoceles
bluish soft transparent cystic swelling
can affect minor or major salivary glands
most common is minor glands of lower lip
peak incidence is second decade
most will rupture spontaneously
surgery only if lesion is fixed in size as will likely damage the adjacent glands leading to recurrence
surgical excision involves removal of cyst and adjacent damaged minor glands
83
What is a ranula
it is a mucocele in the floor of the mouth
84
What can ranulas arise from
minor salivary glands or ducts of sublingual / submandibular glands
85
Why is a MRI or ultrasound needed for a ranula
excludes purging ranulas
| extend through the FOM into sub mental or mandibular space
86
What can ranulas occasionally be found to be
lymphangioma - benign tumor of lymphatics
87
What are Bohn's nodules
```
gingival cysts
remnants of dental lamina
filled with keratin
occur on the alveolar rdige
found in neonates
usually disappear
```
88
What are Epstein pearls
```
small cystic lesions
found along palatal midline
thought to be trapped epithelium in palatal raphe
common
disappears in first few weeks
```
89
What is TMJ dysfunction syndrome characterized by
pain
masticatory muscle spasm
limited jaw opening
90
What questions should be asked in a TMJDS history
```
description of presenting symptoms
when did discomfort begin
is pain worse at any time during day
what are exacerbating factors
habits
stress
```
91
What should an extra oral exam for TMJDS include
palpation of muscles of mastication both at rest and when teeth are clenched to assess tenderness and / or hypertrophy
palpation of the TMJ at rest and when opening and closing to assess tenderness and click/creptius
assessment of opening
92
When assessing opening what are we looking at
check for deviation of jaw
| assess extent of opening (normal 40-50mm)
93
What does an intra oral examination of TMJDS include
assessment of any dental wear facets
| signs of clenching and grinding
94
What are signs of clenching and grinding
scalloped lateral tongue surface
| buccal mucosa ridges
95
What is the management of TMJDS
```
explain the condition
reduction of exacerbating factors
allow the over worked muscles to rest
symptomatic relief
if these measures are unsuccessful then referral for specialist care is indicated
```
96
How can we reduce exacerbating factors of TMJDS
management of stress - mindfulness or yoga
avoid habits such as clenching, grinding, chewing gum, nail biting or leaning on the jaw
a bit raising appliance may be considered if there is nocturnal grinding/clenching
97
How can we allow the over worked muscles in TMJDS to rest
avoid wide opening - stifle yawns with a closed fist
| soft diet which requires little chewing
98
What is the symptomatic relief for TMJDS
use of ibuprofen which has anti-inflammatory action
alternate use of hot and cold packs
if these measure are unsuccessful then referral for specialist care is indicated
