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BDS3 CLINICAL Paeds > Paediatric Oral Medicine > Flashcards

Paediatric Oral Medicine Flashcards

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
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2
Q

What are bacterial ore facial soft tissue infections

A 
staphylococcal
streptococcal
symphilis
TB
cat scratch disease
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3
Q

What is primary herpetic gingivostomatitis

A

acute infectious disease

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4
Q

What are fungal causes of facial soft tissue infections

A

candida

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5
Q

What is the cause of primary herpetic gingivostomatitis

A

herpes simplex virus I

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6
Q

What is the transmission of herpex simplex virus I (PHG)

A

droplet formation with 7 day incubation

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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

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8
Q

What is the treatment of PHG

A 
bed rest
soft diet/hydration
paracetamol 
antimicrobial gel or mouthwash
acyclovir for immune compromised children
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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

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10
Q

What is the most common complication of PHG

A

dehydration

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11
Q

How long does PHG last for

A

14 days

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12
Q

How does PHG heal

A

with no scarring

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13
Q

What is the recurrent disease of PHG

A

it remains dormant in epithelial cells

recurrent disease is is herpes labials (cold sores)

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14
Q

What is recurrent infection of herpes simplex I triggered by

A

sunlight
stress
other causes of ill health

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15
Q

How are cold sores managed

A

with topical acyclovir cream

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16
Q

What two infections can coxsackie A virus cause

A

herpangina

hand foot and mouth

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17
Q

What is the difference between herpangina and PHG

A

the vesicles in the tonsillar pharyngeal region i.e further back

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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

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19
Q

How long does herpangina last for

A

lasts 7-10 days

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20
Q

How does hand foot and mouth last for

A

7-10 days

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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

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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
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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
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24
Q

What are viral infections that can cause oral ulceration

A 
HFM
coxsackie virus
herpes simplex
herpes zoster
CMV
EBV
HIV
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25
Q

What are bacterial infections that cause oral ulceration

A

TB

symphilis

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26
Q

What are immune mediated disorders that cause oral ulceration

A 
crohns
behcets
SLE
coeliac
periodic fever syndromes
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27
Q

Vesiculobullous disorders

A

bullous or mucous membrane pemphigoid
pemphigus vulgaris
linear IgA disease erythema multiform

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28
Q

What are neoplastic/haematological conditions that cause oral ulceration

A

anaemia
leukamia
agranulocytosis
cyclic neutropenia

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29
Q

What is the most common cause of ulceration in children

A

recurrent apthous ulceration

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30
Q

What are the different types of trauma that can cause ulceration

A

physical
chemical
thermal

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31
Q

What is recurrent apthous stomatitis

A

it is this when there is no underlying cause identified

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32
Q

What are the typical apthous ulcer

A

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

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33
Q

What are the 3 patterns of RAU

A

minor
major
herpetiform

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34
Q

What are minor apthous ulcers

A

<10mm

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35
Q

What are major apthous ulcers

A

> 10mm

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36
Q

What are herpetiform ulcers

A

1-2mm

can be up to 100 at a time

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37
Q

What are the aetilogical factors of recurrent ulceration

A 
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
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38
Q

What are initial investigations for recurrent oral ulceration

A

diet diary
full blood count
haematinics (folate/b12/ferritin)
coeliac screen - anti transglutaminase antibodies

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39
Q

What are management of exacerbating factors of RAU

A

nutritional deficiencies
traumatic factors
avoid sharp or spicy foods
allergic factors

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40
Q

What are allergic factors management for RAU

A

dietary exclusion

SLS free toothpaste

41
Q

What are pharmacological management of recurrent oral ulcers

A

prevention of superinfection
protecting healing ulcers
symptomatic relief

42
Q

What do we use to prevent superinfection of RAU

A

corsodyl 0.2% moutwash

43
Q

What do we use to protect healing ulcers

A 
gengigel topical gel (hyaluronate)
geclair mouthwash (hyaluronate)
44
Q

What do we use for symptomatic relief

A

difflam (0.15% benzydamina hydrochloride)

LA spray

45
Q

What is orofacial granulomatosis

A

uncommon chronic inflammatory disorder

46
Q

What is the cause of OFG

A

idiopathic or associated with systemic granulomatous conditions (crohns or sarcoidosis)

47
Q

What gender is OFG more common in

A

males

48
Q

What is the characteristic pathology of OFG

A

non caveating giant cell granulomas which then result in lymphatic obstruction

49
Q

What may OFG be a predictor of

A

future crohn’s disease

50
Q

What are the clinical features of OFG/oral crohns

A 
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
Q

What is the etiology of OFG

A

largely unknown
limited evidence of genetic factors
numerous associated allergens are reported

52
Q

What are the associated allergens with OFG

A

cinnamon compounds
benzoates
much higher IgE mediated atopy rates compared to the general population

53
Q

How is OFG diagnosed

A

clinical

lip biopsy not essential

54
Q

What are the investigations of OFG

A 
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
Q

What is the management of OFG

A

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
Q

What is geographic tongue

A

idiopathic and non contageous

shiny red areas on the tongue with loss of filiform papillae are surrounded by white margins

57
Q

Why can geographic tongue cause intense discomfort in children

A

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
Q

What are the different types of solid swellings

A 
fibroepithelial polyp
epulides
congenital epulis
HPV- associated mucous swellings
neurofibromas
59
Q

What is fibro-epithelial polyp

A

common
firm pink lump (pedunculate or sessile)
once established remains constant in size

60
Q

Where are fibroepithelial polyps mostly seen

A

in the cheeks along the occlusal line, lips and tongue

61
Q

What is the cause fibroepithelial polyps

A

minor trauma

62
Q

What is the tx of the fibroepithelial polyp

A

surgical excision
curative
may need to wait until child is cooperative as hard to justify GA when benign

63
Q

What are epulides

A

common solid swellings of oral mucosa

benign hyperplastic lesions

64
Q

What are the 3 main types of epulides

A

fibrous epulis
pyogenic granuloma
peripheral giant cells granuloma

65
Q

What are fibrous epulis

A

pedunculate or sessile mass
firm consistency
similar color to surrounding ginviae
inflammatory cell infiltrate and fibrous tissue

66
Q

What are pyogenic granuloma/pregnancy epulis

A

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
Q

When should pregnancy epulis treated

A

regresses spontaneously after child is born

excision should be delayed until this time

68
Q

What are peripheral giant cell granulomas

A

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
Q

What makes peripheral giant cell granuloma different from other epulis

A

it is a focal collection of multinucleate giant cells in a rich vascular and cell stroke

70
Q

What are congenital epulis

A 
rare 
occur in neonates
most common in anterior maxilla
more common in fmelaes
granular cells covered with epithelium
benign
simple excision is curative
71
Q

What are HPV associated swellings for

A

verruca vulgaris

squamous cell papilloma

72
Q

What is verruca vulgarizes

A

solitary or multiple intra oral lesions
may be associated with skin warts

most resolve spotnanesouly
can be removed surgically

73
Q

What is the cause of verruca valgarizes

A

caused by HPV 2 and 4

74
Q

What is verruca vulgarisms most commonly seen

A

most commonly on keratinsed tissue - gingiva and palate

75
Q

What is squamous cell papilloma

A

small pedunculate cauliflower like growths
benign

vary in color from pink to white
usually solitary
treatment is surgical excision

76
Q

What are the causes of squamous cell papilloma

A

HPV 6 & 11

77
Q

What are the fluid swellings

A 
mucoceles
ranula
Johns nodules
epstein perals
haemangiomas
vesiculobullous lesions
78
Q

What are the vesiculobullous lesions

A

primary herpes
epidermolysis bullosa
erythema multiform

79
Q

What are the 2 variants of mucocele

A

mucous extravasion cyst

mucous retention cyst

80
Q

What is a mucous extraversion cyst

A

normal secretions rupture into adjacent tissue

81
Q

What is a mucous retention cyst

A

secretions retained in an expanded duct

82
Q

What are mucoceles

A

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
Q

What is a ranula

A

it is a mucocele in the floor of the mouth

84
Q

What can ranulas arise from

A

minor salivary glands or ducts of sublingual / submandibular glands

85
Q

Why is a MRI or ultrasound needed for a ranula

A

excludes purging ranulas

extend through the FOM into sub mental or mandibular space

86
Q

What can ranulas occasionally be found to be

A

lymphangioma - benign tumor of lymphatics

87
Q

What are Bohn’s nodules

A 
gingival cysts
remnants of dental lamina
filled with keratin
occur on the alveolar rdige
found in neonates 
usually disappear
88
Q

What are Epstein pearls

A 
small cystic lesions
found along palatal midline
thought to be trapped epithelium in palatal raphe
common 
disappears in first few weeks
89
Q

What is TMJ dysfunction syndrome characterized by

A

pain
masticatory muscle spasm
limited jaw opening

90
Q

What questions should be asked in a TMJDS history

A 
description of presenting symptoms
when did discomfort begin
is pain worse at any time during day
what are exacerbating factors
habits
stress
91
Q

What should an extra oral exam for TMJDS include

A

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
Q

When assessing opening what are we looking at

A

check for deviation of jaw

assess extent of opening (normal 40-50mm)

93
Q

What does an intra oral examination of TMJDS include

A

assessment of any dental wear facets

signs of clenching and grinding

94
Q

What are signs of clenching and grinding

A

scalloped lateral tongue surface

buccal mucosa ridges

95
Q

What is the management of TMJDS

A 
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
Q

How can we reduce exacerbating factors of TMJDS

A

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
Q

How can we allow the over worked muscles in TMJDS to rest

A

avoid wide opening - stifle yawns with a closed fist

soft diet which requires little chewing

98
Q

What is the symptomatic relief for TMJDS

A

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

BDS3 CLINICAL Paeds (14 decks)

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