Paeds - Oral Medicine Flashcards by Roxanne B

name viral fro-facial soft tissue infections. (3)

Primary herpes
Herpangina
Hand foot and mouth

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what causes primary herpetic gingivostomatitis?

herpes simplex virus 1

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what is rarely affected by primary herpetic gingivostomatitis and why?

children in their 1st year of life - still have circulating maternal antibodies

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how is herpes transmitted?

via droplets

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what are the signs and symptoms of primary herpetic gingivostomatitis?

fluid filled vesicles which can rupture and leave painful ragged ulcers

severe oedematous marginal gingivitis

Fever
Headache
Malaise
Cervical Lymphadenopathy

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how do we treat primary herpetic gingivostomatitis?

Bed rest
Hydrating and soft diet
Paracetamol
Antimicrobial gel/mouthwash

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what can we use in immunocompromised children with primary herpetic gingivostomatitis that doesn’t work in healthy children?

acyclovir

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how does primary herpetic gingivostomatitis present as a secondary infection?

cold sores

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what triggers a secondary infection of primary herpetic gingivostomatitis?

sunlight

stress

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what virus can cause hand, foot and mouth and herpangina?

coxsackie A

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what is the difference between herpangina and primary herpetic gingivostomatitis?

the fluid filled vesicles which can rupture and leave painful ragged ulcers and found in the tonsillar/pharyngeal region.

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how does hand foot and mouth present?

Presents initially with a fever, sore throat and a maculopapular rash in mouth which presents on hands and feet later

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what do we want to investigate regarding ulcers in children? (10)

Onset – when did it begin?
Frequency
Number
Site
Size – are they always the same size?
Duration
Exacerbating factors – dietary factors?
Lesions in other areas
Associated medical problems/ drugs
Treatment so far – was it helpful?

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what are the causes of oral ulceration in children? (9)

The most common cause is no cause! - recurrent aphthous stomatitis
Infection:
• Viral – HFM, herpes simples, coxsackie
• Bacterial – TB
Immune mediated disorders:
• Crohns
• Coeliac
• SLE
Vesticulobullous disorders
Inherited/aquire immunodeficiency
Neoplastic- leukaemia
haematological – anaemia
trauma – physical, thermal or chemical
vitamin deficiency – iron, B12, folate

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what do recurrent aphthous stomatitis ulcers look like?

Round/ovoid
Yellow/grey base
Perilesional erythema

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how do we classify recurrent aphthous stomatitis ulcers?

Minor = < 10mm – heal within 10-14 days
Major = > 10mm - heal within several weeks with potential scarring
Herpetiform = 1-2mm - multiple ulcers with no systemic symptoms

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what are the causes of recurrent aphthous stomatitis ulcers?

Genetic predisposition
Haematological deficiency
GI disease
Stress
Trauma
Allergies
Hormonal disturbance

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how do we manage recurrent aphthous stomatitis ulcers?

Correct nutritional deficiencies
Avoid sharp/spicy foods
Dietary exclusion in allergy

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what are the aims of pharmacological management of recurrent aphthous stomatitis ulcers and what do we use?

Prevent superinfections – Corsodyl 0.2%
Protect healing ulcers – gelclair mouthwash
Provide relief of symptoms – diflam or LA spray

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what’s the common age of onset for orofacial granulomatosis?

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what can orofacial granulomatosis in children predict in the future?

Crohns disease

what are the features of OFG?

Lip swelling (common)
Full thickness gingival swelling
Swelling of non-labial facial tissues
Cobblestone mucosa
Lip/tongue fissuring
Angular chelitis

What is the cause of OFG?

Atopic allergy - cinnamon and benzoate’s

what investigation is useful in determining OFC from crohns disease?

Measure growth as crohns is associated with growth failure and pubertal delay

what is the most common mucosal lesion of the tongue in children?

geographical tongue

what does geographic tongue look like?

- Smooth red areas from loss of filiform papillae - Surrounded by white margins - Areas migrate

how do we rule out haematinic deficiency as the cause of geographic tongue?

if the tongue is sensitive to foods

how do we manage geographic tongue?

- Reassurance | - Bland diet during flare ups/dietary restrictions

name solid swellings that can affect children tongues.

1. Fibroepithelial polyp 2. Epulides 3. Congenital epulis 4. HPV associated mucosal swellings 5. Neurofibromas

what causes fibroepithelial polyps?

- Minor trauma | - Irritation

where are fibroepithelial polyps commonly found?

- Cheeks - Lips - Tongue

what are epiludes?

Benign hyperplastic lesions

what are epiludes caused by?

chronic irritation i.e. from calculus and plaque

where are epiludes commonly found?

Anterior to the molar teeth in the maxilla

name the types of epiludes.

- Fibrous - Pyogenic - Peripheral giant cell granuloma

what type of epilude appears the same colour as the surrounding gingivae?

fibrous epilude

what type of epilude forms interproximally and is hourglass shaped?

peripheral giant cell granulomatosis

what makes peripheral giant cell granulomatosis histologically distinct?

Has focal collections of multinucleate osteo-clast like giant cells seen lying in a richly vascular and cellular stroma

where are congenital epiludes commonly found?

incisor area of the maxilla

name the type of oral swelling associated with HPV 2 &4.

Verruca vulgaris

name the type of oral swelling associated with HPV 6 &11.

squamous cell papillomas

describe how HPV associated swellings appear in the mouth.

Pedunculated Cauliflower growths

what is a mucocele?

a fluid swelling/Cyst arising from a minor salivary gland

name the two types of mucoceles and what they are caused by?

1. Extravasion cysts = caused by rupture of the salivary duct 2. Retention cysts = caused by Cystic dilation

what is a ranula?

A mucocele (fluid swelling) arising from a salivary duct/gland on the floor of mouth.

what are ranulas further investigated?

Could be a plunging ranula – extends into the submental/submandibular space - requires specialist intervention

what are Bohns nodules?

Benign Gingival cysts filled with keratin which are remnants of the dental lamina. – disappear by 3 months old .

what is TMJ dysfunction characterised by?

- Pain - Masticatory muscle spasm - Limited jaw opening

what is normal opening of the jaws?

40-50mm

What shoulf we ask when taking a history of TMJ dysfuntion?

* Description of symptoms – clicking, cracking? * When the discomfort started – any trauma? * When is it painful – in morning? (nocturnal clenching) * Is there anything that makes the pain worse – chewing, yawning? * Have they got anything stressful going on? – exams, death?

how do we manage TMJ dysfunction?

* Explain the condition * Reduce exacerbating factors – manage stress and bite raising appliance * All muscles to rest – avoid wide opening and soft diet * Symptomatic relief – ibuprophen and hot/cold packs