Paeds - Oral Medicine Flashcards
name viral fro-facial soft tissue infections. (3)
- Primary herpes
- Herpangina
- Hand foot and mouth
what causes primary herpetic gingivostomatitis?
herpes simplex virus 1
what is rarely affected by primary herpetic gingivostomatitis and why?
children in their 1st year of life - still have circulating maternal antibodies
how is herpes transmitted?
via droplets
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
how do we treat primary herpetic gingivostomatitis?
Bed rest
Hydrating and soft diet
Paracetamol
Antimicrobial gel/mouthwash
what can we use in immunocompromised children with primary herpetic gingivostomatitis that doesn’t work in healthy children?
acyclovir
how does primary herpetic gingivostomatitis present as a secondary infection?
cold sores
what triggers a secondary infection of primary herpetic gingivostomatitis?
sunlight
stress
what virus can cause hand, foot and mouth and herpangina?
coxsackie A
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.
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
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?
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
what do recurrent aphthous stomatitis ulcers look like?
Round/ovoid
Yellow/grey base
Perilesional erythema
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
what are the causes of recurrent aphthous stomatitis ulcers?
- Genetic predisposition
- Haematological deficiency
- GI disease
- Stress
- Trauma
- Allergies
- Hormonal disturbance
how do we manage recurrent aphthous stomatitis ulcers?
- Correct nutritional deficiencies
- Avoid sharp/spicy foods
- Dietary exclusion in allergy
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
what’s the common age of onset for orofacial granulomatosis?
11
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.
- Fibroepithelial polyp
- Epulides
- Congenital epulis
- HPV associated mucosal swellings
- 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?
- Extravasion cysts = caused by rupture of the salivary duct
- 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
