Paeds Oral Medicine 2 Flashcards
What is geographical tongue?
Its a mucosal lesion of the tongue
Describe geographical tongue
This is a common tongue lesion where there is a benign change to tongue mucosa resulting in shiny red areas on the tongue with loss of filiform papillae and are surrounded by white regions (looks like a map)
What is cause of geographical tongue?
not known but non contagious
entirely benign
What can geographical tongue be associated with?
Intense discomfort in children
discomfort to spicy foods, citrus foods but can also be to bland foods at times
If geographic tongue is sensitive what can be helpful?
Ruling out haemitinic deficiencies - folate, iron, vit b12
What is management of geographical tongue?
Bland diet during flare ups
What happens with geographical tongue as we age?
It becomes less troublesome
What are common causes of solid oral swellings?
Fibroepithelial polyp
Epulides
Congenital epulis
HPV associated mucosal swellings
What is a fibroepithelial polyp?
This is a common BENIGN lesion seen in kids that presents as a firm pink lump that can be pedunculate or sessile mainly in cheeks (along occlusal line), lips or tongue as these are easily traumatised areas
Where are firboepithelial polyps generally found?
lips, tongue and cheeks at occlusal line
What causes fibroepithelial polyps?
trauma is normally the cause - accidental biting or sharp tooth edges
Do fibroepithelial polyps cause pain?
no in general they don’t unless repeated trauma to polyp
How can we treat fibroepithelial polyps?
surgical excision is curative measure
Why may fibroepithelial pulp tx be delayed?
If child can’t cooperate - GA isn’t normally considered and they are of benign nature so hard to justify
What is an epulides?
This is a common solid swelling of oral mucosa that presents as localised gingival enlargements
where do most epulides arise from?
Interproximal dental tissues
What are epulides related to?
chronic irritation particularly in the presence of calculus or plaque
What are the 3 main types of epulides?
Fibrous epulis
pyogenic granuloma
peripheral giant cell granuloma
What are the shared features of the 3 types of epulides?
most occur anterior to molar teeth
more common in maxilla
How do we manage epulides?
Surgical excision and manage and identify exacerbating factors
they tend to recur
What is a fibrous epulis?
this is a pedunculated or sessile mass that has a firm consistency that is similar colour to surrounding gums
it has an inflammatory cell infiltrate and fibrous tissue
What does fibrous epulis look like?
fibroepithelia polyp
What is a pyogenic granuloma/pregnancy epulis
These are both vascular epulis that are clinically and histologically identical but difference is whether pt is pregnant or not
Describe the appearance of
pyogenic granuloma/pregnancy epulis
soft deep red/purple swelling that is often ulcerated and haemorrhages spontaneously or with mild trauma
What arepyogenic granuloma/pregnancy epulis a reaction to?
chronic trauma - calculus
If a pt has a pregnancy epulis how do we manage this?
in pregnancy there is a tendency for spontaneous regression or decrease in size and assume features of a fibrous epulis after baby born so we tend to leave until baby is born to excise it
What is a peripheral giant cell granuloma?
this is a pedunculated or sessile swelling that is usually dark red and ulcerated which arises in IP area and has hour glass shape - buccal and lingual swelling with narrow middle section between teeth
What may radiographs show in peripheral giant cell granulomas?
Superficial erosion of inter dental bone
Why must be radiographs be taken in case of peripheral giant cell granulomas?
To rule out central giant cell lesion that has perforated the cortex (will present similar to peripheral swelling)
What is a congenital epulis?
this is a rare lesion that occurs in neonates
congenital gingival granular cell tumour in incised area of maxilla
What does congenital epulis affectt more and where?
Females
incisal area of maxilla
How do we cure congenital epulis?
sURGICAL EXCISION
What are some HPV associated swellings?
Verruca vulgaris
squamous cell papilloma
What is verruca vulgaris?
These are single or multiple intra oral lesions that can be associated with skin warts and are seen on k tissue - gums and palate
What causes verruca vulgaris?
hpv 2 and 4 - common in skin warts
What is squamous cell papilloma?
This is a small pedunculated cauliflower like growths, benign that can be pink to white in colour and are usually on their own
What causes squamous cell papilloma?
hpv 6 and 11
What are some fluid swellings?
mucoceles
rankles
boons nodules
epstein nodules
What is a mucocele?
cyst that arises in connection with minor salivary glands
What are the two types of mucocele?
Mucous extravasation cysts which is where normal secretions rupture into adjacent tissue
mucous retention cyst - this is where secretions are retained in an expanded duct
What do mucoceles look like?
Blue soft transparent cystic swellings that can affect minor or major saliva glands
What do mucoceles affect most?
lower lip minor saliva glands
What causes mucoceles?
Minor trauma such as lip biting causing damage to duct or gland
When do we do surgery for mucoceles?
if fixed in size as will likely damage adjacent glands leading to recurrence
What does surgical excision of mucocele involve?
removal of cyst and adjacent damaged minor salivary gland
What is a ranula?
mucocele in floor of mouth that resembles a frogs belly
What can a radula arise from?
Minor saliva glands or ducts of sublingual/submandib gland
Why do we do ultrasound or Sri of ranula?
To exclude plunging ranula - sometimes it can extend through the fom into submittal or submandibular space
What is a plunging ranula?
ranula that extends through fom into submental or sumbmandib space
What are ranulas occasionally found to be?
Bening tumour of lymphatics
What are bohns nodules?
benign cysts that are seen on alveolar ridge in neonates - they are filled with keratin and are remnants of dental lamina
Advice to parents about bohns. nodules?
They will usually disappear in early months - 3 months of life
What are Epstein pearls?
these are small cystic lesions that are found along the palatal mid line
What are Epstein pearls though to be?
trapped epithelium in the palatal raphe
Advice on Epstein pearls?
Dissapears in first few weeks and occur in majority 80% of neonates
What is TMJDS characterised by? 3
pain
masticatory muscle spasm
limited jaw opening
How do we take a TMJDS history?
When did symptoms begin?
What symptoms?
Is pain ever worse at certain times?
exacerbating factors?
habits?
stress?
What are some symptoms of tmjds?
pain swelling clicking cracking limited jaw opening locked jaw generalised facial discomfort ear ache numbness over masseter
What might worse tmjd pain in morning suggest?
nocturnal clenching
grinding habit
How do we ask about stress in tmjd?
Ask if any stress in life - pending exams, death, divorce?
What should extra oral exam include?
Palpate the muscles of mastication both at rest and when teeth are clenched to assess any tenderness or hypertrophy
palpate TMJ at rest and when opening and closing to assess tenderness and presence of a click or crepitus
Assess opening of jaw - check for any deviations and extend of opening
What is normal mouth opening?
40-50mm
How do we do do intra oral TMJDS exam?
Assess for any dental wear facets
look for signs of clenching and grinding
What are signs of clenching and grinding?
Scalloped lateral tongue surface
buccal mucosa ridges
How do we explain tmjds?
It is normally due to muscles being overworked and misused - its very similar to doing leg exercises where you will feel pain the next day and may need to alter how you walk to ease the pain - this happens with the jaws
What happens if jaw muscles are overworked?
they will be sore and not be able to function correctly which an result in alteration how how jaw is used which can make the problem worse
How do we manage overworked jaw muscles?
Rest and relive exacerbating factors
How can we reduce exacerbating factors?
by managing stress - relaxation, mindfulness, yoga
avoid habtits like clenching, chewing gum, nail biting or leaning on jaw
How do we allow over worked muscles to rest?
avoid opening wide
cut food up small
eat on both sides of mouth
avoid incising food which requires anterior movement of mandible and stretching of muscles
How do we get symptomatic relief of tmjd?
ibuprofen - anti inflam action
alternating use of hot and cold packs
small gap must remain between teeth except when eating and swallowing
