PAEDS- oral medicine Flashcards
Identify and describe this clinical image?
This is primary herpetic gingivostomatitis.
This results in fluid filled vesicles found on the gingiva, lips, tongue, buccal and palatal mucosa.
These vesicles can rupture causing ulceration.
This will normally last 10-14 days.
identify and describe this clinical image.
This is a herpangioma.
This is when there are fluid filled vesicles in the tonsillar area or the pharyngeal regions.
This normally lasts 7-10 days.
These vesicles can rupture to cause ulceration.
Identify and describe this clinical image?
This is hand foot and mouth.
It is characterised by ulceration on the gingivae/tounge/cheeks/palate and a maculopapular rash on the hands and feet.
It commonly lasts 7-10 days.
What are the symptoms of primary herpetic gingivostomatitis?
Fever
Headache
Severe oedematous marginal gingivitis
Vesicles/ulceration.
How do we treat:
Primary herpes
Herpangina
Hand foot and mouth.
Bed rest
soft diet
Paracetamol
Antimicrobial gel or mouthwash.
What is Herpes labialis?
What triggers it?
How do we manage it?
This is a secondary herpes infection.
It can be triggered by stress, sunlight or other causes of ill health.
We manage it with a topical acylovir cream.
What is oral ulceration ?
an inflamed and exposed area of connective tissue due to destruction of the epithelium (covering)of the oral mucosa.
list some causes of oral ulceration?
Trauma
Infection (e.g. hand, foot and mouth)
Immune deficiencies
Vitamin deficiencies (e.g. Iron/ folate/ vitamin B12)
Systemic diseases (e.g. chrons disease)
Neoplastic
Recurrent apthous stomatitis- no underlying cause.
What information do we want to know for an ulcer history?
Onset
Frequency
Number
Size
Site
Duration
Exacerbating factors
Lesions in other areas
Any treatments? (what did and didn’t work)
How do we describe an ulcer?
Border
Shape
Colour
Size
Location
Lesion characteristics.
What investigations should we consider after diagnosing an ulcer?
Full blood count
Diet diary
Haematinics
Coeliac screening (looking for anti-transglutaminase antibodies. )
How do we manage ulcers?
Deal with the exacerbating factors
- Nutritional deficiencies (iron supplements or refer)
- Traumatic factors.
- Avoid sharp or spicy foods
- Avoid allergic reactions.
Pharamceutical
- Prevent superinfection infection- Corsodyl 0.2% mouthwash
- Provide a barrier- (Hyaluronate) Gengigel topical gel or Gelcair mouthwash
- Symptomatic relief- Difflam or LA spray.
List the clinical features of Orofacial granulomatosis and oral chron’s
- Swelling:
- Lips
- Gingiva
- Non-labial facial surfaces
- Peri-oral erythema
- Cobblestoning of the buccal mucosa
- Linear oral Ulceration.
- Mucosal tags
- Lip/tongue fissuring/ angular cheilitis
How do we manage OFG?
Oral hygiene support
Symptomatic relief for the oral ulceration
Dietary exclusion to reduce the infammation.
Topical steroids
Topical Tacrolimus (immunosuppressants)
Discuss this clinical image?
This is geographical tongue.
We have red inflamed areas surrounded by white margins.
This caused by a loss of filiform papillae.
It can cause intense discomfort especially with spicy food, tomato and citrus fruits.
This managed by: a bland diet during flare ups.
Discuss this clinical image
This is a fibro-epithelial polyp.
A firm pink lump found mainly in the cheeks/lips or tongue.
This remains constant in size and is caused by minor trauma.
This is treated by surgical excision.
Discuss this clinical image?
Congential epulis.
This is found on the anterior maxilla of neonates.
It is benign and is treated by excision.
Discuss this clinical image?
This presents with pedunculated cauliflower like lesion. That is caused by HPV.
-HPV6&11- Squamous cell papilloma
HPV2&4- Verruca Vulgaris (also associated with skin warts)
What are epiludes?
Solid swellings of the oral mucosa .
Discuss this clinical image?
This is a fibrous epulis.
The lesion is a similar colour as the gingivae.
It is a pedunculated or sessile mass with a firm consistency
Discuss this clinical image?
Pyogenic granuloma.
This is a soft, deep red/ purple swelling that is often ulcerated.
It can haemorrhage spontaneously or with mild trauma.
If found in a pregnant women we call it a pregnancy epulis.
Discuss this clinical image?
This is a peripheral giant cell granuloma.
This is a dark red and ulcerated swelling.
It is interproximal with an hourglass shape- buccal and lingual swellings joined by a narrow middle section between the teeth.
Discuss this clinical image?
This is a mucocele.
It is a cyst originating from a minor salivary gland.
This is normally related to trauma.
Most will rupture spontaneously.
Discuss this clinical image?
This is a ranula- which is a mucocele from a minor or major salivary gland in the floor of the mouth.
We need to do an MRI to exclude a plunging ranula (the ranula goes submandibular or submental)
Discuss this clinical image?
Bohn’s nodules-
Gingival cysts seen on the alveolar ridge.
This usually disapears in the first few months of life.
Discuss this clinical image?
Epstein’s pearls.
Small cystic lesions found along the palatal midline.
They disappear in the 1st few weeks.
What is characteristic of temporomandibular joint dysfunction syndrome
Pain when opening the mouth
Restricted mouth opening.
Mastigatory muscle spasm.
How do we manage temporomandibular joint dysfunction syndrome?
Reduction of exasterbating factors :
- Habits ( clenching/ grinding/ chewing gum/ nail biting/leaning on the jaw)
- Manage stress
- A bite raising device (if nocturnal grinding/ clenching)
Rest the overworked muscles
- Avoid wide mouth opening
- Soft diet
Symptomatic relief
- Analgesic
- Alternating hot and cold packs.
