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3. Paediatrics > Peads Oral Medicine 1 > Flashcards

Peads Oral Medicine 1 Flashcards

1
Q

What infections can affect oral tissues?

A

Viral

Bacterial

Fungal

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2
Q

What are some viral infections affecting soft tissues?

A

primary herpes

Herpangina

Hand foot and mouth

MMR

Epstein barr virus

Varicella Zoster

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3
Q

What bacterial infections affect soft tissues?

A

Staph

Strep

Syphillis

TB

Cat scratch disease

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4
Q

What is an example of an oral infection caused by fungi?

A

Candida

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5
Q

What is primary herpetic gingivostomatitis?

A

most common viral infection of the mouth.

its an acute infectious disease resulting from herpes simplex 1

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6
Q

What causes primary herpetic gingivostomatitis?

A

Primary herpetic gingivostomatitis is caused by an initial infection with the herpes simplex virus Type I and characterized by painful, erythematous, and swollen gingivae.

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7
Q

How is primary herpetic gingivostomatitis transmitted?

A

Droplet formation with 7 day incubation period

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8
Q

What can a recurrence of herpes simplex virus type 1 cause?

A

Herpes labialis = cold sores

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9
Q

Why is herpes simplex 1 infection rare in first year of life?

A

Due to circulating maternal antibodies

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10
Q

What does primary herpetic gingivostomatits initially present like?

A

multiple fluid filled vesicles on gums, tongue, lips, buccal and palatal mucosa which then rupture into large painful ragged ulcers

severe oedematous marginal gingivitis

fever

headache

illness

cervical lymphadenopathy

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11
Q

What is most common presentation of primary herpetic gingivostomatitis?

A

painful rugged ulceration

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12
Q

What other symptoms can be seen alongside oral symptoms of primary herpetic gingivostomatitis?

A

malaise

fever

headache

pt may be unable to eat or drink due to pain –> leads to dehydration

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13
Q

What is the treatment for primary herpetic gingivostomatitis?

A

it is a self limiting condition which must be managed with

bed rest

adequate fluid intake/soft diet

paracetamol

antimicrobial gel or mouthwash

aciclovir for immunocompromised kids

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14
Q

Why would we use mouthwash or antimicrobial gel in children with PHG?

A

To prevent super infections

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15
Q

When would we use aciclovir for PHG?

A

In immunocompromised pts - we would also want to seek medical impute for these groups of children

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16
Q

What is most common complication of PHG?

A

Dehydration - child may find eating and drinking difficult du eat pain

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17
Q

How long does PHG last?

A

14 days

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18
Q

How does PHG heal?

A

No scarring

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19
Q

What happens following primary infection of herpes simplex I?

A

it remains dominant in epithelial cells and can re present with secondary infection such as cold sores

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20
Q

What can trigger re occurrence of herpes simplex I?

A

Stress

Ill health

Sun

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21
Q

How can we manage herpes labialis?

A

Aciclovir topical cream 5% (2g applied to lesion every 4 hours 5x day for 5 days)

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22
Q

How can we manage herpes simplex?

A

Aciclovir tablets - 200mg oral tablets or oral suspension (2-17 years 5x daily) under 2 is diff dose

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23
Q

What can the coxsackie A virus cause?

A

herpangina

hand foot and mouth

both are herpes like infections

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24
Q

What is herpangina?

A

mouth blisters, is a painful mouth infection caused by coxsackieviruses. Usually, herpangina is produced by one particular strain of coxsackie virus A

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25
Q

What does herpangina present like?

A

Vesicles in the tonsillar/pharyngeal region

its a mild condition that presents like PHG with vesicles rupturing to ulceration but further back in the mouth (tonsil pharyngeal region)

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26
Q

What is hand foot and mouth?

A

caused by coxackie A virus
Hand, foot and mouth disease is a common infection that causes mouth ulcers and red spots on the hands and feet. It mainly affects children.

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27
Q

What does child present with in hand foot and mouth?

A

Ulcers on the gingival/tongue/cheeks and palate

and a maculopapular rash on hands and feet

soar throat

reluctance to eat

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28
Q

What appears a few days after mouth ulcers in hand foot and mouth?

A

Maculopapular rash on hands and feet

29
Q

What is management like for hand foot and mouth?

A

Same as herpes simplex 1 - bed rest, stay hydrated, paracetamol if required and will heal in 7-10 days

30
Q

What is an oral ulceration?

A

Localised defect in surface oral mucosa where covering epithelium is destroyed leaving inflamed area of exposed connective tissue

31
Q

What are the 10 facts we need when taking ulcer history?

A

onset

freq

number

size

site

duration

exacerbating diet factors

lesions in other areas?

associated med problems

any tx so far that has helped or not helped?

32
Q

What are the 8 causes of oral ulceration?

A

infection

immune mediated disorders

vesticulobullous disorders

inherited or acquired immunodeficiency disorders

neoplastic/haematological

trauma

vitamin deficiencies

recurrent apthous stomatitis

33
Q

What infections can cause ulcers?

A

herpes simplex

hand foot and mouth

coxsackie virus

syphillis

34
Q

What immune mediated conditions can cause ulcers?

A

Crohns

coeliac

35
Q

What neoplastic/haemotological conditions can cause ulcers?

A

leukaemia

anaemia

36
Q

What causes trauma ulcers?

A

Physical, thermal or chemical trauma can cause ulceration which will cause ulcer in area of trauma that will resolve approx 2 weeks after causative factor is identified and solved - ie if sharp tooth we manage it and ulcer should resolve within 14 days

37
Q

What vitamin deficiencies can cause ulcers?

A

iron

b12

folate

38
Q

What is recurrent apthous stomatitis?

A

This is when there is no underlying cause

39
Q

What is the most common cause of ulceration in children?

A

recurrent apthous ulceration

40
Q

How would apthous ulcers be described as?

A

Round or ovoid in shape with grey or yellow base and varying degree of perilesional erythema

41
Q

What are the 3 subgroups of recurrent apthous ulceration?

A

minor

major

herpetiform

42
Q

What are minor ulcers?

A

These are under 10mm in size and don’t affect keratinised mucosa and tend to heal within 10-14 days

43
Q

Describe the mucosa in the mouth

A

Keratinized squamous epithelium is present in the attached gingiva and hard palate as well as areas of the dorsal surface of the tongue. Nonkeratinized squamous epithelium covers the soft palate, inner lips, inner cheeks, and the floor of the mouth, and ventral surface of the tongue.

44
Q

What are major ulcers?

A

These are >10mm in size and can affect keratinised tissue and takes several weeks to heal and can leave residual scarring

45
Q

What are heptiform ulcers?

A

Ulcers 1-2mm in size, normally multiple present at a time and can be up to 100 present

46
Q

What can heptiform ulcers appear like?

A

similar to PHG however unlike viral infections they aren’t normally accompanied by a fever and can be recurrent

47
Q

What are the causes of recurrent ulcers?

A

Aetiology unclear - no single causative factor however genetic predisposition holds strongest risk for children developing ulcers where pattern of ulceration changes

48
Q

What are some other causes of recurrent ulcers?

A

Haematological and deficiency disorders - iron demands increase in childhood and low iron levels and subsequent ulcers can be seen during growth

GIT disease such as coeliac - low level of b12 will warrant referral

stress

allergic disorders

hormonal disturbances

49
Q

What allergies can cause ulcerations?

A

SLS in toothpaste

foods with benzoate - chocolate, tomatoes

50
Q

If following history and exam pt is considered to have recurrent apthous ulceration then what should we do?

A

Often useful to carry out some investigations such as:

  • diet diary
  • FBCs
  • Haematinics - folate/b12/ferritin
  • coeliac screen
51
Q

If pt is expected coeliac what investigation do we do?

A

Anti-transglutaminase antibodies

52
Q

How do we manage recurrent ulceration?

A

Diet analysis to see if any exacerbating food groups

low ferritin - 3 months of iron supplementation

low b12 or folate then refer to paediatrician

positive anti-ttransglutaminase then referral also

53
Q

How can we manage exacerbating factors of ulcers?

A

we can correct nutritional deficiencies

avoid sharp or spicy foods

manage traumatic factors

allergic facets - diet exclusion, sis free toothpaste

54
Q

What is the main aim of pharmacological intervention in recurrent ulcers?

A

To prevent superinfection, protect healing ulcers and provide relief of symptoms

55
Q

What do we use to prevention superinfection?

A

Corsodyl 0.2% mouthwash

56
Q

What do we use to protect healing ulcers?

A

gengigel topical gel
- 3-4 times a day

gengigel mouthwash

57
Q

How do we relieve symptoms of ulcers?

A

benztdamine mouthwash, spray echt

(bran - difflam)

0.15%

58
Q

When does OFG begin

A

Often begins in childhood - average onset of age is 11

59
Q

What is OFG?

A

rofacial granulomatosis (OFG) is an uncommon condition of the mouth that causes lip swelling, and sometimes swelling of the face, inner cheeks, and the gums.

60
Q

What does OFG appear like?

A

Identical to oral manifestation of crohns disease - can be future predictor of crohns

61
Q

What causes the clinical features of OFG?

A

Allergic component which results in lymphoedema and swelling of oral tissues and the presence of non caveating granulomas in oral tissues which prevent normal lymphatic drainage

62
Q

What is the characteristic pathology of OFG?

A

Non caveating giant cell granulomas which then result in lymphatic obstruction

63
Q

What can OFG be a future predictor of?

A

Crohns disease

64
Q

What are the clinical features of OFG?

A

Lip swelling

full thickness gingival swelling

swelling of non labial facial tissues

cobblestone appearance of buccal mucosa

mucosal tags

lip tongue fissuring

angular chelitis

deep penetrating ulcers

65
Q

Whats the cause of OFG?

A

Unknown - limited evidence of genetic predisposition

66
Q

How do we dx OFG?

A

Mostly by clinical basis as biopsy of lip not essential and can be uncomfy and distressing resulting in additional post op swelling

67
Q

For pts who have clinical OFG dx what do we do?

A

Consider investigations to aid management and rule out other underlying conditions

68
Q

What are some OFG investigations we can do?

A

Measure growth - to track weight and height - growth failure or pubertal delay can be see in crohns disease and can indicate this disease

FBC - iron deficiency may be present

Check for c reactive proteins - usually raised in crohns

faecal calcirotein

69
Q

How do we manage OFG in kids?

A

Can be difficult - needs referral to specialist often

support needed with OHI as oral discomfort often present

can provide symptomatic relief as per oral ulceration (difflam)

manage nutritional deficiencies

topical steroids

short courses of oral steroids if severe or unresponsive to topical

3. Paediatrics (10 decks)

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