Soft tissue lesions Flashcards
Why are soft tissues important
Look for systemic diseases that are realted to soft tissues
Complications with GA –> enlarged tonsils, sleep apnoea etc
Biopsies in children rare
6 categories of lesions
Infections
Ulcers
White lesions
Cysts
Epulides - swellings of gingiva
Factitious - self inflicted
Most common viral infection
Primary herpes simplex (and secondary)
Primary herpes simplex vs secondary (intra-oral)
Primary:
-red, swollen, inflamed, bleeding gingiva
-whitish vesicles evolved to yellow ulcers on tongue, throat, palate, lips, buccal mucosa
-soreness
Secondary:
-vesicular lesion on vermillion border
-break down and crust (superinfected)
-reactivation of herpes (older children)
-exposure to UV light, stress, hormonal change, immunocompromised
Other clinical signs of primary herpes simplex and tx
18 mos - 2 years old
Fever
Malaise
Pain on eating/drinking (dehydration)
Excessive dribbling
Treatment of primary and secondary herpes simplex virus and most other viral infections
tx: SUPPORTIVE, FLUIDS, REST etc (self-limiting)
primary - supportive, analgesia, hydration with food and drink, reassurance, minimal contact
secondary - acyclovir cream (immunocompromised etc)
REVIEW In 7 days
Other viral infections: varicella-zoster-virus
Chicken pox
-oral ulcerations
-vesicles on skin
-easily spread unless crusted over
-vaccinate
Other viral infections: human papilloma virus
HPV- benign oral warts
-small cauliflower lesions, 5mm
-cut off but may recur
-vaccination against cancer causing HPV etc (not associated with the one that causes warts)
Other viral infections: mumps
Paramyxovirus - single stranded RNA is cause
-bilateral swelling of the parotid glands
-unilateral swelling of salivary glands mimicking large dental abscess
-MMR vaccine
Other viral infections: herpangina and hands foot mouth
Herpangina:
Coxsacki A virus
-vesicles on back of throat - fauces, soft palate, uvula and tonsils (coalesce)
-fever
HFM:
-similar to herpangina
-vesicles in all 3 areas
Other viral infections: epstein-barr virus (infectious mononucleosis)
-teenagers
-flu-like symptoms
-white vesicles at back of throat
Most common bacterial infections and uncommon severe manifestation
Dental abscess
-normally associated w/ caries
-change in colour, mobility, pain
-sinus or red spot in gum
-extraoral drainage (red, swollen area)
Severe life threatening manifestation of this:
LUDWIGS ANGINA - bilateral swelling of submandibular and sublingual spaces - not common in children
TB
-facial swelling (cervical LN)
What is dens in dente
Tooth within a tooth
Clinical:
-tooth with deep pit
-strange, conical shaped
-2 pulp chambers
-Upper 2s
-RG diagnosis
Any slight bacterial ingress will cause whole teeth - non vital as PC within crown is close to surface –> EXTRACTION/fissure seal early
Most common fungal infections
Candidiasis:
-chronic white plaque on tongue, buccal mucosa
-concerning for children –> sign of immunosuppression etc
Denture (avulsed teeth)/ortho appliance related stomatitis:
-red, delineation hard palate in line with appliance
-continuously wearing denture
-should soak overnight in miltons, myconazole gel or nystatin to tx
REFERAL for antifungals
What is an ulcer and common types of ulcer
Ulcer is a break in the mucosa
Traumatic - heals on removal of cause
RAS - recurrent aphthous stomatitis
Recurrent aphthous ulceration and associated factors
Recurrent episodes of ulcers in healthy individuals
Minor, major and herpetiform subtypes
Factors:
-genetic or immune predispoition
-cell mediated immunity
-haematinic (fe, B12, folate) deficiency
-sex hormones (puberty)
-emotional and physical stress
-tobacco smoking protective
Minor RAS
50% of cases of RAS
Yellow/grey base, halo of erythema and soreness
Non-keratinised mucosa
Average size < 10mm
Oval
1-5 per crop
Heal within 1-2 weeks
Non scarring
Peak onset: 10-20 years
Major RAS
25% of cases of RAS (rarer)
All mucosal surfaces
Average size 5 - 15 mm - bigger
Oval
1-5 per crop
Heal within 4 months - much longer
Scarring
Peak onset: 5-20 years
Herpetiform RAS
25% of cases of RAS - rare in children
Non-keratinised
Average size < 3mm
Round / irregular
5-20 per crop (coalesce)
Heal within 2 months
Non scarring
Peak onset: 20-35 years
RAS treatment
Supportive - comfort
Topical anaesthetics
-lidocaine 5% oral gel
-difflam: benzydamine hydrochloride oral rinse/spray
-orabase muco-adhesive paste
Antimicrobials
-CHX/doxy MW
-prevent secondary infection
Non-supportive - healing:
Topical steroids
-betamethasone or prednisolone MW tablets
-corlan muco-adhesive pellets
-fluticasone spray
Systemic agents
-colchicine
-prednisolone
Common white lesions
Cheek biting
- linea alba (in line occlusal plane on BM, stress)
Burns
-uncommon
Geographic tongue
-areas of red depapillation on tongue
-serpentine border
-move around
Salivary gland cysts - 2 types
Mucocele (minor salivary glands)
-round, mobile, translucent
-trauma related
-refer 2 week pathway by GP
Tx:
-eliminate cause
-burst
-excise with care if persistent (sedation or GA, cooperativity, eliminate cause or will recur)
Ranula (major salivary gland)
-SMALL = mucus plug in sublingual gland that releases saliva
-LARGE - cause deviation of tongue
Tx:
-marsupialisation: cut top of it, let saliva drain, stitch to keep open, heals by secondary intention
=care with nerves/vessels near FoM
Gingival cysts
Infants
-cluster of nodules on alveolar ridge –> dental lamina remnants
-tiny keratinised cysts - rupture 5 mos after birth
-palate similar
Epulides
Fibrous Epulis
-pedunculated (stalk), swollen papilla
-red with white keratinisation spots
-trauma e.g. from lower teeth = growth
-gingival reaction to inflammatory stimulus
-non plaque induced gingivitis
-plaque or calculus set it off
Tx:
Small = clean under it
Large = excise
Histopathology
Congenital epulis
-newborns lump on gum
-uncommon
-leave and monitor if no malaise
