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Paediatric dentistry > Soft tissue lesions > Flashcards

Soft tissue lesions Flashcards

1
Q

Why are soft tissues important

A

Look for systemic diseases that are realted to soft tissues

Complications with GA –> enlarged tonsils, sleep apnoea etc

Biopsies in children rare

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2
Q

6 categories of lesions

A

Infections
Ulcers
White lesions
Cysts
Epulides - swellings of gingiva
Factitious - self inflicted

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3
Q

Most common viral infection

A

Primary herpes simplex (and secondary)

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4
Q

Primary herpes simplex vs secondary (intra-oral)

A

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

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5
Q

Other clinical signs of primary herpes simplex and tx

A

18 mos - 2 years old
Fever
Malaise
Pain on eating/drinking (dehydration)
Excessive dribbling

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6
Q

Treatment of primary and secondary herpes simplex virus and most other viral infections

A

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

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7
Q

Other viral infections: varicella-zoster-virus

A

Chicken pox
-oral ulcerations
-vesicles on skin
-easily spread unless crusted over
-vaccinate

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8
Q

Other viral infections: human papilloma virus

A

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)

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9
Q

Other viral infections: mumps

A

Paramyxovirus - single stranded RNA is cause
-bilateral swelling of the parotid glands
-unilateral swelling of salivary glands mimicking large dental abscess
-MMR vaccine

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10
Q

Other viral infections: herpangina and hands foot mouth

A

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

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11
Q

Other viral infections: epstein-barr virus (infectious mononucleosis)

A

-teenagers
-flu-like symptoms
-white vesicles at back of throat

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12
Q

Most common bacterial infections and uncommon severe manifestation

A

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)

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13
Q

What is dens in dente

A

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

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14
Q

Most common fungal infections

A

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

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15
Q

What is an ulcer and common types of ulcer

A

Ulcer is a break in the mucosa

Traumatic - heals on removal of cause
RAS - recurrent aphthous stomatitis

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16
Q

Recurrent aphthous ulceration and associated factors

A

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

17
Q

Minor RAS

A

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

18
Q

Major RAS

A

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

19
Q

Herpetiform RAS

A

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

20
Q

RAS treatment

A

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

21
Q

Common white lesions

A

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

22
Q

Salivary gland cysts - 2 types

A

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

23
Q

Gingival cysts

A

Infants
-cluster of nodules on alveolar ridge –> dental lamina remnants
-tiny keratinised cysts - rupture 5 mos after birth
-palate similar

24
Q

Epulides

A

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

25
Q

Oro-facial granulomatosis presentation +/- crohns disease

A

Crohns disease:
-autoimmune disorder of gut (genetics, food allergies etc)

OFG in crohns presents as:

Lip swelling
Cobblestoning of mucosa
Mucosal tags (pedunculated)
Thick fibrous hyperplastic gingiva

26
Q

Factitious lesions (self inflicted)

A

Munchhousons syndrome
-psychological illness
-stress and attention seeking
-self inflicted repeated injuries that dont heal unless seek help

Paediatric dentistry (8 decks)

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