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BDS3 Paediatrics > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

3 main causes of orofacial soft tissue infections

A
  1. viral
  2. bacterial
  3. fungal
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2
Q

viral causes of orofacial soft tissue infections

A

primary herpes
herpangina
hand foot & mouth
MMR
epstein barr virus
varicella zoster

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3
Q

bacterial causes of orofacial soft tissue infections

A

staphylococcal
streptococcal
syphilis
TB

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4
Q

fungal causes of orofacial soft tissue disease

A

candida

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5
Q

describe primary herpetic gingivostomatitis

A

acute infectious disease caused by herpes simplex I
primary infection common in children
recurrence of this is herpes labialis which is cold sores
transmission by droplet formation with 7 day incubation
children under 1 very at risk
lasts 14 days & heals with no scarring

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6
Q

signs & symptoms of primary herpetic gingivostomatitis

A
  • fluid filled vesicles that rupture to ulcers on gingivae, tongue, lips, buccal & palatal mucosa
  • severe oedematous marginal gingivae
  • fever, headache, nausea, malaise
  • cervical lymphadenopathy
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7
Q

treatment of primary herpetic gingivostomatitis

A

rest, soft diet, paracetamol, antimicrobial gel or mouthwash, topical aciclovir for immunocompromised children
most common complication = dehydration

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8
Q

causes of PHG

A

sunlight stress or other causes of ill health
recurrent disease in 50-75% via herpes labialis
remains dormant in epithelial cells

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9
Q

describe herpangina

A

vesicles in the tonsillar / pharyngeal region
lasts 7-10 days

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10
Q

describe hand foot & mouth

A

ulceration on gingiva/tongue/cheeks/palate
maculopapular rash on hands and feet
lasts 7-10 days

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11
Q

describe oral ulceration

A

a localised defect in the surface oral mucosa where the covering epithelium is destroyed leaving an inflamed area of exposed connective tissue

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12
Q

10 key things to ask about

A

onset
frequency
treatment so far (i.e. helpful or unhelpful)
exacerbating factors
number
lesions in other areas
associated medical problems
duration
site
size
OFTEN LADSS

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13
Q

causes of oral ulceration (8)

A

infection - viral e.g. HFM, coxsackie virus, herpes simplex // bacterial e.g. TB, syphilis
immune mediated disorders - crohns, behcets, coeliac
vesiculobullous - pemphigoid, pemphigus vulgaris
inherited or acquired immunodeficiency disorders
neoplastic / haematological - anaemia, leukaemia, cyclic neutropenia
trauma
vit deficiencies - iron, B12, folate
recurrent apthous stomatitis

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14
Q

what is the most common cause of ulceration in children

A

recurrent apthous ulceration

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15
Q

describe recurrent apthous ulceration

A

round or ovoid in shape with a grey or yellow base and have a varying degree of perilesional erythema

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16
Q

describe the patterns of recurrent apthous ulceration

A

minor <10mm
major >10mm
herpetiform 1-2mm - can present with multiple ulcers but unlike herpetiform gingivostomatitis viral infection it is not accompanied by a fever or recurrent

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17
Q

investigations to undertake for oral ulceration

A

diet diary
FBC
haematinics i.e. folate/B12/ferritin
coeliac screen - anti-transglutaminase antibodies

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18
Q

management for oral ulceration

A

diet diary may suggest exacerbating food groups
low ferritin = 3mths of iron supplements
low folate/B12 / positive anti-transglutaminase antibodies = referral to paediatrician for further investigation
allergic factors - dietary exclusion / SLS free toothpaste

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19
Q

pharmacological management in GDP of oral ulceration

A
  1. prevention of superinfection - corsodyl 0.2% mouthwash
  2. protecting healing ulcers - gengigel topical gel (hyalonurate) // gelclair mouthwash (hyalonurate)
  3. symptomatic relief - difflam (0.15% benzydamine hydrochloride) // local anaesthetic spray
20
Q

orofacial granulomatosis in children

A

uncommon chronic inflammatory disorder
idiopathic / associated with systemic granulomatous conditions e.g. crohn’s or sarcoidosis
av age = 11yrs
males > females
characteristic pathology = no caseating giant cell granulomas which then result in lymphatic obstruction

21
Q

clinical features of OFG

A

same as oral Crohn’s
lip swelling - most common
full thickness gingival swelling
swelling of non labial facial tissues
peri-oral erythema
cobblestone appearance of buccal mucosa
linear oral ulceration
mucosal tags
lip/tongue fissuring
angular chelitis

22
Q

investigations for OFG

A

measure growth - paediatric growth charts
FBC
haematinics
patch testing - ID triggers
diet diary - ID triggers
faecal calprotectin
endoscopy risky in childhood
serum angiotensin converting enzyme (raised in sarcoidosis)

23
Q

OFG management

A

can be difficult
OH support
symptomatic relief as per oral ulceration
dietary exclusion
manage nutritional deficiencies
topical steroids
topical tacrolimus
short courses of oral steroids if unresponsive to topical
intralesional corticosteroids
surgical intervention - if unresponsive long standing disfigurement

24
Q

describe geographic tongue in children

A

idiopathic and non contagious
benign change to mucosa with loss of filiform papillae
shiny red areas surrounded by white margins and appears to migrate over time
can be very uncomfortable
thinner oral mucosa in children

25
Q

management of geographic tongue in children

A

rule our haematinic deficiencies
bland diet during flare ups
likely to become less troublesome with age

26
Q

5 examples of solid swellings

A
  1. fibroepithelial polyp
  2. epulides
  3. congenital epulis
  4. HPV associated mucosal swellings
  5. neurofibromas
27
Q

describe fibroepithelial polyps

A

common
firm pink lump (pedunculated / sessile)
mainly in cheeks along occlusal line; lips or tongue
once established remains constant size
initiated by minor trauma
surgical excision is curative
benign nature means difficult to justify GA

28
Q

describe epulides & what are the 3 main types

A

common solid swelling of oral mucosa; benign hyperplastic lesions. 3 main types:
1. fibrous epulis
2. pyogenic granuloma
3. peripheral giant cell granuloma
mainly anterior to molar teeth in maxilla - management is surgical but tendency to recur

29
Q

fibrous epulis

A

pedunculated / sessile mass
firm consistency
similar colour to surrounding gingivae
inflammatory cell infiltrate & fibrous tissue

30
Q

pyogenic granuloma / pregnancy epulis

A

soft deep red/purple swelling
often ulcerated
haemorrhage spontaneously or with mild trauma
vascular proliferation supported by a delicate fibrous stroma
reaction to chronic trauma e.g. calculus
tend to recur after removal

31
Q

peripheral giant cell granuloma

A

pedunculated / sessile swelling
typically dark red & ulcerated
usually arises interproximally & has an hour glass shape
radiographs may reveal superficial erosion to interdental bone
multinucleate giant cells in a vascular stroma
may recur after surgical excision

32
Q

congenital epulis

A

rare lesion
occurs in neonates
most commonly affects anterior mucosa
F>M
granular cells covered with epithelium
benign
simple excision curative

33
Q

2 types of HPV associated swellings

A
  1. verruca vulgaris
  2. squamous cell papilloma
34
Q

verruca vulgaris

A

solitary / multiple intra oral lesions
may be associated with skin warts
caused by HPV 2 & 4
commonly on keratinised tissue i.e. gingivae / palate
can be removed surgically

35
Q

squamous cell papilloma

A

small pedunculated cauliflower like growths
benign
HPV 6 & 11
vary in colour from pink to white
usually solitary
treatment = surgical excision

36
Q

4 main fluid swellings

A
  1. mucoceles
  2. ranula
  3. Bohn’s nodules
  4. epstein pearls
37
Q

2 variants of mucoceles

A
  1. mucous extravasation cyst - normal secretions rupture into adjacent tissue
  2. mucous retention cyst - secretions retained in an expanded duct
38
Q

describe mucoceles

A

bluish soft transparent cystic swelling
can affect minor / major salivary glands
most = minor glands of lower lip
peak incidence = 2nd decade
most will rupture spontaneously
surgery only if lesion fixed in size as will likely damage adjacent glands leading to recurrence
surgical excision involves removal of cyst and adjacent damaged minor salivary gland

39
Q

describe ranula

A

mucocele in floor of mouth
can arise from minor salivary glands / ducts of sublingual or submandibular glands
ultrasound/MRI needed to exclude plunging ranula (extend through FOM into submental/submandibular space)
occasionally found to be lymphangioma - benign tumour of lymphatics

40
Q

Bohn’s nodules

A

gingival cysts
remnants of dental lamina
filled with keratin
occur on alveolar ridge
found in neonates (1st 28 days)
usually disappear in early months of life

41
Q

epstein pearls

A

small cystic lesions
found along mid palatal line
thought to be trapped epithelium in palatal raphe
in 80% neonates
disappear in 1st few weeks

42
Q

most common condition affecting temporomandiublar joint region

A

temporomandibular joint dysfunction syndrome (TMJDS)

43
Q

characterisation of TMJDS

A

pain
masticatory muscle spasm
limited jaw opening

44
Q

TMJDS extraoral exam

A
  • palpation of MoM both at rest & clenching to assess tenderness and/or hypertrophy
  • palpation of TMJ at rest and when opening / closing to assess tenderness & click/crepitus
  • assessment of opening ; check for deviation of jaw and assess extent of opening (normal = 40-50mm)
45
Q

TMJDS intraoral exam

A
  • assessment of any dental wear facets
  • signs of clenching / grinding; scalloped lateral tongue surface and buccal mucosa ridges
46
Q

management of TMJDS

A

reduce exacerbating factors - manage stress, avoid habits i.e. clenching, grinding, nail biting, a bite raise/guard if nocturnal habit
allow overworked muscles to rest - avoid wide opening, soft diet with little chewing
symptomatic relief - use ibuprofen (anti-inflammatory)
teeth should not be in contact at rest

BDS3 Paediatrics (5 decks)

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