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Paediatrics > oral medicine > Flashcards

oral medicine Flashcards

1
Q

What are possible oro-facial soft tissue infections

A

Viral
-Primary herpes
-Herpangina
-Hand foot and mouth

Bacterial
-Staphylococcal
-Streptococcal
-Syphilis
-TB
-Cat Scratch Disease

Fungal
-Candida

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2
Q

What is Primary hepatic gingivostomatitis

A

Its an acute Infectious disease caused by herpes Simplex Virus I

Primary infection common in children

Transmission by droplet formation with 7 day incubation period

Almost 100% of the adult population are carriers

lasts 14 days

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3
Q

What are S&S of Primary Herpetic Gingivostomatitis

A

Fluid filled vesicles
–rupture to painful ragged ulcers on the gingivae, tongue, lips, buccal and palatal mucosa

Severe oedematous marginal gingivitis

Fever

Headache

Malaise

Cervical lymphadenopathy

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4
Q

What is the treatment of PHG

A

Bed rest

Soft diet/hydration

Paracetamol

Antimicrobial gel or mouthwash

topical acyclovir cream for immunocompromised children

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5
Q

What is the most common complication with PHG

A

Dehydration

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6
Q

What is the recurrency of PHG

A

Recurrent disease in 50-75% = herpes labialis (cold sores)

As it remains dormant

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7
Q

Coxsackie virus can cause what 2 herpatic like infection

A

Herpangina
-Vesicles in the tonsillar/ pharyngeal region
-Lasts 7-10 days

Hand/ foot and mouth
-Ulceration on the gingivae/tongue/cheeks and palate
-Maculopapular rash on the hands and feet
-Lasts 7-10 days

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8
Q

What is oral ulceration

A

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

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9
Q

What are the 10 key facts in oral ulceration history

A

-Onset
-Frequency
-Number
-Site
-Size
-Duration
-Exacerbating dietary factors
-Lesions in other areas
-Associated medical problems
-Treatment so far (helpful/unhelpful)

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10
Q

What are the causes of oral ulceration

A

Infection:
-Viral: Hand foot and mouth/ Coxsackie Virus/ Herpes Simplex/ Herpes Zoster, CMV, EBV, HIV
-Bacterial: TB, syphilis

Immune mediated Disorders:
-Crohns, behcets, SLE, Coeliac, Periodic fever syndromes

Vesiculobullous disorders:
-Bullous or mucous membrane pemphigoid, pemphigus vulgaris, linear IgA disease, erythema multiforme

Inherited or acquired immunodeficiency disorders

Neoplastic/Haematological:
Anaemia/Leukaemia/agranulocytosis/cyclic neutropenia

Trauma

Vitamin deficiencies – Iron, B12, Folate

Recurrent Apthous Stomatitis

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11
Q

What is the most common form of oral ulceration in children

A

Recurrent Apthous ulceration (RAU)

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12
Q

What do RAU’s look like and what are the 3 patterns

A

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

3 patterns:
Minor - <10mm
Major - >10mm
Herpetiform – 1-2mm

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13
Q

What are posible aeitiology factors of recurrent ulceration

A

-Hereditary predisposition (FH in 45%)
-Haematological and deficiency disorders (iron Def in 20%)
-Gastrointestinal disease (Coeliac in 2-4%)
-Minor trauma in a susceptible individual
-Stress
-Allergic disorders
-Hormonal disturbance: Menstruation

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14
Q

When investigating ulceration what do you do

A

Initial Investigations:
-Diet diary
-Full Blood Count
-Haematinics (Folate/B12/Ferritin)
-Coeliac Screen: Anti-transglutaminase antibodies

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15
Q

What is the management of ulceration

A

Diet anaylsis may suggest exacerbating food groups

Low Ferritin = 3 months of iron supplementation

Low Folate/B12 or positive Anti-transglutaminase antibodies = referral to paediatrician for further investigation

Manage exacerbating factors:
-Nutritional deficiencies
-Traumatic factors
-Avoid sharp or spicy food

Manage pharmacologically:
-Prevention of Superinfection:
Corsodyl 0.2% Mouthwash
-Protect healing ulcers
Gengigel topical gel (hyaluronate)
Gelclair mouthwash (hyaluronate)
-Symptomatic relief
Difflam (0.15% benzydamine hydrochloride)
Local anaesthetic Spray

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16
Q

What is orofacial granulomatosis

A

Uncommon chronic inflammatory disorder

Idiopathic or associated with systemic granulomatous conditions (Crohn’s disease or Sarcoidosis)

17
Q

What may OFG be a predictor for

A

Crohns

18
Q

What are clinical features of OFG

A

-Lip Swelling on
-Full thickness gingival swelling
-Swelling of the non labial facial tissues
-Peri-oral erythema
-Cobblestone appearance of the buccal mucosa
-Linear oral ulceration
-Mucosal tags
-Lip/ tongue fissuring
Angular cheilitis

19
Q

How would you manage OFG

A

-Oral hygiene support
-Symptomatic relief as per oral ulceration
-Dietary exclusion (does not cure just reduces orofacial inflammation)
-Manage nutritional deficiencies which may contribute to oral ulceration
-Topical steroids
-Topical tacrolimus
-Short courses of oral steroids (severe or unresponsive to topical)
-Intralesional corticosteroids
-Surgical intervention – unresponsive long standing disfigurement

20
Q

What is geographic tongue

A

Mucosal lesions of the tongue

Its Idiopathic and non contagious

May be seen at a young age
Shiny red areas on the tongue with loss of filiform papillae are surrounded by white margins

Can cause intense discomfort in children
Discomfort with spicy food/ tomato or citrus fruit/juice

21
Q

How would you manage Geo. tongue

A

Bland diet during flair ups

22
Q

Give examples of solid swellings

A

Fibroepithelial Polyp
Epulides
Congenital epulis
HPV-associated mucosal swellings
Neurofibromas

23
Q

What is a fibroepithelial polyp

A

-Common
-Firm pink lump (pedunculated or sessile)
-Mainly in the cheeks (along occlusal line); lips or tongue
-Once established remains constant size
-Thought to be initiated by minor trauma
-Surgical excision is curative

24
Q

What is Epulides and what are the 3 main types

A

Common solid swelling of the oral mucosa

Benign hyperplastic lesions

3 main types:
-Fibrous epulis
-Pyogenic granuloma
-Peripheral giant cell granuloma

25
Q

What is a fibrous epulis

A

-Pedunculated or sessile mass
-Firm consistency
-Similar color to surrounding gingivae
-Inflammatory cell infiltrate and fibrous tissue

26
Q

What is Pyogenic Granuloma

A

-Soft, deep red/purple swelling
-Often ulcerated
-Haemorrhage spontaneously or with mild trauma
-Vascular proliferation supported by a delicate fibrous stroma
-Probably a reaction to chronic trauma e.g. calculus
-Tend to recur after removal

27
Q

What is Peripheral Giant Cell Granuloma

A

-Pedunculated or sessile swelling
-Typically dark red and ulcerated
-Usually arises inter-proximally and has an hour-glass shape
-Radiographs may reveal superficial erosion of the interdental bone
-Multinucleate giant cells in a vascular stroma
-May recur after surgical excision

28
Q

What is a congenital Epulis

A

-Rare lesion
-Occurs in neonates
-Most commonly affect the anterior maxilla
-Granular cells covered with epithelium
-Benign
-Simple excision is curative

29
Q

What are the 2 HPV associated swellings

A

Verruca vulgaris

Squamous cell papilloma

30
Q

Talk about Verruca vulgaris

A

Solitary or multiple intra-oral lesions
May be associated with skin warts
Caused by HPV 2 and 4
Most commonly on keratinized tissue – gingivae and palate
Most resolve spontaneously
Can be removed surgically

31
Q

Talk about squamous cell papilloma

A

Small pedunculated cauliflower like growths
Benign
HPV 6 and 11
Vary in colour from pink to white
Usually solitary
Treatment = surgical excision

32
Q

Name some oral fluid swellings

A

Mucoceles
Ranula
Bohn’s nodules
Epstein Pearls

33
Q

What is a mucoceles and what are the 2 types

A

Bluish, soft, transparent cystic swelling

Mucous extravasation cyst – normal secretions rupture into adjacent tissue

Mucous retention cyst – secretions retained in an expanded duct

34
Q

What is ranula

A

Mucocele in the Floor of mouth

Can arise from minor salivary glands or ducts of sublingual/submand gland

Ultrasound or MRI needed to exclude plunging ranula

Occasionally found to be lymphangioma

35
Q

What is Bohns modules

A

Gingival cysts
Remnants of the dental lamina
Filled with keratin
Occur on the alveolar ridge
Found in neonates (1st 28 days)
Usually disappear in the early months of life

36
Q

What are epsteins pearls

A

Small cystic lesions
Found along the palatal mid-line
Thought to be trapped epithelium in the palatal raphe
In ~ 80% neonates
Disappear in the 1st few weeks

37
Q

What s the most common condition affecting the temporomandibular region

What is it characterised by

A

Temporomandibular joint dysfunction syndrome(TMJDS)

Pain
Masticatory muscle spasm
Limited jaw opening

38
Q

If a patient comes in with TMJDS what would you ask in history taking

A

A description of presenting symptoms
When did the discomfort begin
Is the pain worse at any time during the day
Exacerbating factors
Habits
Stress

39
Q

With a patient with TMJDS what would you check in intra and extra oral examination

A

Extra

Palpation of the muscles of mastication both at rest and when the teeth are clenched to assess tenderness and/or hypertrophy

Palpation of the TMJ at rest and when opening and closing to assess tenderness and click/crepitus

Assessment of opening
-Check for any deviation of the jaw
-Assess extent of opening (normal = 40-50mm)

Intra

Assessment of any dental wear facets

Signs of clenching/grinding:
Scalloped lateral tongue surface
Buccal mucosa ridges

Paediatrics (6 decks)

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