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Module 8 > PAEDS oral medicine > Flashcards

PAEDS oral medicine Flashcards

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1
Q

what are ways in which a child can develop?

A

cognitive
dental
skeletal

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2
Q

what is an ulcer?

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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3
Q

what are the 10 aspects to be noted when you see an ulcer?

A

onset
frequency
number
site
size
duration
exacerbating factors
lesions in other areas
associated medical conditions
treatment so far (helpful/ unhelpful)

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4
Q

what are types of infections which may cause oral ulceration?

A

viral: hand foot and mouth/ coxsackie virus/ herpes simplex/ herpes zoster, CMV, EBV, HIV

bacterial: TB, syphilis

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5
Q

what are the immune mediated disorders which can cause oral ulceration?

A

Crohns
Behects
SLE (systemic lupus erythematous)
Coeliac
Periodic fever syndromes

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6
Q

what are the vesiculobullous disorders which can cause oral ulceration?

A

bullous or mucous membrane pemphigoid
pemphigus vulgaris
linear IgA disease
erythema multiforme

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7
Q

list causes of oral ulceration?

A

inherited or acquired immunodeficiency disorders
trauma
vitamin deficiencies - B12, Iron, Folate
neoplastic/ haematological - anaemia/ leukaemia/ agranulocytosis/ cyclic neutropenia
recurrent aphthous ulceration

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8
Q

what is the most common cause of ulceration in children?

A

recurrent aphthous ulceration

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9
Q

how do aphthous ulcers present?

A

round or ovoid in shape
grey/ yellow base
a varying degree of perilesional erythema

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10
Q

what are the 3 patterns of aphthous ulcerations?

A

minor - <10mm
major - >10mm
herpetiform - 1-2mm

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11
Q

what is the aetiology of recurrent aphthous ulceration?

A

unclear

aetiological factors:
- hereditary predisposition
- haematological and deficiency disorders (iron def)
- GI disease (ceoliac)

other possible factors:
- minor trauma in a susceptible individual
- stress
- bacterial/ viral infection
- allergic disorders (toothpaste containing SLS/ foods containing benzoate or sorbate preservatives)
- hormonal imbalance: menstruation

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12
Q

what is SLS?

A

sodium lauryl sulphate - the foaming agent in toothpastes

causes recurrent aphthous ulceration in some pts and irritates the mouth

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13
Q

what investigations should be performed if a pt presents with recurrent aphthous ulceration?

A

FBC
Haemanitics - folate/ B12/ ferritin
Coeliac screen - for endomyseal antibodies, tissue transglutaminase

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14
Q

what is the management of aphthous ulceration if the cause is low ferritin?

A

3 months of iron supplementation

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15
Q

mx for aphthous ulceration caused by low folate/ B12 or +ve endomyseal antibodies?

A

referral to paediatrician for further investigation

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16
Q

general mx for aphthous ulceration?

A

manage the exacerbating factors:
- nutritional deficiencies
- traumatic factors
- avoid sharp or spicy food
- allergic factors: dietary exclusion, SLS free toothpaste

to avoid superinfection, especially if pt not managing OH:
- Corsodyl 0.2% mouthwash

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17
Q

what can be used to protect healing aphthous ulcers?

A

gengigel topical gel (hyaluronate)
gelchair mouthwash (hyaluronate)

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18
Q

what can be used for relief in a pt with recurrent aphthous ulceration?

A

difflam 0.15% benzydamine hydrochloride
local anaesthetic spray

topical steroid mediation - beneficial if used in the prodromal phase

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19
Q

what is the SDCEP prescribing guidelines for managing recurrent aphthous ulceration?

A

mouthwash:
- salt water
- chlorhexidine
- hydrogen peroxide
- tetracycline (not for those <12 years) dissolve 1 tablet in water: 4xday for 3 days

local analgesia:
- benzydamine mouthwash 0.15% (not for those <12 years)
- benydamine oromucosal spray 0.15%
- lidocaine ointment 5%
- lidocaine spray 10%

topical corticosteroids steroids:
- clenil modulite inhaler
- betamethasone soluble tablets (not for those <12 years)
- hydrocortisone oromucosal tablets 2.5mg

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20
Q

what is PFAPA?

A

periodic
fever
aphthous stomatitis
pharyngitis
adenitis

a childhood condition characterized by recurring episodes of fever, mouth ulceration, sore throat, and swollen lymph nodes

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21
Q

when does PFAPA usually onset?

A

<5 years old

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22
Q

management of PFAPA?

A

exclude cyclic neutropenia
oral steroids
normally resolves by teenage years

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23
Q

what is a differential for PFAPA?

A

primary herpetic stomatitis - HSV infection for the first time which causes a florid eruption of ulcers inside the mouth

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24
Q

treatment for primary herpetic stomatitis?

A

hydration
analgesia (Calpol)
rest
soft diet
gentle OH, if cant tolerate a toothbrush:
- CHX dilute 50/50 to gently sweep round the gums to remove plaque

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25
what is orofacial granulomatosis?
uncommon chronic inflammatory disorder
26
orofacial granulomatosis aetiology?
aetiology largely unknown allergens reported: cinammon, benzoates idiopathic or associated with systemic granulomatosis conditions (crohns disease or sarcoidosis)
27
average onset of OFG and who does it affect?
males> females 11 year old onset (pre pubertal)
28
what is the characteristic pathology of OFG?
non caseating giant cell granulomas which then result in lymphatic obstruction
29
what can OFG be a predictor of?
future Crohns disease
30
OFG clinical presentation?
lip swelling - most common full thickness gingival swelling swelling of the non labial facial tissues peri-oral erythema cobblestone buccal mucosa linear oral ulceration mucosal tags lip/ tongue fissuring angular cheilitis
31
if you think you suspect OFG, what must you remember it may also look like?
lip licking habit presents the same with the peri-oral erythema
32
what disease do clinical features of OFG also present in?
Crohns
33
what is Crohns disease?
chronic inflammatory bowel disease segmental and transmural intestinal inflammation can involve any part of the GI tract
34
bowel symptoms of crohns disease?
- diarrhoea - abdominal pain - weight loss
35
how many children with OFG will also have CD?
40%
36
if you suspect your pt has OFG, what should you ask about and why?
bowel health as 40% of children with OFG will have CD at the time of presentation or in the following months
37
how is OFG diagnosed?
clinical with investigations: - FBC - Haemanitics - Faecal calprotein - serum angiotensin converting enzyme (raised in sarcoidosis) - chest xray (sarcoidosis) - patch testing - diet diary to assess triggers
38
what age of pt can get an endoscopy?
14 years +
39
OFG mx?
- OH support - symptomatic relief as per oral ulceration - dietary exclusion - manage nutritional deficiencies which may contribute to oral ulceration - topical steroids - topical tacrolimus - short courses of oral steroids - intralesional corticosteroids - surgical intervention if long standing disfigurement
40
what types of trauma can cause thickening of keratin in the mouth?
chemical physical thermal
41
what are the developmental/ hereditary white lesions of the mucosa?
white sponge naevus dariers disease dyskeratosis congenita pachyonychia congenita
42
what are the infective white lesions of the mucosa?
candida hairy leukoplakia syphilis papilloma
43
what are the dermatological white lesions of the mucosa?
lichen planus (uncommon in children) lichenoid reaction desquamative gingivitis lupus erythematosus
44
what are the idiopathic white lesions of the mucosa?
leukoplakia leukoedema
45
what are neoplastic white lesions of the mucosa most likely to be?
squamous cell carcinoma (extremely rare in children)
46
white sponge naevus appearance?
- rough folded sponge like lesion affecting any part of the oral mucosa - usually bilateral
47
how is white sponge naevus diagnosed?
hereditary - autosomal dominant biopsy - thickening of the epidermis with a spongy appearance
48
tx for white sponge naevus?
no treatment is required
49
lichen planus aetiology?
unknown but a variety of factors are implicated immunologically mediated mucocutaneous disorder
50
difference between lichen planus and lichenoid?
both are clinically identical lichenoid = in response to well recognised precipitants
51
what are the clinical forms that lichen planus can present like?
radicular papular plaque atrophic ulcerative bullous
52
how do we get a lichen planus diagnosis?
incisional biopsy
53
tx for lichen planus?
corticosteroids
54
desquamative gingivitis presentation?
full thickness gingivitis desquamation of attached gingivae bleeding on brushing and gingival tenderness
55
what causes desquamative gingivitis?
most commonly lichen planus or allergic gingivitis (most commonly toothpaste allergy)
56
how is desquamative gingivitis diagnosed?
biopsy
57
how does leukoedema present?
faint whiteness or the oral mucosa mild keratosis simple variation of normal anatomy of no significance
58
how does leukoplakia present?
a white patch that cannot be characterised, clinically or pathologically, as any other disease
59
is leukoplakia worrying?
10% malignant transformation
60
leukoplakia tx?
biopsy and examination for dysplasia
61
how does the presentation of geographic tongue differ in children and adults?
it is PAINFUL in children due to their thinner mucosa no symptoms in adults
62
is geographic tongue always painful in children?
may only have discomfort with spicy food/ tomato or citrus fruit/ juice
63
how does geographic tongue present?
shiny red areas on the tongue with loss of filiform papillae surrounded by white margins
64
mx of geographic tongue?
bland diet during flare ups likely to become less troublesome with age
65
what is Kawasaki disease and how does it present?
inflammation of the blood vessels which normally affects children <5 years old part of a systemic illness which can damage coronary arteries key symptoms: - conjunctival infection in both eyes - changes to the mouth or throat - changes to hands and feet - rash - swollen lymph nodes in neck *if suspected urgently refer to a paediatrician
66
what suspected disease should be an urgent referral to a paediatrician and why?
Kawasaki disease - can cause damage to coronary arteries which can lead to severe cardiac damage
67
types of solid swellings?
- fibroepithelial polyp - pyogenic granuloma - congenital epulis - HPV associated mucosal swellings - neurofibromas
68
what is a fibroepithelial polyp and how does it present?
a firm pink lump (pedunculated or sessile) mainly in cheeks thought to be initiated by minor trauma
69
fibroepithelial polyp tx?
can just leave it or surgically excised
70
what is a fibrous epulis and how does it present?
pedunculated or sessile mass with a firm consistency similar in colour to surrounding gingivae inflammatory cell infiltrate and fibrous tissue - can be plaque induced or pregnancy epulis
71
what is a pyogenic granuloma and how does it present?
soft deep red/purple swelling which is often ulcerated - a reaction to chronic trauma i.e., calculus tend to bleed freely a vascular proliferation supported by a delicate fibrous stroma well recur after removal
72
what is peripheral giant cell granuloma and how does it present?
- pedunculated or sessile swelling which is typically dark red and ulcerated - usually arises interproximally and has an hour glass shape
73
how do peripheral giant cell granulomas present radiographically?
may reveal superficial erosion of the interdental bone
74
what is a congenital epulis and how does it present?
occurs in neonates and commonly in the anterior maxilla granular cells covered with epithelium
75
complications of congenital epulis and tx?
may interfere with feeding surgical excision is curative
76
what are the types of HPV associated swellings?
verruca vulgaris squamous cell papilloma
77
describe squamous cell papilloma?
- small pedunculated cauliflower like growth - which varies in colour from pink to white - usually solitary
78
what causes squamous cell papilloma?
HPV 6 and 11 it is benign
79
squamous cell papilloma tx?
surgical excision
80
what is a neurofibroma?
discrete swelling along the length of the peripheral nerves which can present as solitary or multiple lesions of the skin or oral mucosa
81
what type of neurofibroma is common?
NF-1 : autosomal dominant
82
what types of neurofibromas present in NF1 and what one has dental implications?
cutaneous plexiform: can cause facial asymmetry and disfigurement, and infiltrate surrounding soft tissues and nerves - also cause difficulty gaining dental anaesthesia and may pose a risk of bleeding on extraction of teeth in close proximity
83
list types of fluid swellings?
mucoceles ranula haemangiomas bohns nodules epstein pearls vesiculobullous lesions: primary herpes, epidermolysis bullosa, erythema multiforme
84
what are the 2 variants of mucoceles?
- mucous extravasation cyst: normal secretions rupture into adjacent tissue - mucous retention cyst (secretions retained in an expanded duct)
85
mucocele presentation?
- bluish, soft, transparent cystic swelling - lower lip minor glands is a common site
86
mucocele tx?
most will rupture spontaneously
87
why is surgery not recommended for a mucocele?
likely damage to adjacent salivary glands leading to recurrence
88
what does surgical excision of a mucocele involve?
removal of the cyst and the adjacent damaged minor salivary gland
89
what is a ranula?
mucocele in FOM - can arise from minor salivary glands or ducts of sublingual/ submandibular gland
90
why do you ultrasound or MRI a ranula?
to exclude plunging ranula - extends through the FOM into the submental or submandibular space
91
what are ranulas occassionally diagnosed as?
benign tumour of lymphatics
92
what is a lipoma and how does it present?
a benign neoplasm slow growing, spherical, smooth and soft semi-fluctuent lump yellow colour
93
how do you classify vascular anomalies?
1. vasculoproliferative or vascular neoplasms e.g., haemagioma 2. vascular malformations
94
difference between vascular neoplasms and vascular malformations?
vascular neoplasms - have abnormal cell turnover, exhibit rapid post natal growth and slow regression into late childhood vascular malformations - abnormally formed channels within a vascular apparatus, congenital in nature and grow proportionately with the child and never regress
95
what are the major categories of vascular malformations?
slow flow - capillary - venous - lymphatic fast flow - arteriovenous
96
what imaging modalities are available to confirm anatomic location boundaries of vascular malformations, to help plan surgical interventions?
ultrasound colour doppler MRI
97
what is the most common vascular malformation?
venous
98
what is Sturge weber syndrome?
congenital neurological syndrome which affects 1-3 of the following systems: - skin - brain - eyes
99
how does sturge weber affect the skin?
facial haemangioma - related to the distribution of trigeminal nerve it spreads to underlying bone: this makes LA complicated and the bleeding risk high
100
what eye condition may present with Sturge Weber?
glaucoma
101
what are Bohns nodules and how do they present?
gingival cysts which are remnants of the dental lamina found in neonates - occur on alveolar ridge - filled with keratin usually disappear in early months of life
102
what are Epstein pearls and how do they present?
small cystic lesions found along the palatal mid-line thought to be trapped epithelium in the palatal raphe found in 80% neonates disappear in the 1st few weeks
103
what is erythema multiforme and what causes it?
hypersensitivity reaction usually triggered by: - infections (90%) - drugs (10%) generic tendency and nearly always associated with HSV
104
what type of lesions present with erythema multiforme?
skin lessions = target lesions oral lesions = oral ulceration/ lip crusting other mucous membranes (eyes/ genitalia) can be affected *oral mucosa affected in EM major
105
erythema multiforme tx?
majority needs no tx recurrent EM is treated with 6 months of low dose acyclovir
106
list the viral orofacial and salivary infections?
- primary herpes - varicella zoster - epstein barr virus - mumps - measles - rubella - herpangina - hand foot and mouth
107
what is primary herpes (HSVI) and how does it present?
acute infectious disease common in children transmitted by droplets - fever - headache - malaise - oral pain - severe oedematous marginal gingivitis - fluid filled vesicles which rupture to ragged ulcers
108
tx for primary herpes HSV1?
bed rest soft diet hydration paracetamol antimicrobial MW- can be patted onto areas by parent
109
how long do HSV1 lesions last?
14 days - heal with no scarring
110
what triggers HSV1?
sunlight stress ill health
111
how do you manage HSV1 recurrent lesions?
acyclovir cream
112
cause of varicella zoster virus?
primary = chicken pox secondary = shingles
113
how does varicella zoster virus present?
painful cluster of ulcers affecting defined areas
114
what is epstein barr virus and how does it present?
infectious mononucleosis primary infection from glandular fever - fever - malaise - lymphadenopathy - oral ulceration and petechial haemorrhage (at junction of hard and soft palate)
115
epstein barr virus symptomatic mx?
analgesia and hydration AVOID amoxicillan and ampicillan as will cause a rash
116
what is EBV also known as?
kissing disease
117
what can coxsackie A virus present as?
herpangina - vesicles in tonsillar region hand foot and mouth - oral ulceration, rash on hands and feet
118
what is general viral mx?
rest fluids soft diet OH as well as you can
119
types of candida?
- pseudomembranous: easily removed white patches with red base - erythematous - chronic hyperplastic: bilateral lip commissure white patches - chronic mucocutaneous: mucous membrane and skin/ nails
120
SDCEP candida mx guidelines?
antifungal medication Nystatin fluconazole miconazole
121
advice for pts using oral corticosteroid inhaler to avoid candida?
rinse with water after use
122
what is angular cheilitis and what causes it?
crusted lesions at corners of mouth - nutritional deficiencies i.e., iron/ B12/ folate - diabetes
123
angular cheilitis tx?
first line: miconazole gel and sodium fusidate ointment unresponsive: miconazole gel + hydrocortisone cream no response: refer for investigation
124
what are natal/ neonatal teeth?
natal = tooth present at birth neonatal = tooth erupts in first month
125
what is important to know about natal/ neonatal teeth?
they are NOT supernumeraries so if XLA, will be a gap until permanent successor comes through
126
when would you xla a natal tooth?
if interfering with feeding trauma to soft tissues present airway risk?
127
whats important to know about your pt if removing a natal tooth?
did they get their vitK booster injection at birth - if not, bleeding risk

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