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Section Questions and Answers

Oral Medicine/Pathology In Children And Adolescents

"The mouth is a mirror of health or disease, a sentinel or early warning system" "As the gateway to the body, the mouth is challenged by a constant barrage of invaders - bacteria, viruses, parasites, fungi." - U.S. Surgeon General's Report

Only the more common ailments that occur during childhood are dealt with in this section. The information is intended to raise your awareness about oral conditions in children. Do not attempt to diagnose or treat these ailments yourself, but always refer to your dentist or a specialist.

This section is divided into infections, ulcers, white lesions and cysts.
A. Oral Infections: Viral, bacterial, fungal.
B. Mouth Ulcers: Canker or Apthous ulcer.
C. White Lesions.
D. Cysts: Mucocoele, eruption, dentigerous and radicular.

A. Oral infections

Common Infections Of The Mouth In Children (other than caries or periodontal disease)
These may be caused by Viruses, Bacteria, or Fungi.
Viral Infections

  • Cold sores
    These are caused by a herpes virus. They are mostly evident on the lips.

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Cold sore
  • Primary Herpes Infection
    • This occurs after six months of age, because babies are usually protected by their mothers' antibodies up that time.
    • Small white blisters are first seen on the soft tissues. They then become painful small red ulcers.
    • The child may have a fever.
    • This condition, as with other viral infections, usually lasts for about ten days .
    • Treatment is confined to treating the symptoms, with analgesics to control any fever and pain.

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Herpes
  • Secondary Herpes Infection
    • It appears around the lips as multiple small blisters which break down to form scabs.
    • Treatment is directed to managing the symptoms of pain and possible fever.

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Herpes
  • Herpangina
    • This differs from herpes infection in that the location of the blisters is on the throat and palate.
    • The blisters become ulcers.
    • Treatment is confined to alleviating the symptoms.
  • Hand, Foot and mouth Disease
    • The symptoms are a rash on the hands and feet, and ulcers on the gums and soft tissues of the mouth.
    • Analgesics are use to relieve the pain and possible fever.
  • Chicken Pox
    • With chicken pox a rash develops on the skin, and small blisters may also be seen in the mouth. It is contagious.
  • Measles
    • Before the appearance of the skin rash, white spots (Koplicks spots), surrounded by a red margin, may appear on the inside of the cheek, and disappear quickly.
  • Glandular Fever (Infectious mononucleosus)
    • It is more common in teenagers.
    • Mouth ulcers and small bleeding spots may be seen at the junction of the hard and soft palates.

Bacterial Infections

  • Impetigo
    • This is a very infectious skin disease.
    • It starts around the mouth, and can cause ulceration in the mouth and on the lips
    • It may lead to the formation of crusty wounds, easily mistaken for a herpes infection.
  • Streptococcal Infection
    • It is usually seen in the throat, but may also occur on the gums.
    • The gums are very red and tender.
    • Treatment is usually with antibiotics.

Fungal Infections

  • Thrush (Candidiasis)
    • This can occur soon after birth.
    • White patches can be seen in the mouth, which are easily removed leaving a raw bleeding surface.
    • Anti-fungal medications and rinses should cure this condition.

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Thrush

B. Mouth Ulcers

  1. What is an ulcer?
  2. What causes an ulcer?
  3. What is a canker sore or apthous ulcer?

 
1. What is an ulcer?

  • It is an open sore that can appear anywhere in the mouth.
    • These small, white, painful sores are probably the most common of all oral diseases.
    • They should disappear within 14 to 21 days, but may persist for longer.

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2. What causes ulcers?

  • They can be the result of an injury.
    After a local anaesthetic, the numbed lips or tongue can easily bitten or chewed.
    Hot foods, like pizza, can burn the soft tissues of the mouth.
  • Chemicals, such as aspirin, placed directly onto the soft lining of the mouth, can also cause white painful ulcers. Aspirin is acidic.

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3. What is a canker sore or apthous ulcer?

  • These are painful, fairly common, white ulcers which vary in size.
    • They usually last for l0 to l4 days, and are treated by using bland mouth- washes, and applying topical anaesthetics and protective ointments.
    • They may appear singly, or in groups, and are often recurrent.
  • Viruses are thought to cause this ulcer.
    Stress may be a cause, but this would only apply to adolescents.

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Canker sore

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C. White Lesions

  1. What are white lesions?
  2. What causes white lesions?
  3. What is a White Spongy Naevus?

 
1. What are white lesions?

  • They are white areas that show up on the soft tissue of the mouth.

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2. What causes white lesions?

  • The most common causes of white lesions in children are:
    • Chemical injury or burns.
    • Physical injury, by biting or chewing the lip or cheek.
    • Burns with hot food or drink.
    • Fungal infections (Thrush or Candidiasis).

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Thrush

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3. What is a White Spongy Naevus?

  • This is a large, soft, uneven thickening of the lining of the mouth, with no definite boundary.
    • It is usually evident on the inside of the cheek.
    • It is benign and may be seen in infancy.

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White spongy naevus

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D. Cysts

  1. What is a cyst?
  2. What types of cyst are there?

 
1. What is a cyst?

  • This is an abnormal painless swelling, usually small, that contains a clear fluid.
  • When a cyst becomes infected it will be painful.

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Cysts

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2. What types of cyst are there?

  • Mucocoeles
    • These are not uncommon in children.
    • They are caused by injury to the small mucous glands, usually located on the lip or palate.
    • They may be recognised as small, localised ball shaped, painless swellings.
    • They can burst spontaneosly, disappear and recur.

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Mucocoele
  • Eruption cysts
    • Theses are seen as swellings of the gum over baby or permanent teeth, before eruption.
    • They are sometimes filled with blood, giving them a bluish colour.
    • When the tooth erupts into the mouth, they usually rupture (burst).
  • Dentigerous cysts
    • These are the most common cysts seen in the jaws of children.
    • The cyst forms around the crown of a permanent tooth before eruption takes place i.e. before the tooth is seen in the mouth.
    • It is usually painless and mostly discovered on x-ray.
    • The eruption of a tooth may be delayed by it.
  • Radicular cysts
    • This cyst forms around the apex of a root of a permanent tooth, in which the nerves and blood vessels have died.
    • Baby teeth do not usually form this type of cyst.
    • They are very often not painful and are treated by root canal therapy.

See Oral Medicine in the adult section.

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