Pediatric Oral Health Quiz

Pediatric Pharyngitis and Laryngeal Disorders Overview

• Differential diagnosis for pediatric pharyngitis includes respiratory viruses, Neisseria gonorrhoeae, Mycoplasma, and Chlamydia trachomatis.
• Notable differential diagnoses for pharyngitis include HIV, mononucleosis (EBV), and diphtheria, the latter characterized by a grey pseudomembrane and low-grade fever.
• Management of pharyngitis/tonsillitis involves viral symptomatic treatment, antibiotics for Group A Streptococcus (GAS), and patient education on antibiotic usage and return to school/work.
• Scarlet fever, a complication of bacterial strep throat, is characterized by a strep throat with a rash. It is highly contagious and may be treated symptomatically with emollients.
• Streptococcal glomerulonephritis, a potential complication of strep pharyngitis, presents with urinary and edema manifestations, hypertension, and abdominal and back pain.
• Diagnosis and management of scarlet fever are clinical, with a need to identify the source of infection and treatment similar to strep throat.
• Other post-strep complications include streptococcal toxic shock syndrome, post-streptococcal reactive arthritis, pediatric autoimmune neuropsychiatric disorder associated with group A strep (PANDAS), and various other infections.
• Laryngeal disorders are characterized by symptoms such as hoarseness and stridor, with laryngitis being inflammation of the larynx.
• Acute laryngitis typically lasts less than three weeks and can be caused by acute URI, vocal strain, or irritants, while chronic laryngitis lasts over three weeks and may be due to various factors, including reflux and vocal cord lesions.
• Clinical presentation and physical examination of laryngitis involve assessing hoarseness and examining the ears, upper airway, oral cavity, cranial nerve function, and respiration.
• Treatment for acute laryngitis involves supportive care and rest, while chronic laryngitis requires removing the offending agent and treating the underlying cause.
• Epiglottitis, primarily affecting the pediatric population, is inflammation of the supraglottic area and is often caused by H. influenzae type B or S. Pneumoniae. It can be life-threatening and requires urgent medical attention.

Oral Ulcers and Inflammatory Conditions: Risk Factors and Clinical Presentation

• Risk factors for aphthous ulcers include parental history, female non-smokers, high stress, elevated socioeconomic status, neutropenia, oral trauma, certain medications, food and chemical sensitivities, and nutritional deficiencies.
• Systemic diseases associated with aphthous ulcers are HIV, Behҫet syndrome, celiac disease, systemic lupus, inflammatory bowel disease, and neutropenia.
• Aphthous ulcers present as painful, small, red, round/oval spots with a prodromal tingling/burning, which can occur 1-2 days before the ulcer. The lesion turns gray and usually resolves in 7-10 days.
• Diagnosis of aphthous ulcers involves clinical assessment, biopsy, CBC, E sed rate, C-reactive protein, and assessment of vitamin B12, folate, iron, and vitamin D levels.
• Treatment for aphthous ulcers includes oral hygiene, pain control, and control of secondary infection using topical corticosteroids, oral steroids, and other medications.
• "Nonna’s cure" for aphthous ulcers involves wetting a finger, dipping it in salt, and placing it directly over the ulcer to alleviate pain and promote resolution.
• Cheilitis, an inflammation of the lips, can be eczematous, irritant contact, allergic contact, atopic, actinic, or angular.
• Treatment of irritant, allergic, and atopic cheilitis involves removing causative irritants or allergens from the patient’s environment.
• The most common infectious cause of pharyngitis/tonsillitis is viral, with viral pharyngitis presenting as sore throat, cough, congestion, oral ulcers, and fever.
• Group A streptococci (GAS) is the most common bacterial cause of pharyngitis, with symptoms including sore throat, fever, lymphadenopathy, and tonsillar exudates.
• Differentiating between viral and bacterial pharyngitis involves considering clinical history, examination findings, and the Centor criteria, which include fever, absence of cough, tender anterior cervical lymph nodes, and tonsillar swelling or exudates.
• Making the diagnosis of viral pharyngitis is usually based on clinical assessment, while bacterial pharyngitis can be confirmed through throat culture or rapid antigen detection testing.