Pediatric Oral Pathology/Oral Medicine PDF

P E D I AT R I C O R A L PAT H O L O G Y/ ORAL MEDICINE Yasmin Alayyoubi DMD, DMSc, MSD, CAGS INTRODUCTION Oral lesions in children and adolescents can affect both soft and hard tissues in the oral maxillofacial region Majority of lesions are mucosal conditions, developmental ano...

P E D I AT R I C O R A L PAT H O L O G Y/ ORAL MEDICINE Yasmin Alayyoubi DMD, DMSc, MSD, CAGS INTRODUCTION Oral lesions in children and adolescents can affect both soft and hard tissues in the oral maxillofacial region Majority of lesions are mucosal conditions, developmental anomalies, or reactive/inflammatory lesions Vigilance during clinical examinations is crucial DIAGNOSING A LES ION Requires a thorough patient history, risk assessment, and appropriate clinical documentation Rank order lesions with similar characteristics from most to least likely diagnosis The most likely disease becomes the working diagnosis and guides initial management Definitive diagnosis often requires a biopsy, the gold standard diagnostic test Soft tissue biopsy recommended if a lesion persists for over two weeks despite treatment or if the differential diagnosis includes significant disease/neoplasm  TYPES OF BIOPSIES Excisional biopsy: Total Incisional biopsy: For removal of small lesions suspected malignancies, ( 3 years) WHITE SPONGE NEVUS Symmetrical, white, irregular, diffuse plaques that are thickened, velvety, and sponge-like Autosomal dominant, caused by mutations in the KRT4 or KRT13 gene Primarily found on the buccal mucosa & ventral tongue (although it can also be found in other parts of the body, e.g., nose, esophagus) Does not disappear when tissue is stretched Promote good OH, as folds of extra tissue can promote bacterial growth & infection No treatment; condition usually persists into adulthood O R A L LY M P H O E P I T H E L I A L C Y S T Rare, well-circumscribed white/yellow developmental cyst, not tender Common Locations: ventral surface and lateral borders of the tongue, floor of the mouth Typically asymptomatic, can mimic an abscess or sialolithiasis; can cause pain if causing partial obstruction of Wharton’s duct Treatment: Conservative surgical excision if diagnosis is uncertain or if symptomatic Small, characteristic lesions may be monitored without surgical intervention SIALOLITHIASIS Aka salivary gland stones Hard, white-pinkish solitary lesion, composed of calcium salt deposits in a salivary duct Most commonly affects the submandibular gland, causing Wharton’s duct blockage Can cause episodic pain and swelling during eating Can be identified on panoramic or occlusal radiographs Treatment: Salivary stimulants, or surgical removal Recurrence is possible ORAL BURNS Over 90% of oral burns are thermal burns (super-heated solids or liquids) Chemical burns also cause painful lesions Tissue may appear necrotic and irregular Treatment: Depends on severity; palliative in most cases DARK LESIONS MEDI AN RH OMB OI D G LO SSI TIS Smooth, red, flat or raised nodular area on the posterior dorsal midline of the tongue, about 2-3 centimeters long Affected area lacks the normal coating of filiform papilla Usually asymptomatic, often first noticed during a routine dental examination Some patients may experience a burning sensation when eating certain foods Thought to represent a chronic candidiasis in the affected area of the tongue Treatment: Antifungal agents Good OH ERYTHEMA MIGRANS AKA geographic tongue or benign migratory glossitis Appearance: Affected tongues have red areas of varying sizes These areas are typically surrounded by an irregular white border The appearance is due to the loss of papilla in certain areas Causes: Exact cause is unknown Proposed factors: stress, allergies, diabetes, hormonal disturbances (no conclusive associations) Prevalence: 1-2.5% of the population Can occur at any age Characteristics: Varies in color, shape, and size Multiple affected areas are common Lesions may disappear for a time and then reappear Commonly occurs with fissured tongue Treatment: None, if asymptomatic If symptomatic or tender, topical steroids may be prescribed Advise refraining from spicy/ acidic food ERUPTION CYST AKA eruption hematoma Asymptomatic soft tissue cyst resulting from the separation of the dental follicle from the crown of an erupting tooth Fluid accumulates in the follicular space created by this separation Color ranges from normal to blue-black or brown, depending on the amount of blood in the cystic fluid Treatment: Typically, no treatment is necessary as the tooth erupts through the lesion If the cyst does not rupture spontaneously or becomes infected, surgical opening of the cyst roof may be required  ORAL MELANOTIC MACULE A benign pigmented condition of the mouth Appears as a flat, brown-to-black patch less than a third of an inch in size Resembles a large “freckle” inside the mouth Unlike freckles, sun exposure does not darken oral melanotic macules Most commonly located on the lips but can also appear on the gums, roof of the mouth, and inside cheeks Diagnosis: Typically diagnosed based on appearance A biopsy may be needed if the lesion is very large, changes in size, shape, or color, or becomes raised Laboratory tests may be performed to rule out systemic conditions if multiple macules are present Multiple oral melanotic macules may indicate more serious conditions such as Addison disease or Peutz-Jeghers syndrome Treatment: No treatment is necessary Lesions on the lip may be removed if their appearance is a concern MELANOCYTIC NEVUS Rare lesions derived from nevus cells in the oral mucosa, causing focal hyperpigmentation The most common sites of occurrence are the hard palate, buccal mucosa, gingiva Clinical Presentation: Usually present as small, well-circumscribed macules They can also appear as slightly raised papules Treatment: Excisional biopsy due to risk of risk of malignant transformation Note: All pigmented lesions in the oral cavity should be cautiously diagnosed and monitored SOFT TISSUE ENLARGEMENTS MUCOCELE Common in children and adolescents Results from the rupture of a minor salivary gland excretory duct, leading to mucin leakage into adjacent connective tissues, sometimes surrounded by a fibrous capsule Appearance: Well-circumscribed bluish translucent fluctuant swelling Firm to palpation Deeper or long-standing lesions may range from normal color to a whitish keratinized surface Common Locations: Most frequently observed on the lower lip, usually lateral to the midline Can also be found on the buccal mucosa, ventral surface of the tongue, retromolar region, and floor of the mouth (ranula) Treatment: Most lesions require treatment to minimize the risk of recurrence Superficial mucoceles may burst spontaneously, leaving shallow ulcers that heal within a few days RANULA A fluid-filled cyst (mucocele) under the tongue, formed by saliva leakage from a damaged salivary gland Smooth, translucent red/blue swelling Fluctuates in size, mildly tender Periodic drainage, may elevate the tongue Causes: Trauma to sublingual or submandibular salivary glands Mucous retention Types: Simple Ranula: Stays under the tongue Plunging Ranula: Extends into the neck Treatment: Surgical excision Marsupialization (may recur) I R R I T AT I O N F I B R O M A Benign reactive lesion resulting from chronic trauma/irritation to the mucosa Firm, pink nodule Composed of fibrous connective tissue Common locations include the buccal mucosa, tongue, and attached gingiva Treatment: Excisional biopsy is recommended Lesions can recur if the source of irritation is not removed PAR U LI S AKA Soft tissue abscess Acute inflammatory lesion due to odontogenic infection (necrotic primary or permanent tooth) Pinkish-white solitary nodule or red nodule with erythema Fluctuates in size, may be tender or painful and may have pus drainage Can develop into cellulitis if not treated Treatment: Eliminate the source of infection S Q U A M O U S PA P I L L O M A Benign lesion caused by HPV types 1 and 6 Soft, painless, pink to white, pedunculated lesions Surface may have multiple fingerlike projections, resembling a cauliflower Mostly occurs in adulthood; 20% of cases occur before age 20 Vertical transmission in children; horizontal transmission in adults Treatment: Thorough patient history Surgical excision Recurrence is uncommon VERR UCA VULGA RIS (COM MON WA RT) Caused by HPV type 2, 4, 6 Generally found on the skin of the hand Can develop intraoral lesions due to autoinoculation from finger or thumb sucking Malignant transformation is rare Appearance: Similar to squamous papilloma Can be sessile (broad based) or pedunculated Displays a rough, bumpy surface Common sites in oral cavity include lips, tip of the tongue, and labial mucosa Treatment: Surgical excision Low recurrence PYOGEN IC GRANULOMA Reactive inflammatory lesion arising from fibrous connective tissue in response to irritation or hormonal changes Smooth to irregular, ulcerated, soft to firm Pedunculated or sessile nodule Usually ulcerated and bleeds easily Can occur at any age; more common in females Causes: Tissue response to local irritation or trauma Hormonal changes, especially during pregnancy Common Locations: Attached gingiva (maxillary/mandibular anterior labial) Lips, tongue, buccal mucosa Treatment: Excisional biopsy Removal of local irritant May recur LOCALIZED JUVENILE SPONGIOTIC GINGIVAL HYPERPLASIA An isolated patch of sulcular/ junctional epithelium affected by local factors e.g., mouth breathing, orthodontic appliances Bright red enlargement of the anterior facial gingiva Bleeds easily, does not respond to oral hygiene measures More common in females Most lesions occur under age 20; median age of diagnosis at 12 years Treatment: Excision Up to 16% of lesions may recur PERIPHERAL OSSIFYING FIBROMA A reactive gingival lesion, common in adolescents (more common in females) Rare in children with primary dentition Declines after age 30, suggesting a hormonal influence Common Location: Maxilla, usually