Lesions of the mouth and throat are common in children and can
range from benign conditions that require no intervention to significant
systemic illness requiring extensive treatment and support (Table 117-1). Making the distinction between
these conditions can be difficult. Mouth pain secondary to viral
infections of the oropharynx are among the most common presenting
complaints of pediatric patients; however, most require no treatment
beyond supportive care and pain control. Bacterial infections of
the mouth and throat, such as pharyngitis and uvulitis, cause local
and systemic illness and rarely can lead to life-threatening complications.
The management of dental injuries, whether from neglect or trauma,
differs for primary and permanent teeth.
Table 117-1 Common
Causes of Oral Lesions in Children |Favorite Table|Download (.pdf)
Table 117-1 Common
Causes of Oral Lesions in Children
|Aphthous ulcers||Adenovirus pharyngitis||Autoimmune disease|
|Contact stomatitis||Coxsackie virus||Candidiasis (thrush)|
|Herpes simplex gingivostomatitis||Cytomegalovirus||Chemotherapy-related mucositis|
|Trauma||Streptococcal pharyngitis||Medication-related [phenytoin (Dilantin)]|
Epstein pearls are remnants of embryonic development that present
as white, slightly raised nodules seen most commonly midline at
the junction of the soft and hard palates of neonates. They are
often seen incidentally during feeding and do not cause the child
any pain or discomfort. Most resolve spontaneously.
Geographic tongue (Figure 117-1) can be
a source of great parental concern. It is a benign, asymptomatic
condition and is often incidentally noticed by parents during another
illness. Patients will present with an area of erythema and atrophy
of the papillae of the tongue surrounded by a serpiginous, elevated
white or yellow border usually located in the anterior two thirds.
The lesions will improve and disappear gradually over time but tend
to recur in other areas of the tongue. There is no known cause,
although it has been associated with childhood allergies and atopy. No
treatment other than reassurance is necessary.
Geographic tongue. (Photo from Ageekgal. Available at http://en.wikipedia.org/wiki/File:Human_geographic_tongue.jpg.)
Mucoceles (Figure 117-2) and ranulas are
lesions of the oral mucosa that present as small, bluish, discrete,
mucosal swellings on the lower lip or sublingual areas.1 Intervention
is needed only with disruption of feeding or development of speech.
Adjacent salivary glands are usually removed in addition to the
lesion to prevent recurrence.
Mucocele. (Reproduced with permission from Wolff KL,
Johnson R, Suurmond R: Fitzpatrick’s Color Atlas
& Synopsis of Clinical Dermatology, 6th ed. © 2009,
McGraw-Hill, New York, Figure 34-14.)
Eruption cysts are smooth, painless bluish-black areas of swelling
found over an erupting tooth that usually resolve with the eruption
of the underlying tooth. Although these ...