Chapter 378

While dental caries and its consequences represent the most common oral pathology encountered in children, both localized and systemic conditions of noncariogenic origin may manifest themselves in the mouth and surrounding tissues. This chapter will review some of the common and uncommon pathologies observed in or around the oral cavity of children.

### Angioneurotic Edema

Angioneurotic edema is an allergic reaction often involving the oral soft tissues (see Chapter 189). Antigens precipitating this reaction include food and latex allergies, vaccines, insect bites, and medications. Typically, facial edema follows exposure to the antigen and may include swelling of intraoral soft tissues, potentially resulting in airway embarrassment. Initial management is provided with antihistamines. More aggressive therapy may require the administration of corticosteroids.1–10

### Ankyloglossia

Ankyloglossia (tongue-tie; Fig. 378-1) is a congenital anomaly of the tongue characterized by a short and sometimes anteriorly inserted frenulum. Ankyloglossia reportedly occurs in approximately 2% to 5% of newborn infants with a male-to-female ratio of 2.6:1. Most do not require treatment. The clinical significance of ankyloglossia is a matter of controversy, particularly as it relates to breast-feeding difficulties such as sore nipples, poor infant weight gain, neonatal dehydration, and shortened breast-feeding duration. Infants with ankyloglossia and associated problems with latching may benefit from frenectomy. Rarely in the older child will it interfere with speech or contribute periodontal problems. Recent studies suggest some advantage of laser frenectomy over traditional surgical frenectomy relative to pain and recovery times.11–13

###### Figure 378-1.

Ankyloglossia (tongue tied). A short lingual frenum may interfere with feeding or speech and may necessitate surgical intervention.

### Bacterial Infections

Dental caries is the most common bacterial infection in the mouth that may progress to abscess and cellulitis if left untreated. (The caries process is described in Chapter 374). Nontooth-related intraoral bacterial infections are relatively uncommon. Extraoral bacterial infections tend to be far more common (see Chapter 367). Several other systemic conditions that have bacterial etiologies can present with oral lesions. These include streptococcal infections (see Chapter 285), diphtheria, tuberculosis, cat-scratch disease, actinomycosis, gonorrhea, and syphilis. Impetigo (see Chapter 367) is typically a superficial infection of the perioral tissues caused by Streptococcus pyogenes and Staphylococcus aureus. The classic clinical presentation is multiple delicate vesicles that spread and rupture to produce thickened amber crusts.14,15 Some cases may resemble exfoliative cheilitis or herpes labialis. Localized infections respond to topical antibiotics, while more widespread infections may require a 1-week course of clindamycin, cephalexin, or dicloxacillin. It commonly presents in younger children and is associated with poor oral hygiene; crowded living conditions; and hot, humid climates. Streptococcus pyogenes (Chapter 285) is also implicated in streptococcal tonsillitis, pharyngitis, and erysipelas, which are infections of the dermis. These infections can rapidly spread through the lymphatic channels. ...

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