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While dental caries and its consequences represent the most common oral pathologies 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.



Angioedema is an allergic reaction often involving the oral soft tissues (see Chapter 190). 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 with antihistamines. Administration of corticosteroids and/or epinephrine may be required in those with severe symptoms.

There are also several rare hereditary forms of angioedema (HAE), all inherited as an autosomal dominant trait, as well as an acquired form. Common to the hereditary forms is a deficiency or dysfunction with C1 esterase inhibitor (C1-INH). The classic manifestations of the disease typically include a history of recurring episodes of swelling without urticaria and may follow dental manipulation. Management of an acute attack includes intravenous administration of a C1-INH concentrate.


Ankyloglossia (Fig. 373-1) is a congenital anomaly of the tongue characterized by a short and sometimes anteriorly inserted lingual frenulum. Although attempts have been made to develop objective means of characterizing this condition, the diagnosis remains for the most part clinical.

Figure 373-1

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

Ankyloglossia reportedly occurs in approximately 2% to 5% of newborn infants with a male-to-female ratio of 2.6:1. While generally presenting as an isolated anomaly, it can be associated with other craniofacial abnormalities, ie, X-linked cleft palate syndrome, Kindler syndrome, van der Woude syndrome, and Opitz syndrome.

Tongue mobility may be restricted and consequently associated with functional limitations in breastfeeding; swallowing; articulation; orthodontic problems including malocclusion, open bite, separation of lower incisors; mechanical problems related to oral clearance; periodontal problems; or psychological stress to infant and mother. The tip of the tongue may appear notched or heart shaped. The frenum is typically observed to insert near the tip of the tongue. The clinical significance of ankyloglossia is a matter of controversy, particularly as it relates to breastfeeding difficulties such as sore nipples, poor infant weight gain, neonatal dehydration, and shortened breastfeeding duration.

Diagnosis of ankyloglossia typically involves observation of tongue function and tongue tip position, and visual inspection and/or palpation of the frenulum. More complex multiscale classification systems, such as the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF), allow for a more objective evaluation. The ...

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