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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.
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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
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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
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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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