Diseases and Disorders of Oral

Mucosa in Children

Siti Chumaeroh

Disorder of the tongue

2. Macroglossia

- A tongue larger than normal

- Either congenital or aquired
Congenital macroglossia :

an overdevelopment of the lingual

musculature
or vascular tissue, becomes
apparent as the child develops
An abnormally large tongue hypothyroidism ,
may extent out of the mouth

abnormal growth pattern of the

mandible and malocclusion Angle class III
maloclussion

In Infant

3. Ankyloglossia

Ankyloglossia
Developmental anomaly

4. Fissured Tongue

Median Rhomboid Glossitis

Congenital anomaly

Appears

6. Benign Migratory Glossitis

- Unknown etiology
- Migrating patches on the tongue surface
- Stress-related,

male: female = 1:2

- 5 to 18 years of age
- Multiple area of desquamation of filliform
papillae, irregular pattern
-The central portion is inflamed, the outer part is
thin and outlined by a yellowish white band
- The desquamative areas show filliform papillae
as
red elevated remain for a short period
in one location, heal then reappear at another
location

 -Frequent recur after spontaneusly healing

- ectopic geographic tongue in the

buccal mucosa, gingiva, lips

etc

7. Hairy Tongue
- Etiology is attributed to candidiasis

infection
- May not exactly be a developmental
anomaly
- Characteristic by hypertrophy of filliform
papillae
thickly ,
extensive on the
dorsal surface
- Dorsal surface of the tongue appears
hairy
- The color depends on extrinsic factors
like tobacco
become blackish
brown black hairy tongue

- Treatment : -keeping the tongue clean

with tooth
brush avoid food
accumulation , irritation

DISORDERS OF THE BUCCAL MUCOSA

Fordyces Spot Granules
- developmental anomaly heterotropic/ectopic
collections of sebaceous glands on the oral mucosa
- during development of maxillary and mandibular
process some portion of the ectoderm from
neigbouring skin get included in these site
development of sebaceous glands inside the mouth
- yellowish-white papules
- buccal mucosa, vermillion border of upper lip,
tonsils, etc
- asymptomatic no treatment

Leukodema
- greysh-white, milky, opalescent appearance of
oral mucosa most on cheeck streched
white patch
disappear
- unkown etiology
- surface of the mucosa appears folded wrinkles
- cannot be scraped of
- bilateral extent on to the lip mucosa
- not pre-malignant condition
- No treatment

Disorders of the lips

Forms

Disorders of the lips

Peutz-Jeghers Syndrome

INFECTION

A. Bacterial Infection

1. Diphtheria
- caused by a gram +bacillus Cornebacterium

diphtheri
- most frequenty in children
- transmitted through droplet infection or direct contact
- incubation period is a few days
- is manifested by malaise, headache, fever and vomiting
- associated with sore throat, mild redness and edema of
the pharynx
- cervical lymphadenopathy

INFECTION
Bacterial Infection

2. Tuberculosis
- is an infection granulomatous disease
- caused by bacillus Mycobacterium tuberculosis -

pulmonary tuberculosis
- may also occur by way of the intestinal tract, tonsils,
skin
- tuberculosis infection of submaxillary and cervical nodes
a tuberculous lymphadenitis tender or painful
- tuberculosis of the oral cavity secondary to a
pulmonary disease. The organism are carried in the
sputum enter the mucosal tissue through a small break
in the surface
- occur on the tongue (mostly), palate, lips, buccal
mucosa,
gingiva , frenula

- is an irregular, superficial or deep, painful

ulcer which
tends to increase slowly in size
- dentist may contract an infection from his
contact with living tubercle
- tuberculosis gingivitis a difuse, hyperemic,
nodular or papillary proliferation of the
gingival tissue
- tuberculosis osteomyelitis in the later stages
of the disease unfavourable prognosis
- treatment of oral tuberculosis is secondary to
treatment of the pimary lesions

3. Actinomycosis
- is a chronic granulomatous , suppurative, and

fibrosing
disease
- caused by anaerobic, gram-positive, nonacidfast, filamentous bacteri, Actinomyces israeli,
A. Naeslun
A. naeslundi, A. viscosus,
A.odontolyticus , A. propionica
- the pattern of the disease the formation of
abscesses which tend to drain by the formation
of sinus tracts pus
- pus is examined shows sulfur granules

or colonies of
organism which appear in the
suppurative material as tiny yelow grains

- is classified

according to the location :

* cerficofacial ( the most common )

* abdominal

* pulmonary
Cervicofacial actinomycosis :

- involves the salivary glands, bone, skin

of the face and neck swelling induration
of the tissue develop into one or more
abscess pus containing sulfur granules

- the skin overlying the abscess is purplish

red, indurated or fluctuant

- rarely mucosal surface

- may extent to involve the mandible and

maxilla specific osteomyelitis

involve the cranium, meninges, brain
itself
- Treatment:

* difficult

* penicillin and tetracycline

the course of the disease is

still prolonged

4. Syphilis
- Infection of a spirochaeta Treponema pallidum
- classified : - acquired

- congenital

- Congenital Syphilis

* is transmitted by an infected mother

* manifestation: - frontal bossae
- short maxilla
- high palatal arch
- saddle nose
- Mulberry molars

- rhagade

- Hutchinsons trias:

* hyplopasia of the incisor

and molar (mulbery
molar)

* eight nerve deafness

* interstitial keratitis
Treatment :

- adequate treatment of the

mother
before 16th week of
gestation

5. NOMA ( Cancrum Oris )

- Is rapidly spreading gangraen of the oral and

facial tissue in delibated or nutritionally

deficient persons
- a secondary complication of systemic disease
- chiefly in children
- specific infection by Vincents organism
- an acute necrotizing gingivostomatitis is
complicated by secondary invasion of many
microbial forms ( streptococci, staphylococci,
diphtheria bacilli )

- begins as a small ulcer of the gingiva

rapidly spread the surrounding tissues

of the jaws, lips, cheeks by gangrenous
necrosis

odor is extremely foul

- high temperature sufer secondary
infection

die from toxemia or pneumonia

- mortality rate 75% before the ability of
antibiotics
- the prognosis is better antibiotics are
administered
before final

VIRAL INFECTION
Herpes Simplex Virus Type 1 Infection
primary herpetic gingivostomatitis

1.

- develops in both children and young adult

- rarely before the age of 6 months, the peak at 14

months

- characterized by fever, irritability, headache,

pain of swallowing, regional lymphadenopthy

- a few days the mouth becomes painful gingiva

intensely inflammed

- lips, tongue, buccal mucosa, palate, pharynx, tonsil

yellowish fluid-filled vesicles rupture form
shallow, ragged, extremely painful ulcers covered by a
gray membrane surrounded by an erythematous margin

Diagnosis :

- clinical appearance and history

- exfoliative cytology : - multinucleated
giant cell

- viral inclusion
body
-direct immunofluorescence for viral
antigen
- viral culture
- cytology and antigen detection

- heal within 7 14 days leave no scar

- treatment :

* symptomatic topical
anaesthetic
agents on the
ulcer

soft diet

adequate fluids
hospital
admission if necessary
mouthwashes for
older children
chlorhexidine
gluconate 0,2%,
10 ml for 4

For

young children with severe

ulceration, chlorhexidine may be
swabbed over afected areas with
cotton wool swabs. A mouthwash
chlorhexidine 0,12% and benzydamine
hydrochloride can be used with good
result
antiviral chemotherapy, aciclovir
oral suspension reserved for children
who are immunocompromised
pain control with paracetamol
antibiotics are unhelpful

2. Herpangina and Hand, foot and

mouth disease
- is caused by Coxsackie group A virus
- most seen in young children
- a summer disease
- transmitted through contact multiple cases

in a sinlge household are common

- incubation periode is 2-10 days
- clinical manifestations are mild, short
duration sore throat, low grade fever,
headache,
vomiting, abdominal pain
- small vesicles short duration rupture
ulcer

- ulcer with a gray base, inflamed

periphery
- in Herpangina on the anterior faucial
pillars, hard and soft palate, posterior
pharyngeal wall, buccal mucosa, tongue
a cluster of 4 to 5 vesicles
- in had ,foot and mouth disease up to 10
vesicles occur in the mouth in addition to
the hand and feet(on the palmar and
plantar )
- heal within a few days to a week
- self limiting symptomatic care, as for

3. Chickenpox ( Varicella )
- an acute viral infection in children
-herpes-varicella-zoster virus
- incubation

2 weeks
- transmission is by airborne droplets or
direct contact
- portal of the entry respiratory tract
- characterized : prodormal of headache,
nasopharingitis,

anorexia
- followed by maculopapular or vesicular
eruption of the skin
begin of the trunk spread to the face

- small blister-lik erythemae lesions in the

oral cavity : buccal mucosa,

, tongue, gingiva, palate, pharynx
- the lesion is a slightly raised vesicle with
surrounding ruptures small eroded
ulcers with red margin
Management : - topical anaesthetic gel
- mouth rinses

4. Herpes Zoster ( Singles)

- an acute viral infection
- herpes-varicella-zoster virus
- extremely painful, inflammation of dorsal root

ganglia or
extra medullary cranial
nerve ganglia
vesicular eruption of the skin or mucous membrane

primary infection by the V-Z virus chickenpox

while recurrent infection herpes Zoster
- Initially fever, malaise,pain, tenderness along the
envolve
sensory nerve, unilateral
- a few days a linear or vesicular eruption of the skin or
mucous supplied by the afected nerve

- triggering factors : - trauma

- maglinancy / tumor
- Local X-Ray radiation
- immunosuppressive

therapy

trigeminal nerve

- infection of

6. Mumps ( Epidemic
Parotitis)
- an acute viral infection disease
- unilateral or bilateral swelling of the

salivary gland usually

parotid
- incubation 2 3 weeks
- preceded by headache, chills, fever ,
vomiting, pain below the ears
- are followed by a firm, rubbery or elastic
swelling of the salivary glands, elevating
the ear, last for one week
- management includes : - adequate rest ,

- fluid intake

7. Acquired Immuno Deficiency

Syndrome ( AIDS )
- caused by human immunodeficiency virus ( HIV )
- 1/3 to 1/2 HIV positive babies mother infected HIV
- virus transmission occurs to the fetus in pregnancy in the

first
trisemester more common in perinatally
- infected children may not survive for a year
- also get the infection from blood transfusion or blood
products
- Abnormal cell function :
* T4 helper cells is destroyed by direct or indirect
cytopathic mechanism of HIV
* intefere in the production of interfer

opportunistic infection

maglinancy,
thrombocytopenia
- HIV on CNS lead to progressive
encephalopathy
behaviour and motor
deficit
- chronic diarrhoea, lymphadenopathy ,
tuberculosis, opportunistic bacterial
infection
- lymphocytic interstitial pneumoni ( is
most common in children)
kaposis sarcoma, toxoplasmosis ,

- typical findings in children :

*
- Oral futures :

lymphoid hyperplasia
salivary gland enlargement
pyogenic bacterial infection
developmental delay
dysmorphic craniofacial
candidiasis
HSV infection
RAU/RAS
progresive periodontal disease

* oral hairy leukoplakia

* petechiae
* linear gingival erythema
* cervical lymphadenopathy
Specific test:* antigen detection
* virus isolation
* polymerase chain reaction
* antibody detection test ( ELISA)
Treatment : * symptomatic
*antiviral drugs
* acyclovir, etc

FUNGAL INFECTION
Acute Pseudomembranous Candidiasis

( Thrush )
- occur in the debilitated or chronically ill and on the infant
- oral lesions : - soft, white, slightlly elevated plaques

can be
wiped away leaving a normal or an

erythematous

area
- on the buccal mucosa, tongue, palate,
gingiva, floor of the mouth
treatment : * application of antifungal medication
( nystatin, amphotericin B , etc )

 Oral Thrush

is a very common infection in infants that

causes irritation in and around a baby's
mouth.
It is caused by the overgrowth of ayeast
(a type of fungus) called Candida albicans.
Most people (including infants) naturally
have Candida in their mouths and digestive
tracts, which is considered normal growth.
The amount of this fungus in the body is
controlled by a healthy immune system and
some "good" bacteri

If the immune system is weakened (due to an

illness or medicines like chemotherapy), or if the

immune system is not fully developed as is the
case in infants
the Candida in thedigestive tract can overgrow
and lead to an infection causes diaper rash
and vaginal (yeast) infections.
Candida overgrowth (or candidiasis) can happen
after a baby has received antibiotics for a bacterial
infection because antibiotics can kill of the "good"
bacteria that keep the Candida from growing.
Similarly, it can happen after the use ofsteroid
medicines

Symptoms
Oral thrush can afect anyone, although it's most
common in babies younger than 6 months of
age and in older adults.
A baby with oral thrush might develop cracked
skin in the corners of the mouth or whitish
patches on the lips, tongue, or inside the
cheeks
Scraping the white patches of can cause some
bleeding.
Many babies don't feel anything at all, but some
may be uncomfortable when sucking. Some
babies may not feed well because their mouth
feels sore.
Babies can have oral thrush and a diaper rash

OTHEReS

RECURRENT APHTHOUS STOMATITIS

- triggered to * stress

* gastrointestinal disturbance

* nutritional deficiency

* hormonal imbalance

* infection

* allergy , genetic, etc

- 3 types :
* minor ( commmon) ulcers up to 5 mm ,
yellow pseudomembranous slough with an
erythematous borde

heal within 10-14 days without scarring

* major ulcers > 5mm, last longer, heal with

scarring

* herpetiform

Management:
* Symptomatic care with mouthrinsees

- chlorhexidine gluconate 0,2%, 10 ml

three times daily

- tetracycline mouthwash 250mg in 10

ml water three times daily for 4 days for
children > 8 years

- benzydamine hydrocloride 1,2%

- xylocain spray may be helpful for some

patient
* Topical steroid

- triamcinolone in orabase (maybe

difficult to apply in
children)

* Systemic corticosteroids only in severe

cases of major ulceration

* Herpetiform ulcertion seems to respond
best to tetrcycline mouthwash

Behcets Syndrome
-Characterized by recurrent aphthous ulceration

together with genital and ocular lesions

- the skin and other systems can also be involved
Behcets syndrome can be divided into four types:

*mucocutaneous form : involvement of oral

and genital mucosa and conjunctiva

* arthritic form : arthritis in association with

mucutaneous lesions

* neurological form : central nervous system

involvement
* Ocular form with uveitis in addition to oral and
genital lesions

Behcets syndrome
Diagnosis :

- clinical presentation and biopsy

Management :

- as for recurrent aphthous ulceration,

systemic treatment (corticosteroid) is
required

Erythema multiforme , StevenJohnson syndrome

- is an acute, often recurrent , hypersensitivity

reaction efecting mucocutaneous tissue

- 20% of cases occur in children
- is more common in males
-EM afects the mouth with serousanguinous
exudate on the lips,
and widespread
ulceration
- Predisposing factors :- drugs : penicilin,
sulfa, barbiturat

- herpes simplex infection

Clinical Features

EM may present from mild limited to a severe

widespread and life-threatening illness

Oral Lesions:
- difuse, widespread macules progress through
blister ulcerationon on the non-keratinized mucosa
pronounced in the anterior mouth
- lips become swollen and cracked, bleeding and
crusted
- recur in about 25% from weeks to years

Oral manifestation

Haemorrhagic crust

Skin Lesions :

- afect the distal extremitas: the extensor surface of

the arms, legs, elbows, knees, dorsum of hands and feet
- macules that are symmetric, round, erythematous,
slightly pruritic or non-itchy
- ring- shape target lesions , well-demarcated centre of
the papule forms a necrotic ulcer, which result in a
depressed white, yellow or grey area surrounded by a red
edge and then a pale oedematous ring; a bright red
margin may surround this pale ring

Other mucosae
- eye involvement may cause lacrimation, photophobia
- genital lesions are painful, may result in urinary
retention

Khas pada kulit (lesi target)

Steven-Johnson Syndrome
Varian dari erithema multiforme yang

parah
Melibatkan kulit, mukosa mulut, mata
dan genital
Life threatening (dehidrasi)
Penyembuhan lama
Memerlukan penatalaksanaan dalam tim

THANK

YOU

References
1. Rao A. 2008 : Principles and Practise of

Pedodontics
(2nd ed) Jaypee Brothers Medical
Publishers (P) LTD, New
Delhi : 421- 434
2. Langlais R.P. at all 2009 : Color Atlas of
Common Oral
Diseases 4th ed Lippincott Williams &
Wilkins, Philladelphia
3. Scully C. 2008 : Oral and Maxillofacial
Medicine The Basis of
Diagnosis and Treatment 2nd Churchill