Pediatric emergency medicine trisk 1017 1017
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CHAPTER 52 ■ ORAL LESIONS
MARISSA A. HENDRICKSON, MARK G. ROBACK
INTRODUCTION
Oral lesions in children can represent a wide range of illnesses. Lesions range
from benign and self-resolving to indicative of life-threatening diseases. Many
oral lesions, both congenital and acquired, are localized. However, lesions
associated with systemic disease must also be considered ( Fig. 52.1 and Table
52.1 ). Most often, patients with isolated oral complaints are found to have
common, self-limited conditions ( Table 52.2 ). However, a complete history and
physical examination is essential for all patients with oral lesions to rule out
systemic and potentially life-threatening diseases ( Table 52.3 ) that may present
initially with isolated mouth findings.
PATHOPHYSIOLOGY
Oral lesions may result from localized or systemic pathophysiologic processes.
Localized causes include congenital masses and cysts, infectious diseases, and
oral tumors. Systemic illnesses with prominent oral involvement include a
number of infectious, inflammatory, and toxin-mediated conditions. Given the
broad spectrum of illnesses presenting with oral lesions, it is helpful to consider
individual causes under specific headings within the differential diagnosis.
Conditions with typical oral lesions that do not comfortably fit under these
headings are discussed in the section on miscellaneous lesions.
DIFFERENTIAL DIAGNOSIS
Congenital Oral Lesions
There are a number of benign, self-limited lesions that appear at birth. Epstein
pearls, epithelial inclusion cysts that appear as clusters of small, white milia in the
midline of the hard palate, occur in more than 60% of newborns. Epithelial pearls
appear as small, shiny, white lesions on the gums. Bohn nodules are cysts that
appear on the mandibular or maxillary dental ridges. Dental lamina cysts occur on
the alveolar ridge of newborns and stem from trapped remnants of the dental
lamina.
Natal teeth are prematurely erupted primary teeth present at birth; teeth
erupting within the first month of life are termed neonatal teeth. These teeth are
