Pediatric emergency medicine trisk 1027 1027
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lymphadenopathy, and facial cellulitis. Penicillin or clindamycin is considered
first-line therapy; definitive therapy requires drainage of the abscess. Pericoronitis
is the local infection of the gingiva surrounding an erupting tooth, sometimes
associated with lymphadenopathy and facial swelling. Although antibiotic
therapy may be required, good oral hygiene is essential.
Acute necrotizing ulcerative gingivitis (ANUG), also called trench mouth or
Vincent angina, is a spirochetal infection of the gingiva found in adolescents,
causing tender, bleeding gums and fetid breath. Gums are hyperemic and appear
“punched out” due to tissue loss between the teeth. Treatment includes oral
hygiene, hydrogen peroxide mouth rinses, oral antibiotics, and sometimes
debridement of necrotic tissue.
Noma, or cancrum oris, is a potentially fatal, gangrenous anaerobic infection of
the oral cavity that may spread rapidly outward to involve large areas of the face.
It typically begins as an oral mucosal ulcer or as ANUG, particularly after a bout
of measles or other illness in malnourished or immunocompromised patients. It is
being recognized increasingly in HIV-infected or malnourished children in subSaharan Africa.
The oral lesions of congenital syphilis may not be seen until several months of
age. Erythematous papules can be seen in the mouth and other mucocutaneous
sites. Hutchinson teeth , peg-shaped upper central incisors, present later in life.
The secondary stage of acquired syphilis is characterized by patches of ulcers or
raised lesions in the mouth along with generalized rash, fever, malaise, and
adenopathy.
Patients receiving long-term antibiotic therapy may develop elongation of
filiform papillae of the dorsum of the tongue and a “hairy” appearance from
fungal overgrowth called hairy tongue. Hairy leukoplakia of the lateral aspects of
the tongue is found in HIV-infected patients with intraepithelial proliferation of
Epstein–Barr virus infection.
Tumorous Oral Lesions
The vast majority of tumorous oral lesions in children are self-limited and benign.
Eruption cysts, which may contain blood, may appear on the alveolar ridge with
eruption of teeth; they resolve spontaneously. In addition, there are a number of
types of odontogenic cysts that can arise from tissues involved in tooth
development.
Oral papillomas are finger-like extensions from the epithelium of the oral
mucosa, commonly caused by human papillomavirus. They are typically benign,
although a small percentage may become malignant. Treatment is generally
surgery or laser ablation.
