Pediatric emergency medicine trisk 1032 1032
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FIGURE 52.5 Strawberry tongue and cracked lips in Kawasaki disease.
Bleeding disorders such as thrombocytopenia or hemophilia may lead to
intraoral petechiae, purpura, or ecchymosis. These findings may also be due to
intraoral trauma. Particularly in young children, consideration of child abuse is
warranted when intraoral injuries are identified.
Hereditary epidermolysis bullosa is a rare, vesiculobullous condition that
affects mucous membranes and teeth, as well as skin. Scarring may lead to
restriction of mouth opening.
The painful cracking and erythema at the bilateral oral commissures known as
angular cheilitis may be due to nutritional deficiencies of riboflavin, folate, or
iron, or due to infections, allergies, physical irritation, or bruxism. Treatment
varies based on cause; antifungals may be helpful.
A spontaneous gingival abscess known as parulis may develop in children with
vitamin D–resistant rickets; defects in tooth formation lead to bacterial invasion
of the gingiva. They present as fluctuant swelling; treatment is root canal therapy
or tooth extraction.
Miscellaneous Oral Lesions
Aphthous stomatitis is a painful, localized, self-limited ulceration of the oral
epidermis of unknown cause. Lesions typically present as 5- to 10-mm
