Pediatric emergency medicine trisk 1033 1033
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ulcerations with a rim of erythema on the buccal mucosa, lips, and lateral aspect
of the tongue. Patients are usually afebrile. Spontaneous resolution occurs in 7 to
10 days, and recurrence is common.
Less commonly, aphthous stomatitis may occur with a constellation of
symptoms seen in the syndrome of PFAPA (p eriodic f ever, a phthous stomatitis,
p haryngitis, and cervical a denitis). Children with PFAPA are usually between 2
and 6 years of age, and experience episodes of 4 or 5 days of high fevers along
with aphthous stomatitis, pharyngitis, and cervical adenitis, recurring every 2 to 8
weeks. Etiology is unknown, and there are no long-term effects.
Erythema migrans, also known as benign migratory glossitis or geographic
tongue, is a benign inflammatory disorder causing migratory, smooth, annular
patches on the tongue. Patients are typically asymptomatic, but may complain of
pain. No treatment is required.
Traumatic tooth brushing or other habits leading to friction on the oral mucosa
may cause white or gray lesions that may be smooth or rough, termed frictional
keratosis. Lesions are most commonly found on the buccal mucosa and resolve
with removal of the irritant.
Gingival hyperplasia seen in patients receiving long-term anticonvulsant
therapy with phenytoin is irreversible. However, gingival overgrowth occurring
with cyclosporine or nifedipine use is reversible with discontinuation of the drug.
Poor dental hygiene appears to play a role in the cause. The gingivae undergo
fibrous enlargement but are not inflamed or painful. Gingival fibromatosis is an
inherited form of gingival hyperplasia.
Painless, leathery, white patches or plaques termed leukoplakia may develop in
areas of long-term smokeless tobacco exposure. This is typically found on the
mucosa of the buccal sulcus, and may result in dysplasia or carcinoma.
Linea alba is a sharply demarcated white line on the buccal mucosa opposite
the plane of dental occlusion. It is a benign finding present in up to 5% of
adolescents.
Areas of brown or black hyperpigmentation may be physiologic in patients
with darker skin. The bronzing of adrenal insufficiency (Addison disease) may be
present on intraoral mucosa, as well as over the external skin. Flat, blue-gray
lesions known as amalgam tattoos may be found in soft tissue adjacent to
amalgam dental fillings due to inadvertent misplacement of filling material.
Graphite exposure from trauma may result in similar lesions. Localized brown,
blue, gray, or black macules or papules, most commonly on the hard palate, may
represent melanotic nevi. These are often treated with excisional biopsy to rule
out mucosal melanoma. The finding of multiple intraoral and perioral
