Chapter 8 Periodontal disease in children

And Pediatric Oral Pathology Soft Tissue LesionAnd Pediatric Oral Pathology Soft Tissue Lesion

Section 1 Periodontal disease in children

1 Periodontal diseasesToday, we’ll introduce you periodontal disease in children. What is periodontal

disease? Just as its name implies, periodontal disease comprise a group of infection that affect the periodontal tissue, we say the supporting structures of the teeth. Then, I want to ask: what is periodontal tissue or periodontium? We say, periodontium include four parts: Gingiva, Periodontal ligament, Cementum and Alveolar bone.

2 Anatomy of the periodontium in childrenIncreasing information emphasizes the relevance of the prevention, early

diagnosis and early treatment of periodontal diseases in children. In order to avoid erroneous diagnosis and unnecessary treatments, the pediatric dentist is required to differentiate between pathologic processes and normal changes that take place in the periodontum with age.

We know the children are in the course of growth and development, so in different stages, they have their characteristic of physiology and psychology. Then, what is the different between the periodontium of children and adults? Let’s see.

2.1 Gingiva 2.1.1 Marginal gingival: When we talk about the marginal gingival tissue, you should pay attention to two key words:vascular and fibers. For children,marginal gingival tissue around the primary dentition are more highly vascular and contain fewer connective tissue than tissues around the permanent teeth. The epithelia are thinner with a lesser degree of keratinization, giving an appearance of increased redness that may be interpreted as mild inflammation, and it’s easy for marginal gingiva to be affected 2.1.2 Attached gingival: It may maintain the sulcus depth, resist the functional stress during mastication, and resist the tensional stress by acting as a buffer between the gingival margin and the alveolar mucosa. The width of attached gingival is less variable in the primary dentition, so there is less mucogingival problem in the primary dentition2.1.3 Junctional epithelium: When we refer to the gingiva, we can’t help but talk about junctional epithelium. Because it’s very important in the health of the periodontium .There is some normal change that take place in junctional epithelium and we should not treat it as disease. First, let’s see what happens during eruption of the teeth? It migrates apically. There continue to be an apical

shift when the teeth are fully erupted. So the gingival margins are frequently at different levels on adjacent teeth that are at different stages of eruption. Sometimes it gives an erroneous appearance that gingival recession has occurred around those teeth that have been in the mouth longest. Stability is achieved at 12 years for 1 2 3 5 6, 16 years for the other teeth.2.2.Periodontal ligamentPeriodontal ligament space is wider in children and is less fibrous and more vascular2.3 Cementum Thinner2.4 Alveolar bone

Thinner cortical plates(皮质层） Larger marrow spaces（骨髓腔） Greater vascularity Fewer trabeculae

*Clinical significance of the anatomy: Enhance the rate of progression of periodontal disease

3 A classification of periodontal disease in children 3.1Gingival conditions

Acute gingivitis Chronic gingivitisGingival overgrowth

Factitious（自伤性）gingivitis

Mucogingival problems 3.2 Periodontal conditions

Chronic periodontitisEarly-onset periodontitisPrepubertal（青春期前的） periodontitis associated with systemic disease

4 Acute gingivitis4.1 Primary herpetic gingivostomatitis（原发性疱疹性龈口炎）4.1.1 Definition: An acute infectious disease of the gingiva caused by the herpesvirus 4.1.2 Pathogeny: Herpes simplex viruses (HSVs)Herpes simplex viruses (HSVs)(( 单 纯 疱 疹 病 毒 ）单 纯 疱 疹 病 毒 ） HerpesHerpes simplex viruses (HSVs)simplex viruses (HSVs) are ubiquitous, extremely host-adapted pathogens that canare ubiquitous, extremely host-adapted pathogens that can cause a wide variety of illnesses. Two types exist: type 1 (HSV-1) and type 2cause a wide variety of illnesses. Two types exist: type 1 (HSV-1) and type 2 (HSV-2). Both are closely related but differ in epidemiology(HSV-2). Both are closely related but differ in epidemiology..Type-1Type-1

Gingivostomatitis; Type-2 GenitaliaGingivostomatitis; Type-2 Genitalia（生殖器）（生殖器） 4.1.34.1.3 Transmission: Transmission: HSV-1 is transmitted chiefly by contact with infected saliva,HSV-1 is transmitted chiefly by contact with infected saliva,

Infected saliva from an adult or another child is the mode of infection. whereasInfected saliva from an adult or another child is the mode of infection. whereas HSV-2 is transmitted sexually or from a mother's genital tract infection to herHSV-2 is transmitted sexually or from a mother's genital tract infection to her newborn.newborn.

4.1.44.1.4 Prevalence: Prevalence: HSV infection appears to have increased worldwide in the last 2HSV infection appears to have increased worldwide in the last 2 decades, making it a major public health concern. Many primary infections aredecades, making it a major public health concern. Many primary infections are asymptomatic, Herpes simplex infections are asymptomatic in as many as 80% ofasymptomatic, Herpes simplex infections are asymptomatic in as many as 80% of

patients, but symptomatic infections may be characterized by significantpatients, but symptomatic infections may be characterized by significant morbidity and recurrence. Moreover, infections can cause life-threateningmorbidity and recurrence. Moreover, infections can cause life-threatening complications, particularly in immunocompromised hosts. complications, particularly in immunocompromised hosts. 4.1.5 4.1.5 Clinical features: Clinical features: 1) 1) AgeAge: 6 months to 3 years : 6 months to 3 years

2)2) Incubation period Incubation period((潜伏期潜伏期):): 1 week 1 week 3) 3) Prodrome:Prodrome:

AA Febrile Febrile（发烧的）（发烧的） illness illness BB Headache, malaise, oral pain, mild dysphagia Headache, malaise, oral pain, mild dysphagia（吞咽困难）（吞咽困难）

CC Cervical lymphadenopathy Cervical lymphadenopathy((淋巴结病）淋巴结病） 4) 4) SymptomSymptom

AA Gingivitis: Gingivitis is the most striking feature,with markedly swollen,Gingivitis: Gingivitis is the most striking feature,with markedly swollen, erythe-matous, friable gumserythe-matous, friable gums

BB Vesicular lesions: Vesicular lesions develop on oral mucosa ,lip andVesicular lesions: Vesicular lesions develop on oral mucosa ,lip and tongue , can occur anywhere in the oral cavity, on the perioral skin, ontongue , can occur anywhere in the oral cavity, on the perioral skin, on the pharynxthe pharynx

4.1.6 4.1.6 PrognosisPrognosisOral lesions heal without scarringOral lesions heal without scarring

4.1.7 4.1.7 Course: Course: Acute disease lasts 5-7 days, and the symptoms subside in 2Acute disease lasts 5-7 days, and the symptoms subside in 2 weeks. Viral shedding from the saliva may continue for 3 weeks or more. Adultsweeks. Viral shedding from the saliva may continue for 3 weeks or more. Adults also may develop acute gingivostomatitis, but it is less severe and is associatedalso may develop acute gingivostomatitis, but it is less severe and is associated more often with a posterior pharyngitis.more often with a posterior pharyngitis.4.1.8 4.1.8 Diagnosis: Diagnosis: According to Clinical features,History and ageAccording to Clinical features,History and age4.1.9 4.1.9 Treatment: Treatment: The availability of effective chemotherapy underscores that theThe availability of effective chemotherapy underscores that the prompt recognition of the infection and early initiation of therapy are of utmostprompt recognition of the infection and early initiation of therapy are of utmost importance in the management of the disease. The goals of treatment are to makeimportance in the management of the disease. The goals of treatment are to make the patient comfortable and to prevent secondary infections or worsening systemicthe patient comfortable and to prevent secondary infections or worsening systemic illness. It includes:illness. It includes:

1) Pharmacotherapy1) Pharmacotherapy((药物疗法药物疗法) :) : A Antiviral treatment :A Antiviral treatment : Overall, medical treatment of HSV revolves Overall, medical treatment of HSV revolves

around specific antiviral treatment. Patients should be advised about thearound specific antiviral treatment. Patients should be advised about the potential for autoinoculation if they touch the herpetic lesion and thenpotential for autoinoculation if they touch the herpetic lesion and then touch a mucous membrane or an eye. Controlling autoinoculation can betouch a mucous membrane or an eye. Controlling autoinoculation can be a challenge if the patient is a young child. a challenge if the patient is a young child.

B Symptomatic treatmentB Symptomatic treatment : In situations in which constitutional effects : In situations in which constitutional effects such as fever occur, symptomatic treatment can be used. Analgesics,such as fever occur, symptomatic treatment can be used. Analgesics, such as acetaminophen, may make the patient more comfortable. Aspirinsuch as acetaminophen, may make the patient more comfortable. Aspirin should be avoided in pediatric patients because of the possibility of Reyeshould be avoided in pediatric patients because of the possibility of Reye syndrome. Topical anesthetics and coating agents may make the patientsyndrome. Topical anesthetics and coating agents may make the patient more comfortable and may aid in the consumption of food; however,more comfortable and may aid in the consumption of food; however, they do not speed healing. Appropriate wound care is needed, andthey do not speed healing. Appropriate wound care is needed, and treatment for secondary bacterial skin infections may be requiredtreatment for secondary bacterial skin infections may be required..

2) Supporting treatment: 2) Supporting treatment: A A Bed restBed rest

B B Soft dietSoft dietC C Be kept well hydratedBe kept well hydrated: : The patient should maintain fluid intake and aThe patient should maintain fluid intake and a

balanced diet with the use of liquid food replacement if necessarybalanced diet with the use of liquid food replacement if necessary4.1.10 4.1.10 Warnings to parent:Warnings to parent:

A A Children are highly contagious Children are highly contagiousB B No school, day care etc.No school, day care etc.

C C Sterilize eating and drinking utensilsSterilize eating and drinking utensils D D Disease is self-limiting; 10-14 days in duration Disease is self-limiting; 10-14 days in duration

4.2 Acute necrotizing ulcerative gingivitis(ANUG)4.2 Acute necrotizing ulcerative gingivitis(ANUG)4.2.1 4.2.1 Aetiology:Aetiology:Broad anaerobic infectionBroad anaerobic infection

Causative organism: Fusiform bacteria , SpirochaeteCausative organism: Fusiform bacteria , Spirochaete（螺旋体）（螺旋体）Other Gram-negativeOther Gram-negative((革兰氏阴性革兰氏阴性))anaerobic organismanaerobic organism4.2.2 4.2.2 Clinical features:Clinical features:

A A Necrosis and ulceration :Necrosis and ulceration : Interdental papillae marginal gingivalInterdental papillae marginal gingival

Covered by yellowish-grey pseudomembranousCovered by yellowish-grey pseudomembranous(( 假 膜假 膜 )) slough, Acute slough, Acute stage enters a chronic phase after 5-7days. Recurrence of the acutestage enters a chronic phase after 5-7days. Recurrence of the acute condition is inevitablecondition is inevitable

B B Pre-existing gingivitis Pre-existing gingivitis C C Distinctive halitosis Distinctive halitosis

D D Acute-chronic clinical course: Acute-chronic clinical course: If acute-chronic cycle continues, theIf acute-chronic cycle continues, the marginal tissues lose their contour and appear roundedmarginal tissues lose their contour and appear rounded. . Eventually,Eventually, involve the alveolar crestinvolve the alveolar crest

4.2.3 4.2.3 TreatmentTreatmentA A Intense oral hygiene Intense oral hygiene B B Oxidant: hydrogen peroxideOxidant: hydrogen peroxide

C C Mechanical debridement Mechanical debridement D D Metronidazole Metronidazole

5 Chronic gingivitis5 Chronic gingivitisChronic gingivitis is a common condition. In fact, gingivitis affects over 90%Chronic gingivitis is a common condition. In fact, gingivitis affects over 90%

of the population of the United States. If treated, the prognosis for those who haveof the population of the United States. If treated, the prognosis for those who have gingivitis is good. Untreated, gingivitis may progress to gum disease orgingivitis is good. Untreated, gingivitis may progress to gum disease or periodontal disease. Gingivitis is painless in the early stages, but may lead toperiodontal disease. Gingivitis is painless in the early stages, but may lead to bleeding gums and other oral problems. Bleeding gums are only one sign ofbleeding gums and other oral problems. Bleeding gums are only one sign of gingivitis. Gums become red and swollen, teeth may become loose or maygingivitis. Gums become red and swollen, teeth may become loose or may eventually fall out. eventually fall out.

Prevalence: Prevalence: increases steadily between the ages of 5 and 9 years, peaks at 11increases steadily between the ages of 5 and 9 years, peaks at 11 years and decrease slightly with age to 15 years. years and decrease slightly with age to 15 years.

Etiology: Etiology: Closely associated with the amount of plaque, debris and calculusClosely associated with the amount of plaque, debris and calculus present.present.5.1 Eruptive gingivitis5.1 Eruptive gingivitis

CauseCause：：

11））Trauma of gingivaTrauma of gingiva

22）） Debris and food residue Debris and food residue

Clinical feature:Clinical feature:

11））Site: Primary teeth and the 1st permanent molar Site: Primary teeth and the 1st permanent molar

22））SymptomSymptom：：

TreatmentTreatment：：Oral hygieneOral hygiene

5.2 Filth gingivtis(5.2 Filth gingivtis(不洁性龈炎不洁性龈炎))

CauseCause：：

Clinical feature:Clinical feature: Age: 3Y~5YAge: 3Y~5Y

SiteSite：：Buccal, PapiBuccal, Papi

SymptomSymptom：：redness, bleedingredness, bleeding

Treatment:Treatment:

11））Local cleaning, antiinflection 2Local cleaning, antiinflection 2））Oral hygieneOral hygiene

5.3 Crowding gingivitis (5.3 Crowding gingivitis (牙列拥挤性龈炎牙列拥挤性龈炎))CauseCauseSymptom: Symptom: Redness and thickness Redness and thickness Treatment: Treatment: A: Oral hygiene B: Orthodontic treatmentA: Oral hygiene B: Orthodontic treatment

5.4 Puberty gingivitis(5.4 Puberty gingivitis(青春发育期龈炎青春发育期龈炎))Cause: Cause: Increase of sex hormones in circulating levels Increase of sex hormones in circulating levels *sex hormones : *sex hormones :

OestrogenOestrogen((雌激素雌激素)): Increases the cellularity of tissues and provides suitable: Increases the cellularity of tissues and provides suitable growth condition for species associated withgrowth condition for species associated with established gingivitis established gingivitis

Progesterone (Progesterone (黄体酮黄体酮):):Increases the permeability of the gingival vasculatureIncreases the permeability of the gingival vasculature

Clinical featuresClinical features：：

Good oral hygiene, but the gum tends to bleed and hyperplasia Good oral hygiene, but the gum tends to bleed and hyperplasia Bad oral hygieneBad oral hygiene

TreatmentTreatment：：

5.5 Catarrh gingivitis (5.5 Catarrh gingivitis (卡他性龈炎卡他性龈炎))

CauseCause：：TThe infection of hemolytic streptococcus(he infection of hemolytic streptococcus(溶血性链球菌感染溶血性链球菌感染) )

Clinical featuresClinical features：：

11））Oral lesionOral lesion：：soft and hematose gum, but no vesicles or ulcerssoft and hematose gum, but no vesicles or ulcers

22））Systemic reactionSystemic reaction：：feverfever，，headacheheadache，，myalgia, arthralgiamyalgia, arthralgia（（关节痛关节痛））

TreatmentTreatment：：

11））Local: Rinse Local: Rinse

22））Systemic treatment: PenicillinSystemic treatment: Penicillin

6 Drug-induced gingival overgrowth6 Drug-induced gingival overgrowth 6.1 cause: Drug: Phenytoin , Cyclosporin 6.1 cause: Drug: Phenytoin , Cyclosporin

1) Phenytoin1) Phenytoin

A A An anticonvulsant used in the management of epilepsyAn anticonvulsant used in the management of epilepsyB B Rate: occur in about 50% of subjects taking the drugRate: occur in about 50% of subjects taking the drugC C Be most severe in teenagersBe most severe in teenagersD D Associated with a deficiency of folic acidAssociated with a deficiency of folic acid

2) Cyclosporin2) CyclosporinA A An immunsuppressant drugAn immunsuppressant drugB B Rate:30%Rate:30%C C Children: more susceptibleChildren: more susceptible

6.2 Clinical feature:6.2 Clinical feature:1) The clinical changes of drug-induced overgrowth are very similar1) The clinical changes of drug-induced overgrowth are very similar irrespective of the drug involved.irrespective of the drug involved.22) The first signs of changes are seen after 3-4months of drug) The first signs of changes are seen after 3-4months of drug administration.administration.

3) Progress: The interdental papilla become nodular before enlarging3) Progress: The interdental papilla become nodular before enlarging more diffusely to encroach upon the labial tissuemore diffusely to encroach upon the labial tissue

4) Site:The anterior part is most severely and frequently involved4) Site:The anterior part is most severely and frequently involved5) Sypmtom: with a good standard of oral hygiene, overgrowth gingiva is5) Sypmtom: with a good standard of oral hygiene, overgrowth gingiva is pink,firm and stippled, When there is a pre-exiting gingivitis thepink,firm and stippled, When there is a pre-exiting gingivitis the enlarged tissues compromise an already poor standard of plaqueenlarged tissues compromise an already poor standard of plaque control.the gingiva then exhibit the classical signs of gingivitiscontrol.the gingiva then exhibit the classical signs of gingivitis

6.3 Management6.3 Management1)A strict programme of oral hygiene instruction, scaling and polishing1)A strict programme of oral hygiene instruction, scaling and polishing

must be implemented. must be implemented.

2) Severe cases of gingival overgrowth inevitably need to be surgically2) Severe cases of gingival overgrowth inevitably need to be surgically excised and then recontoured to procedure an architecture that allowsexcised and then recontoured to procedure an architecture that allows adequate access for cleaningadequate access for cleaning

3)A follow-up programe is essential to ensure a high standard of plaque3)A follow-up programe is essential to ensure a high standard of plaque control and to detect any recurrence of the overgrowth.control and to detect any recurrence of the overgrowth.

4)To modify or change the anticonvulsant therapy if phenytion-induced4)To modify or change the anticonvulsant therapy if phenytion-induced overgrowth is refractory overgrowth is refractory

5)Indefinite oral care if there is no alternative.5)Indefinite oral care if there is no alternative.

7 Factitious gingivitis7 Factitious gingivitis7.1 Minor form7.1 Minor formEtiology: Etiology: Rubbing or picking the gingiva using the fingernail, or fromRubbing or picking the gingiva using the fingernail, or from abrasive foods abrasive foods Management: Management: correct the habit and remove the source of irritationcorrect the habit and remove the source of irritation7.2 Major form7.2 Major form

The injuries are more severe and widespread , can involve the deeperThe injuries are more severe and widespread , can involve the deeper periodontal tissues.periodontal tissues. Other areas of the mouth such as the lips and tongueOther areas of the mouth such as the lips and tongue may be involved. Extraoral injuries may be found on the scalp, limbs ormay be involved. Extraoral injuries may be found on the scalp, limbs or face.face.

ManagementManagementA A Dressing and protection of oral wounds Dressing and protection of oral wounds B B No lying with dentistsNo lying with dentistsC PC Psychological or psychiatric consultationsychological or psychiatric consultation

8 8 Chronic periodontitisChronic periodontitisA number of epidemio-logical studies have investigated the prevalence ofA number of epidemio-logical studies have investigated the prevalence of

chronic periodonditis in children. The prevalence of the study varied due tochronic periodonditis in children. The prevalence of the study varied due to different methods of diagnosing and different cut-off value in different studies.different methods of diagnosing and different cut-off value in different studies.

PrevalencePrevalenceAt 1-11%, At 1-11%, The chronic periodontitis initiates and progresses during the early teenageThe chronic periodontitis initiates and progresses during the early teenage

yearsyears

9 9 Periodontal complications of orthodontic treatmentPeriodontal complications of orthodontic treatment•• Gingivitis Gingivitis •• Gingival overgrowthGingival overgrowth•• Attachment and bone lossAttachment and bone loss•• Gingival recessionGingival recession•• Trauma Trauma

10 10 Early-onset aggressive periodontal diseaseEarly-onset aggressive periodontal diseasePrepubertal periodontitisPrepubertal periodontitis: mainly influences p: mainly influences primary dentitionrimary dentition i immediatelymmediately

after the teeth have eruptedafter the teeth have erupted. It includes . It includes generalizedgeneralized form and localized form and localized form:form:

Generalized formGeneralized formA A Gingiva:fiery red,swollen,and haemorrhagicGingiva:fiery red,swollen,and haemorrhagic

B B Tissue: hyperplastic with granularTissue: hyperplastic with granular （粒状的）（粒状的） or nodularor nodular （节结状的）（节结状的） proliferationproliferation

C C Gross deposits of plaqueGross deposits of plaqueD D Progress: extremely rapidly, primary teeth loss:3-4 yearsProgress: extremely rapidly, primary teeth loss:3-4 yearsE E Bone loss: may be restricted to one archBone loss: may be restricted to one archLocalized formLocalized formA A Progresses more slowly Progresses more slowly B B Bone loss affects only incisor-molar teethBone loss affects only incisor-molar teethC C Plaque levels are lowPlaque levels are low

TreatmentTreatmentA A Intense oral hygiene at frequent intervalsIntense oral hygiene at frequent intervalsB B AntibioticAntibioticC C Extraction of the teethExtraction of the teeth

Section 2 Section 2 Pediatric Oral Pathology Soft Tissue LesionPediatric Oral Pathology Soft Tissue Lesion

1 1 Infection:Infection:1.1 1.1 Viruses: Viruses:

1) Herpetic infention: Primary herpes simplex infection1) Herpetic infention: Primary herpes simplex infectionSecondary herpes simplex infectionSecondary herpes simplex infection

2) Hand, foot2) Hand, foot，，mouth diseasemouth disease

Cause: Cause: Coxsackie virus A16Coxsackie virus A16 Signs and symptomsSigns and symptoms

Prodrome:Prodrome: Fever, malaise, lymphadenopathyFever, malaise, lymphadenopathy

Skin lesion :Skin lesion : MaculopapuleMaculopapule((斑丘疹）斑丘疹）on the hands and feeton the hands and feetOral lesion:Oral lesion: vesicles ulcerationvesicles ulcerationCourse:Course: 10-14 days10-14 days

3) Herpangina3) Herpangina（疱疹性咽峡炎）（疱疹性咽峡炎）Cause:Cause: Coxsackie virus A4 Coxsackie virus A4 Signs and symptomsSigns and symptoms

A A Light systemic reaction and prodromeLight systemic reaction and prodromeB B Vesicles in the tonsillar or pharyngeal region ulcers, no coalesce forVesicles in the tonsillar or pharyngeal region ulcers, no coalesce for

large areas of ulcerationlarge areas of ulcerationC C Short-livedShort-lived

1.2 1.2 BacteriaBacteria1)1) Staphylococcal infections impetigo Staphylococcal infections impetigo2) 2) Streptococcal infectionStreptococcal infection3) 3) Congenital syphilisCongenital syphilis

1.3 Fungi or protozoa1.3 Fungi or protozoa（原生动物）（原生动物） Oral CandidiasisOral Candidiasis

Candidiasis Candidiasis describes a group of yeastlike fungal infections involving the skindescribes a group of yeastlike fungal infections involving the skin and mucous membranes. and mucous membranes. Classification of oral candidiasisClassification of oral candidiasis

1) 1) Acute pseudomembranous candidiasis (thrush)Acute pseudomembranous candidiasis (thrush)2) 2) Acute atrophic candidiasis, Acute atrophic candidiasis, 3) 3) Chronic hyperplastic candidiasis,Chronic hyperplastic candidiasis,4) 4) Chronic atrophic candidiasis. Chronic atrophic candidiasis.

Acute pseudomembranous candidiasis (thrush) Acute pseudomembranous candidiasis (thrush) Pathogens: Pathogens: Candida albicansCandida albicans. It’s a harmless commensal organism, but if there. It’s a harmless commensal organism, but if there is a disturbance in the oral flora or a decrease in the immune defenses, it becomesis a disturbance in the oral flora or a decrease in the immune defenses, it becomes opportunistic pathogen. opportunistic pathogen. Transmission: Transmission: Vagina or infection from breast or feeding utensilVagina or infection from breast or feeding utensilRisk Factors: Risk Factors: Low level of Antifungals substanceLow level of Antifungals substance

Deficiency of myeloperoxidase Deficiency of myeloperoxidase ( (脊髓过氧化物酶脊髓过氧化物酶))

Low secretion of salivaLow secretion of salivaClinical featuresClinical features

AgeAge：：Neonates and infants within 6 monthsNeonates and infants within 6 months

Oral lesion:Oral lesion:White patches oral mucosa, tongueWhite patches oral mucosa, tongueLesions develop into confluent plaques that resemble milk curds and canLesions develop into confluent plaques that resemble milk curds and can

be wiped off to reveal a raw erythematous and sometimes bleedingbe wiped off to reveal a raw erythematous and sometimes bleeding base.base.

Systemic reactionSystemic reaction

DiagnosisDiagnosis

Clinical diagnosisClinical diagnosis：：Clinical featuresClinical features

Fungal infectionFungal infection：：SmearSmear

Candida albicansCandida albicans：：CultureCulture

TreatmentTreatment Medication Medication

11））1%~2% NaHCO2 once 2~3h1%~2% NaHCO2 once 2~3h

22））0.05% Gentian violet0.05% Gentian violet((龙胆紫龙胆紫))，， three times dailythree times daily

33））1010 万万 U NystatinU Nystatin((制霉菌素制霉菌素))/ml/ml，，once 2~3honce 2~3h

44））Obstinate cases,100mg AmphotericinObstinate cases,100mg Amphotericin((两性霉素两性霉素))/ml/ml，，4 times daily4 times daily

55））Severe casesSevere cases，， clotrimazoleclotrimazole((克霉唑克霉唑))

Assistant managementAssistant managementOral hygiene Oral hygiene SterilizationSterilization

2 2 Traumatic UlcersTraumatic UlcersDue to trauma to the tissueDue to trauma to the tissue

•• Toothbrush abrasionToothbrush abrasion•• Tortilla chipTortilla chip•• BiteBite•• External trauma-physical violenceExternal trauma-physical violence

Any locationAny locationYellow ulcerated tissue with surrounding erythematous haloYellow ulcerated tissue with surrounding erythematous haloPainfulPainful

**Riga-Feda diseaseRiga-Feda diseaseCauseCause

A A Early eruption of primary incisorsEarly eruption of primary incisorsB B Sharpness of primary incisorsSharpness of primary incisorsC C AnkyloglossiaAnkyloglossia

Clinical featuresClinical featuresA A Site: Site: B B Shape:Shape:φφC C Progress:Progress:

TreatmentTreatment•• Local managementLocal management•• Removal of factorRemoval of factorss

•• Change feeding methodChange feeding method•• Excise of AnkyloglossiaExcise of Ankyloglossia

* * Bednar’s ulcerBednar’s ulcerCauseCauseClinical featuresClinical featuresTreatmentTreatment

* * Aphthous UlcersAphthous UlcersBe often found in childrenBe often found in childrenOne or more small ulcersOne or more small ulcersThe majority of aphthous ulcers in children are of the minor varietyThe majority of aphthous ulcers in children are of the minor varietyHeal within 10-14 days Heal within 10-14 days

Treatment is often unnecessaryTreatment is often unnecessaryIn severe cases: topical steroidsIn severe cases: topical steroidsOlder children: antiseptic rinses to prevent secondary infectionOlder children: antiseptic rinses to prevent secondary infection

3 3 White leisionsWhite leisions•• Geographic tongueGeographic tongue•• Normally symptomlessNormally symptomless•• Some discomfort with spicy foodsSome discomfort with spicy foods•• Areas of the tongue appear shiny and red due to loss of filiform papillaeAreas of the tongue appear shiny and red due to loss of filiform papillae•• These red patches are surrounded by white marginsThese red patches are surrounded by white margins•• These areas disappear before reappearing in other region of the tongueThese areas disappear before reappearing in other region of the tongue•• BeginBegin•• Require no treatmentRequire no treatment

4 4 CystsCysts5 5 TumorsTumors