LUTHERAN MEDICAL CENTER

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Dan Boboia Date: 7/17/09
Article title: Differential Diagnosis of Oral Enlargements in Children
Author(s): Flaitz et al.
Journal: Pediatric Dentistry
Volume #; Number; Page #s): 17:4
Year: 1995
Type of Article: Review
Main Purpose: To review soft tissue and bony enlargements that typically occur in the oral and perioral region in children
SOFT TISSUE LESIONS:
Papillary enlargements:
- Viral-induced epithelial proliferation resulting in pale, spongy-to-firm enlargements with a pebbly or papillary appearance and rough surface texture; painless with limited growth potential; divided into isolated or multiple lesions; spontaneous resolution or protracted course

Acute Inflammatory Enlargements:
- Characterized by sudden onset, rapid progression, and compressible tissue distension; fluid-filled or edematous lesion, frequently tender to palpation and may fluctuate in size; systemic effects such as fever, malaise, and lymphadenopathy may develop as the lesion progress; divided into infectious and noninfectious processes with localized or diffuse tissue involvement
Reactive Hyperplasia:
-A benign group of lesions that frequently mimic neoplastic disease; most develop in response to a chronic reoccurring injury that stimulates tissue repair; exhibit moderate growth, absence of pain, and limited growth potential; divided into primary or multifactorial causes for initiation and growth; if source of injury is removed partial regression of the lesion may occur
Benign Submucosal Cysts and Neoplasm:
-Nodular, well delineated, and freely movable enlargements with intact mucosal surfaces; slow persistent growth pattern causing alteration of tissues; usually asymptomatic unless traumatized or they impinge on adjacent tissues
Aggressive / Malignant Soft Tissue Enlargement:
-Rapid progressive growth, infiltrative margins are defining features of this group; irregular surface changes with areas of erythema and ulceration; early lesion are asymptomatic but as progression occurs pain, paraesthesia, lymphadenopathy, and obstruction can occur; prognosis depends on lesion size, malignancy, and proximity to vital structures.
BONEY ENLRAGEMENTS OF THE MAXILLA AND MANDIBLE:
-Three categories: inflammatory lesions of the jaw, benign cystic and neoplastic lesions, and aggressive and malignant lesions.
Inflammatory lesions of the jaw:
-Rapid enlargement, pain, erythema, and drainage; cause is usually a mobile or nonvital tooth; poorly defined radiolucent or radiolucent-radiopaque; may also notice widened PDL, lamina dura loss, internal or external resorption of the root.
Benign cystic and neoplastic lesions of the jaws:
-locally expansile but slow growing; delayed tooth eruption and facial asymmetry are notice; well-delineated unilocular or multilocular with cortical plate expansion; radiolucent, radiopaque, or mixed; can be accompanied by blunt root resorption or displacement of anatomic structures
Aggressive and malignant neoplasms of the jaw:
-Diffuse enlargement with moderate growth rate; pain mucosal ulceration, extrusion of teeth, and paresthesia are common complaints; poorly defined radiolucent or mixed lesion with cortical destruction; irregular root-resorption, loss of lamina dura, widening of the PDL space, and appearance of floating tooth.
Assessment of article: Great review; excellent flow charts