07/24/09 Delayed tooth eruption associated with an ameloblastic firbro-odontoma

Resident: Adam J. Bottrill
Date: 24JUL09
Region: Providence
Article title: Delayed tooth eruption associated with an ameloblastic firbro-odontoma
Author(s): Flaitz, Catherine M. DDS, MS; Hicks, John MD, DDS, PhD
Journal: Pediatric Dentistry
Volume #: Number; Page #s): 23: 253-254
Year: 2001
Major topic: Delayed eruption associated with ameloblastic fibro-odontoma
Minor topic(s): Differential diagnosis for delayed eruption
Type of Article: Case review
Main Purpose: Discussion and differential diagnosis for delayed eruption
Overview of method of research: Case study

Findings: Healthy 31 month-old Hispanic boy presented with unerupted primary left mandibular canine. Bony, hard mass at site of unerupted tooth. Facial asymmetry. Pt occluding on soft tissue covering bony swelling. PA revealed RL with dilacerations of M root of 1st primary molar and displacement of developing premolar. RL lesion is expansile, mixed radiolucent/ radiopaque lesion surrounds crown of unerupted canine. Histo eval revealed cords and islands of odontogenic epithelium, conglomerate foci of enamel and dentin and small tooth-like structures. Connective tissue in the sample resembled the dental papilla. DX: Ameloblastic Fibro-Odontoma (AFO)

Key points in the article discussion: Odontogenic cysts and neoplasms are an uncommon reason for delayed eruption of primary teeth but should be included in the DD. Odontomas are the most common associated lesion, but presence of bony expansion should lead us to explore other etiologies.
A. AFO: Uncommon odontogenic tumor.
1. Resembles ameloblstic fibroma and complex odontoma. Slow growing, painless swelling. Delayed eruption. Unilocular or multilocular. Well-defined margins. Varied radiopacities. Central opacity resembles the same density as a tooth. Can displace teeth. Several cm large.
2. Mean age: 8-11.
3. Occurs equally in both jaws
a. anterior when in maxilla
b. posterior when in mandible
4. Tx: conservative curettage with possible splint. Recurrence following conservative surgery is uncommon.
B. DDX: AOT, COC, CO (most common)
1. CO: asymptomatic developmental abnormality (hamartoma)
a. pericoronal molar region.
b. delayed eruption
c. typically opaque with thin margin of lucency, a developing odontoma may actually resemble AF-O.
d. minimally expansile
2. AOT: benign tumor usually found during second decade.
a. anterior maxilla
b. no bony expansion
c. well-defined, unilocular RL around crown tooth.
3. COC: uncommon with varying clinical behavior.
a. in children, typically cystic type.
b. anterior region
c. peak in 2nd and 3rd decade
d. unilocular/multilocular associated with unerupted tooth
e. 50% associated with tooth-like opacities.
f. Tx: enucleation with uncommon recurrence.

Summary of conclusions: Delayed eruption of a SINGLE primary tooth is very uncommon. After ruling out trauma, neoplasms and odontogenic tumors become the most common etiology. This article outlined a short DDX of the condition.

Assessment of article: A concise DDX for delayed eruption of single primary tooth in the absence of traumatic event. This article could use a conclusion paragraph. Builds up to a real cliffhanger and then leaves the audience with no closure!

07/24/09 Palatal Erythema in Patients Using Listerine Cool Mint PocketPaks

Resident: Jason Hencler Date: 07/24/09
Article title: Palatal Erythema in Patients Using Listerine Cool Mint PocketPaks Oral Care Strips: Case Reports
Author(s): Chris L. Pham, DDS; A. Jeffrey Wood,DDS; Michael B. Lambert, DMD; William Carpenter, DDS, MS
Journal: Journal of Dentistry for Children
Volume #72; Number 2; Page #52-55
Year: 2005
Major topic: Palatal Erythema
Minor topic(s):
Type of Article: Case Report
Main Purpose: Present 2 cases of similar erythematous lesions in patients using Listerine Cool Mint PocketPaks Oral Care Strips
Overview of method of research: Review of 2 similar cases including diagnosis, treatment, and outcome.
Findings: Case 1: 44yo Caucasian female presents with asymptomatic rectangular lesion on mid-hard palate. Patient was unaware of lesion. Upon questioning patient revealed frequent use of strips. When patient discontinued strips, erythematous lesion was not present at next evaluation. Patient was asked to resume use of strips and at the next appointment the lesion had returned. An exfoliative cytology specimen was obtained to rule out suspicion of Candida albicans. Periodic acid-schiff test was negative for C. albicans. Case 2: 7 yo Hispanic female with no significant med history, no systemic diseases, and age appropriate dental development. Patient had no unusual habits. A very symmetrical square shaped lesion was located on the mid palate. The anterior border was feathered with subtle gradation toward the anterior 1/3 of the palate. Lesion was almost identical to case 1. After discontinuation of cool strips the lesion disappeared.
Key points in the article discussion: Possible differential diagnosis for erythematous lesions of th epalate include: 1) Chemical or Physical allergy/irritation 2) yeast infection (C. albicans) 3) sexual abuse 4) foreign object trauma. With evidence gathered from removing and reapplying Listerine cool strips, there is support for these strips to be the causative agent. These oral aids adhere to the palate after applications, so prolonged exposure to these strips and the various chemical compositions they contain, was a likely suspect. The lesion’s feathered anterior border is consistent with use of this agent due to the swallowing reflex. It is unlikely that this is a case of allergy contact dermatitis. Past studies indicate menthol, thymol, and propylene glycol as possible causative agents. Shape of the lesions found in this study indicate that Listerine cool strips. Type III hypersensitivity is implied which may take 48hrs to develop.
Summary of conclusions: Patients presenting with asymptomatic, square shaped, erythematous macular lesions on the mid-hard palatal gingival who report use of Listerine strips, a differential diagnosis of sensitivity to this oral aid should be considered. These cases presented here provide clinicians with one more differential diagnosis to consider.
Assessment of article: Article presented some good points but not particularly groundbreaking. I thought after patients revealed using strips, characteristics of lesion, especially shape, made the diagnosis quite obvious.

07/24/09 Oral Abnormalities in Taiwanese Newborns

Resident: Jason Hencler

Article title: Oral Abnormalities in Taiwanese Newborns

Author(s): Ming-Hui Liu, DDS; Wen-Hsi Huang, DDS

Journal: Journal of Dentistry for Children

Volume #71; Number 2; Pg: 118-120

Year: 2004

Major topic: Oral Abnormalities in Newborns

Type of Article: Observational

Main Purpose: Investigate the frequency of oral abnormalities in newborns in Taiwan

Overview of method of research: Study included 420 infants born between February and April 2000. Babies with craniofacial abnormalities and systemic conditions were excluded. One dentist examined all newborns within 3 days of birth. Authors segmented each arch into 12 separate areas to record oral abnormalities. They also recorded natal and neonatal teeth.

Findings: All 420 newborns were of East Asian ethnicity and consisted of 231 males and 189 females. 4 kinds of oral abnormalities were found: 1) natal teeth 2) neonatal teeth 3) palatal cyst of the newborn 4) gingival cyst of the newborn. Frequency of natal and neonatal teeth was 1%. All teeth were located in the mandibular anterior area. Among the subjects examined, 86% had palatal cysts, 79% had gingival cysts. Overall the frequency was 94%.

Key points in the article discussion: Oral abnormalities of newborns include: 1) inclusion cyst 2) alveolar lymphangioma 3) median alveolar notches 4) natal teeth 5) neonatal teeth 6) congenital epulis 7) commissural lip pits 8) ankyloglossia. The terms natal and neonatal refer only to the time of eruption but not the origin of tooth germ. Crowns are either well formed or discolored with irregular surface and are mostly mobile due to short or missing roots. Histologically they have hypoplastic enamel and some have irregular dentin and enlarged interlobular areas in the dentin tubules. Most have large vascular pulp and may fail to form cementum. Other studies reported a slightly lower frequency of natal and neonatal teeth. Larger sample sizes in the other studies may explain this difference. Most natal and neonatal teeth occur in the mandible incisor region except in the case of cleft lip and palate, where they occur in the maxillary cleft areas. Gingival cysts near the surface appear as white masses. They don’t increase in size with age and they are rarely seen after 3 months of age. Frequency of cysts (94%) in this study was higher than recorded in any other published reports. Palatal cysts (84%) and gingival cysts (79%) were not low. This variance with past data may be due to racial difference, examination methods, and different definitions of cysts. This study found no significant correlation between gender, body weight, and gestational age.

Summary of conclusions: Palatal cyst frequency was highest. Of the gingival cysts, buccal aspects of the maxillary arch and lingual aspects of the mandibular arch were more pronounced. Frequency of palatal and gingival cysts of the newborn was not significantly affected by gender, body weight, gestational age, or delivery pattern variables. One natal tooth in 1 newborn and 2 neonatal teeth in another were located in the mandibular anterior for an incidence less than 1%.

Assessment of article: Data from this study could be useful to a Pediatric dentist when treating a patient population that included patients of East Asian ethnicity. Compared with other races, East Asian newborns may have higher incidence of the oral abnormalities considered in this study. The high frequency of oral cysts found in this study may be due to small sample size when compared with other past studies.

A clinicopathologic and immunohistochemical analysis of melanotic neuroectodermal tumor of infancy

Resident’s Name: Brian Schmid DMD
Author(s): A.W. Barrett et al.
Journal: Oral Surg Oral Med Oral Path
Month, Year: 2002
Major topic: A small retrospective, histological study of melanotic neuroectodermal tumors in infants (MNTI)
Type of Article: Retrospective
Findings: MNTI’s are quite rare and usually considered benign with only 250 reported cases, typically as a single or paired lesion but also in clusters of 5 or more. The membrane can be intact or ulcerated, blue, brown or red and can even resemble an eruption cyst. There is no sex predilection and presentation is typically less than 1y.o. The treatement of choice is surgical removal with a conservative lymph node dissection to rule out metastasis. Radiotherapy and chemotherapy are ineffective and would be contraindicated in such young patients anyhow.
Searching through pathology department archives, 8 cases of melanotic neuroectodermal tumors were found; 7 in males and 7 affected the maxilla. The cases ranged from 1963-1999. The age of presentation was 2.5-14 months and all were treated with excision. Three of the cases “involved the whole maxilla” and 2 crossed the midline but only 1 case required a radical bilateral maxillectomy. Radiographically the lesions could present a radiopaque or radiolucent state and moth single and multilocularity. Histologically the lesions present as small melanocyte-like cells mixed with smaller neuroblast-like cells. There is good evidence that these lesions are of neural crest origin. The purpose of this study as to elucidate a histological/immunological assay that could be performed to successfully predict aggression and malignancy of a given tumor. NB84 is a reliable marker for childhood neuroblastoma but was negative on all account in this study. While the most aggressive case was the only one positive for CD99 and Ki67, this is inconsistent with many previous findings. There is a small chance of recurrence which can be monitored with regular intra-oral exams.
Key points/Summary: While this study did not specify any immunohistological markers which could help identify the more malignant episodes of this tumor, further study is necessary and in the meantime it is in the best interest of the patient to perform proper soft tissue exams at regular intervals in all patients. Erythroplakic and pigmented lesions are of particular importance to note, monitor and treat.
Assessment of article: Chock full of biochemistry goodness but with some valuable clinical peppering. They included no photos of the study patients, which may not have been available, or even stock photos of an MNTI.

Oral candidiasis

Department of Pediatric Dentistry
St Joseph Hospital

Resident’s Name: Joanne Lewis Date: July 17, 2009
Article title: Oral candidiasis in children with immune suppression: Clinical appearance and therapeutic considerations
Author(s): Catherine M. Flaitz, DDS, MS; M. John Hicks, DDS, MS, PhD, MD
Journal: Journal of Dentistry for Children
Month, Year: May-June 1999
Major topic: Oral candidiasis in immuno-suppressed children
Type of Article: review
Main Purpose: to review the clinical appearance, diagnosis, and treatment of oral candidiasis
Key points/Summary: Oropharyngeal candidiasis is of considerable importance in any condition that results in an immune suppressed state; it is particularly important in individuals with HIV infection. The development of oral candidiasis is considered to be an ominous sign, indicative of a severely depressed immune system. Oral candidiasis may present in several forms: 1.) pseudomembranous candidiasis (thrush) – white to yellow plaques overlying the oral mucosa – can be removed with gauze – symptoms include tenderness, burning, and dysphasia. 2.) erythematous (atrophic) candidiasis – marked erythematous mucosa on palate and/or dorsum of tongue – associated with broad-spectrum antibiotics and corticosteroid therapy. 3.) papillary hyperplasia – anterior hard palate, small ovoid nodules raised 2-3 mm above erythematous palatal mucosa – response to a chronic fungal infection. 4.) chronic hyperplastic candidiasis – thickened hyperkeratotic mucosa, looks like a localized area of leukoplakia – seen in long-standing fungal infections – presents on dorsum of tongue or retrocommissural region 5.) angular chelitis – seen at the commissures, may become encrusted secondary to fissuring and erosion – seen commonly in children with a lip-licking habit. 6.) median rhomboid glossitis – lesion surface varies from nodular to fissured to smooth and depapillated. Diagnosis: clinical appearance (most common), exfoliative cytology, biopsy, or culture (when lesions are resistant to anti-fungal therapy). Treatment: 1.) topical – nystatin creams, rinses, pastilles, ketoconazole cream, clotrimazole creams and lozenges, amphotericin B cream and lotion – usually have high sucrose or dextrose content, long term use may increase caries risk. 2.) prophylactic – chlorhexidine rinses. 3.) systemic – clotrimazole, ketoconazole, fluconazole, itraconazole (azole class) – side effects include – nausea, vomiting, pruritus, skin rash, abdominal discomfort, headache, abnormal liver function, drug-induced hepatitis – assess liver function at time of administration. Fluconazole and itraconazole have been more effective at treating oral candidiasis. Prophylaxis with antifungal agents in children and adolescents with HIV infection is not routinely recommended, but may be indicated on a case-by-case basis.
Assessment of article: good review.

Herpesvirus Infections

LUTHERAN MEDICAL CENTER

Dental Residency Program

Literature Review Form

Resident: Adam J. Bottrill Date: 17JUL09 Region: St. Joseph’s

Article title: HERPESVIRUS INFECTIONS

Author(s): Greenberg, Martin S. DDS

Journal: Infectious Diseases and Dentistry

Volume #; Number; Page #s): Vol. 40; Number 2, pp. 359-367

Year: 1996

Major topic: Herpesvirus

Minor topic(s): NA

Type of Article: Topical Review

Main Purpose: Review various presentations and treatments of multiple forms of the herpesvirus.

Overview of method of research: Literature review and summary.

Findings: N/A

Key points in the article discussion:

A. All 7 herpesviruses have the following common characteristics.

1. Four Layers (DNA, capsid, tegument, lipid envelope)

2. Primary infection followed by latent period.

3. Recurrent infections (symptomatic or asymptomatic)

4. Transmitted through direct contact with saliva or genital secretions.

5. Shed in the saliva of asymptomatic hosts.

6. Known to transform cells in tissue culture.

B. Herpes Simplex Virus: Two major herpes simplex viruses are HSV 1 and HSV2. HSV1 is MOSTLY transmitted via saliva and associated with “upper body” infections. HSV2 is MOSTLY transmitted via genital secretions and associated with anal/genital infections. Rate of HSV1 infection goes up after 6 mo. And peaks between 2 and 3 y.o. HSV2 infection rate increases after sexual activity begins.

1. Primary: Frequently subclinical or are difficult to distinguish from URI’s. Can be preceded by fever, chills, malaise, nasea and lymphadenopathy. Oral manifestations include vesicles and ulcers of oral mucosa.

2. Reactivation: Stimulated by trauma, fever menstruation etc. Recurrences appear most commonly on the lips but can be present on the hard palate and gingiva.

3. Dx: Typically diagnosed clinically but may be done via lab tests. SHOULD ALWAYS BE RULED OUT WRT THE IMMUNOCMPROMISED (IC) PT.

C. Cytomegalovirus: Frequent cause of asymptomatic infection in humans. Clinically significant cases are rare except in neonates and IC Pt’s. Xmitted via genital secretions, breast milk, saliva and blood. CMV can cause potentially fatal congenital infection cytelomegalic inclusion disease. Infant CMV almost always involves enlarged salivary glands. In adults, can cause a mono-like disease with clinical manifestations including hepatitis, pneumonitis, lymphadenopathy, splenomegaly and myocarditis. At-risk individuals include organ transplant, HIV and IC pts. Oral lesions in AIDS pts have been described as slowly enlargening ulcers.

1. Dx: Histologic evaluation and culture of suspected lesions (owl eye cells) or viral culture. Culture can take up to 1 month but is most diagnostic.

D. Varicella-Zoster Virus:

1. Primary: Chicken pox (varicella) is usually a benign illness of children spread by direct contact with lesions or nasopharyngeal secretions. Lesions are typically pruritic macules and papules that become vesicles with erythematous halo.. 10-20 day incubation and pts are infectious for about 1 week after symptoms begin. Adults have 15x higher mortality rate due to increased incidence of encephalitis. Other symptoms include pneumonitis and Reye’s syndrome (progressive encephalopathy).

2. Recurrent: Shingles (herpes zoster) occurs when the latent virus (dorsal root nerve ganglia) becomes reactivated. Typically occurs at C-3, T-5, L-1, L-2. When trigeminal nerve involved, usually involves ophthalmic. Symptoms initially include pain, tenderness and parasthesia. This is followed by unilateral vesicles forming along the course of the affected nerve (Ramsay-Hunt syndrome). 15-20% of trigeminal infections involve 2nd and 3rd division leading to possible intra-oral lesions. Can be life-threatening to IC pts. Course of the zoster can be shortened with large doses of acyclovir. Additional sequela of herpes zoster may take the form of postherpetic neuralgia.

3. Dx: Typically made via characteristic clinical signs and proper medical history. When atypical cases present, tissue culture and viral isolation can confirm.

E. Epstein-Barr Virus: Affinity for B lymphocytes. Virus is spread by infected saliva or blood.

1. Primary: Typically subclinical or mild in children. Young adults present with infectious mononucleosis. Symptoms of “mono” include fever, malaise, pharyngitis, lymphadenopathy and possible splenomegally. Most pts recover within a month.

2. Dx: Based on clinical signs and bloodwork (detection of activated T-lymphcytes and heterophil antibodies).

3. Important note: EBV is associated with: Hairy leukoplakia, Burkitt’s lymphoma, nasopharyngeal carcinoma and possibly B cell lymphoma.

F. Human Herpes Virus 6: Discovered in 1986, has a strong affiliation for CD4 lymphocytes. Causes roseola (common disease among children) which presents with fever and a rash. Suspected the HHV6 is related to mono, pneumonia, meningitis and encephalitis.

G. Human Herpes Virus 7: Most recently discovered herpesvirus detected on CD4 lymphocytes. Distinguishable from HHV-6 by DNA analysis. Can initially infect in the 2nd yr of life (later than HHV-6). Transmitted via saliva.

Summary of conclusions: There are more than 80 known viruses of the herpes group. This article presents brief summaries of seven of them

Assessment of article: Though not an experimental research-based article, it did provide concise summaries of the seven aforementioned herpesviruses. One area not covered was effective treatment methods. It is possible that there may be a more recent summary article with more updated information on this.

: Juvenile Xanthogranuloma of the Oral Cavity in Children: A Clinico-pathologic study.

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 7/17/2009
Article title: Juvenile Xanthogranuloma of the Oral Cavity in Children: A Clinico-pathologic study.
Author(s): Flaitz C., Allen C., Neville B., et al
Journal: Oral Surg Oral Med Oral pathol Oral Radiol Endod
Volume (number): 345-52
Date: Sept 2002
Major topic: Clinical and Histochemical evaluation of JXG
Type of Article: Case Reports
Main Purpose: This article reviews 5 cases of oral JXG in children
Review of Cases: JXG is a benign reactive self-healing disorder of children which is classified as a normolipenic, non Langerhans cell disease caused by the proliferation of phagocytoid monocytes. It most commonly affects infants less than 1 year of age with a male predilection. The cutaneous type is most commonly associated with the head and neck region of the skin and occurs as single or multiple lesions in a cluster. The lesion is papulonodular with a color varying from yellow to red to red brown to normal skin color. The lesions are usually asymptomatic and the lesions undergo spontaneous regression after several months leaving a permanent scar.
Systemic JXG can affect several different organ systems, and skin lesions are associated with it in 40-50% of cases. Treatment includes surgical excision. If left untreated, this disorder may be life threatening
Five cases of Oral JXG were studied ranging in age from 5 months to 10 years with a mean age of 6.3 years. Most lesions were solitary affecting the gingival, dorsum of tongue, and buccal mucosa and none were associated with cutaneous lesions. Histopathological examination indicated an increase in histiocytes and dendritic cells in the lesions. Extensive histological evaluation was discussed in the article.
Differential diagnosis with Langherhan cell disease (LCD0 is necessary. Other diseases linked to JXG are neurofibromatosis type I, juvenile chronic myeloid leukemia, ALL, LCD, Diabetes Mellitus, etc.
Key points/Summary : Oral JXG tends to occur in an older age group than the other types of JXG. Cellular analysis of a biopsy is necessary to differentiate it from LCD
Assessment of article: Good article. Too much information about the ultrastuctural and immunocytochemical studies of the lesions.

Department of Pediatric Dentistry

Lutheran Medical Center

Date: 07/17/2009

Article title: Periodontal and Soft-Tissue Abnormalities

Author(s): Jayne E. Delaney, DDS, MSD

Journal: Dental Care for the Preschool Child

Volume (number): vol 39 num 4

Month, Year: 1995

Major topic: soft tissue and periodontium

Minor topics:

Type of Article: Informative

Main Purpose: Review pertinent clinical information concerning periodontal problems in children as well as proper treatment. Many common soft tissue abnormalities are also reviewed.

Overview of method of research: Review of Literature

Findings:

Gingival and other soft tissues differ from those of adults. Additionally, they frequently present with myriad soft tissue and periodontal problems. Frequent review of these lesions helps providers better care for children and provide proper referral to medical colleagues, should they need to.

Children are generally more resistant to periodontal disease than adults. Therefore, when children present with periodontal problems, systemic factors should be investigated.

Key points/Summary :

Periodontium

Localized and generalized periodontitis

At least one study says that 6-7% of children approximately age 5 have been shown to have radiographic peridontal bone loss. Treatment is scaling and root planning as well as antibiotics as needed.

Prepubertal Periodontitis

Often associated with systemic diseases. Most successfully treated when localized.

Neutropenias

Neutrophils play a protective role in the periodontium. In their absence, disease and bone loss can occur quickly; ulcers are a common occurrence. Treatment is scrupulous oral hygiene and antibiotic therapy.

Papillon-Leferve Syndrome

Hyperkeratosis on the palms and soles of teeth and premature loss of teeth are common manifestations of this disease. Primary teeth are often lost by age 5. A treatment modality that has shown some promise is the endulate the child, treat heavily with antibiotics and allow later eruption of any unerupted teeth, which can erupt into an oral environment lacking in periodontal bacteria.

Metabolic disorders

Diabetic children may manifest with early periodontal disease due to altered neutrophil chemotaxis

Histiocytosis X

aka Langerhans cell disease. Mostly a radiographic finding of "teeth floating in space" but gingival inflammation is also common.

Hypophosphatasia

Most common oral finding is early loss of teeth, sometimes with primary tooth exfoliation at age 1.5

Soft Tissue

Ankyloglosia

Most children will have some frenum growth with age, but others may need surgical intervention. A speech pathologist should be consulted in any case affecting speech and before any decision for surgery.

Geographic tongue

aka benign migratory glossitis. Asymtomatic and most common in girls.

Fissured tongue

Associated with geographic tongue, also benign.

Retrocuspid Papillae

Present in most children behind the mandibular cuspids. Not anything to worry about.

Gingival Fibromatosis

Can be drug induced, inherited or associated with leukemia. Poor OH exacerbates this problem.

Hemangioma

Benign tumor of mesenchymal origin. Usually painless. Surgical removal is the usual treatment.

Lymphangioma

Benign tumor of lymphatic origin. Usually present at birth. Tongue is the most common site.

Mucocele

Retention of mucous in subepithelial tissues, most common in children and adolescents. Treatment of choice is surgical removal.

Fibroma

One of the most common benign lesions. Treatment is surgical removal with low recurrence.

Parulis

End point of draining sinus tract associated with an abcessed tooth.

Eruption Cyst and Hematoma

see image

Herpesvirus Infection

I think we all know plenty about this

Herpangina

Acute viral infection usually in summer or early fall. Usually has vesicles on tonsillar fauces.

Hand-Foot-and-Mouth Disease

Caused by coxsackie. Ulcerating and crusting vesicles, treatment is palliative only.

Recurrent Apthous Ulceration

Cause is unknown, but suspect food allergies, trauma, stress and hormonal changes. Mouthrinse and topical anesthetics are treatment.

Candidiasis

Treat with topical application of antifungals.

Impetigo

Perioral purulent bacterial infection. Usually due to strep A or Staph aureus; treat with topical or systemic antibiotics.

HIV

Usually children will present with candidiasis. Parotid swelling is also more common in HIV children than adults.

Leukemias

Leukemic gingival enlargement is most common. But mucositis is also common due to chemotherapy associated with leukemia. Poor OH can really worsen the situation.

Traumatic Ulcer

Most common ulcer in children. Often postanesthesia bites.

Assessment of article: Good review, lots of clinical applicability. I wish it had talked about periodontal defects caused by orthodontic problems, like cross bite.