Conditions Exhibited in Infants and Children

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From the Cradle to the Grave: Oral pathology through the life span
Conditions Exhibited in Infants and Children:
Dental Lamina Cysts

Etiology: Developmental

Clinical appearance: Cystic nodules on alveolar ridges

No tx required-resolve spontaneously

Retrocuspid papilla

Etiology: Developmental

Clinical appearance: 2-4 mm raised area on mandibular lingual inferior to canine

No tx required

Commissural Lip pits

Etiology: developmental

Clinical appearance: Labial commissure area, Opening-1 to 2 mm, depth-2 to 4 mm

No tx required


Etiology: developmental

Gemination-one tooth bud attempts to split

Fusion-two tooth buds join

Clinical appearance- Large tooth with invagination

No tx required


Etiology: Developmental

Clinical Appearance: radiopacities resembling rudimentary toothlets

Composed of enamel, dentin, pulp, cementum

Two types

Compound-small, rudimentary toothlets

Complex-larger than compound-conglomerate mass of enamel and dentin



Epithelial lined cavity filled with fluid

Can be intraosseous or in soft tissue

Can be odontogenic or developmental

Can be destructive
Dentigerous Cyst:

Etiology: Developmental-Odontogenic

Clinical Appearance: Surrounds the crown of an unerupted tooth (attached at CEJ) radiographically

Tx -excision

Eruption Cyst

Etiology: Developmental

Soft tissue variant of dentigerous

Clinical Appearance: Bluish gray raised area

No Tx required

Etiology: Developmental Vascular anomaly

Becomes apparent in childhood

Clinical Appearance: Raised or flat blue lesion variable size

Tx: Excision, may resolve spontaneously
Ectodermal Dysplasia

Etiology: hereditary disease of ectoderm, Group of 150+ genetic disorders hypohidrotic form most common, affects hair, skin, teeth, nails

Clinical Appearance: dry sparse hair, dry skin, missing and developmentally deficient teeth, dystrophic nails

Only fully expressed in males-females are carriers

Tx-Prosthetic therapy
Tricho-dento-osseous Syndrome

Etiology: Hereditary

Rare form of ectodermal dysplasia

Affects hair (tricho), teeth (dento) and bone (osseous)

Tx-manage dental defects

Dental Manifestations

Most common:

Enamel Hypoplasia

Osteogenesis Imperfecta with Opalescent teeth

Etiology: Hereditary bone disease

Fragile bones, fracture easily

If associated with Opalescent teeth:

Clinical Appearance: Bluish/brown discoloration with translucency, attrition, bulbous crowns, obliterated root canals

Tx: Restorative

Hand Foot and Mouth Disease

Etiology: Coxsackievirus

Seen in mini epidemics-children

Clinical Appearance: Flu like symptoms-fever, sore throat, malaise

Red macules with central vesicles-heal without crusting

Intraorally-multiple vesicles that rupture-ulcers, 2-4 mm in diameter

Tx: symptomatic

Etiology: Coxsackievirus (not associated with herpes as name implies)

Clinical Appearance: Symptoms similar to HFM. Oral lesions similar to HFM, but posterior soft palate area-rarely anterior to this.

Tx: symptomatic

Multifocal Epithelial Hyperplasia (Heck’s Disease)

Etiology: Human papilloma virus, types 13 and 32

Seen mostly in children and teenagers of ethnic populations

Clinical Appearance: Normal color of surrounding tissue, clustered small soft rounded papules on labial, buccal, lingual mucosa

No tx required
Conditions Exhibited in Adolescents and Young Adults
Adenomatoid Odontogenic Tumor

Etiology: Unknown-Epithelial Odontogenic tumor with gland like structures

Young age group

Clinical Appearance: Anterior jaws, often assoc with impacted tooth radiographically

Tx: Excision
Conditions Manifesting Intraoral Pigmentation

Racial pigmentation

Drug therapy

Metal impregnation

Oral melanotic macule

Smoker’s melanosis

Systemmic Diseases

Peutz-Jegher’s Syndrome

Addison’s Disease

Albright’s Syndrome

Gardner’s syndrome

Kaposi’s Sarcoma

Oral Melanoma
Peutz-Jegher’s Syndrome

Etiology: hereditary- Intestinal polyposis

Clinical Appearance: Perioral and intraoral pigmentation, pigmentation on hands and feet

Gastrointestinal Adenocarcinoma or tumors of other organs

Tx: Monitor polyps
Addison’s Disease

Etiology: Autoimmune, infections, tumors

Insufficiency of the adrenal cortex

Clinical Appearance: Bronzing of the skin and oral pigmentation

Tx: corticosteroid replacement therapy
Hereditary Hemorrhagic Telangiectasia (HHT)

Etiology: Hereditary disorder – Offspring 50% chance of having the disease

Also called Rendu-Osler-Weber Syndrome

Highly variable – even among family members

Only 10% are diagnosed

Clinical Appearance: Telangiectasias-skin and mucous membranes

Intraoral-telangiectasias on tongue, labial/buccal mucosa, palate, gingiva

Nosebleeds in 90%

arteriovenous malformations (AVMs)-lungs, brain, GI tract (iron deficiency anemia), liver

Tx-Embolization of AVM’s, close follow-up, premedicate patients with AVM’s

Pyogenic Granuloma

Etiology: exuberant tissue response to local irritation or trauma

Clinical Appearance: Red lesions, most common in interdental papilla region

Granulation tissue-Endothelial cells, very vascular

Tx: Excision

Etiology: chemical

Clinical Appearance: “moth eaten” loss of tooth structure from frequent purging

May have enlarged salivary glands

Tx: therapy for eating disorder, restorations
Conditions exhibited in Adults
Oral Cancer

90% are squamous cell carcinomas

Most common area-lateral/ventral tongue, floor of mouth
Risk factors(Etiology???)

Tobacco (Smoked and smokeless)

Alcohol (synergistic effect of the two)

History of infections (HPV, EBV, HIV, Candida)

Chronic irritation


Actinic Radiation (lip)
Clinical Appearance: Types of lesions

White patch-Leukoplakia

Red patch-erythroplakia

Red and white patch



*It can look very innocuous!!!!!!

Snuff dipper’s lesion-wrinkled, white lesions

Tx: If no dysplasia, remove cause and lesion will resolve

Carcinoma In Situ: “Cancer in place”

Tx: Excision

Oral cancer Tx-Combination of excision, radiation, chemotherapy

Human Papilloma Virus

More than 100 subtypes, several oral manifestations in epithelial tissue

Papilloma, Verucca Vulgaris, Multifocal Epithelial Hyperplasia

Subtypes noted for Oral Cancer, primarily 16, but also 6,7,33,35,59


Etiology: Human papilloma virus, primarily HPV 6 and 11

Any age – most in 30-50

Clinical Appearance: Exophytic, cauliflower like lesion, may have surface keratinization

Tx-Surgical excision
Verucca Vulgaris

Etiology: Human papilloma virus 2,4,6, & 40

Clinical Appearance: Exophytic, cauliflower like lesion, found most in children (hands), most common on skin, rarely intraoral

Vermillion border, labial mucosa, anterior tongue

Tx-Surgical excision
Multifocal Epithelial Hyperplasia-described earlier
Condyloma Acuminatum

Etiology-HPV, 2,6,11,53,54, sexually transmitted

Clinical Appearance: Exophytic, cauliflower like lesion on oral mucosa or genitalia

TX-surgical excision


Etiology-Human Immunodeficiency virus, targets the CD4+ helper T lymphocyte

Transmitted by sexual contact, parenteral exposure to blood, mother to fetus

Acquired immunodeficiency syndrome-opportunistic infections as a result of immunosuppression

Tx: Extended survival with highly active anti-retroviral therapy (HAART), no cure
HIV Related Oral Lesions (HIV-ROL), 30% reduction of HIV-ROL with HAART

Condyloma acuminatum, Oral candidiasis, Hairy leukoplakia, Kaposi sarcoma

Detection of oral manifestations critical in unaware individual
Oral Candidiasis

Etiology: Candida albicans

Clinical Appearance: erythematous-diffuse redness, acute pseudomembranous-white plaques which can be wiped off leaving a red base

Tx: antifungals

Oral Hairy Leukoplakia

Etiology: Epstein Barr virus (EBV)

Clinical Appearance: white corrugated plaques, lateral border of tongue

Tx: antivirals

Kaposi’s sarcoma

Etiology: strongly associated with human herpesvirus type 8

Clinical Appearance: asymptomatic red macule, red/purple plaque, lobulated violet nodules that can ulcerate and cause pain

Tx: radiation, injection of chemotherapeutics or sclerosing agents

Irritation fibroma (focal fibrous hyperplasia)

Etiology: Chronic irritation-the most common hyperplastic lesion of the oral cavity, fibrous connective tissue

Clinical Appearance: Most commonly seen on gingiva, buccal mucosa, tongue. Smooth round sessile nodule

Tx-Surgical excision

Giant cell fibroma-variant of irritation fibroma

Conditions Exhibited in Older Adults
Candidiasis (moniliasis)-several forms, Etiology: candida albicans (fungal infection)


Acute (erythematous) – typically result of antibiotic therapy

Chronic (denture stomatitis)-

Pseudomembranous (thrush)

Chronic hyperplastic

Angular cheiltiis
Chronic Atrophic Candidiasis

Clinical Appearance: Common beneath dentures, partials, flippers, usually asymptomatic, red area oftentimes in outline of appliance

Tx-antifungal Medications (nystatin, clotrimazole)
Acute Pseudomembranous Candidiasis (thrush)

Clinical Appearance: White areas that can be wiped off with gauze and gentle pressure

Tx-antifungal Medications (nystatin, clotrimazole)
Median Rhomboid Glossitis

Also called central papillary atrophy,Long term candida albicans infection, Usually asymptomatic

Clinical Appearance: red, oval area on dorsum of tongue, anterior to circumvallate papillae

Tx - antifungal

Inflammatory Papillary Hyperplasia

Etiology: Chronic irritation from ill fitting denture/appliance

Clinical Appearance: Red papules in palatal area, asymptomatic, may be secondarily infected with candida albicans

Tx-Refit denture/appliance, antifungal for candida

Epulis Fissuratum

Etiology-chronic trauma to oral mucous membranes

Forms around the flanges of an ill-fitting denture

Inflammatory fibrous hyperplasia, denture induced fibrous hyperplasia

Clinical Appearance: Tumor-like hyperplasia of fibrous connective tissue

Can be firm and fibrous, same color as surrounding tissue or erythematous and ulcerated

Tx: excise redundant tissue, reline or remake denture
Gingival Hyperplasia

Etiology: multiple

Exaggerated response to local factors, hormonal changes, drugs, hereditary, systemic disease: leukemia

Tx: Remove/adjust cause

Comprehensive home care program, gingivoplasty/gingivectomy
Lichen Planus

Etiology: Immune mediated

Relatively common skin disease with oral manifestations, middle aged adults

Several forms – reticular and erosive most common

Clinical Appearance: Characteristic white lesion – Wickham’s striae on buccal mucosa (reticular) and erosive areas on gingiva (erosive)

Tx: Corticosteroids

Sjogren (Sicca) Syndrome

Etiology: Autoimmune

Complex multifactorial disease

Two types-primary and secondary

Primary affects the salivary and lacrimal glands

Clinical Appearance: Enlarged Salivary glands, xerostomia

Secondary Sjogren Syndrome

90% of cases women

Rheumatoid arthritis most common assoc disease

Can affect other body tissues-dry skin, nasal and vaginal mucosa

Fatigue, depression, raynaud’s phenomenon, is chronic, risk of malignant transformation to lymphoma

TX: Symptomatic

Artificial tears and saliva

Immaculate oral hygiene

Dietary modification

Fluoride therapy

Anemia/Vitamin Deficiencies

Etiology: lack of iron, vitamins

Clinical Appearance: papillary atrophy on tongue, aphthous like ulcerations

Tx: Determine cause, iron/vitamin therapy

Systemic Conditions manifesting aphthous like ulcerations:

Gastrointestinal disorders

Nutritional deficiencies

Cyclic Neutropenia

Celiac Disease

Behcet Syndrome

Sherri M Lukes, RDH, MS, FAADH

President, Illinois Dental Hygienists’ Association

Associate Professor Emerita

Southern Illinois University Carbondale

680 Wing Hill Road

Cobden, IL 62920


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