Soft tissue lesions of the oral cavity are common in children, and distinguishing between findings that are normal and those that are indicative of gingivitis, periodontal disease, local or systemic infection, and potentially life-threatening systemic conditions is important. The loss of periodontal attachment in children, manifest by tooth mobility or premature loss, can be a symptom of neoplasia, immunodeficiency, or metabolic defects . The early detection and treatment of these conditions can be life-saving.
Systemic conditions associated with childhood periodontitis will be reviewed here. Soft tissue lesions and periodontitis not associated with systemic conditions are discussed separately. (See "Soft tissue lesions of the oral cavity in children" and "Gingivitis and periodontitis in children and adolescents: An overview".)
Langerhans cell histiocytosis (previously known as histiocytosis X or eosinophilic granuloma) is a rare disorder that affects infants, children, and young adults and is characterized by histiocytic infiltration of the bones, skin, liver, or other organs . (See "Clinical manifestations, pathologic features, and diagnosis of Langerhans cell histiocytosis".)
Langerhans cell histiocytosis (LCH) presents with single or multiple-site involvement. The skin, oral mucosa, bone, and lymph nodes are typical locations for single-site involvement. Multisite involvement occurs in the liver, spleen, lungs, bone marrow, and gastrointestinal and central nervous systems.
Between 10 and 20 percent of patients present with infiltration of the oral cavity, usually the posterior mandible . The typical dental presentation of LCH is eruption of the primary molars at or soon after birth (picture 1). Additional oral manifestations include pain; ulceration; enlargement, inflammation, or recession of the gingiva; and mobility of teeth because of expansion of the alveolar bone [4,5]. Dental radiographs may show discreet, destructive bone lesions that make the teeth appear to be "floating on air" [2,5]. Periosteal new bone formation and slight root resorption also may be present . Cases may present as aggressive periodontitis lesions that do not respond to routine periodontal therapy , despite the presence of periodontal flora typically associated with periodontitis .