Soft tissue lesions of the oral cavity are common in children. When evaluating soft tissue lesions, it is important to distinguish between findings that are normal and those that are indicative of gingivitis, periodontal disease, local or systemic infection, and potentially life-threatening systemic conditions.
The clinical findings, diagnostic criteria, and treatment recommendations for common soft tissue lesions will be reviewed here. Gingivitis, periodontal disease, and the oral manifestations of systemic conditions are discussed separately. (See "Gingivitis and periodontitis in children and adolescents: An overview" and "Periodontal disease in children: Associated systemic conditions".)
Gingiva — The teeth erupt through an existing band of keratinized gingiva, known as the attached gingiva. In dark-skinned individuals, pigmentation of the attached gingiva, due to melanin, is a normal finding.
The width of the keratinized band and its relationship to the teeth remain relatively constant during the child's growth and development. Deflections in the path of eruption (eg, due to crowding or overretention of primary teeth) may result in a narrowed band of attached gingiva . This finding is particularly common when mandibular incisors erupt labial to the alveolar ridge (picture 1). If the band of attached gingiva is very narrow (eg, less than 3 mm), subsequent loss of attachment can result in the absence of attached gingiva or a "mucogingival defect." Mucogingival defects, defined by a pocket depth that exceeds the width of keratinized gingiva, predispose to rapid gingival recession (picture 1).
Labially erupted teeth are particularly vulnerable to attachment loss and periodontal disease because they are difficult to clean, especially after recession has occurred. (See "Gingivitis and periodontitis in children and adolescents: An overview", section on 'Gingivitis'.)