Soft tissue lesions of the oral cavity in children
- Martha Ann Keels, DDS, PhD
Martha Ann Keels, DDS, PhD
- Associate Professor of Pediatric Dentistry
- Duke University Medical Center
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'.)
- Andlin-Sobocki A, Bodin L. Dimensional alterations of the gingiva related to changes of facial/lingual tooth position in permanent anterior teeth of children. A 2-year longitudinal study. J Clin Periodontol 1993; 20:219.
- De Felice C, Toti P, Di Maggio G, et al. Absence of the inferior labial and lingual frenula in Ehlers-Danlos syndrome. Lancet 2001; 357:1500.
- De Felice C, Di Maggio G, Zagordo L, et al. Hypoplastic or absent mandibular frenulum: a new predictive sign of infantile hypertrophic pyloric stenosis. J Pediatr 2000; 136:408.
- Sigal MJ, Mock D. Symptomatic benign migratory glossitis: report of two cases and literature review. Pediatr Dent 1992; 14:392.
- Barton DH, Spier SK, Crovello TJ. Benign migratory glossitis and allergy. Pediatr Dent 1982; 4:249.
- Mueller DT, Callanan VP. Congenital malformations of the oral cavity. Otolaryngol Clin North Am 2007; 40:141.
- Geographic tongue and fissured tongue. In: Online Mendelian Inheritance in Man. http://omim.org/entry/137400 (Accessed on November 07, 2011).
- Orlando MR, Atkins JS Jr. Melkersson-Rosenthal syndrome. Arch Otolaryngol Head Neck Surg 1990; 116:728.
- Singer SL, Goldblatt J, Hallam LA, Winters JC. Hereditary gingival fibromatosis with a recessive mode of inheritance. Case reports. Aust Dent J 1993; 38:427.
- Raeste AM, Collan Y, Kilpinen E. Hereditary fibrous hyperplasia of the gingiva with varying penetrance and expressivity. Scand J Dent Res 1978; 86:357.
- Delaney JE, Keels MA. Pediatric oral pathology. Soft tissue and periodontal conditions. Pediatr Clin North Am 2000; 47:1125.
- Oral Pathology: Clinical-Pathologic Correlations, 2nd, Regezi JA, Sciubba J (Eds), WB Saunders, Philadelphia 1993. p.196.
- Dongari A, McDonnell HT, Langlais RP. Drug-induced gingival overgrowth. Oral Surg Oral Med Oral Pathol 1993; 76:543.
- Thomason JM, Seymour RA, Ellis JS, et al. Determinants of gingival overgrowth severity in organ transplant patients. An examination of the rôle of HLA phenotype. J Clin Periodontol 1996; 23:628.
- Majola MP, McFadyen ML, Connolly C, et al. Factors influencing phenytoin-induced gingival enlargement. J Clin Periodontol 2000; 27:506.
- Bökenkamp A, Bohnhorst B, Beier C, et al. Nifedipine aggravates cyclosporine A-induced gingival hyperplasia. Pediatr Nephrol 1994; 8:181.
- Fishman SJ, Mulliken JB. Hemangiomas and vascular malformations of infancy and childhood. Pediatr Clin North Am 1993; 40:1177.
- Shiels WE 2nd, Kang DR, Murakami JW, et al. Percutaneous treatment of lymphatic malformations. Otolaryngol Head Neck Surg 2009; 141:219.
- Langlais RP, Miller CS. Color Atlas of Common Oral Diseases, Lea & Febiger, Philadelphia 1992. p.32.
- Cherry JD, Jahn CL. Herpangina: the etiologic spectrum. Pediatrics 1965; 36:632.
- Adler JL, Mostow SR, Mellin H, et al. Epidemiologic investigation of hand, foot, and mouth disease. Infection caused by coxsackievirus A 16 in Baltimore, June through September 1968. Am J Dis Child 1970; 120:309.
- Chonmaitree T, Menegus MA, Schervish-Swierkosz EM, Schwalenstocker E. Enterovirus 71 infection: report of an outbreak with two cases of paralysis and a review of the literature. Pediatrics 1981; 67:489.
- Lum LC, Wong KT, Lam SK, et al. Fatal enterovirus 71 encephalomyelitis. J Pediatr 1998; 133:795.
- Leggott PJ. Oral manifestations of HIV infection in children. Oral Surg Oral Med Oral Pathol 1992; 73:187.
- ANATOMIC PROBLEMS
- DEVELOPMENTAL LESIONS
- Geographic tongue
- Fissured tongue
- Retrocuspid papillae
- Gingival overgrowth
- BENIGN TUMORS
- Lymphatic malformations
- Pulpal necrosis and parulis
- Eruption cyst
- Traumatic ulcers
- Aphthous ulcers
- Herpes simplex virus
- - Herpangina
- - Hand, foot, mouth
- Candida albicans
- HIV infection