your limit has been reached. plz Donate us to allow your ip full access, Email: sshnevis@outlook.com

Soft tissue lesions of the oral cavity in children

Lesion	Clinical features	Management
Lesions of the gums
Eruption cyst/hematoma	Normal finding Dome-shaped cyst Associated with eruption of teeth Cyst fluid may be mixed with blood (eruption hematoma)	No treatment necessary
Gingival pigmentation	Normal finding in dark-skinned children	No treatment necessary
Retrocuspid papillae	Firm, round, pink to red papule 2 to 3 mm (0.1 inches) in diameter Located on the inner gum below the lower canines Often bilateral	Resolves spontaneously
Parulis ("gum boil")	Associated with primary tooth abscess Soft, solitary, reddish papule on the outer gum above or below the abscessed tooth Drainage or pus may be observed	Complete pulpectomy or extraction of involved tooth
Gingival overgrowth
Inflammatory	Associated with longstanding gingivitis or chronic mouth breathing Erythematous gums with shiny, friable surface that bleeds easily Involves the gums between the teeth and at the margins of the teeth	Often resolves with adequate plaque control May require gingivectomy
Infiltrative	Associated with leukemia, particularly AML Edematous and hemorrhagic	Treatment of underlying disease
Drug-induced	Commonly precipitated by phenytoin, nifedipine, and cyclosporine A Painless, firm, fibrous overgrowth Bleeding is uncommon May progress to cover the crown of the tooth	Meticulous oral hygiene Discontinuation of offending drug, if possible May require gingivectomy
Hereditary	Onset in early childhood Progressive nonhemorrhagic fibrous enlargement May be associated with failure or delay of primary or permanent tooth eruption	Meticulous oral hygiene Gingivectomy
Vascular (localized juvenile spongiotic gingival hyperplasia)	Localized erythema of the attached gingiva of the front teeth Most common in female adolescents	Topical corticosteroids
Gingival recession	Associated with abnormally erupted teeth Narrowing of the gums above and below the teeth	Orthodontic repositioning of malpositioned teeth Gingival grafting may be necessary for severe recession
HIV gingivitis (linear gingival erythema)	Brightly inflamed gums at the margins of the teeth Bleeds easily Painful	Debridement Antibiotics Antibacterial oral rinses
Other gum lesions: Hemangiomas Irritant fibromas Peripheral ossifying fibromas Pyogenic granulomas Peripheral giant cell granulomas Traumatic ulcers Aphthous ulcers HSV gingivostomatitis	Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites"
Lesions of the tongue
Ankyloglossia	Tongue movement is restricted by a short, tight frenum between the tongue and floor of the mouth	May require frenotomy (refer to UpToDate content on ankyloglossia in children)
Congenital melanotic macules	Present from birth Single or multiple, asymptomatic, hyperpigmented macules Range from 3 mm to 3 cm (0.1 to 1.2 inches) in diameter; size increases proportionally as the child grows No family history of systemic conditions associated with mucosal pigmentation (eg, Peutz-Jeghers syndrome)	Monitor over time
Geographic tongue	Pink to red, slightly depressed lesions with irregular, elevated, curvilinear white or yellow borders Pattern of lesions changes continuously	Does not require treatment Avoidance of acidic foods and beverages is helpful if the lesions are sensitive
Fissured tongue	Marked central fissure from front to back of tongue Smaller fissures radiate laterally from the central fissure	Removal of trapped food particles through brushing of the tongue
Mucoceles	Clinical feature and management of mucoceles are described in the section on "Lesions of the lips"
Other tongue lesions: Hemangiomas Lymphangiomas Irritation fibromas Traumatic ulcers Aphthous ulcers Thrush HSV gingivostomatitis HFMD	Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites"
Lesions of the lips
Herpes labialis (fever blister, cold sore)	Vesicular eruption of skin adjacent to lip Vesicles rupture to form ulcers and crusts Caused by HSV	Refer to UpToDate content on treatment of HSV type 1 infection for treatment indications and options
Angular cheilitis (perlèche)	Painful fissuring at the corners of the mouth Usually caused by Candida albicans	Maintain oral hygiene Apply barrier cream or petrolatum May require antifungal therapy (refer to UpToDate content on angular cheilitis)
Abnormalities of the labial frena
Persistence of raphe between the upper labial frenum and the palatal papilla	May lead to widely spaced front teeth (diastema)	Diastema may require orthodontic treatment May require frenotomy
Extension of frenum to central incisors	May lead to gingival recession and bone loss	May require frenotomy to prevent bone loss
Absence or hypoplasia	May be associated with Ehlers-Danlos syndrome May be associated with infantile hypertrophic pyloric stenosis	No treatment required Monitor for signs and symptoms of Ehlers-Danlos syndrome and infantile hypertrophic pyloric stenosis
Mucoceles and ranulas	Painless swelling, smooth walled, bluish or translucent Usually <1 cm (0.4 inches) in diameter Usually located on the inside of the lower lip but may occur on the tongue or floor of the mouth (ranula)	May spontaneously resolve Surgical excision with associated minor salivary gland for mucoceles that interfere with function or cause discomfort Surgical treatment, ranging from incision and drainage to marsupialization to excision for ranulas
Other lip lesions: Hemangiomas Lymphangiomas Irritation fibromas Pyogenic granulomas Traumatic ulcers Aphthous ulcers Thrush HSV gingivostomatitis HFMD	Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites"
Lesions of the palate
Herpangina	Lesions progress from yellow/greyish-white papules to vesicles to shallow ulcerations The lesions most frequently involve the soft palate, tonsils, and uvula Typically occurs in children age 3 to 10 years	Supportive care to prevent dehydration Symptomatic treatment of pain
Other palatal lesions: Irritation fibromas Traumatic ulcers Aphthous ulcers Thrush HSV gingivostomatitis HFMD	Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites"
Lesions of the buccal mucosa
Hemangiomas Lymphangiomas Irritation fibromas Aphthous ulcers Traumatic ulcers Thrush HSV gingivostomatitis HFMD	Clinical features and management of these lesions are described in the section on "Lesions that occur at multiple sites"
Lesions that occur at multiple sites
Hemangioma	Red or bluish-red, raised, moderately firm to palpation Appear early in life, enlarge during infancy, and regress during childhood May occur on any oral mucosa (eg, gums, tongue, lips, palate, buccal mucosa)	Refer to UpToDate content on management of infantile hemangiomas
Lymphangiomas	Pink to reddish-blue, soft, compressible May be present at birth or develop early in life May occur on the tongue, lips, or buccal mucosa	May require surgical resection or percutaneous chemoablation
Irritation fibroma	Pale, pink, smooth, firm, <1 cm (0.4 inches) in diameter, sessile or pedunculated base Usually occur on the tongue, lip, palate, or buccal mucosa, but may occur on any mucosal surface	Surgical excision if it interferes with function
Peripheral ossifying fibroma	Traumatic overgrowth that contains mineralized tissues (eg, bone, calcifications) Predominantly occurs on the gingiva	Surgical excision down to the bone
Pyogenic granuloma (lobular capillary hemangioma)	Bright red lesion with rapid growth, friable surface, easy bleeding May be triggered by trauma More common in females	Surgical excision
Peripheral giant cell granuloma	Bluish-purple traumatic overgrowth Typically occur on the gingiva Slightly more common on the lower gums More common in children with mixed dentition and adults between 30 and 40 years of age More common in females	Surgical excision
Traumatic ulcers	Occur on the gums, tongue, lips, palate, and buccal mucosa	Spontaneous healing with removal of source of trauma
Aphthous ulcer	Localized, shallow, round to oval ulcers with grayish base Occur on the gums, tongue, lips, palate, and buccal mucosa	Refer to UpToDate content on aphthous ulcerations
Thrush	White plaques on the tongue, lips, palate, and/or buccal mucosa	Sterilization/decolonization of items placed in the mouth (eg, pacifiers, bottle nipples) Topical or systemic antifungal therapy may be warranted for symptomatic patients Refer to UpToDate content on oropharyngeal candidiasis in children
HSV gingivostomatitis	Red, edematous marginal gingivae Clusters of small vesicles that become yellow after rupture and are surrounded by a red halo Vesicles occur on the gums, tongue, lips, hard palate, buccal mucosa, and perioral skin	Supportive care to prevent dehydration Symptomatic pain control Topical barrier cream Oral acyclovir may be warranted (refer to UpToDate content on herpetic gingivostomatitis in young children)
HFMD	Oral vesicles, small cutaneous lesions on the hands, feet, buttocks, and genitalia	Supportive care to prevent dehydration Symptomatic pain control

AML: acute myeloid leukemia; HIV: human immunodeficiency virus; HSV: herpes simplex virus; HFMD: hand, foot, and mouth disease.

Graphic 114185 Version 3.0