Penyakit Mukosa Pada Pediatric

DR. drg Sandy Christiono Sp.KGA

UNISSULA
2022
 Introduction
Although some disorders are confined
to the mouth, oral lesions may be a
sign of a systemic medical disorder.
The majority of oral pathology seen in
children is benign; however, it is
essential to identify or eliminate more
serious conditions.
Primary herpetic gingivostomatitis

This is the most common cause of

severe oral ulceration in children. It is
caused by herpes simplex type 1 virus.
Occasional cases of type 2 (the usual
cause of genital herpes) infection have
been reported, mainly in cases of
sexual abuse.
Infection with primary herpes often occurs at the
time of eruption of primary teeth
Common presentation with multiple small
ulcers on the lower lip, and gingival swelling
and inflammation.
Herpangina and hand, foot and
mouth disease
These infections are caused by the
Coxsackie group A viruses. As with
primary herpes, both of the above
conditions have a prodromal phase of
low-grade fever and malaise that may
last for several days before the
appearance of the vesicles
Herpangina with characteristic palatal and
pharyngeal ulceration and inflammation
Cutaneous lesions in hand, foot and
mouth disease.
 Varicella
• This is a highly contagious virus causing chickenpox
in younger subjects and shingles in older individuals.
• There is a prodromal phase of malaise and fever for
24 h followed by macular eruptions and vesicles.
• In chickenpox, oral lesions occur in around 50% of
cases but only a small number of vesicles occur in
the mouth. These lesions may be found anywhere in
the mouth in addition to other mucosal sites such as
conjunctivae, nose or anus. Healing of oral lesions is
uneventful.
Gingival ulceration and stomatitis during an
acute episode of infectious
mononucleosis.
Gingival ulceration in chickenpox infection
Lip ulceration after mandibular block
anaesthesia

This is one of the most common

causes of traumatic ulceration. Parents
should be warned and children
reminded not to bite their lips after
mandibular block anaesthesia
Traumatic oral ulceration from biting
the lip after a mandibular block
injection.
 Riga–Fedé ulceration

• This is ulceration of the ventral

surface of the tongue caused by
trauma from continual protrusive
and retrusive movements over the
lower incisors.
• Once a common finding in cases of
whooping cough, it is now almost
exclusively seen in children with
cerebral palsy.
Riga–Fedé ulcer on the ventral surface of
the tongue arising from rubbing on the
solitary mandibular incisor
Recurrent aphthous ulceration

• Recurrent aphthous ulceration (RAU)

has been estimated to affect up to
20% of the population.
• Lesions are classification according to
size, duration and severity.
Minor recurrent aphthae in an adolescent girl. These
lesions were extremely painful. Haematological
investigations revealed a low folate level, which
when corrected eliminated further ulceration
Major recurrent aphthous ulceration is a
debilitating condition and heals with
scarring. This girl’s ulcers were managed
with systemic steroids
 Erythema multiforme
(von Hebra)
• The original description of erythema
multiforme was that of a self-limiting but
often recurrent and seasonal skin disease
with mucosal involvement limited to the
oral cavity.
• The lips are typically ulcerated with
blood-staining and crusting. The
characteristic macules (‘target lesions’)
occur on the limbs but with less
involvement of the trunk or head and
neck.
Erythema multiforme presenting with pan-
stomatitis and severe dehydration.
Treatment included rehydration and
symptomatic care of the ulceration.
 Stevens–Johnson syndrome
• The condition presents with acute febrile
illness, generalized exanthema, lesions
involving the oral cavity and a severe
purulent conjunctivitis.
• The skin lesions are more extensive than
those of erythema multiforme. Stevens–
Johnson syndrome is characterized by
vesiculobullous eruptions over the body, in
particular the trunk, and severe involvement
of multiple mucous membranes including the
vulva or penis and conjunctiva.
Stevens–Johnson syndrome with severe
mucocutaneous involvement.This child
required admission to the intensive care
unit for 3 days.
 Epidermolysis bullosa
Epidermolysis bullosa is a term used to describe
several hereditary vesiculo-bullous disorders of the
skin and mucosa. Within the hereditary variants,
there are three groups according to the location of
skin separation:
• Epidermolysis Bullosa Simplex, non-scarring form,
transmitted as an autosomal dominant or sex-
linked trait.
• Junctional Epidermolysis Bullosa, with demi-
desmosome defect and severe scarring,
transmitted as an autosomal recessive trait.
• Dystrophic Epidermolysis Bullosa.
Vesiculobullous diseases often present with
ulceration due to fragility of the preceeding
vesicles or bullae.
 Orofacial granulomatosis and
Crohn disease
Although not primarily an ulcerative condition, oral
ulceration may be the presenting sign in orofacial
granulomatosis. Orofacial granulomatosis may be
confined to the orofacial region and precede or be a
manifestation of Crohn disease, an inflammatory
condition of the gastrointestinal tract, or of
sarcoidosis.
Haemangioma/localized
vascular anomaly
Haemangiomas are endothelial
hamartomas. Typically present at birth,
they may grow with the infant but then
may regress with time to disappear by
adolescence. As such, they require no
treatment other than observation,
excepting cosmetic concerns.
Different presentations of haemangiomas in infants
 Lymphangioma

Diagnosis of developmental lymph

vessel abnormalities must exclude
vascular involvement. Surgical
excision is only necessary if of
functional or aesthetic concern.
Lymphangioma in the palate
Red lesions Eruption cyst or
haematoma
Follicular enlargement appearing just prior
to eruption of teeth. These lesions tend to be
blue-black as they may contain blood. They
usually require no treatment unless infected.
The parents and child should be reassured
and the follicle allowed to rupture
spontaneously or it may be surgically
opened if infected
Eruption cysts may be associated with any
tooth
 Geographic tongue
• This condition is also termed glossitis
migrans, benign migratory glossitis,
erythema migrans or ‘wandering rash of
the tongue’.
• It presents as areas of depapillation and
erythema with a heaped ‘serpentine-
like’, keratinized margin on the lateral
margins and dorsal surface of the
tongue.
Geographic tongue & fissured
tongue
 Fibrous epulis
One of the most common epulides that is seen
in children resulting from an exuberant
fibroepithelial reaction to plaque. Commonly
arising from the interdental papillae and
covered by epithelium, they range in colour
from pink to red to yellow. Those appearing
yellow are ulcerated.
Fibrous epulis.
Giant cell granuloma – central or
peripheral (epulis)

These lesions usually occur in the

region of the primary dentition. The
colour of these lesions tends to be
dark purple. Bone loss of the alveolar
crest can sometimes be observed as
‘radiographic cupping’.
Peripheral giant cell granuloma/giant cell
epulis.
 Squamous papilloma

A squamous papilloma is a benign

neoplasm caused by the human
papilloma virus (HPV), presenting as a
cauliflower-like growth on the mucosa.
The colour of the lesion depends on
the degree of keratinization.
A papilloma in the palate of a young child. In
this case the lesion was associated with viral
warts on the extremities, hence this is
assumed to be a viral papilloma
Hereditary gingival fibromatosis

Gingival enlargement may be a

feature of several syndromes,
some of which include learning
disabilities. These syndromes may
occur sporadically or as an
autosomal dominant or an
autosomal recessive trait.
Hereditary gingival fibromatosis
 Cyclic neutropenia
• In this condition, there is an episodic decrease
in the number of neutrophils every 3–4 weeks.
• Peripheral neutrophil counts usually drop to
zero and during this time, the child is extremely
susceptible to infection.
• Recurrent oral ulceration often occurs when cell
counts are low.
• Gingival and periodontal involvement occurs
with the emergence of teeth and is progressive.
Gross gingival inflammation in an adolescent with
cyclic neutropenia. This girl lost most of her primary
teeth by the age of 7 years.