Oral Soft Tissue Lesions in Children
🔍 1. Core Concept
- Oral
lesions ในเด็กมี spectrum กว้าง:
- normal
variant →
infection →
inflammatory →
neoplasm →
systemic disease
- ส่วนใหญ่ benign แต่บางกรณีเป็น early
sign ของ systemic disease (เช่น leukemia,
HIV)
🧾 2. Approach (ใช้จริงในคลินิก)
🔹 Key step
1.
Age + tooth eruption stage
2.
Location (gum / tongue / lip / palate)
3.
Pain vs painless
4.
Acute vs chronic
5.
Systemic symptoms
🦷 3. Lesions of Gums
(high-yield)
🟢 Benign / developmental
- Eruption
cyst / hematoma
- dome-shaped
- หายเองเมื่อฟันขึ้น
- Retrocuspid
papillae
- papule
หลัง canine
- bilateral,
no treatment
- Physiologic
pigmentation
- normal
ในเด็กผิวคล้ำ
🔴 Infection / dental
origin
- Parulis
(gum boil)
- abscess
→ draining fistula
- ต้องรักษา tooth (extract / pulpectomy)
⚠️ Gingival overgrowth (ต้องคิด cause)
1. Inflammatory
- plaque
/ braces
- bleeding
easily
2. Drug-induced
- phenytoin
(most common)
- nifedipine,
cyclosporine
👉 management: - oral
hygiene + consider stop drug
3. Infiltrative (IMPORTANT)
- Leukemia
- edematous,
hemorrhagic gingiva
- systemic
symptoms
4. Hereditary
- gingival
fibromatosis
🦠 HIV gingivitis
- linear
erythema
- pain
+ bleeding
- ไม่ตอบสนองต่อ hygiene
👉 Tx: debridement + antibiotics ± antifungal
👅 4. Tongue Lesions
🟢 Common benign
- Geographic
tongue
- migratory
red patch + white border
- no
treatment
- Fissured
tongue
- groove
trapping debris
🔴 Important conditions
- Ankyloglossia
(tongue-tie)
- Mucocele
(ventral tongue/lip)
- Thrush
/ HSV / HFMD
👄 5. Lip Lesions
🔹 Infection
- Herpes
labialis
- vesicle
→ ulcer → crust
- Angular
cheilitis
- Candida-related
fissure
🔹 Others
- Freckling
→ consider genetic
disease (Peutz-Jeghers)
- Labial
frenulum abnormality →
orthodontic issue
🫧 6. Common Lesions
Across Multiple Sites
🟢 Benign tumors
- Hemangioma
- Lymphangioma
🔴 Reactive lesions
- Irritation
fibroma
- Pyogenic
granuloma
- Peripheral
giant cell granuloma
🔥 Ulcers (VERY COMMON)
1. Traumatic ulcer (most common)
- heal
<2 weeks
2. Aphthous ulcer
- painful,
recurrent
3. Infection
- Candida
(thrush)
- HSV
(gingivostomatitis)
- HFMD
🚨 7. Red Flags (ต้องคิด serious disease)
- Gingival
enlargement + bleeding →
leukemia
- Persistent
ulcer >2 weeks
- Systemic
symptoms (fever, weight loss)
- Severe
mucositis → SJS /
immunologic disease
🧠 8. Clinical Pattern
Recognition (ใช้เร็ว)
|
Finding |
Likely Dx |
|
Bluish dome over erupting tooth |
Eruption cyst |
|
Gum boil with pus |
Parulis |
|
Gingival hypertrophy + drug |
Phenytoin effect |
|
Gingiva bleeding + systemic |
Leukemia |
|
White wipeable plaque |
Candida |
|
Multiple ulcers + fever |
HSV / HFMD |
|
Single painful ulcer |
Aphthous |
💊 9. Management
Principles
- ส่วนใหญ่ benign →
reassurance
- Remove
cause (trauma, plaque)
- Treat
infection:
- antifungal
(Candida)
- antiviral
(HSV severe)
- Dental
referral (abscess, eruption issue)
- Investigate
systemic disease when suspected
🔑 Key Takeaways
- เด็กส่วนใหญ่ = benign + self-limited
- Parulis
→ treat tooth,
not lesion
- Gingival
enlargement ต้อง rule out leukemia
- Ulcer
>2 weeks → evaluate
further
- ใช้ pattern recognition + age + location เป็นหลัก
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