Color Atlas of Oral Diseases in Children and Adolescents. George Laskaris
• Clinically, the lesions present as an asymptomatic, grayish or melanotic macule or plaque, or even as an inflammatory swelling (Figs. 5.2, 5.3).
• The diagnosis is based on the history, clinical features, and occasionally on histopathological features.
Laboratory tests
• Radiographic examination.
• Biopsy and histopathological examination.
Differential diagnosis
• Amalgam tattoo
• Melanocytic nevus
• Pyogenic granuloma
• Soft-tissue abscess
Treatment
• Surgical excision of the foreign body.
Fig. 5.1 Amalgam tattoo on the palatal alveolar mucosa
Fig. 5.2 Fish bone implantation on the lateral border of the tongue, resulting in an inflammatory swelling
Fig. 5.3 Pencil graphite implantation into the dentogingival sulcus of the leteral incisor
Materia Alba of the Gingiva
Definition
• Materia alba is the result of necrotic epithelial cells, bacteria, and accumulation of food debris on the oral mucosa.
Etiology
• It is usually seen in patients with poor oral hygiene who neglect toothbrushing, or in cases in which painful oral lesions make oral hygiene difficult.
Occurrence in children
• Common.
Localization
• Dentogingival margins, attached gingiva, alveolar vestibular mucosa.
Clinical features
• Clinically, a white or yellow-whitish plaque is seen, which can be easily removed with slight rubbing, leaving an erythematous surface (Fig. 5.4).
• The plaque is painless, and is usually accompanied by halitosis.
• The diagnosis is based on the clinical features.
Differential diagnosis
• Candidiasis
• Leukoplakia
• Lichen planus
• Chemical burn
Treatment
• Good oral hygiene.
Fig. 5.4 Materia alba on the attached lower gingiva
6 Periodontal Diseases
Gingivitis
Definition
• Gingivitis is an inflammatory disease of the marginal gingiva, either localized or generalized.
Etiology
• It is primarily caused by bacterial plaque accumulation due to inadequate oral hygiene.
• Calculus, mechanical irritation, and irregularities in the position of the teeth may be contributory factors.
Occurrence in children
• Common.
Localization
• Free and interdental gingiva. Mainly observed during the mixed dentition, and more rarely in the primary dentition.
• Sometimes in areas of tooth eruption (eruption gingivitis).
Clinical features
• Redness and edema, usually without pain (Fig. 6.1).
• Gingival hyperplasia may sometimes be observed (Fig. 6.2).
• Bleeding may occur spontaneously, or after light probing.
• There is often halitosis.
• The diagnosis is made clinically.
Differential diagnosis
• Desquamative gingivitis
• Drug-induced gingival hyperplasia
• Gingivitis due to mouth breathing
• Acute leukemia
Treatment
• Plaque control and good oral hygiene.
• Gingivectomy, in cases of severe gingival hyperplasia.
Periodontitis
Definition
• Periodontitis is the result of progression of the inflammatory process from the gingiva to the deeper periodontal structures.
Etiology
• Bacterial plaque is important for the initiation of the disease.
• The same factors as in chronic gingivitis, which usually evolve into periodontitis.
• Systemic predisposing factors include: diabetes mellitus, human immunodeficiency virus (HIV) infection, immune diseases, metabolic diseases, etc.
• Host factors are also important, and appear to be influenced by genetic and environmental factors such as smoking.
Occurrence in children
• Rare, mainly in adolescents.
Localization
• Localized or generalized.
Clinical features
• The consequences of periodontitis are alveolar bone resorption and loss of attachment, followed by periodontal pocket formation.
• Inflammation and edema of the gingiva, pockets deeper than 3 mm (Fig. 6.3).
• Bleeding and malodorous breath, teeth migration, tooth movement.
• The diagnosis is usually made clinically.
Radiographic features
• Alveolar bone resorption.
Differential diagnosis
•