Intraoral soft tissue abnormalities

• ANKYLOGLOSSIA :

  • tongue tie
  • common, characterised by abnormally short lingual Frenum and inability to extend tongue
  • frenum can lengthen with growth to produce normal function
  • if ankyloglossia is servere = impedes speech thus speech therapy or surgical correction is indicated
  • if child can lengthen tongue to moisten lower lip frenectomy not indicated
• GEOGRAPHIC TONGUE:

  • aka benign migratory glossitis
  • common , occurs comely on the dorsal and lateral borders of the anterior 2/3 of the tongue
  • appears pink-red, round/irregular areas of Dekeratinization and desquamation of filliform papillae with white/yellow margins
• FISSURED TONGUE:

  • developmental anomaly, presents as one marked central fissure, anteroposteriorly from which smaller fissures radiate laterally
  • in deeper fissures food particles my get trapped causing inflammation or secondary fungal infection
  • common in children with Down’s syndrome
• GEOGRAPHIC TONGUE:

  • chnages patterns creating migratory appearence
  • typically asymptomatic but painful when inflammed
  • no definite cause, associated with allergies, more common in girls
  • treament = reassurance
• GINGIVAL ENLARGEMENT:

  • inherited trait
  • induced by drugs
  • associated with leukemia
• HEREDITARY GINGIVAL FIBROMATOSIS:

  • it is also known as idiopathic hyperplasia.
  • rare, progressive, fibrous enlargement of the gingiva beginning in early childhood
  • appears thick, firm and pink …. Affects the buccal and lingual surfaces of both jaws.
  • associated with delayed or no eruption of primary and permanent teeth
  • treatment of choice = gingivectomy
  • oral hygiene is used to reduce recurrence.
• GINGIVAL ENLARGEMENT ASSOCIATED WITH LEUKEMIA:

  • Occurs due to infiltration of malignant white blood cells most typically in monocytic leukemia
  • gingival overgrowth = edematous and hemorragic
  • due to bleeding tendency patients tend to not practice good OHI
  • inflammation = stimulant for more connective tissue hyperplasia
• DRUG INDUCED GINGIVAL ENLARGEMENT:

  • seen in 50% of children taking

  1. phenytoin- seizure Control
  2. cyclosporin A - immunosuppressant
  3. Nifedipine - calcium channel blocker

  • use of drugs before tooth eruption = delayed/ failure of eruption Due to dense fibrous overgrowth
  • after tooth eruption enlargement occurs at gingival papillae
  • gingival enlargement is exacerbated by inflammator response to dental plaque( prominent on labial of anterior teeth)
• DRUG INDUCED GINGIVAL ENLARGEMENT:

  • combo of drugs = rapid gingival proliferation - need for alteration of drug regimen
  • gingival enlargement is not dose dependent but cessation = resolution
  • children on aforementioned meds OHI paramount
  • servere cases = gingivectomy