Paediatrics: Disorders of mouth and tongue

Disorders of mouth and tongue

Gingivostomatitis

Gingivostomatitis refers to inflammation of the oral mucosa and is charac-terized by the presence of multiple sores and mouth ulcers. The condition is common, particularly among pre-school aged children, and is usually secondary to a viral infection, particularly those that cause common child-hood illness such as:

•   Herpes simplex (resulting in cold sores and acute herpetic stomatitis).

•   Coxsackie viruses (hand, foot, and mouth disease, and herpangina).

Vesicular lesions may erupt on the lips, gums, tongue, and on the hard palate. There is a wide spectrum of clinical features ranging from the mild to the severe, which is often characterized by:

•   Pain on eating and drinking.

•   High fever.

•   Bleeding from gums.

•   Extensive ulceration of the tongue, palate, and buccal mucosa.

•   Cervical lymphadenopathy.

•   Dehydration due to refusal to eat or drink may occur.

Investigation

Usually no specific tests are required for the diagnosis. Nevertheless, blood for coxsackie or herpes virus serology and culture of material obtained from the surface of the sore may identify the viral infection.

Treatment

•   Symptomatic (analgesia) and supportive (fluids).

•   Good oral hygiene should be maintained with antiseptic mouth washes where tolerated.

•   Severe infection may need admission for rehydration with IV fluids and treatment with oral or IV aciclovir.

Macroglossia

Macroglossia is tongue enlargement that leads to functional and cos-metic problems. Although this is a relatively uncommon disorder, it may cause significant morbidity. Macroglossia may be congenital or acquired in origin.

Congenital

•   Down syndrome.

•   Beckwith–Wiedemann.

•   Mucopolysaccharidoses.

Acquired

Congenital hypothyroidism.

In infants macroglossia poses early difficulty with feeding and, in the longer term, children may need assistance with speech and language therapy.