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74 comments:
Magic Minute:
Stevens-Johnsons Syndrome, a severe form of erythema multiforme, can be an allergic reaction to antibiotics.
NEVER EVER give a child aspirin.
Sydon Arroyo #102
ANUG is associated w/ extreme foul breath. Chlorohexidine is useful for apthous ulcers but not Behcets.
Farshid Siami #177
To treat an eruption cyst, you can either excise the tissue, puncture the cyst with a high-speed bur, or simply just watch; and all three have an equally successful outcome. Just be careful with posterior molar cysts, as they can interfere with occlusion.
Sanam Soroudi #180
Herpes occurs in young pts while Minor aphthous ulcer most in older kids (5+.).
The most effetive tx for aphthous ulcer is CHX mouthrinse.
Tiffany Hsu #529
Pts with Sturger Weber Syndrome present blood- filled enlarge gingiva. If we try to remove it by gingivectomy the pt may bleed to death.
Heidi Gonzalez # 526
Stevens-Johnson Syndrome (erythema multiforme) manifests secondary to antibiotic treatment; thus, simple discontinuation of the antiobiotics may remedy the condition. Also, eruption cysts are commonly seen in children, usually presenting over the anterior teeth or first molars.
Christine Chung #112
Nuggets of wisdom from the lecture:
1) Don't freak out & send your patient to UCLA if he/she has something that looks like erythema multiforme: it may be secondary to ABX use.
2) You can diagnose ANUG in pts when they walk through the door because their breath is so foul.
3) Be careful with any blood-engorged lesion. Don't attempt simple excision in such cases. You should probably refer that one to an oral surgeon. :)
Sean Young #192
If a child with brackets presents with gingival hyperplasia remove the brackets and see if the problem resolves before doing perio surgery.
Liz Miltner #150
In younger children, gingivitis is most common interpapillary and the cellular response is mediated by T-Lymphocytes.
The treatment for Primary gingivo-stomatitis herpetic is palliative. The most important is to avoid dehydration.
Claudia Rodriguez #531
Chlorhexidine is the best treatment for aphthous ulcers.
#165 - Neilesh Patel
Be careful when diagnosing oral pathologies because misdiagnoses can easily occur. For example, Bechet's Syndrome may be misdiagnosed as primary herpes, and symptoms of mouthbreathing may be misdiagnosed as an allergy.
Joanne Kim #140
It was interesting to know that probably 99% of us have had primary herpetic gingivostomatitis, but the clinical symptoms weren't as severe as that which occured in the other 1% patients!
Asha Sethu Madhavan
#532
Stevens-Johnsons syndrome can simply be an adverse reaction to antibiotics and therefore treated by discontinuation of the antibiotics.
Josh Cardwell #108
Even though seeing major periodontal problems in children is unusual, it is important to understand the etiology and treatment for these rare diseases, as some of them may become fatal.
-Carol Kim (138)
The clasiic skin lesions of Steven-Johnsons syndrome and Erythema Multiforme are Target lesions. Must discontinue use of antibiotics to resolve condition.
If ANUG is not treated can lead to NOMA which is often lethal.
Dilshad Abtin #524
3 year olds may have gingival problems. Begin periodontal probing with 10 year olds. Periodontal problems in children tend to be interpapillary, acute, and transient.
Austin Tung 187
ANUG is eventually deadly and important to treat as soon as it's discovered. Chlorohexidine is a good tx for apthous ulcers.
Shannon Lazarian #133
A sign to look for in determining whether or not someone has ANUG is deep pitting in the gingiva as if "someone took a round bur and punched it right in the papilla"
99% of us had HSV Type I, but majority of people wasnt Dx or need tx. Watch out for blood filled lesions because rupturing it may causes pt to bleed to death.
Eric Cheung #110
Jonathan Do #121
Most kids will have had HSV type I in their lifetime with only about 1% being symptomatic. In treating Herpes care is usually pallitve where nothing has to be done 99% of the time.
The revelation was this: children ALSO have periodontal disease!
Varo Boyajyan #106
Children can have serious perio disease even at a young age (as young as 3 yo). I am glad to find this out because I was told earlier that you should not expect perio problems in young kids other than some plaque and minor to no calculus.
Karen Li #146
One of the characteristic symptoms of ANUG is that the young patients will have very foul breath.
Amy Dixon #120
Michelle Duong #123
Stevens Johnsons Syndrome can be an allergic reaction to antibiotics, therefore it could subside if antibiotic therapy is discontinued.
I learned that mouthbreathing should NOT be confused w/ allergic response because mouthbreathing leaves a characteristic stain on the teeth from the dried saliva.
-Catherine Do #122
Even though children are not expected to have perio problems, be aware that it does occur and proper diagnosis is important for the child's health.
Even though children are not expected to have perio problems, be aware that it does occur and proper diagnosis is important for the child's health.
Kim Pham 167
The best tx. for apthous ulcers is chlorhexidine mouth rinse. Stevens-Johnson Syndrome may be an allergic rxn. to Ab's. Stop Ab's tx. and see what happens before getting too concerned.
Ryan Plewe
#168
They say that stevens-johnsons syndrome can be due to an allergic reaction to antibiotics, and abrupt ceasement of the Ab tx should be done to see if that reduces the effects, but doesn't that just potentially build up Ab resistance? I guess it's just one of those pick your poison type dilemma's...
Sean Nguyen #160
Enlarged and inflammed gingiva can be caused by many things. One that often gets over looked is mouth breathing. To handle this problem you may need to refer to an ENT doc or for Ortho tx.
Morris Poole #169
Dilantin hyperplasia is seen between 2 weeks and 3 months after treatment. Interestingly, the dosage and duration of treatment does not correlate. There is also a cycle of poor oral hygiene that can worsen the condition.
J. Oka #162
Cyclosporin A triggers gingival enlargement at 5-20mg/kg, in all the children younger than 15 year old. It is used in psoriasis, pemphigus, pemphigoid, Bechet's Syndrome, type 1 diabetes, RA and immunosuppression.
Jing Lee #144
Cyclosporin A's die effect will show in
Adult: 50%
children < 15: 100%
Jeffrey Kim 139
Herpes occurs in younger children and on attached gingiva while apthous ulcers occur in older children and on unattached gingiva.The most effective treament for minor apthous ulcers is chlorhexidine rinse.
Amandeep Iqbal
#527.
Symptoms of ANUG include deep pitting gingiva and foul breath.
Matthew Moadel #151
I learned that several of the pathological lesions that I assosciated with adults can be seen in children and should be looked for.
Marc Thomas #182
Stevens-Johnson Syndrome might be an allergic reaction, so stop the antibiotic treatment to see if it resolves. To treat apthous ulcers, the best treatment is chlorhexidine mouth rinse.
Nicholas Quach #170.
Begin periodontal probing in children at 10 years of age and always porbe prior to orthodontic therapy.
Soheil Yashari #191
Patents with ANUG generally present with very foul breath and deeply pitted gingiva. Most children will aquire HSV type 1, but it is rarely symptomatic.
Jared Martin #147
Natalie Nguyen #159:
Begin perio probing of children at 10 years of age. Never give kids with viral infections aspirin. Behcet's Syndrome has early onset, often misdiagnosed as primary HSV, and is severe.
Most children will have positive titer for type I Herpes, but majority go undiagnosed. Of those diagnosed, 99% of them will not undergo any treatment; when necessary, several meds can be prescribed for palliative treatment, like 5% acyclovir topical ointment, but Herpes rarely presents any complications that will require treatment.
-Jeanne Wong, #195
Magic minute: Stevens-Johnson Syndrome which is a severe form of erythema multiforme occurs secondary to antibiotic treatment and its treatments is to simply discontinue the drugs.
poonam rai #530
Mouthbreathing results in chronic drying of tissue and presents as red, inflamed, and enlarged gingiva. Treatment options include ENT referral and/or Orthodontics.
Kevin Omoto
#163
Frequently, pain due to teething could be due to primary herpes infection.
Naomi Nguyen
#158
It is important to consider that ortho brackets might be contributing to gingival hyperplasia. If the dentist does not think about this then the child may go through unnecessary perio surgery.
Steph Morphis #154
Dilantin, Nifedipine, Cyclosporine, Sodium Valproate and Phenobarbital are drugs that can cause gingival hyperplasia.
Paul Hoang #135
There are many systemic diseases and drugs-related side effects that can cause oral lesions/manifestations and it is important to recognize and diagnose each lesion since it can be life threatening.
Sonia Lee #145
ANUG can be treated by debridement, mouth rinses, and antibiotics. I did not know that ANUG can progress into a worse form: Terminal Norma
Jun Flores #130
To treat eruption cyst, we can excise the tissue over the crown or penetrate it with a high speed bur.
Erythema multiforme can be an allergic reaction to antibiotics.
Lei Zeng, #535
Normal gingiva in children have a wider PDL and the crest of bone is more flattened compared to adult gingiva.
Shelton Chow #111
To tx eruption cysts you can excise the tissue over the crown, penetrate the cyst with a high-speed bur and then observe it.
Dave Tajima #181
Stevens-Johnsons Syndrome, a severe form of erythema multiforme. CHX is the best for treatment of aphtous ulcers.
Jan Slapnicka #533
Erythema multiforme/Stevens Johnsons Syndrome can be caused by an allergy to antibiotics and mouthbreathing can sometimes be mistaken for an allergy.
Cynthia Morford #153
Stopping antibiotic tx, maybe the best method of treating Stevens-Johnsons Syndrome. Chlorhexidine can be used to treat apthous ulcers.
Ernest Lai #141
Mouthbreathing should not be overlooked as a possible cause of red inflamed enlarged gingiva. Look at the teeth in the anterior for staining for a clue, too. Send to an ENT and an orthodontist for treatment
Trish Barsanti
#105
If you suspect that your pediatric patient is suffering from minor apthous ulcers, it is useful to ask if the parents or siblings get them too, as there is a hereditary link.
Emmy Le #142
To minimize the likelihood of children developing perio disease, dentists should begin perio probing at 10 years old. If a kid comes in with really foul breath and perio-like patterns, think ANUG.
#176
Although periodontal probing is not usually done until age 10, a child's periodontal health should always be a priority. Children can have periodontal disease, and it can be fatal if overlooked.
In children less than 15 yrs old, cyclospproin A cause 100% of gingival enlargement. chen 109g
Mouth breathing can confuse some to think its a gingival allergic rxn, when in fact its allergies that's causing post nasal drip, resulting in snoring, or open mouth breathing, which then produces the red, inflammed gums.
Jake Cragun
#117
Often one of the first signs of Chicken pox is seen in the mouth. Oral lesions occur before skin lesions do. Asprin should not be given to children.
Niki Zarabian
#194
almost almost all of us had primary herpes at some point during our lives.
Pedram Sooferi #179
1) There are several medications that can result in gingival hyperplasia such as dilantin, nifedipine, cyclosporin, sodium valproate, and phenobarbitol.
2) Dilantin gingival hyperplasia tends to worsen with poor oral hygiene and generally occurs on attached gingiva.
Richard Duong #124
Inflamation process in different in kids than adults. There is less stippling in kids than adults.
Regina Espinoza #126
That herpes infection is a common cause of fever in babies, and that eruption cysts can be punctured with a high speed handpiece as treatment.
Steve Kim, #528
Dilantin hyperplasia is not dose-dependent. It's a watch-and-see. There is no trigger dose, and worsens significantly with poor oral hygiene.
Dissanayake #119
Erythema multiforme may be caused by antibiotic use, so the first step should be to discontinue use and see if the condition resolves.
-Harry Virk #189
Reye's syndrome ( Symptoms include lethargy, obtundandation, seizures and in a 10-30% percentage--> death), is the direct result of giving a child Aspirin and is STRICTLY contraindicated as a treatment modality for children.
Jeff Flores # 129
Antibiotics can cause an allergic reaction that can lead to stevens- johnsons syndrome that is a very severe form of erythema multiforme.
Hamid Shafizadeh #174
Chlorhexidine is the ideal treatment for aphthous ulcers.
ANUG in young patients will have very foul breath.
175
Mihir Shah
Azadeh Ahmadi Ardakani 101
You should excise an eruption cyst with a hand piece
Apthous ulcers should be treated with chlorhexidine
Enayat Astani #308
Stevens-Johnson Syndrome is known to occur after taking medication. The best way to treat the problem is by discontinuing the abtibiotices
Paredes #164
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