White lesions in the pediatric oral cavity represent a diagnostic challenge due to their diverse etiology. Accurate diagnosis is essential to distinguish benign, infectious, and potentially malignant conditions.
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✅ Introduction
White lesions in the oral mucosa are frequent findings in pediatric dental practice. They may range from simple keratotic changes to fungal infections or early mucosal diseases. A systematic clinical approach is crucial to prevent misdiagnosis and inappropriate treatment.
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The most prevalent conditions include:
▪️ Frictional keratosis due to chronic trauma from dental appliances or biting.
▪️ Candidiasis, commonly caused by Candida albicans, appearing as removable white plaques.
▪️ Leukoplakia, a rare but important potentially malignant lesion.
▪️ Lichen planus, uncommon in children but characterized by reticular white striations.
▪️ Chemical burns from topical medicaments or toothpastes.
▪️ Congenital disorders such as White Sponge Nevus.
Each condition presents distinct clinical features, necessitating thorough anamnesis and visual-tactile examination.
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Diagnosis should begin with:
▪️ Detailed clinical evaluation (location, symmetry, texture, and presence of pain).
▪️ History taking, including trauma, medications, or recent infections.
▪️ Removal test, as in candidiasis where the lesion can be wiped away.
▪️ Biopsy and cytology, recommended for persistent or atypical lesions.
Use of adjunctive diagnostic tools, such as toluidine blue staining or autofluorescence, may aid in differentiating potentially malignant conditions.
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The differential diagnosis of pediatric white lesions requires distinguishing between reversible inflammatory lesions and potentially precancerous alterations. While traumatic and fungal lesions are the most common, clinicians should remain alert for unusual presentations such as leukoplakia or lichen planus.
Early diagnosis allows for conservative treatment and prevention of complications. Overdiagnosis, however, should be avoided through confirmatory tests and follow-up evaluations.
✍️ Conclusion
White lesions in the pediatric oral mucosa are mostly benign and transient, but some may indicate systemic or precancerous conditions. Clinical observation, microbiological analysis, and biopsy when indicated are key to correct diagnosis and management. Dental professionals should maintain a structured diagnostic protocol to ensure patient safety and accurate intervention.
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▪️ Conduct a comprehensive oral examination in all pediatric patients.
▪️ Educate parents about avoiding chemical irritants and oral trauma.
▪️ Treat fungal infections early and reassess lesions that persist beyond 2 weeks.
▪️ Refer for biopsy any lesion with induration, ulceration, or unexplained persistence.
馃搳 Summary Table: Differential Diagnosis of Pediatric Oral White Lesions
| Aspect | Advantages | Limitations |
|---|---|---|
| Clinical observation | Non-invasive, allows identification of trauma or fungal infection | May not differentiate early neoplastic changes |
| Microbiological tests | Useful for diagnosing candidiasis and bacterial superinfections | Limited utility for keratotic or autoimmune lesions |
| Biopsy and histopathology | Definitive diagnosis for atypical or persistent lesions | Invasive, requires child cooperation and healing period |
| Follow-up examination | Allows monitoring of lesion evolution and treatment response | Requires long-term compliance from caregivers |
馃摎 References
✔ Al-Maweri, S. A., Al-Soneidar, W. A., & Halboub, E. (2020). Oral mucosal lesions in children: A systematic review. Dental Research Journal, 17(6), 401–409.
✔ Farah, C. S., & McCullough, M. J. (2019). Oral white lesions: An updated clinical diagnostic approach. Journal of Dental Research, 98(7), 715–728.
✔ Mortazavi, H., Baharvand, M., & Mehdipour, M. (2021). Oral white lesions: An updated clinical diagnostic decision tree. Dental Research Journal, 18(1), 22.
✔ Glick, M. (Ed.). (2021). Burket’s Oral Medicine (13th ed.). Wiley-Blackwell.
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