Cold Sore, Canker Sore, and Oral Thrush: Key Differences You Should Know

Cold sores, canker sores, and oral thrush are among the most frequent oral lesions, often mistaken for one another.

📌 Recommended Article :

Video 🔽 Frequent oral pathologies in the newborn - Diagnosis and treatment (cysts, infections, tumors) ... The video that we share details the most common oral pathologies in neonates, detailing their etiology, clinical characteristics, diagnosis and treatment.

This article explains their main features, clinical presentation, diagnosis, and treatment in both children and adults, providing practical keys for differentiation.

Advertisement

✅ Introduction
Oral lesions are common in dentistry and general practice. Cold sores (herpes labialis), canker sores (recurrent aphthous stomatitis), and oral thrush (candidiasis) are frequent conditions, but they differ in etiology: viral, inflammatory, and fungal, respectively. Correct identification is essential for adequate management, prevention, and recurrence control.

📌 Recommended Article :

PDF 🔽 Mucocele in Pediatric Dentistry: Clinical and pathological characteristics ... The presence of a mucocele may be due to trauma or ductal obstruction. The treatment is surgical and anesthesia is local, but depending on the behavior of the pediatric patient it can be performed with general anesthesia.

1. Cold Sore (Herpes Labialis)

➤ Etiology
Caused by herpes simplex virus type 1 (HSV-1).
➤ Signs and Symptoms
° Prodromal stage: tingling, itching, or burning on the lip.
° Lesion: grouped vesicles on the vermilion border that ulcerate and form crusts.
➤ Diagnosis
Mainly clinical; PCR or serology can be used in atypical cases.
➤ Treatment
° Adults: oral or topical antivirals (acyclovir, valacyclovir).
° Children: symptomatic management; antivirals in severe cases.

📌 Recommended Article :

Video 🔽 What is Oral Candidiasis? - Everything you need to know - Symptoms, diagnosis and treatment ... The Candida Albicans fungus, responsible for oral candidiasis, lives in our oral cavity together with other microorganisms but does not generate any pathological alteration.

2. Canker Sore (Recurrent Aphthous Stomatitis)

➤ Etiology
Multifactorial: genetic predisposition, nutritional deficiencies (iron, folic acid, vitamin B12), trauma, or stress.
➤ Signs and Symptoms
° Round, painful ulcers with a white-yellow base and red halo.
° Pain can impair eating and speaking.
➤ Diagnosis
Clinical, based on ulcer morphology and absence of vesicular stage.
➤ Treatment
° Adults and children: antiseptic rinses (chlorhexidine), topical anesthetics (lidocaine), and topical corticosteroids for severe episodes.

📌 Recommended Article :

PDF 🔽 Hereditary Gingival Fibromatosis in a pediatric patient - Characteristics and treatment ... We share the clinical case report of a pediatric patient with hereditary gingival fibromatosis, the clinical and histological characteristics, diagnosis and treatment are addressed.

3. Oral Thrush (Oral Candidiasis)

➤ Etiology
Fungal infection caused by Candida albicans. Risk factors: immunosuppression, antibiotic use, inhaled corticosteroids, dentures.
➤ Signs and Symptoms
° Forms:

• Pseudomembranous: removable white plaques with red underlying mucosa.
• Atrophic: painful red mucosa.
• Hyperplastic: non-removable white lesions.

° Burning sensation, dysphagia, taste disturbances.
➤ Diagnosis
Mainly clinical; confirmed with exfoliative cytology or fungal culture.
➤ Treatment
° Adults: topical antifungals (nystatin, miconazole) or systemic antifungals (fluconazole) in resistant cases.
° Children: oral suspension of nystatin.

📊 Comparative Table: Cold Sore, Canker Sore, and Oral Thrush

💬 Discussion
Although similar in appearance, these conditions can be clearly distinguished through careful clinical evaluation. Cold sores show a vesicular stage and recurrence, canker sores are isolated painful ulcers without vesicles, and oral thrush presents as persistent plaques or erythematous mucosa. Treatment differs according to etiology, highlighting the need for precise diagnosis and tailored therapy in both children and adults.

📌 Recommended Article :

Video 🔽 What are Oral Potentially Malignant Disorders? ... Early detection is recommended in these cases, in this way we prevent neoplasms from developing and increase the possibility of successful treatment.

✍️ Conclusion
Recognizing the differences between cold sores, canker sores, and oral thrush ensures appropriate treatment and reduces recurrence or complications. Patient education, preventive measures, and early evaluation remain key in managing these frequent oral conditions.

📚 References

✔ Arduino, P. G., & Porter, S. R. (2008). Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features. Journal of Oral Pathology & Medicine, 37(2), 107-121. https://doi.org/10.1111/j.1600-0714.2007.00586.x
✔ Belenguer-Guallar, I., Jiménez-Soriano, Y., & Claramunt-Lozano, A. (2014). Treatment of recurrent aphthous stomatitis. A literature review. Journal of Clinical and Experimental Dentistry, 6(2), e168–e174. https://doi.org/10.4317/jced.51402
✔ Scully, C., & Porter, S. (2008). Oral candidosis: current concepts in pathogenesis and therapy. Dental Update, 35(9), 606-612. https://doi.org/10.12968/denu.2008.35.9.606

📌 More Recommended Items

► Guide for the surgical management and oral pathology of the pediatric patient
► Oral manifestations of eating disorders in adolescent patients
► What are those bony bumps in my mouth? (Torus)

Dental Abscess, Fistula, Cellulitis, and Ludwig's Angina: Differences, Symptoms & Treatment

Odontogenic infections such as dental abscess, fistula, cellulitis, and Ludwig's angina are frequent but vary in severity and required intervention.

📌 Recommended Article :

Dental Article 🔽 Key Differences Between Pediatric and Adult Odontogenic Infections: Updated Clinical Guidelines ... This article outlines the major anatomical, clinical, and therapeutic distinctions between pediatric and adult odontogenic infections, highlighting the need for age-specific diagnosis and treatment approaches.

Understanding their differences is essential for timely treatment and complication prevention.

Advertisement

1. Definitions and Pathophysiology

➤ Dental Abscess: A localized accumulation of pus caused by pulp necrosis or advanced caries spreading to the periapical tissues.
➤ Fistula (Sinus Tract): A chronic drainage pathway from a periapical infection to the oral mucosa or skin, typically painless after drainage.
➤ Cellulitis: A diffuse bacterial infection of soft tissues with no localized pus accumulation, commonly involving facial or cervical regions.
➤ Ludwig’s Angina: A life-threatening, rapidly progressing cellulitis affecting the submandibular, sublingual, and submental spaces, mostly originating from infected mandibular molars.

📌 Recommended Article :

PDF/Video 🔽 How to manage dental infections? - Specific pharmacological treatment ... The dentist must recognize the symptoms, the clinical and pharmacological management of odontogenic infections, in order to act immediately and thus avoid the aggravation of the conditions.

2. Clinical Signs and Symptoms

3. Causes and Risk Factors

➤ Abscesses and Fistulas: Poor oral hygiene, untreated caries, failed endodontic therapy, or trauma.
➤ Cellulitis: Often follows abscess progression without proper drainage.
➤ Ludwig’s Angina: Usually triggered by untreated second or third molar infections, especially in immunocompromised patients.

📌 Recommended Article :

PDF 🔽 Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation ... In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient.

4. Pharmacologic Treatment

➤ Abscess: First-line antibiotics include amoxicillin-clavulanate or clindamycin (for penicillin-allergic patients), plus NSAIDs for pain.
➤ Fistula: Antibiotics are not curative alone. Treating the primary cause (e.g., root canal or extraction) is essential.
➤ Cellulitis: Requires broad-spectrum systemic antibiotics (e.g., ampicillin-sulbactam or clindamycin + metronidazole) and close monitoring.
➤ Ludwig’s Angina: Urgent IV antibiotics (e.g., ampicillin-sulbactam, piperacillin-tazobactam, or clindamycin + metronidazole) and coverage for MRSA if needed (e.g., vancomycin).

📌 Recommended Article :

PDF 🔽 Antimicrobial therapies for odontogenic infections in children and adolescents ... We share a literature review that establishes guidelines for antimicrobial therapy in infections of odontogenic origin and clinical recommendations.

5. Surgical Management

➤ Abscess: Requires incision and drainage (I&D), followed by root canal treatment or extraction.
➤ Fistula: Resolve through definitive dental treatment. Surgical excision may be required if the tract persists after resolution.
➤ Cellulitis: May require I&D if abscess formation develops. Initial antibiotic therapy should be monitored for response.
➤ Ludwig’s Angina: Surgical drainage is mandatory, often under general anesthesia. Airway protection (via fiberoptic intubation or tracheostomy) is crucial.

📌 Recommended Article :

PDF 🔽 Antibiotics and its use in pediatric dentistry: A review ... Antibiotics are among the most frequently prescribed medication for the treatment as well as prevention of bacterial infection in modern medicine.

6. Discussion

In the U.S., dental abscesses represent the most common odontogenic infection seen in emergency rooms. While fistulas and cellulitis are often managed on an outpatient basis, Ludwig’s angina remains a true medical emergency. Studies confirm that delays in treatment and misdiagnosis are strongly associated with airway obstruction, ICU admissions, and mortality. Early recognition of systemic signs, particularly in vulnerable populations, is vital.

7. Conclusions

➤ Dental abscesses should be identified early and drained appropriately.
➤ Fistulas represent chronic infections and require definitive endodontic or surgical therapy.
➤ Cellulitis demands aggressive antibiotic treatment and possible surgical evaluation.
➤ Ludwig’s Angina requires a multidisciplinary approach, emphasizing airway security, IV antibiotics, and immediate surgical drainage.

Timely diagnosis, tailored antimicrobial therapy, and prompt referral to specialized care are key to reducing the risk of complications in odontogenic infections.

📌 Recommended Article :

PDF 🔽 Guideline on use of antibiotic therapy for pediatric dental patients ... The use of antibiotic prophylaxis for dental patients at risk for infection is addressed in a separate best practices document.

References

✔ Brook, I. (2017). Odontogenic infections. New England Journal of Medicine, 376(13), 1231–1239. https://doi.org/10.1056/NEJMra1615281

✔ Topazian, R. G., Goldberg, M. H., & Hupp, J. R. (2002). Oral and Maxillofacial Infections (4th ed.). Saunders.

✔ Flynn, T. R. (2000). Ludwig's angina. Oral and Maxillofacial Surgery Clinics of North America, 12(4), 725–738.

✔ StatPearls Publishing. (2024). Ludwig Angina. In StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482354

✔ Sheehan, A., & Carr, E. (2021). Odontogenic sinus tracts: Diagnosis and management. Medscape. https://emedicine.medscape.com/article/1077808-overview

✔ Navarro, V. C., et al. (2022). Cervicofacial odontogenic infections: prevalence and therapeutic approach. Latin American Journal of Oral and Maxillofacial Surgery, 2(4), 156–160.

📌 More Recommended Items

► Are Antibiotics Enough To Treat A Tooth Infection?
► Management of antibiotics in odontogenic infections in pediatric dentistry
► Updated Criteria for the Selection of Antibiotic Dosage and Regimen in Dentistry

Odontogenic Infections in Children: Updated Diagnosis, Treatment and Prevention Guidelines (2025)

Odontogenic infections are among the most frequent pediatric dental emergencies and may lead to serious systemic complications if not managed properly.

📌 Recommended Article :

Video 🔽 Management of antibiotics in odontogenic infections in pediatric dentistry ... We share two videos on the correct use and management of the most used antibiotics in infections of odontogenic origin in pediatric dentistry.

This academic article presents an updated overview of their causes, clinical presentation, therapeutic approach, and prevention strategies, based on current evidence and international recommendations.

Advertisement

✅ Introduction
Pediatric odontogenic infections originate in the dental or periodontal tissues and commonly arise from untreated caries, dental trauma, or eruptive complications. According to the American Academy of Pediatric Dentistry (AAPD, 2023) and the World Health Organization (WHO, 2023), these infections require prompt intervention to avoid serious outcomes, including cellulitis, airway obstruction, and sepsis. Early diagnosis and rational antibiotic use are critical in reducing risks and improving patient outcomes.

📌 Recommended Article :

PDF 🔽 Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation ... In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient.

✅ Etiology and Risk Factors
The most frequent causes include:

° Advanced dental caries: The main entry route for bacteria into the pulp and periapical tissues.
° Dental trauma: Which exposes the pulp to bacterial contamination.
° Complicated tooth eruption: Such as pericoronitis in erupting molars.
° Poor oral hygiene and high-sugar diets: Major modifiable risk factors for infection.

✅ Clinical Signs and Symptoms
Typical features include:

° Persistent toothache
° Facial swelling
° Intraoral or extraoral abscess
° Fever, trismus, and general discomfort
° Regional lymphadenopathy

Diagnosis involves a comprehensive clinical examination supported by radiographs (periapical or panoramic) and, when necessary, blood tests (Fuks & Peretz, 2022).

📌 Recommended Article :

Video 🔽 Are Antibiotics Enough To Treat A Tooth Infection? ... Night pain is one of the characteristic signs of dental infection and one of the reasons for most consultation in dental emergencies.

✅ Current Management Guidelines

1. Early Diagnosis
Timely diagnosis is crucial. Delayed treatment increases the risk of systemic spread and hospitalization. Pediatricians and general dentists should be trained to recognize signs of odontogenic infections and refer appropriately.

2. Clinical Treatment
° Abscess drainage: Via incision or puncture depending on site and severity.
° Pulp therapy or extraction: Based on the degree of structural damage.
° Antibiotics: Indicated only for systemic involvement (fever, facial cellulitis, trismus). Amoxicillin-clavulanate is first-line, while clindamycin is used for penicillin-allergic patients (AAPD, 2023).

3. Pain and Inflammation Control
Use of over-the-counter analgesics like acetaminophen or ibuprofen under professional guidance is effective for symptom relief.

✅ Prevention and Long-Term Strategies
Effective prevention includes:

° Early dental visits: By age 1 or upon eruption of the first tooth.
° Oral hygiene education: For caregivers and children.
° Fluoride applications and sealants: For high-risk teeth.
° Routine check-ups every 6 months: To detect early-stage caries.

📌 Recommended Article :

Dental Article 🔽 Key Differences Between Pediatric and Adult Odontogenic Infections: Updated Clinical Guidelines ... This article outlines the major anatomical, clinical, and therapeutic distinctions between pediatric and adult odontogenic infections, highlighting the need for age-specific diagnosis and treatment approaches.

💬 Discussion

Odontogenic infections in children are highly preventable yet remain a public health concern in underserved communities. Misuse of antibiotics and delayed care often worsen outcomes. Studies show that infections of dental origin are a leading cause of pediatric facial cellulitis and hospital admissions for deep-space infections (Thikkurissy et al., 2020).
There is also a pressing need to address antimicrobial resistance. Inappropriate prescriptions for viral or non-infectious conditions continue to contribute to global resistance patterns (WHO, 2023). Proper clinical judgment and caregiver education are vital components of comprehensive care.

Conclusion

Managing pediatric odontogenic infections effectively involves prompt diagnosis, evidence-based treatment, and sustained preventive efforts. Dental professionals, physicians, and families must work collaboratively to ensure oral health is prioritized from early childhood. Rational antibiotic use, regular dental assessments, and public health education are key pillars for minimizing complications.

📌 Recommended Article :

PDF 🔽 Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation ... In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient.

📚 References

✔ American Academy of Pediatric Dentistry. (2023). Guideline on oral health care for the pediatric patient. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: AAPD.

✔ Fuks, A. B., & Peretz, B. (2022). Pediatric Endodontics: Current Concepts in Pulp Therapy for Primary and Young Permanent Teeth (2nd ed.). Springer. https://doi.org/10.1007/978-3-030-80157-0

✔ Thikkurissy, S., Miller, C., Casamassimo, P. S., & Berg, J. (2020). Management of dental infections in children: A review. Journal of the American Dental Association, 151(3), 180–187. https://doi.org/10.1016/j.adaj.2019.12.004

✔ World Health Organization. (2023). Antimicrobial resistance: global report on surveillance 2023. Geneva: WHO. https://www.who.int/publications/i/item/9789240071928

📌 More Recommended Items

► Antibiotic Selection in Pediatric Dental Infections: Updated Clinical Criteria for U.S. Dentists
► Updated Criteria for the Selection of Antibiotic Dosage and Regimen in Dentistry
► Antibiotics and its use in pediatric dentistry: A review

Can a Dental Infection Affect a Child's Heart? Risks Every Parent Should Know

Oral health plays a crucial role in overall well-being. In pediatric dentistry, there's growing concern about the systemic effects of dental infections, particularly in children with underlying heart conditions.

📌 Recommended Article :

PDF 🔽 Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation ... In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient.

Bacteria from an infected tooth can enter the bloodstream and travel to the heart, potentially triggering infective endocarditis, a life-threatening infection of the heart lining or valves. Although more common in adults, this condition can also occur in children, especially those with congenital heart defects.

Advertisement

✅ Etiology
Most dental infections in children originate from untreated tooth decay, pulpitis, or periodontal disease, caused by bacteria such as Streptococcus mutans, Fusobacterium nucleatum, and Porphyromonas gingivalis. During infection or invasive dental procedures (e.g., extractions), these bacteria can enter the bloodstream—a process known as bacteremia.
Children with certain congenital heart conditions are more vulnerable to bacterial colonization of the heart, which can result in infective endocarditis.

📌 Recommended Article :

PDF 🔽 Antimicrobial therapies for odontogenic infections in children and adolescents ... We share a literature review that establishes guidelines for antimicrobial therapy in infections of odontogenic origin and clinical recommendations.

✅ Diagnosis
Detecting a dental infection with potential cardiac implications involves both dental and medical assessments:

° Clinical signs: Toothache, swelling, pus discharge, fever, halitosis.
° Radiographic findings: Periapical radiolucency, abscesses, or advanced dental decay.
° Medical evaluation: In high-risk children, blood cultures and echocardiograms may be necessary if systemic symptoms are present.

Pediatric patients with known cardiac conditions must be identified early to manage their dental care proactively.

📌 Recommended Article :

PDF 🔽 Antibiotics and its use in pediatric dentistry: A review ... Antibiotics are among the most frequently prescribed medication for the treatment as well as prevention of bacterial infection in modern medicine.

✅ Prevention
Prevention is essential to protect children from oral infections and their systemic consequences:

° Daily oral hygiene: Brushing with fluoride toothpaste, flossing, and limiting sugary foods.
° Regular dental visits: Every 6 months for checkups and cleanings.
° Antibiotic prophylaxis: Recommended by the American Heart Association (AHA, 2021) before certain dental procedures in children at high risk of infective endocarditis.
° Parental awareness: Caregivers must understand that oral health is connected to heart health.

📌 Recommended Article :

PDF 🔽 Guideline on use of antibiotic therapy for pediatric dental patients ...The use of antibiotic prophylaxis for dental patients at risk for infection is addressed in a separate best practices document.

✅ Treatment
Management of dental infections in children, especially those at cardiac risk, requires a timely and coordinated approach:

1. Eliminate the source of infection: Through drainage, pulp therapy, or tooth extraction if necessary.
2. Antibiotic therapy: Typically amoxicillin; clindamycin is used in penicillin-allergic patients.
3. Medical follow-up: Collaboration with a pediatric cardiologist is crucial in high-risk cases.

📌 Recommended Article :

Video 🔽 Are Antibiotics Enough To Treat A Tooth Infection? ... The administration of antibiotics is necessary to control the pain and the evolution of the infection, but is it enough? The answer below...

💬 Discussion

Although infective endocarditis in children is rare, it can have devastating outcomes. The risk increases when poor oral hygiene and untreated dental infections coincide with congenital heart disease. This emphasizes the importance of an interdisciplinary approach—pediatric dentists and cardiologists should work together to create safe, effective care plans for at-risk children.
Moreover, public health strategies must include pediatric oral health as a priority, especially in underserved populations where dental care access may be limited.

💡 Conclusions

° Dental infections in children can cause bacteremia, increasing the risk of infective endocarditis in those with cardiac conditions.
° Prevention through good oral hygiene, regular dental care, and targeted antibiotic use is the best defense.
° A team-based approach involving dental and medical professionals is vital for safeguarding the overall health of children with heart disease.

📌 Recommended Article :

Video 🔽 Severe Dental Infections: Symptoms, Treatment & Antibiotics ... A person with diabetes increases the risk of suffering from periodontal disease, even losing one or more teeth more quickly.

📚 References

✔ Wilson, W., Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison, M., ... & Baltimore, R. S. (2021). Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation, 143(1), e963–e978. https://doi.org/10.1161/CIR.0000000000000969

✔ Lockhart, P. B., Brennan, M. T., Sasser, H. C., Fox, P. C., Paster, B. J., & Bahrani-Mougeot, F. K. (2008). Bacteremia associated with toothbrushing and dental extraction. Circulation, 117(24), 3118-3125. https://doi.org/10.1161/CIRCULATIONAHA.107.758524

✔ Pallasch, T. J., & Slots, J. (1996). Dentistry and endocarditis: the end of the antibiotic era. Compendium of Continuing Education in Dentistry, 17(8), 740–752. PMID: 8931236

📌 More Recommended Items

► Antibiotics in dental infections in children. Which one to use?
► Management of antibiotics in odontogenic infections in pediatric dentistry
► How to manage dental infections? - Specific pharmacological treatment

Updated Guide to Labial and Lingual Frenulum Management in Pediatric Dentistry

The labial and lingual frenula are normal anatomical structures, but when their attachment is abnormal or restrictive, they can interfere with oral function, facial development, and esthetics.

📌 Recommended Article :

Video/PDF 🔽 What is frenectomy? Step by step surgical procedure ... We share complete information about frenectomy, effectiveness and the step-by-step procedure regarding a clinical case. In addition to the case of a laser frenectomy in pediatric patients.

Early diagnosis in children is crucial to prevent issues related to speech, feeding, breathing, and oral hygiene. This guide provides an evidence-based overview of how to identify and manage frenulum-related conditions in pediatric patients.

Advertisement

✅ Diagnosis of Frenulum Abnormalities

1. Abnormal Maxillary Labial Frenulum
➤ Clinical Diagnosis:
° Low attachment (near the interdental papilla)
° Midline diastema
° Blanching of the papilla when the frenulum is pulled

➤ Evaluation Tools:
° Visual and tactile inspection
° Kotlow Classification for insertion level
° Periapical radiographs to assess spacing

➤ Classification (Miralles et al., 2009):
° Mucosal, gingival, papillary, penetrating

2. Lingual Frenulum (Ankyloglossia or "Tongue-Tie")
➤ Clinical Diagnosis:
° Limited tongue mobility
° Difficulties in breastfeeding, speech, or swallowing
° Heart-shaped appearance of the tongue tip

➤ Assessment Tools:
° Hazelbaker Assessment Tool (function and anatomy)
° Observation during oral functions (e.g., protrusion, suction)
° Referral to multidisciplinary specialists when needed

📌 Recommended Article :

PDF 🔽 Oral Surgery: Use of laser in lingual frenectomy in pediatric patients ... Among the benefits of using laser in frenectomy are: a quick surgical procedure, and a shorter and less painful post-operative period. Other benefits are: it promotes hemostasis and sterilizes the surgical site.

✅ Common Signs and Symptoms

✅ Consequences of Untreated Frenulum Issues

° Persistent midline diastema
° Periodontal recession due to tissue pulling
° Speech disorders (e.g., lisps, articulation delay)
° Breastfeeding difficulties in infants
° Orofacial myofunctional disorders
° Orthodontic complications later in life

📌 Recommended Article :

Video 🔽 What are impacted canines? - Treatment ... Impacted canines is a common anomaly, and is especially seen in the maxilla. The cause of the retention of the canine should be evaluated clinically and radiographically.

✅ Treatment Options for Frenulum Disorders

1. Labial Frenulum
➤ Management:
° Monitoring (especially in children under age 6 with physiological spacing)
° Surgical Frenectomy indicated when:

• Diastema persists after eruption of permanent incisors 
•  Orthodontic treatment is planned 
•  Gingival recession or tension is observed

➤ Surgical Techniques:
° Traditional scalpel technique
° Electrosurgery
° Diode laser (minimizes bleeding, faster healing)

2. Lingual Frenulum (Tongue-Tie)
➤ Management:
° Frenotomy: simple incision, typically for infants
° Frenectomy: complete removal, suitable for older children or severe cases
° Pre- and post-surgical myofunctional therapy
° Multidisciplinary approach: pediatric dentist, lactation consultant, speech-language pathologist

📌 Recommended Article :

PDF/Video 🔽 Ankyloglossia in infants - Diagnosis and surgical protocol ... We share the signs and symptoms for a correct diagnosis of ankyloglossia in infants and the surgical aspects of its treatment.

✅ Clinical Recommendations

° Assess frenula during the infant’s first dental or pediatric visit
° Treat ankyloglossia early if it impacts feeding or oral function
° Avoid surgery for purely esthetic reasons in primary dentition
° Use laser technology for anxious children or those needing fast recovery
° Always include functional assessment before deciding on surgery

💬 Discussion

Frenulum-related conditions are common in children but often overlooked. Evidence suggests that function-based assessment should take precedence over anatomical appearance when making treatment decisions. Early intervention in cases like tongue-tie can greatly improve oral and facial development. Diode lasers have significantly improved surgical outcomes in children, making the procedures less invasive and more tolerable. Still, collaboration between specialties remains the gold standard for long-term success.

📌 Recommended Article :

PDF/Video 🔽 Ameloblastoma in a pediatric patient - Characteristics, treatment and clinical case ... Ameloblastoma is an odontogenic tumor, non-malignant but locally aggressive, with high recurrence, and is evidenced as a facial swelling, or sometimes as a radiographic finding.

💡 Conclusion

° Early identification of abnormal frenula prevents future complications.
° Treatment decisions must prioritize function over appearance.
° Conservative surgical techniques are preferred in pediatric cases.
° A team-based approach enhances treatment outcomes, especially in tongue-tie.
° Parental education and regular follow-up are essential to successful management.

📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2023). Guideline on Management of the Frenulum in Pediatric Patients. https://www.aapd.org/research/oral-health-policies--recommendations/

✔ Baxter, R., & Dupont, J. (2020). Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More. Alabama Tongue-Tie Center.

✔ Hazelbaker, A. (2010). Assessment Tool for Lingual Frenulum Function (ATLFF). Columbus, OH.

✔ Kotlow, L. A. (2004). Oral diagnosis of abnormal frenum attachments in neonates and infants: evaluation and treatment of the maxillary and lingual frenum using the Erbium:YAG laser. Journal of the Laser and Health Academy, 2(3), 1–7.

✔ Miralles, R., et al. (2009). Clinical classification of upper labial frenulum insertions in children. Revista Chilena de Odontopediatría, 3(1), 23–27.

✔ Nakhash, A., et al. (2021). Surgical interventions for ankyloglossia in children: A systematic review and meta-analysis. International Journal of Pediatric Otorhinolaryngology, 145, 110714. https://doi.org/10.1016/j.ijporl.2021.110714

📌 More Recommended Items

► How to control bleeding after extraction?
► Oral Mucocele in Pediatric Patients: Clinical Features and Surgical Management
► Oral cysts in newborns: Characteristics, diagnosis and treatment

Oral Mucocele in Pediatric Patients: Clinical Features and Surgical Management

Oral mucoceles are common benign lesions of the salivary glands, frequently encountered in pediatric dentistry. This article explores the clinical characteristics of mucoceles in children, current diagnostic approaches, and the surgical procedures recommended for effective management.

📌 Recommended Article :

PDF🔽 Marsupialization of a large mandibular cyst in a pediatric patient - Clinical Case ... Various techniques are used to surgically remove the mandibular cyst, enucleation when the cyst is small, or marsupialization when it is large.

✅ Introduction
Mucoceles are mucous-filled cystic lesions primarily resulting from trauma to minor salivary glands. They commonly appear in children and adolescents, particularly on the lower lip. While they are benign and painless, their recurrence and interference with oral functions can necessitate surgical intervention. Early identification and appropriate treatment are essential to prevent complications and ensure optimal oral health outcomes.

Advertisement

✅ Clinical Characteristics

➤ Etiology
Oral mucoceles typically arise from:
° Extravasation: due to trauma or biting, leading to mucin leakage into surrounding tissues.
° Retention: due to ductal obstruction causing mucous accumulation.

➤ Common Features in Pediatric Patients:
° Location: Predominantly on the lower lip, but may also appear on the buccal mucosa, ventral tongue, or floor of the mouth (ranula).
° Appearance: Bluish, translucent, and fluctuant swelling.
° Size: Ranges from a few millimeters to over 1 cm.
° Symptoms: Usually asymptomatic but may interfere with speech, chewing, or aesthetics.

📌 Recommended Article :

PDF🔽 Guide for the surgical management and oral pathology of the pediatric patient ... Some of the pathologies that we can frequently find in children that need surgical procedures are: supernumerary and impacted teeth, congenital cysts, mucoceles.

✅ Diagnosis
Diagnosis is primarily clinical, but additional tools may be required in atypical presentations:

° Clinical Examination: Inspection and palpation to assess size, consistency, and mobility.
° Ultrasound or MRI: For deeper lesions such as plunging ranulas.
° Histopathology: Confirms diagnosis post-excision.

📌 Recommended Article :

PDF🔽 Oral Surgery: Use of laser in lingual frenectomy in pediatric patients ... Among the benefits of using laser in frenectomy are: a quick surgical procedure, and a shorter and less painful post-operative period.

✅ Surgical Management
Surgical intervention is the preferred treatment for persistent or recurrent mucoceles.

➤ Common Techniques:
1. Conventional Excision
° Complete removal of the lesion along with associated salivary gland tissue.
° Local anesthesia is sufficient for most pediatric patients.
° Suturing may be required depending on the lesion's size.
2. Marsupialization
° Typically used for large ranulas.
° Involves unroofing the lesion and suturing the edges of the mucosa to the surrounding tissue.
3. Laser Surgery
° CO₂ or diode lasers offer minimal bleeding and faster healing.
° Suitable for cooperative pediatric patients.
4. Micro-marsupialization
° A conservative technique for younger children with high recurrence rates.

➤ Postoperative Care
° Soft diet and good oral hygiene.
° Analgesics for discomfort.
° Follow-up to monitor for recurrence.

📌 Recommended Article :

PDF🔽 Mucocele in Pediatric Dentistry: Clinical and pathological characteristics ... The presence of a mucocele may be due to trauma or ductal obstruction. The treatment is surgical and anesthesia is local, but depending on the behavior of the pediatric patient it can be performed with general anesthesia.

💬 Discussion
Oral mucoceles are frequently misdiagnosed or underestimated in pediatric populations. Due to their benign nature, some clinicians may prefer observation; however, surgical management offers definitive resolution and histopathological confirmation. Recurrence may occur if the associated glandular tissue is not entirely removed. Laser techniques show promise in reducing intraoperative bleeding and improving healing times, making them especially useful in pediatric dentistry.

💡 Conclusion
Oral mucoceles in pediatric patients, though benign, can impact oral function and quality of life. A comprehensive clinical evaluation followed by surgical excision remains the gold standard for treatment. Pediatric dentists must be familiar with both conventional and advanced surgical approaches to provide optimal care.

📚 References

✔ de Pontes, F. S., Neto, F. B., de Sousa, F. B., de Carvalho, M. G. F., & de Moraes Ramos-Perez, F. M. (2020). Clinical-pathological study of 206 cases of oral mucoceles in a Brazilian population. Medicina Oral, Patología Oral y Cirugía Bucal, 25(5), e566–e570. https://doi.org/10.4317/medoral.23368

✔ Azenha, M. R., Bueno, R. B., & Silva, T. M. (2019). Management of oral mucoceles in pediatric patients: A review and case report. Journal of Clinical and Experimental Dentistry, 11(6), e571–e575. https://doi.org/10.4317/jced.55873

✔ Baurmash, H. D. (2003). Mucoceles and ranulas. Journal of Oral and Maxillofacial Surgery, 61(3), 369–378. https://doi.org/10.1053/joms.2003.50071

📌 More Recommended Items

► Dentigerous cyst in mixed and primary dentition. Diagnosis and surgical treatment
► Surgical excision of mucocele with local anesthesia in an 8-month-old baby
► Webinar - Minor Oral Surgery in Pediatric Dentistry

Key Differences Between Pediatric and Adult Odontogenic Infections: Updated Clinical Guidelines

Odontogenic infections are a common reason for dental and emergency visits across all age groups. However, there are critical differences in how these infections manifest, spread, and are managed in children versus adults.

📌 Recommended Article :

PDF🔽 Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation ... In comparison, the metabolism of a drug in a child is different from that of an adult, so the administration of an antibiotic should be taking into account the diagnosis, age and weight of the pediatric patient.

This article outlines the major anatomical, clinical, and therapeutic distinctions between pediatric and adult odontogenic infections, highlighting the need for age-specific diagnosis and treatment approaches.

Advertisement

✅ Anatomical and Physiological Differences
The anatomical structure of the maxillofacial region changes significantly from childhood to adulthood:

° In children, the jawbones are more porous and less mineralized, allowing for faster spread of infections into adjacent soft tissues (Borkar et al., 2020).
° In adults, denser bone structure typically leads to more localized infections, often presenting as periapical abscesses.

Additionally, primary teeth in children are closely associated with the developing permanent tooth buds, making untreated infections a potential threat to future dental development (Andreadis et al., 2021).

📌 Recommended Article :

PDF🔽 Antibiotics and its use in pediatric dentistry: A review ... The purpose of this review article is to provide information on proper use of antibiotics in pediatric dental practice for control of oral infection

✅ Etiology and Risk Factors
The root causes of odontogenic infections vary by age group:

° In children, the most common causes include deep caries in primary teeth, dental trauma, and issues related to tooth eruption.
° In adults, infections are often linked to chronic periapical disease, periodontal conditions, or post-extraction complications (Flynn, 2011).
° Systemic risk factors such as diabetes, cancer therapy, or immunosuppression increase susceptibility to severe odontogenic infections, especially in adults (Kuriyama et al., 2019).

📌 Recommended Article :

PDF 🔽 Guideline on use of antibiotic therapy for pediatric dental patients ... The use of antibiotic prophylaxis for dental patients at risk for infection is addressed in a separate best practices document.

✅ Clinical Presentation and Spread
The way odontogenic infections present and evolve differs significantly between children and adults:

° Pediatric patients often show rapid infection spread, leading to facial cellulitis, periorbital involvement, or submandibular swelling, frequently accompanied by fever and irritability (Auluck et al., 2020).
° Adults are more likely to present with localized abscesses, although delayed treatment can result in deep neck space infections or even mediastinitis.

Airway compromise is rare but poses a greater threat in adults due to fully developed fascial planes and deeper anatomical spaces.

📌 Recommended Article :

Video 🔽 Management of antibiotics in odontogenic infections in pediatric dentistry ... We share two videos on the correct use and management of the most used antibiotics in infections of odontogenic origin in pediatric dentistry.

✅ Diagnosis and Treatment

➤ Diagnosis
Diagnostic evaluation includes detailed history, clinical examination, and imaging such as periapical or panoramic X-rays. CT scans are warranted in advanced or deep space infections.
° In children, clinicians must assess tooth eruption stage and the proximity of infection to permanent tooth buds.
° In adults, factors such as past root canal treatments or the presence of periodontal disease are important in diagnosis.

➤ Treatment Approach
Treatment focuses on eliminating the source of infection (via extraction, root canal, or incision and drainage), systemic support, and appropriate antibiotic therapy.
° For pediatric patients, first-line antibiotics include amoxicillin or amoxicillin-clavulanate. Tetracyclines are contraindicated due to their adverse effects on tooth development (AAPD, 2022).
° In adults, a wider range of antibiotics can be used, including clindamycin for penicillin-allergic patients or metronidazole for anaerobic coverage.
Timely intervention in both groups is crucial to avoid systemic complications and long-term morbidity.

📌 Recommended Article :

PDF 🔽 Antimicrobial therapies for odontogenic infections in children and adolescents ... We share a literature review that establishes guidelines for antimicrobial therapy in infections of odontogenic origin and clinical recommendations.

💬 Discussion
Anatomical, immunological, and developmental factors necessitate different clinical strategies when managing odontogenic infections in children and adults. In children, protecting the integrity of developing permanent teeth and facial structures is critical, requiring more conservative and preventive approaches. In adults, the presence of comorbidities and a higher likelihood of chronic infections demand comprehensive evaluation and individualized care.
Additionally, odontogenic infections continue to be a significant public health concern, especially when early dental care is neglected. Preventive dentistry, public education, and timely treatment are key to reducing the prevalence and severity of these infections across all age groups.

💡 Conclusion
While pediatric and adult odontogenic infections share a bacterial origin, they differ markedly in presentation, progression, and treatment needs. Dental professionals must understand these distinctions to provide safe, effective, and age-appropriate care. A tailored treatment approach not only improves clinical outcomes but also minimizes complications, especially in growing children and medically compromised adults.

📚 References

✔ American Academy of Pediatric Dentistry. (2022). Guideline on Antibiotic Prophylaxis for Dental Patients at Risk for Infection. AAPD Reference Manual. https://www.aapd.org

✔ Andreadis, D., Epivatianos, A., Papanayotou, P., & Antoniades, D. (2021). Odontogenic infections in children: A retrospective analysis over a 7-year period. Journal of Clinical Pediatric Dentistry, 45(2), 92–96. https://doi.org/10.17796/1053-4625-45.2.7

✔ Auluck, A., Pai, K. M., & Mupparapu, M. (2020). Maxillofacial space infections in children: diagnostic challenges and case-based approach. Dentistry Journal, 8(2), 35. https://doi.org/10.3390/dj8020035

✔ Borkar, S. A., Joshi, P., & Sapate, R. B. (2020). Odontogenic infections in pediatric patients: A review. Journal of International Oral Health, 12(3), 177–182. https://doi.org/10.4103/jioh.jioh_242_19

✔ Flynn, T. R. (2011). Principles and surgical management of head and neck infections. Oral and Maxillofacial Surgery Clinics of North America, 23(3), 331–349. https://doi.org/10.1016/j.coms.2011.03.006

✔ Kuriyama, T., Karasawa, T., Nakagawa, K., & Yamamoto, E. (2019). Past medical history and clinical findings in patients with odontogenic infection. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 127(5), 407–412. https://doi.org/10.1016/j.oooo.2018.12.013

📌 More Recommended Items

► Are Antibiotics Enough To Treat A Tooth Infection?
► Antibiotics in dental infections in children. Which one to use?
► Antibiotic prescriptions in pediatric dentistry: A review

Herpangina in Children: Causes, Symptoms, and Treatment of This Viral Infection

Herpangina is a common viral illness that primarily affects children under the age of five. It is marked by a sudden onset of fever, sore throat, and small ulcers or blisters in the back of the mouth—typically on the soft palate, uvula, and tonsils.

📌 Recommended Article :

Video 🔽 Top 10 Mouth Cancer Symptoms ... The early detection of cancer ensures a better recovery and success of the treatment, for that we must know the warning signs and the changes that happen in our mouth

Although self-limiting, early recognition is crucial to manage symptoms and prevent complications such as dehydration.

Advertisement

✅ What Is Herpangina?
Herpangina is an acute viral infection characterized by painful mouth ulcers and systemic symptoms such as fever and malaise. It typically affects the posterior region of the oral cavity and is most prevalent during summer and early fall in the United States.

📌 Recommended Article :

Video 🔽 Effects of tobacco on the oral cavity: Nicotine Stomatitis ... We must bear in mind that smoking generates short and long-term consequences. In the oral cavity it can generate periodontitis, gingivitis and pathologies in the oral mucosa

✅ Causes (Etiology)
Herpangina is caused primarily by Coxsackievirus A, though other enteroviruses like Coxsackie B and echoviruses may also be responsible. These viruses spread easily through:

° Fecal-oral route
° Respiratory droplets
° Contaminated surfaces (e.g., toys, utensils)

Outbreaks are common in daycare centers and preschools (Khetsuriani et al., 2006).

📌 Recommended Article :

PDF 🔽 How does hypertension affect oral health? ... As a consequence, in most cases hypertension is treated non-specifically, resulting in the large number of minor side effects and relatively high non-compliance rate

✅ Symptoms and Clinical Features
The condition develops rapidly and typically includes:

° High fever (101–104°F / 38.5–40°C)
° Sore throat and painful swallowing
° Loss of appetite
° Irritability
° Abdominal pain (occasionally)

➤ Oral findings appear within 24–48 hours:

° Small, fluid-filled blisters (1–2 mm) on the soft palate, uvula, and tonsils
° Blisters rupture into shallow ulcers with red halos
° Symptoms usually resolve in 5 to 7 days

Unlike hand, foot, and mouth disease, herpangina typically does not involve skin rashes or lesions on the hands and feet (Puenpa et al., 2019).

📌 Recommended Article :

Video 🔽 Why did oral HPV cases increase in men? ... HPV (Human Papillomavirus) is an infection whose most frequent contagion is by sexual transmission. This infection can cause genital warts and in other cases cause uterine cancer

✅ Differential Diagnosis
Conditions that may resemble herpangina include:

° Primary herpetic gingivostomatitis
° Strep throat (streptococcal pharyngitis)
° Infectious mononucleosis
° Hand-foot-and-mouth disease

Diagnosis is clinical and based on the child’s age, symptom pattern, and the appearance of the lesions. Lab tests are rarely needed.

📌 Recommended Article :

Video 🔽 How the symptoms of Dry Mouth can be combated ? ... Dry mouth or xerostomia is the consequence of decreased salivary flow, and is basically the symptom of some disease, or side effect of certain types of medications

✅ Treatment
There is no specific antiviral medication for herpangina. Treatment focuses on supportive care:

➤ Hydration: Encourage frequent sips of water or electrolyte solutions
➤ Pain relief: Acetaminophen or ibuprofen for fever and sore throat
➤ Soft, cold foods: Popsicles, smoothies, and yogurt to reduce discomfort
➤ Avoid acidic or spicy foods: These may worsen oral pain

Antibiotics are not effective and should not be used unless there is a confirmed secondary bacterial infection.

📌 Recommended Article :

PDF 🔽 Riga-Fede Disease (Dentitia Praecox): Report of Two Cases with Literature Review ... The lesion initially presents as an ulcerated area on the ventral surface of the tongue and with repeated trauma, it may progress to an enlarged, fibrous mass giving the appearance of an ulcerative granuloma

✅ Prevention
Key preventive strategies include:

° Frequent handwashing with soap and water
° Avoiding the sharing of utensils or cups
° Disinfecting surfaces and toys
° Keeping infected children home during the contagious period

There is no vaccine specifically for herpangina, though vaccine research targeting certain enteroviruses is ongoing in high-incidence regions.

📌 Recommended Article :

Video 🔽 What can cause tongue injuries? - Management ... The tongue is susceptible to diseases and pathologies, and we must be attentive to any change in shape or color, and the appearance of a lesion that does not close or is recurrent

💬 Discussion
While herpangina is generally mild, it can be distressing for both children and parents due to painful symptoms and feeding difficulties. In some cases—especially in younger children—dehydration may require medical attention. Additionally, misdiagnosis can lead to inappropriate use of antibiotics, contributing to antibiotic resistance.
Public health education for caregivers and accurate clinical guidance are essential to avoid unnecessary treatments and improve patient outcomes. Healthcare providers should offer clear instructions for at-home care and signs that warrant medical evaluation.

💡 Conclusion
Herpangina is a self-limiting viral illness in children caused by enteroviruses such as Coxsackievirus A. It presents with fever, sore throat, and ulcers in the back of the mouth. Management is supportive, focusing on hydration and pain relief. Understanding its symptoms, transmission, and proper care helps reduce complications and prevents unnecessary medical interventions.

📚 References

✔ Khetsuriani, N., Lamonte-Fowlkes, A., Oberst, S., & Pallansch, M. A. (2006). Enterovirus surveillance—United States, 1970–2005. MMWR Surveillance Summaries, 55(8), 1–20. https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5508a1.htm

✔ Puenpa, J., Vongpunsawad, S., & Poovorawan, Y. (2019). Enterovirus infections in children with herpangina and hand, foot, and mouth disease in Thailand, 2012–2018. Virology Journal, 16(1), 1–10. https://doi.org/10.1186/s12985-019-1202-0

✔ National Institutes of Health. (2022). Herpangina. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/001366.htm

📌 More Recommended Items

► Surgical excision of mucocele with local anesthesia in an 8-month-old baby
► Guide for the surgical management and oral pathology of the pediatric patient
► What are those bony bumps in my mouth? (Torus)

Why Does Diabetes Cause Dry Mouth? Understanding the Link Between Xerostomia and Blood Sugar Levels

Dry mouth, or xerostomia, is a common but often overlooked complication of diabetes mellitus. Affecting both type 1 and type 2 diabetes patients, this condition results from altered salivary gland function, often exacerbated by high blood glucose levels.

📌 Recommended Article :

Video 🔽 Is a dental extraction recommended to a diabetic? ... It is vitally important that before performing the surgical procedure, the dentist check the patient's sugar level, thus avoiding bleeding during the procedure

Since saliva plays a critical role in maintaining oral and systemic health, understanding the mechanisms behind xerostomia in diabetes is essential for prevention and management of related complications.

Advertisement

✅ The Role of Saliva in Oral Health
Saliva is crucial for maintaining oral homeostasis. It lubricates the oral tissues, aids in digestion, neutralizes acids, and has antimicrobial properties that protect against infections and tooth decay. A decrease in saliva flow or a change in its composition can disrupt this balance, leading to:

° Increased risk of dental caries
° Oral infections, such as candidiasis
° Burning mouth sensation
° Difficulty speaking, chewing, and swallowing

📌 Recommended Article :

Video 🔽 How is oral health affected by diabetes? ... Diabetic people should visit the dentist to eliminate infectious sources (cavities, gum inflammation, fractured restorations) and to maintain oral hygiene

✅ How Diabetes Leads to Dry Mouth

1. Hyperglycemia and Fluid Loss
Persistent high blood glucose levels lead to osmotic diuresis—a process in which glucose is excreted in the urine along with large amounts of water. This results in systemic dehydration, which also affects the salivary glands. Dehydration reduces salivary output and increases oral dryness (Lopez-Pintor et al., 2016).

2. Neuropathy Affecting Salivary Glands
Diabetic neuropathy, a common long-term complication of poorly controlled diabetes, can damage the autonomic nerves responsible for salivary gland stimulation. This autonomic dysfunction leads to reduced salivary secretion and altered gland response (Darwazeh & Al-Dwairi, 2019).

📌 Recommended Article :

Video 🔽 Why Is Thumb Sucking Harmful? ... It is important to take the child to an orthodontist to stop the suction and thus avoid complicated consequences such as: open bite and alignment of the permanent teeth

3. Microvascular Damage
Diabetes can impair blood flow due to damage in the small blood vessels (microangiopathy), including those that supply the salivary glands. Reduced perfusion limits the glands' ability to function properly, contributing to xerostomia (Ghezzi & Ship, 2003).

4. Medication Side Effects
Many people with diabetes are on multiple medications, including antihypertensives, antidepressants, and diuretics. These drugs are known to cause dry mouth as a side effect, compounding the issue (Scully, 2003).

📌 Recommended Article :

Video 🔽 Diabetes and gum health - Periodontitis ... Control of diabetes is essential to achieve successful periodontal treatment. That is why it is important to visit your doctor and dentist regularly for an early evaluation and treatment

💬 Discussion
Xerostomia in diabetes is multifactorial and often worsens with poor glycemic control. The consequences are not limited to discomfort; dry mouth can significantly impair a patient's quality of life and lead to further systemic complications. For instance, diabetic patients with xerostomia are more likely to develop periodontal disease, which in turn can increase systemic inflammation and complicate blood sugar management.
Healthcare professionals—including endocrinologists, primary care physicians, and dentists—must work collaboratively to identify and manage xerostomia early. Glycemic control should be the cornerstone of treatment, alongside patient education, salivary substitutes, sugar-free lozenges, and regular dental evaluations.

💡 Conclusion
Dry mouth is a common and clinically significant symptom in patients with diabetes. It results primarily from dehydration, neuropathy, vascular damage, and medication use. Effective management requires a comprehensive, multidisciplinary approach centered on optimal blood sugar control and targeted oral care strategies. Awareness of this connection can improve both oral and overall health outcomes in diabetic populations.

📚 References

✔ Darwazeh, A. M. G., & Al-Dwairi, Z. N. (2019). The relationship between xerostomia and glycemic control in patients with type 2 diabetes mellitus. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 127(5), 409–416. https://doi.org/10.1016/j.oooo.2018.12.013

✔ Ghezzi, E. M., & Ship, J. A. (2003). Aging and secretory reserve capacity of major salivary glands. Journal of Dental Research, 82(10), 844–848. https://doi.org/10.1177/154405910308201106

✔ Lopez-Pintor, R. M., Casañas, E., González-Serrano, J., Serrano, J., & Hernández, G. (2016). Xerostomia, hyposalivation, and salivary flow in diabetes patients. Journal of Diabetes Research, 2016, 4372852. https://doi.org/10.1155/2016/4372852

✔ Scully, C. (2003). Drug effects on salivary glands: dry mouth. Oral Diseases, 9(4), 165–176. https://doi.org/10.1034/j.1601-0825.2003.03967.x

📌 More Recommended Items

► Oral manifestations of human immunodeficiency virus in children
► What is Oral Candidiasis? - Everything you need to know - Symptoms, diagnosis and treatment
► Oral Manifestations of Systemic Diseases: Updated Clinical Review

Medications and Developing Teeth: Dental Risks, Mechanisms, and Prevention in Children

Tooth development is a complex process influenced by genetic and environmental factors, including exposure to certain medications. During critical stages—from pregnancy through early childhood—various drugs can interfere with odontogenesis, leading to permanent changes in tooth color, structure, and eruption patterns.

📌 Recommended Article :

Video 🔽 Formation and development of the face and oral cavity (Orofacial Complex) ... The formation of the face starts from the five prominences (one frontonasal, two maxillary and two mandibular). The prominences develop giving rise to different regions of the face

Understanding how specific medications affect dental development is crucial for pediatricians, dentists, and caregivers to make informed decisions and prevent long-term oral health issues.

Advertisement

✅ Dental Development and Critical Windows
Odontogenesis begins around the 6th to 8th week of gestation and continues into adolescence. The most vulnerable phases include:

➤ Amelogenesis: enamel formation.
➤ Dentinogenesis: dentin formation.
➤ Calcification and eruption: mineralization and emergence of the tooth into the oral cavity.

Cells like ameloblasts and odontoblasts are especially sensitive to systemic disturbances during these stages.

📌 Recommended Article :

Video 🔽 Formation and development of the face and oral cavity (Orofacial Complex) ... The formation of the face starts from the five prominences (one frontonasal, two maxillary and two mandibular). The prominences develop giving rise to different regions of the face

✅ Medications Commonly Linked to Dental Effects

1. Tetracyclines
Tetracyclines (e.g., doxycycline, tetracycline) bind to calcium ions and become incorporated into developing dentin and enamel, causing yellow to brown tooth discoloration and enamel hypoplasia. These antibiotics are contraindicated in children under age 8 and during pregnancy (Chopra & Roberts, 2020).

2. Excessive Fluoride
Prolonged intake of fluoride above recommended levels—whether from supplements, toothpaste, or water—can lead to dental fluorosis. This enamel defect ranges from mild white streaks to severe brown staining and surface irregularities (Wong et al., 2011).

3. Sugary Syrups, Antihistamines, and Asthma Medications
Pediatric medications often come in syrup forms with high sugar content. Chronic use increases the risk of early childhood caries. Additionally, some antihistamines and bronchodilators reduce salivary flow, contributing to enamel demineralization and increased caries risk (Daly et al., 2021).

📌 Recommended Article :

Dental Article 🔽 Nolla Stages in Dental Age Estimation: Characteristics, Importance, and Applications ... the Nolla stages serve as a foundational tool in dental science, offering a systematic approach to assessing tooth development

4. Chemotherapy and Radiation Therapy in Pediatric Patients
Cancer treatments during childhood can disrupt tooth development, leading to enamel hypoplasia, microdontia, delayed eruption, or root malformations. The younger the child at the time of therapy, the greater the impact (Pérez et al., 2019).

5. Teratogenic Drugs: Thalidomide and Anticonvulsants
Drugs like thalidomide, known for causing congenital abnormalities, may result in craniofacial defects and missing teeth. Phenytoin, an anticonvulsant, is associated with gingival overgrowth and abnormal tooth eruption patterns (Naziri et al., 2022).

📌 Recommended Article :

PDF 🔽 Malformations and anomalies of the branchial arches - Diagnosis and management ... During the process of growth and development of tissues, alterations may occur that lead to sinuses, fistulas or cysts. The location of the alteration determines which branchial arch it belongs to

💬 Discussion
Tooth development is highly sensitive to pharmacological interference. The consequences of early exposure to certain drugs are not only cosmetic but also functional—affecting chewing, speech, and a child’s self-esteem. Preventive efforts must prioritize careful medication prescribing during pregnancy and childhood, use of sugar-free formulations, and regular dental monitoring.
Healthcare providers should work collaboratively across disciplines—medical, dental, and pharmaceutical—to reduce the risks. Early oral health education for caregivers is equally important to ensure safe medication practices and early detection of developmental dental problems.

💡 Conclusion
Several medications can cause permanent changes in tooth development when administered during critical periods. Avoiding high-risk drugs in pregnancy and early childhood, choosing sugar-free options, and ensuring regular dental follow-up are key strategies for prevention. Coordinated care and caregiver awareness play essential roles in protecting pediatric oral health.

📚 References

✔ Chopra, I., & Roberts, M. (2020). Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance. Microbiology and Molecular Biology Reviews, 65(2), 232–260. https://doi.org/10.1128/MMBR.65.2.232-260.2001

✔ Daly, B., Thompsell, A., Rooney, Y. M., & White, D. A. (2021). Oral health and drug therapy in children: a review. British Dental Journal, 231(4), 225–230. https://doi.org/10.1038/s41415-021-2913-7

✔ Naziri, E., Karami, E., & Torabzadeh, H. (2022). The effect of antiepileptic drugs on oral health in pediatric patients. Journal of Pediatric Dentistry, 10(1), 45–50. https://doi.org/10.1055/s-0042-1742451

✔ Pérez, J. R., Luján, A., & Moraes, A. (2019). Dental abnormalities after pediatric cancer therapy: clinical considerations. Pediatric Dentistry Journal, 44(2), 89–96. https://doi.org/10.1016/j.pdj.2018.09.003

✔ Wong, M. C. M., Glenny, A. M., Tsang, B. W. Y., Lo, E. C. M., Worthington, H. V., & Marinho, V. C. C. (2011). Topical fluoride for caries prevention in children and adolescents. Cochrane Database of Systematic Reviews, (1). https://doi.org/10.1002/14651858.CD007693.pub2

📌 More Recommended Items

► What are the medicines used in pediatric dentistry?
► Guideline on use of antibiotic therapy for pediatric dental patients
► Pharmacological treatment of oral infections in pediatric dentistry - Recommendations and dose calculation

How to Correct Harmful Oral Habits in Children That Affect Facial and Dental Development

Early childhood is a critical period for craniofacial and dental development. Certain harmful oral habits, such as thumb sucking, mouth breathing, or nail biting, can interfere with proper facial growth and tooth alignment.

📌 Recommended Article :

Video 🔽 Why Is Thumb Sucking Harmful? ... It is important to take the child to an orthodontist to stop the suction and thus avoid complicated consequences such as: open bite and alignment of the permanent teeth

If not addressed early, these habits may lead to malocclusion, facial asymmetry, and the need for complex orthodontic treatment later in life. This article outlines the most common harmful oral habits in children, their effects on dental and facial development, and effective evidence-based treatment strategies.

Advertisement

✅ Common Harmful Oral Habits in Children: Definitions and Treatments

1. Thumb Sucking
➤ Definition:
° A repetitive behavior in which the child inserts one or more fingers into the mouth, usually for comfort or stress relief.
➤ Potential Effects:
° Anterior open bite
° Protrusion of upper front teeth
° Underdeveloped lower jaw
° Improper lip seal
➤ Treatment Options:
° Positive reinforcement techniques (e.g., reward charts)
° Behavior tracking with family support
° Intraoral appliances (e.g., palatal crib or tongue rake) in persistent cases
° Psychological support for anxiety-linked cases (Barbería et al., 2021)

2. Prolonged Pacifier or Bottle Use
➤ Definition:
° Using a pacifier or bottle beyond age 2–3, leading to non-nutritive sucking behavior.
➤ Potential Effects:
° Anterior open bite
° Posterior crossbite
° High, narrow palate
➤ Treatment Options:
° Parent education on weaning by age 2
° Gradual transition to cups and comfort objects
° Orthodontic intervention if malocclusion persists
° Oral muscle training to improve lip seal and tongue posture

📌 Recommended Article :

Dental Article 🔽 Early interceptive treatment management ... Interceptive orthodontics makes use of various devices to correct alterations in the development of the jaws and prevent them from worsening over time

3. Tongue Thrust (Atypical Swallowing)
➤ Definition:
° Pushing the tongue against or between the teeth when swallowing or speaking, instead of placing it against the palate.
➤ Potential Effects:
° Anterior open bite
° Gaps between front teeth
° Weak orofacial muscles
➤ Treatment Options:
° Orofacial myofunctional therapy (OMT)
° Palatal cribs or tongue spurs if habit continues past age 6
° Collaboration with a speech-language pathologist
° Long-term monitoring by pediatric dentist or orthodontist

4. Mouth Breathing
➤ Definition:
° Breathing through the mouth instead of the nose, often due to nasal obstruction or habit.
➤ Potential Effects:
° Long face syndrome
° Incompetent lips (open mouth posture)
° Narrow upper jaw and posterior crossbite
° High-arched palate
➤ Treatment Options:
° ENT evaluation for nasal or adenoid obstruction
° Palatal expansion in cases of narrow maxilla
° Orofacial therapy to re-establish nasal breathing
° Nasal hygiene and breathing retraining exercises

📌 Recommended Article :

PDF/Video 🔽 Parafunctional oral habits. Which are? Diagnosis and treatment ... Let's know what the most common parafunctional habits are and their etiology, clinical manifestations, diagnosis, treatment and their relationship with malocclusions

5. Nail Biting (Onychophagia)
➤ Definition:
° A compulsive habit of biting or chewing nails, often triggered by stress or anxiety.
➤ Potential Effects:
° Tooth wear or misalignment
° Microfractures in front teeth
° Risk of infections around the mouth
° Jaw tension or muscle strain
➤ Treatment Options:
° Behavioral strategies (e.g., bitter nail polish, habit reversal training)
° Psychological support if anxiety-related
° Orofacial therapy to manage perioral muscle tension
° Parental coaching and support at home and school (Maia et al., 2019)

✅ Diagnosis
A thorough diagnosis involves both physical and behavioral evaluation:
Comprehensive dental and facial exam
History of the habit (age of onset, frequency, triggers)
Functional assessment of breathing, swallowing, and oral posture
Referral to ENT, speech therapist, or child psychologist if needed

📌 Recommended Article :

PDF 🔽 Space Maintainers: Types, indications and complications ... We share complete information on the importance of space maintainers in the prevention of dental malocclusions, reviewing their applications, indications and complications

💬 Discussion
Persistent oral habits beyond ages 3–4 can significantly impact a child's bite, facial symmetry, and speech development. Studies have shown that early intervention is key, ideally before age 6, when craniofacial structures are still adaptable (Grippaudo et al., 2020; Souki et al., 2019).
Most habits can be addressed successfully through behavioral therapy and parent involvement. In more severe cases, interceptive orthodontics or interdisciplinary care may be required. Educating caregivers is essential for consistent support at home.

💡 Conclusion
Harmful oral habits can disrupt normal facial and dental development if not treated in time. Each habit presents specific risks and requires a tailored treatment approach. Early identification, behavioral guidance, and, when necessary, interdisciplinary therapy, offer the best outcomes. Prevention and early parental education remain the most effective tools in managing these behaviors.

📚 References

✔ Barbería, E., Lucavechi, T., & Suárez-Clúa, M. C. (2021). Clinical Pediatric Dentistry. Elsevier España.

✔ Grippaudo, C., Paolantonio, E. G., Antonini, G., Saulle, R., La Torre, G., & Deli, R. (2020). Association between oral habits, mouth breathing and malocclusion. Acta Otorhinolaryngologica Italica, 40(5), 282–289. https://doi.org/10.14639/0392-100X-N0616

✔ Souki, B. Q., Pimenta, G. B., Souki, M. Q., Franco, L. P., Becker, H. M. G., & Pinto, J. A. (2019). Prevalence of malocclusion among mouth breathing children: do expectations meet reality? International Journal of Pediatric Otorhinolaryngology, 119, 146–150. https://doi.org/10.1016/j.ijporl.2019.01.032

✔ Viggiano, D., Fasano, D., Monaco, G., & Strohmenger, L. (2020). Oral habits and orthodontic anomalies in preschool children. International Journal of Paediatric Dentistry, 30(3), 326–333. https://doi.org/10.1111/ipd.12594

✔ Maia, B. R., Marques, D. R., & Barbosa, F. (2019). Nail biting in children: an integrative review. Psicologia: Reflexão e Crítica, 32(1), 1–9. https://doi.org/10.1186/s41155-019-0116-1

📌 More Recommended Items

► What is temporomandibular disorder? - Concept, diagnosis and current treatment
► Is there a relationship between headache and temporomandibular disorder?
► Can children suffer from bruxism?