Mostrando entradas con la etiqueta Pediatric Dentistry. Mostrar todas las entradas
Mostrando entradas con la etiqueta Pediatric Dentistry. Mostrar todas las entradas

martes, 15 de julio de 2025

Oral Mucocele in Pediatric Patients: Clinical Features and Surgical Management

Oral Mucocele

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.

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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.

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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.

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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.

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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.

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💬 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

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Antibiotic Selection in Pediatric Dental Infections: Updated Clinical Criteria for U.S. Dentists

Pediatric Dental Infections

Pediatric dental infections are common in clinical practice and can progress rapidly due to anatomical and immunological factors specific to children. When systemic signs or soft tissue involvement are present, selecting the right antibiotic becomes critical.

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However, antibiotic prescription in pediatric patients requires careful consideration of the likely pathogens, the child’s age and weight, medical history, drug allergies, and antibiotic pharmacokinetics.

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This article outlines the evidence-based criteria for selecting safe and effective antibiotics for pediatric odontogenic infections, in accordance with U.S. clinical guidelines.

When Are Antibiotics Indicated in Pediatric Dentistry?
According to the American Academy of Pediatric Dentistry (AAPD, 2022) and current literature, systemic antibiotics in children should be adjunctive, not primary, to dental treatment (e.g., extraction, pulpectomy, or drainage). Antibiotics are indicated in the following situations:

° Infections with systemic involvement (fever, lymphadenopathy, malaise).
° Spread to soft tissues or fascial spaces (e.g., cellulitis).
° Delayed access to dental treatment.
° Medically compromised or immunosuppressed children.

For localized infections without systemic signs, antibiotics are not recommended (Robertson et al., 2020).

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Key Criteria for Antibiotic Selection

1. Bacterial Spectrum and Common Pathogens
Most odontogenic infections in children are caused by facultative and anaerobic Gram-positive bacteria, including Streptococcus viridans, Prevotella, and Fusobacterium species. Therefore, antibiotics must provide coverage for both aerobic and anaerobic oral flora.
° First-line therapy: Amoxicillin or Amoxicillin-clavulanate.
° Penicillin allergy: Clindamycin or Azithromycin (with caution).

2. Age and Weight-Based Dosing
Pediatric dosing is weight-dependent and must be calculated accurately to ensure therapeutic efficacy and safety. Liquid oral formulations are preferred in most outpatient scenarios.



3. Safety Profile and Contraindications
Certain antibiotics such as tetracyclines are contraindicated in children under 8 years due to the risk of permanent tooth discoloration. Fluoroquinolones are generally avoided in pediatric patients due to concerns about cartilage and tendon development.

4. Route of Administration and Adherence
The oral route is the first choice for mild to moderate infections. Short treatment durations (5–7 days), pleasant-tasting liquid preparations, and fewer daily doses improve adherence in children. For severe infections with fever or poor oral intake, intravenous antibiotics may be required in a hospital setting.

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💬 Discussion
While antibiotics are essential in managing pediatric dental infections with systemic signs, inappropriate use contributes to antimicrobial resistance, a major global and national health concern. In pediatric dentistry, prescribers must balance effectiveness with safety, keeping in mind the developmental sensitivity of the patient and the limited options available.
The cornerstone of management remains the removal of the infection source through local treatment. When antibiotics are necessary, they must be selected using evidence-based guidelines, adjusted for age and body weight, and monitored for adverse effects. Parental education on dosage compliance is also essential.

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💡 Conclusion Antibiotic selection in pediatric dental infections must be grounded in clear clinical indications and guided by updated U.S. pediatric dental protocols. Amoxicillin remains the first-line antibiotic for most cases. Alternatives such as clindamycin or azithromycin should only be used in specific situations. Rational antibiotic use, combined with timely dental intervention and follow-up, ensures optimal outcomes and minimizes complications.

📚 References

✔ American Academy of Pediatric Dentistry. (2022). Guideline on Use of Antibiotic Therapy for Pediatric Dental Patients. AAPD Reference Manual. https://www.aapd.org/research/oral-health-policies--recommendations/

✔ Robertson, D., Smith, A. J., & Garton, M. (2020). The role of systemic antibiotics in the treatment of acute dental infections. British Dental Journal, 228(9), 657–662. https://doi.org/10.1038/s41415-020-1464-x

✔ Pichichero, M. E. (2018). Understanding antibiotic pharmacokinetics in children. Pediatrics in Review, 39(1), 5–17. https://doi.org/10.1542/pir.2016-0165

✔ Wilson, W., Taubert, K. A., Gewitz, M., et al. (2007). Prevention of infective endocarditis: Guidelines from the American Heart Association. Circulation, 116(15), 1736–1754. https://doi.org/10.1161/CIRCULATIONAHA.106.183095

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lunes, 14 de julio de 2025

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

Odontogenic Infections

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.

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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.

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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).

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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).

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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.

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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.

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💬 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

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domingo, 13 de julio de 2025

Indications and Contraindications of Serial Extractions in Pediatric Dentistry: Updated Clinical Guide

Serial Extractions

Serial extractions are a preventive orthodontic procedure used to manage severe crowding by sequentially removing selected primary and permanent teeth. Correct case selection is essential to ensure long-term success and avoid complications.

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This article reviews the clinical importance, key indications and contraindications, and current recommendations based on recent scientific evidence.

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Clinical Importance of Serial Extractions
Serial extractions help manage space deficiencies during mixed dentition, guiding permanent teeth into more favorable positions. When indicated appropriately, they can:

° Reduce the need for complex orthodontic treatments in adolescence.
° Minimize treatment duration and need for permanent extractions later.
° Maintain balanced facial growth and dental function.

As Proffit et al. (2019) highlight, interceptive orthodontics, including serial extractions, plays a crucial role in guiding proper occlusal development in growing patients.

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Indications for Serial Extractions
Serial extractions are recommended when the following conditions are met:

1. Severe Crowding (>4–5 mm per quadrant)
The primary indication is significant space deficiency that prevents proper eruption of permanent teeth.

2. Negative Tooth–Arch Size Discrepancy
When the total mesiodistal width of permanent teeth exceeds the basal arch length, serial extractions help achieve alignment.

3. Altered or Asynchronous Eruption Patterns
When the eruption sequence is delayed or misaligned, especially in anterior segments, creating space can improve outcomes.

4. Skeletal Class I Pattern
Serial extractions are most effective in patients with normal skeletal growth and no vertical or sagittal disharmonies.

5. Ideal Age: 8–11 Years (Early Mixed Dentition)
The ideal timing is when the first permanent molars and incisors are present, and canines and premolars are developing.

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Contraindications for Serial Extractions
This procedure is not recommended in the following situations:

1. Skeletal Malocclusions (Class II or III)
Patients with significant jaw discrepancies, open bites, deep bites, or crossbites may require orthopedic intervention instead.

2. Presence of Harmful Oral Habits
Thumb sucking, tongue thrust, or mouth breathing must be addressed first, as they can compromise treatment outcomes.

3. Hypodontia or Congenitally Missing Teeth
Teeth should not be extracted if others are absent, as this may worsen spacing or occlusal issues.

4. Mild Crowding or Adequate Arch Space
Unnecessary extractions may cause undesirable gaps or misalignment in otherwise manageable dentitions.

5. Eruption Anomalies or Tooth Impactions
Ectopic eruptions or impacted teeth may require surgical exposure or space creation through other orthodontic means.

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Updated Clinical Recommendations

° Comprehensive diagnostic workup is essential: panoramic and cephalometric X-rays, dental cast analysis, and space evaluation.
° Collaborate with an orthodontist early in treatment planning.
° Educate parents and caregivers about the rationale, timeline, and phases of serial extraction.
° Ensure long-term follow-up to monitor permanent tooth eruption and intervene if deviations occur.

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💬 Discussion
When applied correctly, serial extractions can greatly reduce future treatment complexity. However, inappropriate indication—such as in skeletal malocclusion cases—may lead to unwanted effects, such as arch collapse or residual spacing. The procedure does not replace orthodontic treatment but is rather a preventive adjunct to simplify it (Jarjoura et al., 2020).
Current research supports the effectiveness of serial extractions in well-selected Class I cases. Multidisciplinary coordination and long-term monitoring are key to avoiding complications and ensuring occlusal harmony.

💡 Conclusion
Serial extractions remain a valuable strategy in pediatric orthodontics, but only when properly indicated. Understanding both indications and contraindications allows clinicians to plan treatment safely and predictably. When combined with accurate diagnosis and follow-up, this preventive approach can optimize dental development and reduce the need for future interventions.

📚 References

✔ Jarjoura, K., Goonewardene, M., & Fleming, P. S. (2020). Serial extraction in orthodontics: A systematic review of effectiveness and efficiency. Orthodontics & Craniofacial Research, 23(2), 122–131. https://doi.org/10.1111/ocr.12338

✔ Proffit, W. R., Fields, H. W., Larson, B., & Sarver, D. M. (2019). Contemporary Orthodontics (6th ed.). Elsevier.

✔ Singh, G., & Clark, W. (2018). Interceptive orthodontics: Key concepts and clinical applications. Dental Clinics of North America, 62(3), 457–471. https://doi.org/10.1016/j.cden.2018.03.002

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viernes, 11 de julio de 2025

Serial Extractions in Pediatric Dentistry: Clinical Phases, Benefits, and Updated Guidelines

Serial Extractions

Serial extractions are a preventive orthodontic technique used to manage severe crowding in mixed dentition. By removing selected primary and permanent teeth in a planned sequence, clinicians can guide the eruption and alignment of permanent teeth.

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This article provides an evidence-based review of the clinical phases of serial extractions, their benefits, indications, and current recommendations.

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What Are Serial Extractions?
Serial extractions refer to the planned and sequential removal of selected primary and permanent teeth to address space discrepancies and facilitate proper eruption of permanent teeth (Proffit et al., 2019). This interceptive orthodontic approach is typically used in children aged 8 to 11 with moderate to severe crowding, where early intervention may reduce the need for complex orthodontic treatment in adolescence.

Why Are Serial Extractions Important?
Properly timed serial extractions can provide several key benefits:

° Prevent severe malocclusions.
° Reduce treatment time and complexity in future orthodontic therapy.
° Support balanced facial aesthetics and functional occlusion.
° Minimize the need for extraction of permanent teeth later in adolescence.

Long-term studies show that patients who undergo serial extractions have more stable outcomes compared to those treated with orthodontic appliances alone (Valentine & Howitt, 2019).

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Phases of the Serial Extraction Protocol

1. Diagnostic Phase
An accurate diagnosis is critical for success. The initial assessment should include:
° Clinical evaluation and dental history.
° Panoramic and cephalometric X-rays.
° Dental model analysis and space assessment.
° Measuring tooth–arch discrepancies.
Candidates for serial extraction typically present more than 4 mm of crowding per quadrant, without skeletal anomalies (Jarjoura et al., 2020).

2. Phase I: Extraction of Primary Teeth
° Common teeth removed: Primary canines and first molars.
° Goal: Facilitate the eruption and alignment of permanent incisors and canines.
° Best timing: Around ages 8–9, with radiographic confirmation of permanent tooth development.

3. Phase II: Extraction of Permanent Premolars (If Needed)
° Indicated in cases of persistent crowding after incisors and canines have erupted.
° Typically performed between ages 10–11, once two-thirds of premolar root formation is complete.
° Must consider periodontal health and adjacent tooth position.

4. Phase III: Orthodontic Guidance and Monitoring
° Use of fixed or removable appliances to guide final alignment.
° Monitoring eruption and alignment every 4–6 months.
° Making necessary adjustments to the treatment plan based on eruption patterns.

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Updated Clinical Recommendations

° Serial extraction should always follow thorough orthodontic planning.
° Multidisciplinary collaboration between pediatric dentists and orthodontists is crucial.
° Families should be fully informed of the steps, benefits, and timeline of treatment.
° Continued monitoring is essential until eruption of all permanent teeth.

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💬 Discussion
While highly effective in selected cases, serial extractions are not suitable for all patients. They do not correct skeletal discrepancies, and thus are not indicated in patients with Class II or Class III malocclusions, open bites, or significant jaw misalignments.
When properly implemented, serial extractions can simplify future orthodontic treatment and improve long-term stability. Clinical evidence supports their use in cases of severe crowding with favorable growth patterns (Proffit et al., 2019; Jarjoura et al., 2020).

💡 Conclusion
Serial extractions are a valuable early intervention technique in pediatric dentistry and orthodontics. With careful diagnosis, proper case selection, and phase-specific monitoring, this protocol offers a predictable and efficient way to manage space discrepancies and support ideal dental development. Incorporating this approach can lead to improved long-term functional and aesthetic outcomes.

📚 References

✔ Jarjoura, K., Goonewardene, M., & Fleming, P. S. (2020). Serial extraction in orthodontics: A systematic review of effectiveness and efficiency. Orthodontics & Craniofacial Research, 23(2), 122–131. https://doi.org/10.1111/ocr.12338

✔ Proffit, W. R., Fields, H. W., Larson, B., & Sarver, D. M. (2019). Contemporary Orthodontics (6th ed.). Elsevier.

✔ Valentine, F., & Howitt, J. W. (2019). Long-term outcomes of serial extraction: A 20-year follow-up. American Journal of Orthodontics and Dentofacial Orthopedics, 155(3), 411–419. https://doi.org/10.1016/j.ajodo.2018.06.015

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domingo, 6 de julio de 2025

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

Herpangina

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.

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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.

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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).

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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).

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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.

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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.

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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.

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💬 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

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viernes, 4 de julio de 2025

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

Harmful Oral Habits

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.

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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.

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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

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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

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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

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💬 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

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