Wow, oral health care can be hard! How to know what is normal and what is not in a child’s mouth? Here are some quick tips for identifying the lumps, bumps, and owies. When in doubt, you can always call your friendly pediatric dentist.
Normal Stuff: Normal oral anatomy is usually midline or symmetrical. That little bump behind your upper front teeth is called an incisal papilla, if it gets burned on pizza or pricked with a chip it can become inflamed but will heal quickly. Those bright red dots under your tongue are superficial blood vessels called varicose veins, they’re okay, mom!
Cold sores: Common cold sores usually occur outside of the mouth on the lips. They are a recurrence of a viral infection called Herpes Simplex. About 90% of children are exposed to the cold sore virus by age four (look what I brought home from mom at preschool!), and about 50% become chronic carriers. That means that since the herpes virus infects nerve cells that never die, periodically the virus will reappear to form a cold sore. Before a cold sore has scabbed over, it sheds viruses and is highly infectious. Fortunately, a whole family of antiviral medications can treat cold sores to limit their size, duration, and discomfort.
Canker Sores: For otherwise healthy children, canker sores occur on the inside of the mouth on the movable tissues only. Also called aphthous ulcers or RAS (recurrent foot-and-mouth syndrome), they have a white, plate-shaped center with a bright red border and are very painful to touch. Parents often mistake this lesion for an abscess if it is located near the teeth in the gums. In reality, canker sores are caused by an overly exuberant immune system response. That’s right, the immune system gets angry at some microtrauma, cleans the house and leaves a painful ulcer. Since it is not an infection, the best treatment is to recognize that it will go away in about a week and to take Tylenol or a topical anesthetic such as Orajel. Some adults remember burning them with silver nitrate. That is very painful, it will leave a scar and cause a riot!
Mucocele – Unknown to most of us, the lips are filled with minor salivary glands, which consist of a small, simple gland that is connected to the oral cavity by a tubular duct. From time to time, one of these tubes is cut, saliva collects on the glans penis, and a soft lump develops on the labia. If the gland ruptures, fills up again, and ruptures again, a scar can form. This produces a hard hit. Children cannot leave these lumps alone and usually chew on them; some mucoceles can reach the size of marbles! The best treatment is simply to make a small incision in the inner lip and remove the mucocele. In a pediatric dentist’s office, this involves one point of anesthesia, one point, and about five minutes. At your oral surgeon’s or otolaryngologist’s office they start talking about general anesthesia! Remember, kids can smell when a doctor has scars on them!
Popcornoma: This is my favorite oral pathology. A child presents with a swollen gum and slight discoloration. He carefully inserts a dental explorer between the tooth and gum to capture and deliver a popcorn husk. The pain disappears instantly! In some ways, parents are often blamed, don’t ask me why.
There are many more unusual and always worrisome lumps and bumps. If you have a head scratcher and need some advice please don’t hesitate to call. Greg Evans, DDS at Big Grins Pediatric Dentistry in Fort Collins is always available for a chat.
