ORAL PATHOLOGY : Intraoral soft-tissue abnormalities

Congenital Lesions


Ankyloglossia, or “tongue-tied,” is a common congenital condition characterized by an abnormally short lingual frenum and the inability to extend the tongue. The frenum may lengthen with growth to produce normal function. 

If the extent of the ankyloglossia is severe, speech may be affected, mandating speech therapy or surgical correction. If a child is able to extend his or her tongue sufficiently far to moisten the lower lip, then a frenectomy usually is not indicated.


Developmental Lesions

Geographic Tongue

Benign migratory glossitis, or geographic tongue, is a common finding during routine clinical examination of children. It occurs most commonly on the dorsum and lateral borders of the anterior two thirds of the tongue. 

Geographic tongue appears as pink to red, round or irregular areas of dekeratinization and desquamation of filiform papillae with white or yellow elevated margins.

Geographic tongue continuously changes patterns, creating a migratory appearance on the tongue. The lesions are usually asymptomatic but may be painful when inflamed.

More common in girls, the condition has no known cause, although it has been associated with allergies in children.' No treatment other than reassurance usually is indicated.

Fissured Tongue

Fissured tongue is a developmental anomaly that usually presents as one marked central fissure, anteroposteriorly, from which smaller fissures radiate laterally. 

The fissures may be shallow or deep. In deep fissures, food debris may become trapped, leading to inflammation or secondary fungal infections. Fissured tongue is less common in children than in adults; however, this is a common finding in children with Down syndrome.

Retrocuspid Papillae

Present in most children, the retrocuspid (or retrocanine) papilla is an anatomic structure located on the attached gingiva lingual to the mandibular canines. Usually 2 mm to 3 mm in diameter, these lesions are pink to red. 

Frequently found bilaterally, these firm, round fibroepithelial papules are asymptomatic. They usually decrease in size and incidence with age; therefore, no treatment is necessary.

Gingival Overgrowth

Gingival enlargement may be an inherited trait, may be induced by drugs, or may occur in patients with leukemia. Hereditary gingival fibromatosis, or idiopathic hyperplasia, is a rare, progressive, fibrous enlargement of the gingiva beginning in early childhood.

The thick, firm, and pink gingival enlargement affects buccal and lingual surfaces of both jaws. Failure or delay in the eruption of primary and permanent teeth is a common finding. Gingivectomy is the treatment of choice.

Meticulous oral hygiene is recommended to help reduce recurrence. A similar drug-induced gingival enlargement is seen in half of children taking phenytoin to control seizures, and other drugs, such as cyclosporin A, an immunosuppressive drug, and nifedipine, a calcium channel blocker.

Use of these drugs before tooth eruption may lead to delay or lack of eruption of the teeth into the oral cavity because of the dense fibrous overgrowth. Taken after tooth eruption, these drugs produce overgrowth beginning at the interdental papillae.

The gingival enlargement is exacerbated by the inflammatory response to dental plaque, with most prominent overgrowth on the labial aspects of anterior teeth. 

A combination of two or more of these drugs can lead to extreme rapid gingival proliferation, necessitating an alteration in the drug regimen for the patient. Gingival enlargement usually is not dose related; however, removal of the drug may resolve the overgrowth.

For any child taking a drug with the potential for gingival enlargement, excellent oral hygiene is recommended. A gingivectomy is recommended for severe cases.

Gingival enlargement also may occur in patients with leukemia, especially the monocytic type, because of infiltration of the gingival tissues by malignant white blood cells.

The gingival overgrowth in this case is edematous and hemorrhagic versus dense and fibrotic. Because of the bleeding tendency, patients may not practice good oral hygiene. Resulting inflammation may provide the stimulus for further connective tissue hyperplasia.

°Jayne E. Delaney, DDS, MSD, and Martha Ann Keels, DDS, PhD

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