DCA06DT Dental Treatment of Pediatric and Adolescent Patients _ __________________________________
The incidence of these lesions varies from 20% to 60% and can reflect the actual population studied. Many patients develop the condition during the first two decades of life [55]. There has yet to be a bacterial, viral, or fungal etiology that can be attributed to the origin of these lesions, but a genetic predis- position to the occurrence is possible. When both parents have a history of these lesions, there is a 90% chance that their children will be similarly affected [56]. Common predisposing factors include physical and emotional stress and sensitivity to ingredients in toothpaste and/or mouthwash, such as sodium lauryl sulfate and alcohol [57; 58]. Tissue manipulation during dental or medical procedures, during which the oral tissues are stretched or manipulated by instruments, is a source of local trauma that can cause the development of these ulcers. Nutri- tional deficiencies in vitamin C, folic acid, iron, and vitamin B12 are other potential etiologies [58]. Systemic chemotherapy and radiotherapy targeting malignant lesions of the oropharynx can cause the development of overlapping aphthous ulcers of considerable size that can serve as areas of systemic access of pathogenic organisms. Occasionally, these ulcers occur as part of a disease such as Behçet syndrome. In patients with Behçet syndrome, major aphthae are more frequent than minor aphthae and occur simultaneously on the nonkeratinized oral mucosa, uvula, and genitals [58]. Sensitivity to certain medications, including NSAIDs, angiotensin-converting enzyme inhibitors, and bisphosphonates, may produce an aphthous-like tissue reaction. Given the multitude of medica- tions available and potential untoward effects that can occur in the patients who take them, this could be a potential issue for numerous medications. Treatment and Prognosis The lesions of recurrent aphthous stomatitis usually revolve spontaneously. Minor aphthae resolve within 7 to 14 days from onset with no residual scarring. Major aphthae can take three weeks or longer to heal and usually do so with scar formation. Antibiotics are only needed if the involved areas become secondarily infected. Treatment is usually designed to avoid contact with these lesions, as a traumatic incident will exacerbate the pain and prolong healing. Palliation of the symptoms associated with these lesions consists of topical anesthetic preparations and systemic analgesics, as needed. A diet that minimizes both acidity and extreme temperatures and avoids foods with sharp edges will facilitate proper nutri- tional support and minimize physical trauma to the affected areas [58]. Patients with removable orthodontic retainers may refrain from using them if an aphthous ulcer is adjacent to their extensions. As the name would suggest, these lesions have periodic recurrences. Because more serious lesions such as squamous cell carcinoma can appear in a multitude of different forms, patients should be advised that lesions that do not heal should be re-evaluated for a biopsy.
ORAL AND MAXILLOFACIAL TRAUMA FROM CHILD ABUSE AND NEGLECT Traumatic injuries to the teeth and the structures of the oral and maxillofacial complex may be the result of falls, sports injuries, car accidents, or violence. Usually, the maxillary anterior teeth take the brunt of the trauma, as they are the first teeth to encounter traumatic forces. The extent of coronal/ radicular (root) fracture, the age of the patient, the degree of root development and apical closure of permanent teeth, the medical history, and access to dental care can all influence the ability to restore traumatized teeth. Of the most concern are oral injuries, cutaneous and intra-oral mucosal bruising, and other injuries to the head and neck that occur due to child abuse and neglect. The head, neck, and arms of pediatric patients should be assessed for signs of bruising or injuries without plausible explanation. All members of the dental profession should be cognizant of their responsibility as advocates for children and adolescents who are victims of physical and emotional abuse. This is a moral and ethical obligation, as all states require den- tists to report suspected cases of child abuse to the appropriate social service or law enforcement agencies. Many cases of child abuse go unreported, so it is difficult to determine the exact number of children affected by physical, emotional, and psychologic abuse. According to the U.S. Department of Health and Human Services, the rate of child abuse and neglect was 7.4 per 1,000 children in 2023 [29]. Neglect represented the most frequent type of abuse, occur- ring in 76.1% of victims; physical abuse occurred in 16.5% of victims. Dental professionals are often the practitioners who have the most frequent interactions with children and therefore must be attentive to any signs of physical abuse, as abusive injuries to children often involve the face, jaw, mouth, teeth, and tongue [13]. Studies indicate that more than half of abused children have visible injuries to the head, face, neck, and intraoral regions [49]. Child abuse should be considered as a potential source for injuries that are inconsistent with an explanation as to their origin, when several injuries in various stages of healing are present, when children or adolescents appear reluctant or fearful to discuss their injuries, and if parents or guardians appear evasive or defensive when they are questioned about the origin of the child’s injuries. While there is no single injury to the head, neck, oral, or peri- oral region that is absolutely indicative of child abuse, some injuries and patterns should be viewed with more suspicion than others. Injuries or bruises in the shape of a distinguish- able object, such as a belt buckle, strap, rope, electrical cord, clothes iron, or hand, are cause for concern [49]. The cheeks and lips are the most common site of intentionally inflicted injuries in the oral and perioral region, with injuries to the oral mucosa, teeth, gingival tissues, and tongue following behind [49; 50]. Beyond the oral and perioral region, the neck should
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