Oral Pathology: Of the infant and toddler

Newborn Oral PathologyInclusion cysts appear as small white or gray lesions on the mucosa, alveolar ridge and hard palate, and are present in 75% of newborns. All three types – Epstein’s pearls, Bohn’s nodules and dental lamina cysts are asymptomatic and are usually shed within the first three months of life. Epstein’s pearls may be found on the mid-palatal raphe of the hard palate. Bohn’s nodules, remnants of salivary glands, are located on the bucal or lingual mucosa, or on the hard palate, away from the raphe. Dental lamina cysts are located on the crests of the alveolar ridges.Epstein's Pearls Bohn's Nodules Dental Lamina CystsCongenital Epulis of the newborn is similar in appearance to a dental lamina cyst, but is usually located in the maxillary anterior region. Although some recede spontaneously, a usually large congenital epulis may cause feeding problems and require excision. Recurrence is unlikely.Melanotic Neurectodermal Tumor of infancy is a benign tumor of neurectodermal origin. The clinical appearance can be similar to congenital epulis of the newborn; an exophytic non-ulcerated mass on the maxillary alveolar mucosa. The tissue may appear to be brown in color (pigmented). Radiographic examination reveals “floating teeth.”Partial Ankyloglossia. The lingual frenum which has a short attachment to the floor of the mouth is often called “tongue-tie.” In a newborn, it may be present, but usually resolves over time with tongue use. Unless it is severe, it usually does not present a problem for speech or eating and does not need to be surgically corrected. In the case of ankyloglossia where movement is restricted, such that the child cannot clean the food off their teeth, a lingual frenectomy may need to be performed. An early evaluation for this is necessary to assure proper speech and placement of teeth. Natal/Neonatal teeth. Usually lower incisors, natal teeth are present at birth; neonatal teeth erupt within the first 30 days of life. As many as 85% of these are a part of the normal primary dentition and are not supernumerary. Efforts should be made to retain these teeth unless they are hypermobile and there is concern of aspiration. These teeth may be associated with Riga-Fede (see Problem with Eruption). Natal teeth may be the first sign of some syndromes including Ellis-van Creveld and Hallermann-Streiff.

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