Oral manifestations of systemic disease — structured clinical encounter

Structured encounter testing the approach to a pale tired six-year-old with swollen bleeding gums and palatal petechiae: the recognition of leukaemic gingival infiltration, the urgent full blood count and film, and the neutropenic-sepsis safety, with a pivot to a child with chalky symmetrical dental enamel defects and faltering growth requiring coeliac serology with a total IgA and the two-handed management of a gluten-free diet and oral care.

structured clinical encounter2 min readVerification in progress

Prompt

A six-year-old boy has two weeks of fatigue, easy bruising and progressively swollen, painful, bleeding gums, with palatal petechiae, shin bruising and a fever of 38.6 degrees Celsius. You are the paediatric registrar working through the urgent work-up and neutropenic-sepsis safety, with a later scenario of a nine-year-old with chalky symmetrical dental enamel defects and faltering growth requiring coeliac serology.

Candidate brief

You are the paediatric registrar in the emergency department. A six-year-old boy has two weeks of fatigue, easy bruising and progressively swollen, painful, bleeding gums. On examination he is pale, the gums are diffusely boggy, enlarged and bleed on touching, there are petechiae on the palate and bruising on the shins, and his temperature is 38.6 degrees Celsius. [1]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References3Show ledger

[1]Bastos Silveira B; Di Carvalho Melo L; Amorim Dos Santos J; Ferreira EB Oral manifestations in pediatric patients with leukemia: A systematic review and meta-analysis J Am Dent Assoc, 2024.PMID 39254613
[2]Wierink CD; van Diermen DE; Aartman IH; Heymans HS Dental enamel defects in children with coeliac disease Int J Paediatr Dent, 2007.PMID 17397459
[3]Spodzieja K; Olczak-Kowalczyk D Premature Loss of Deciduous Teeth as a Symptom of Systemic Disease: A Narrative Literature Review Int J Environ Res Public Health, 2022.PMID 35329073