Oral manifestations of systemic disease — branching viva

Branching viva from a pale tired six-year-old with swollen bleeding gums and palatal petechiae (acute leukaemia), through the urgent full blood count and neutropenic-sepsis safety, with a pivot to a child with chalky symmetrical dental enamel defects and faltering growth (coeliac disease) and a final stem on a child shedding primary incisors years too early with a low alkaline phosphatase (hypophosphatasia) and the periodontitis of Papillon-Lefevre and cyclic neutropenia.

branching clinical structured oral2 min readVerification in progress

Prompt

You are the paediatric registrar in the emergency department. The examiner asks you to work through a pale tired six-year-old with swollen bleeding gums and palatal petechiae, then a child with chalky symmetrical dental enamel defects and poor growth, and finally a child losing primary teeth years too early. Information is released in stages.

Opening — the pale tired child with swollen bleeding gums

Examiner: A six-year-old boy has two weeks of fatigue, easy bruising and progressively swollen, painful, bleeding gums, with palatal petechiae and a fever of 38.6 degrees Celsius. Talk me through your immediate thoughts and examination. [1]

Candidate should cover: the recognition of acute leukaemia from the pale, tired child with boggy enlarged bleeding gums out of proportion to plaque, mucosal petechiae and bruising indicating thrombocytopenia; the differentiation from simple gingivitis on the basis of severity, systemic company and cytopenic signs; and a focused assessment of hydration, sepsis and bleeding risk. [1]

Paediatrics Fellowship Pro

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

References4Show 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
[4]Chen Y; Fang L; Yang X Cyclic neutropenia presenting as recurrent oral ulcers and periodontitis J Clin Pediatr Dent, 2013.PMID 23855177