Paeds Vivas · ent-hearing-and-oral-health
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.
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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]
References4ShowHide
- [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