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J Zhejiang Univ (Med Sci)  2021, Vol. 50 Issue (2): 155-161    DOI: 10.3724/zdxbyxb-2021-0122
    
Clinical diagnosis of oral erosive and ulcerative diseases in children
LIU Chuanxia(),CHEN Qianming()
Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, China
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Abstract  

Mucosal disease is one of the most common oral cavity diseases in children, among which mucosal erosion and ulceration account for about 50%. Oral mucosal erosion and ulcer diseases in children are mostly acute with obvious pain, affecting speech, eating and swallowing. Some oral mucosal diseases are caused by infection and would result in epidemic among children. The onset age, sites, lesions size and quantity could vary, and some would have recurrence. The detailed medical history and comprehensive physical examination are necessary, some diseases can be diagnosed according to the medical history and clinical manifestations. If diagnosis can not be made, biopsy, blood test and immunofluorescence staining, immunohistochemistry, molecular biology detection, gene diagnosis, tuberculin test and other tests should be considered, and further investigation of systemic diseases should also be carried out if necessary. In some cases, multidisciplinary consultation should be sought. For those who still have no abnormal findings, therapeutic diagnosis can be tried out or secondary biopsy should be performed. In this article, the research progress of oral mucosal diseases in children is reviewed and our own clinical experiences of oral erosive and ulcerative diseases in children are summarized.



Key wordsOral mucosa      Children      Erosion      Ulceration      Clinical characteristics      Diagnosis process     
Received: 25 January 2021      Published: 18 June 2021
CLC:  R781.5  
Corresponding Authors: CHEN Qianming     E-mail: 0014806@zju.edu.cn;qmchen@zju.edu.cn
Cite this article:

LIU Chuanxia,CHEN Qianming. Clinical diagnosis of oral erosive and ulcerative diseases in children. J Zhejiang Univ (Med Sci), 2021, 50(2): 155-161.

URL:

http://www.zjujournals.com/med/10.3724/zdxbyxb-2021-0122     OR     http://www.zjujournals.com/med/Y2021/V50/I2/155


儿童口腔黏膜糜烂溃疡类疾病的临床诊断

口腔黏膜疾病是除龋病、牙髓病和根尖周病外最常见的儿童口腔疾病,其中糜烂溃疡类疾病约占儿童口腔黏膜疾病的 50%。儿童口腔糜烂溃疡类疾病多为急性发病,患儿疼痛明显,影响言语、饮食和吞咽,部分疾病具有传染性,可引起患儿群体性发病;患儿的发病年龄有一定的规律性,好发部位有一定的差异性,病损大小不一、数量不等,部分具有复发性。对于儿童患者,结合儿童自身的特点进行详细的病史采集,全面的体格检查,部分疾病根据病史特点和临床表现即可作出诊断;不能确诊者完善术前检查后考虑活体组织检查,进行免疫荧光染色、免疫组化、分子生物学检测、基因诊断、结核菌素试验等;仍然不能确诊者,考虑进一步排查全身疾病,必要时寻求多学科会诊和帮助;仍无异常发现者,可试行治疗性诊断,必要时进行二次活检。根据儿童口腔黏膜疾病的研究进展,结合笔者多年的临床诊治经验,本文分析和总结了儿童口腔黏膜糜烂溃疡类疾病的特点和临床诊断思路。


关键词: 口腔黏膜,  儿童,  糜烂,  溃疡,  临床特征,  诊断思路 

疾病名称

发 病

发热史

传染性

季节性

好发年龄

好发部位

复发性

口腔损害特征

其他部位损害

单纯疱疹

急性

可有

6 岁以下,6 个月~2 岁最多

角化与非角化黏膜

可有

口腔黏膜任何部位和口周皮肤出现成簇小水疱,水疱破溃后形成不规则的糜烂面

一般无

手足口病

急性

可有

较强

夏秋季

5 岁以下

口腔黏膜、手掌、足底及臀部皮肤

可有

口腔黏膜散在的红斑或小疱疹、浅糜烂面

手掌、足底及臀部皮肤红色丘疹或水疱

疱疹性咽峡炎

急性

可有

较强

夏秋季

5 岁以下

口腔后部

可有

口腔后部,软腭、悬雍垂、扁桃体等处丛集成簇的小水疱或糜烂面

复发性阿弗他溃疡

急性

一般无

青春期

无角化或角化程度较差的黏膜

圆形或椭圆形溃疡,具有“红、黄、凹、痛”临床特征

创伤性溃疡

急性/慢性

一般无

性情好动的青少年或患多动症的儿童

与创伤因素相对应

可有

溃疡的部位、大小、形状与刺激因素相吻合

过敏性口炎

急性

一般无

任何年龄

任何部位

可有

口腔黏膜充血、肿胀、水疱、渗出、糜烂坏死等

Table 1 Clinical characteristics and differential diagnosis of common erosive and ulcerative oral mucosal diseases in children

疾病名称

发 病

发热史

传染性

好发年龄

好发部位

化疗史

放疗史

口腔损害特征

化疗性口炎

急性

一般无

任何年龄

颊舌等活动黏膜

黏膜充血糜烂、假膜覆盖

放疗性口炎

急性/慢性

一般无

任何年龄

任何部位

急性:充血,深大溃疡,假膜覆盖;慢性:黏膜萎缩、变薄、充血

结核性溃疡

慢性

午后低热

较强

任何年龄

唇、前庭沟、舌

溃疡深在,形状不规则,周围轻度浸润,呈鼠噬状,底部可见肉芽组织

癌性溃疡

慢性

一般无

任何年龄

任何部位

溃疡一般深浅不一,边缘不整齐,周围有浸润,质硬,底部呈菜花状溃疡

白血病

慢性

3~5 岁

牙龈等口腔黏膜

坏死性溃疡性龈炎,口腔黏膜坏死

艾滋病

慢性

任何年龄,母婴传播感染者多见于婴幼儿

任何部位

可出现口腔念珠菌病、口角炎、单纯疱疹等疾病的临床特征

原发性免疫缺陷病

慢性

可有

儿童

任何部位

口腔溃疡、严重的疱疹和念珠菌感染、苔藓样病损

Table 2 Clinical characteristics and differential diagnosis of seldom or rare erosive and ulcerative oral mucosal diseases in children
Figure 1 The diagnosis process of erosive and ulcerative oral mucosal diseases in children
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