Approach to the Problem
Oral lesions are very common in newborns, infants, and young children. As today’s medical providers increasingly discuss oral health, parents may be particularly concerned when a focal lesion appears on their child’s gum. Fortunately, most of these lesions are benign. Bohn nodules affect up to 85% of children, and natal teeth are present in one to two of 6,000 births. Many gum lesions resolve without intervention, and their presence does not have adverse effects. However, some untreated lesions, such as dental abscesses, may extend to involve adjacent tissue and result in the formation of fistulas, facial cellulitis, and even osteomyelitis. Meticulous oral hygiene is critical to prevent infectious lesions that result from untreated dental caries and poor oral hygiene.
Key Points in the History
• Natal teeth are present at birth, whereas neonatal teeth develop in the first month of life.
• Approximately 85% of natal and neonatal teeth are mandibular.
• Bohn nodules and alveolar cysts, often present at birth, generally do not interfere with feeding.
• Parents may confuse Bohn nodules with oral thrush.
• Eruption cysts are common in infants and children during the mixed-dentition stage, when primary and permanent teeth are present in the mouth.
• Eruption cysts tend to rupture spontaneously and are generally nontender.
• A deflection in the path of tooth eruption (e.g., crowding or overretention of primary teeth) may result in a mucogingival defect.
• Poor dental hygiene and dental caries are risk factors for dental abscesses.
• Children with dental abscesses may have a history of fever, mouth pain, or facial swelling.
• Children with a fistula between a dental abscess and the gum may report drainage, a funny or sour taste in their mouth, or both.
Key Points in the Physical Examination
• Natal and neonatal teeth are most commonly primary, but may be supernumerary.
• Natal teeth are erupted teeth present at the time of birth.
• Bohn nodules are smooth, translucent, pearly white cysts that range from approximately 1 to 3 mm in size.
• Bohn nodules may be isolated or clustered.
• Eruption cysts are usually found in the region of the incisors on the edge of the alveolar ridge where a tooth is erupting.
• Eruption cysts may feel rubbery, be nontender, and have a bluish hue.
• Alveolar cysts are visible along the alveolar ridges.
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