Children of all ages may present with a variety of swellings within the mouth, ranging from benign lesions to very serious infections. Differentiating mouth swellings may be difficult owing to a lack of available diagnostic and laboratory testing. Common benign lesions can be diagnosed using characteristic locations and distinguishing physical features. Serious swellings of the mouth will typically present with associated systemic signs of illness. Peritonsillar abscess and Ludwig angina have potentially life-threatening complications.

• Bohn nodules and Epstein pearls are present in newborns (see Chapter 24: Mouth Sores and Patches and Chapter 25: Focal Gum Lesions).

• Mucoceles and ranulas arise acutely, rupture spontaneously, and are painless and asymptomatic.

• Systemic signs of infection, such as fever and throat pain, help differentiate benign swellings of the mouth from more serious infections.

• Peritonsillar abscess is generally preceded by acute tonsillopharyngitis.

• Patients with Ludwig angina have a history of high fever and an inability to handle secretions.

• Epstein pearls are smooth, nontender, translucent, pearly white, 1- to 3-mm cysts on the palate near the midline of the roof of the mouth. When such lesions occur on the gums, they are referred to as Bohn nodules.

• Mucoceles and ranulas are fluid-filled, nontender, mobile, and glisten and have a bluish hue.

• Mucoceles are most common on the lower lip.

• Ranulas are found on the floor of the mouth.

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