CHAPTER 52 ■ ORAL LESIONS MARISSA A HENDRICKSON, MARK G ROBACK INTRODUCTION Oral lesions in children can represent a wide range of illnesses Lesions range from benign and self-resolving to indicative of life-threatening diseases Many oral lesions, both congenital and acquired, are localized However, lesions associated with systemic disease must also be considered ( Fig 52.1 and Table 52.1 ) Most often, patients with isolated oral complaints are found to have common, self-limited conditions ( Table 52.2 ) However, a complete history and physical examination is essential for all patients with oral lesions to rule out systemic and potentially life-threatening diseases ( Table 52.3 ) that may present initially with isolated mouth findings PATHOPHYSIOLOGY Oral lesions may result from localized or systemic pathophysiologic processes Localized causes include congenital masses and cysts, infectious diseases, and oral tumors Systemic illnesses with prominent oral involvement include a number of infectious, inflammatory, and toxin-mediated conditions Given the broad spectrum of illnesses presenting with oral lesions, it is helpful to consider individual causes under specific headings within the differential diagnosis Conditions with typical oral lesions that not comfortably fit under these headings are discussed in the section on miscellaneous lesions DIFFERENTIAL DIAGNOSIS Congenital Oral Lesions There are a number of benign, self-limited lesions that appear at birth Epstein pearls, epithelial inclusion cysts that appear as clusters of small, white milia in the midline of the hard palate, occur in more than 60% of newborns Epithelial pearls appear as small, shiny, white lesions on the gums Bohn nodules are cysts that appear on the mandibular or maxillary dental ridges Dental lamina cysts occur on the alveolar ridge of newborns and stem from trapped remnants of the dental lamina Natal teeth are prematurely erupted primary teeth present at birth; teeth erupting within the first month of life are termed neonatal teeth These teeth are