ORAL MUCOSAL DISEASES IN CHILDREN WITH CARIES OF PRIMARY TEETH: ETIOLOGY, PATHOGENESIS, AND CLINICAL FEATURES

Diseases of the oral mucosa are common in early childhood and frequently occur in children who already have caries of primary teeth. The most important of these conditions are oral candidiasis, primary herpetic gingivostomatitis, enteroviral stomatitis, including hand, foot, and mouth disease and herpangina, recurrent aphthous stomatitis, plaque-induced gingivitis, and traumatic and odontogenic lesions of the mucosa. Although they differ in their causes, these conditions develop in the same oral environment as early childhood caries and are influenced by the same biofilm, salivary, dietary, and immune factors. This literature-based analytical article describes the etiology, pathogenesis, and clinical features of the main oral mucosal diseases in young children, with particular attention to the features that distinguish them in children with caries of primary teeth and to the diagnostic pitfalls that arise when mucosal lesions are caused by carious teeth. A narrative synthesis of reviews, systematic reviews, meta-analyses, epidemiological surveys, randomized trials, experimental studies, and consensus reports was performed. The analysis shows that oral mucosal lesions are found in a considerable proportion of children, that most episodes of viral stomatitis occur between six months and five years of age, and that children with oral Candida albicans have approximately six times higher odds of early childhood caries. In primary herpetic gingivostomatitis, early aciclovir treatment shortened the duration of oral lesions from about ten to four days and the duration of eating difficulties from about seven to four days. Untreated caries is itself a frequent cause of traumatic ulcers and odontogenic sinus tracts that may imitate primary mucosal diseases. Accurate differential diagnosis, based on knowledge of the etiology, pathogenesis, and clinical course of each condition and on careful examination of the teeth, is essential for correct treatment and for prevention of caries progression in young children.