Geez, oral health care can be tough! How do you know what’s normal and what isn’t inside a kid’s mouth? Here are a few quick tips to identify the lumps, bumps, and owies. If in doubt, you can always call your friendly pediatric dentist.

Normal stuff: Normal oral anatomy is usually midline or symmetrical. That little bump behind the front top teeth is called an incisal papilla, if burned on pizza or poked with a chip it can get inflamed but will quickly heal. Those bright red spots under the tongue are surface blood vessels called varices, they’re fine Mom!

Cold Sores: Common cold sores usually occur outside the mouth on the lips. They are a recurrence of a viral infection called Herpes Simplex. About 90% of children are exposed to the herpes cold sore virus by age four (look what I brought home from preschool Mom!), and about 50% become chronic carriers. That means, since the herpes virus infects nerve cells that never die, periodically the virus will reappear to form a cold sore. Before a cold sore has crusted over, it sheds virus and in very infective. Luckily a whole family of antiviral medicines can treat the cold sore to limit its size, duration and discomfort.

Canker Sores: For otherwise healthy children, canker sores occur on the inside of the mouth on the moveable tissues only. Also named Aphthous ulcers or RAS (recurrent aphthous syndrome), they have a white, dished center with a bright red border and are very painful when touched. Oftentimes, parents confuse this lesion for an abscess if located near the teeth on the gums. In reality, Aphthous ulcers are caused by an over exuberant immune system response. That’s right, the immune system gets mad at some micro trauma, cleans house, and leaves a painful ulcer. Since it’s not an infection, the best treatment is recognizing it will go away in about a week and medicating with Tylenol or a topical numbing agent like Orajel. Some adults remember burning them with Silver Nitrate. That’s very painful, will leave a scar, and cause mutiny!

Mucocele: Unknown to most of us, the lips are full of minor salivary glands, consisting of a simple small gland connect to the oral cavity by a tube duct. Every so often, one of these tubes gets cut, saliva builds up in the gland and a soft bump in the lip occurs. If the gland ruptures, fills again and ruptures again, a scar may form. This produces a hard bump. Kids can absolutely not leave these bumps alone and usually chew on them; some mucoceles can reach the size of marbles! The best treatment is to simply make a small incision in the inside lip and tease the mucocele out. In a pediatric dentist office, this involves a spot of anesthesia, one stitch and about five minutes. At your oral surgeon or ENT office they start talking about general anesthesia! Remember, children can smell when a doctor is scarred of them!

Popcornoma: This is my favorite oral pathology. A child presents with a swollen gum and slight discoloration. A dental explorer is carefully inserted between tooth and gum to capture and deliver a popcorn husk. The pain instantly goes away! Somehow, fathers are usually blamed, don’t ask me why.

Many more unusual and always troubling lumps and bumps exist. If you have a head scratcher and need some advice, never hesitate to call. Greg Evans, DDS at Big Grins Pediatric Dentistry in Fort Collins is always available for a chat.

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