Clinical images: Mouth conditions

Presentations of conditions affecting the mouth.

Impetigo

This common condition presents with a characteristic lesion, which has a gold crust caused by dried serum. The lesions usually start as small blisters, but rupture. The causative organism is most often Staphylococcus aureus. It is highly infectious and usually affects children, although adults may also be affected. If the lesions are very isolated, a topical treatment may be effective, but oral antibiotics are more frequently used.


Fibroepithelial polyp

This child presented with a swelling on the underside of his tongue. It had been present for some time and was a nuisance, but did not cause pain or bleeding. He was referred to the maxillofacial surgeons. These types of lesion are commonly seen in the mouth and are nearly always benign. They are rarely well tolerated, however, because patients report that even small lesions feel quite large when they are in the mouth.


Thrush

This 50-year-old man has multiple health problems and is chronically unwell. He presented with a sore mouth and removing his denture revealed this thrush infection along the line of the denture, which did not fit well. The mild trauma to the surface of the palate had encouraged the growth of candida. Treatment with antifungals was effective, but it has recurred on a number of occasions. The underlying problem with his denture needs to be addressed.


Maxillary lip tie

Occasionally, children with maxillary lip tie can have problems with breastfeeding. This child's mother was worried about a possible effect on speech development in this two-year-old. In the absence of a lisp, this is unlikely to be a problem. The child was referred to a maxillofacial surgeon, who recommended delaying surgery until the age of six or seven years. The tissue can then be divided by frenotomy, a minor surgical procedure.


Geographical tongue

Patients commonly present with this condition. It manifests with a characteristic pattern on the surface of the tongue, which histologically consists of areas of desquamation and dekeratinisation, surrounded by hyperkeratotic areas. The specific cause is unknown, although it may be affected by certain foods. It is also slightly more common in atopic individuals, suggesting a possible genetic link. It is completely benign and generally requires no treatment other than simple reassurance.


Dead tooth

This three-year-old fell forwards on to his face. He damaged his front teeth, which now appear discoloured. This is caused by the death of the nerve and its subsequent breakdown. His dentist recommended that no action was required, as the child was not in any pain. The damaged teeth would be lost in due course, to be replaced by healthy new teeth at around six to seven years.


Tonsillitis

This 18-year-old woman presented with classic acute tonsillitis. She was quite ill, with a high temperature and severe throat pain. Clinically, she had large cervical lymph nodes and pus on her enlarged and inflamed tonsils. After a swab was taken, she was started on penicillin V and advised to complete a 10-day course. The swab confirmed a group A streptococcus.


Angioedema

This 40-year-old man presented with swelling of his lip. It was due to a latex allergy. Although he did not report any respiratory difficulties, latex allergy is a potentially very serious problem. It is made worse by the problems associated with trying to eliminate latex from a person’s environment. The history is not always clear and investigations usually include blood tests such as FBC, C3/C4 and IgE. Referral to immunology may be required to confirm the diagnosis, and management generally follows the lines of strict avoidance, with antihistamines, steroids and adrenaline as required.

  • Dr Marazzi is a GP in East Horsley, Surrey.

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