extractions. The organisms spread through the tissues and can cause dysphagia if the
submandibular region is involved. Abscesses may rupture on to the skin and long-
term antibiotic therapy is required. Penicillin should be prescribed and maintained for
at least 2 weeks following clinical cure.
Protozoal infections
Infection by Toxoplasma gondii may occasionally occur in children. The principal
reservoir of infection being cats. Glandular toxoplasmosis is similar in presentation to
infectious mononucleosis and is found mainly in children and young adults. There
may be a granulomatous reaction in the oral mucosa and there can be parotid gland
enlargement. The disease is self-limiting, although an anti-protozoal such as
pyrimethamine may be used in cases of severe infection.
1001H
Fig. 15.1 Bacterial infection on the lip
of an immunocompromised child. (By
kind permission of Dental Update.)1002H
Fig. 15.2 Oral candidiasis in an
immunocompromised child undergoing
chemotherapy for acute lymphoblastic
leukaemia. (By kind permission of
Dental Update.)15.2.2 Ulcers
Traumatic ulceration of the tongue, lips, and cheek may occur in children, especially
after local anaesthesia has been administered (1003HFig. 15.3). Recurrent aphthous oral
ulceration not associated with systemic disease is often found in children (1004HFig. 15.4).
One or more small ulcers in the non-attached gingiva may occur at frequent intervals.
In the young child the symptoms may be mistaken for toothache by a parent. The
majority of aphthous ulcers in children are of the minor variety (less than 5 mm in
diameter). These usually heal within 10-14 days. Treatment other than reassurance is
often unnecessary; however, topical steroids (Adcortyl in Orabase or Corlan pellets)
may be prescribed in severe cases. Older children may benefit from the use of
antiseptic rinses to prevent secondary infection. In the absence of a history of major