It’s happened to many parents: You’re brushing your child’s teeth at bedtime and you notice something strange that you’ve never seen before. A double row of teeth, a bubble on the gum or lip, a discolored spot on the tongue—it is these types of anomalies that bring many parents in to the dentist for an emergency exam. Below are a few of the most common oral oddities that appear in pediatric mouths.
1. Ectopic eruption of permanent teeth
This condition appears as a tooth behind another tooth. The most common location to see this is behind the lower front teeth. This can happen if the arch of the jaw is narrow, or if there is a large discrepancy in size between the primary and permanent teeth. In many of these cases, the primary teeth are at least a little loose, and can be left to fall out on their own. If the permanent teeth are about halfway erupted and the primary teeth are not loose enough to indicate that they would fall out naturally, your dentist will likely advise that the primary teeth be extracted. The longer the permanent teeth remain in the wrong place the harder they are to move later with orthodontics, since the root completes formation after the tooth erupts and provides a strong anchor for the tooth in that location. If, however, the primary teeth are removed (or fall out) within a short time of the permanent teeth appearing behind them, the normal forces provided by the lips and tongue during talking and eating will move the permanent teeth into the correct location.
2. Parulis
A mucocele, or a mucous retention cyst, forms when one of the many salivary ducts in the mouth becomes damaged or clogged. A mucocele typically looks like a clear blister, and it most commonly appears on the inside of the lower lip, the cheek, or under the tongue. A salivary duct can become damaged if a child is a chronic lip or cheek biter, or as result of a particular trauma (such as a ball hitting the mouth). This more often occurs in adults, but can happen in children. The first course of treatment is to allow the cyst to resolve on its own, which frequently happens. When a child has a mucocele, it is very important to monitor that the child is not chewing on the cyst, as this would cause even more damage and prevent healing. Mucoceles can recur, and if they recur repeatedly the damaged gland may require removal.
3. Mucocele
When tooth decay extends past the enamel and dentin, it then enters the pulp of the tooth. The pulp of the tooth contains the nerves and blood vessels that provide vitality. Once in the pulp, the bacteria travel down the roots of the tooth and out into the bone that houses the tooth. At that point, an infection will form at the tip of the root. When the infection forms a small hole in the bone to drain through, a nodule will form at the gum. This nodule, called a “parulis” often gets larger and smaller in size as the infection peaks and ebbs. The treatment for a primary tooth with a localized abscess is extraction of the infected tooth.
4. Geographic Tongue
Geographic tongue appears as a red area with a white, irregularly-shaped border that gives the appearance of a map. The red area is actually a bald spot on the tongue where the small projections normally present have atrophied. The lesion appears to move around the tongue as one area heals and another atrophies. There may be more than one lesion on the tongue at once, and usually there are no symptoms associated with the condition. The cause of geographic tongue is poorly understood, but seems to be associated with psoriasis, and is also more common in people who have allergies, eczema and/or asthma. This condition usually spontaneously resolves.
5. Eruption Cyst
This bluish-black swelling can occur over a tooth that is close to erupting. A tooth forming in the jaw grows within a sac, which typically breaks down as the tooth breaks through the gum and into the mouth. In the case of an eruption cyst, the sac does not break down and erupts with the tooth. The fluid-filled swelling is usually painless and fluctuant to the touch. In most cases, the cyst will break apart as the tooth erupts through it, but sometimes requires removal if it does not rupture spontaneously or if it becomes infected.
These were just some of the most common issues and manifestations of abnormalities that could arise in a child’s mouth and cause a parent to be concerned. However, because many soft tissue lesions can appear in variant forms, when you come across any anomalies in your child’s mouth it is prudent to seek the expertise of a pediatric dentist who is trained to diagnose and treat such conditions.
Talya Gluck earned her BA from Barnard College in 2004. She attended dental school at University of Medicine and Dentistry of New Jersey and went on to complete a two-year Pediatric Dentistry residency in 2011. She is a board-eligible pediatric dentist and her research has been published in dental journals. She lives in NJ with her husband and three children.
By Dr. Talya Gluck
