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Diagnosis, Biopsy and Investigation of Pathology in Children
Oral Pathology in Children
Fortunately, serious pathology in children is rare. Nonetheless, it is essential for the clinician to understand the different nature of presentation of pathology in children, that may be quite different from that which presents in an adult, and that lesions may change over time with growth and development. Generally, the earlier the appearance of pathology the more potentially serious may be the outcome. Oral manifestations may also point to systemic disease and must be fully investigated.
How to Diagnose
Diagnosis is like solving a puzzle. Unfortunately, not all the pieces of the puzzle may be present or may have to be found. There must be a logical approach to the diagnosis of any pathological condition. Clinicians must not rely on the mere recognition of a condition from experience, from memory or from a text-book photograph. Pathology may have multiple presentations depending on the stage of the development of the lesion, the age of the patient or possibly on environmental factors (Fig. 34.1). Conversely, one presentation may be representative of any number of different pathological lesions.
Figure 34.1 Different presentations of a mucocoele. (a) The typical presentation of a painless fluid-filled lesion on the lower lip. (b) This lesion is long standing and is fibrosed and keratotic on the surface.
Variations of normal must be separated from pathology. While rarities exist and must be excluded, always consider the most likely diagnosis first. The great majority of lesions in children may resolve within a few weeks (such as an ulcer), often without a diagnosis; however, there is great skill in recognising those lesions that are serious and require further investigation and those that can be observed.
Stages in Management of Pathology
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