A service evaluation of pediatric oral mucosal disease experience in a tertiary joint pediatric-oral medicine clinic

Abstract

<h3>Objectives</h3> The true global prevalence of pediatric oral mucosal disease has historically proved difficult to determine, based on heterogeneity and inherent limitations in study designs and a largely descriptive narrative. The 2019 World Workshop on Oral Medicine VII: Relative Frequency of Oral Mucosal Lesions in Children, a Scoping Review quantified pediatric oral mucosal disease experience globally based on pooled and region-specific data from clinical studies and biopsy reports. The aim of this investigation was to retrospectively review clinical data to compare pediatric disease experience in a tertiary joint pediatric-oral medicine clinic at the Royal National ENT and Eastman Dental Hospital, UCLH, London, UK, with published global data from the world workshop. <h3>Methods</h3> Quantitative analysis was retrospectively performed on recorded clinical data from 22 joint clinics attended between January and December 2018, with recording of patient demographic characteristics, diagnosis, investigations, and management. <h3>Results</h3> Two hundred sixty-six patients (143 males, 128 females; age range, 8 months to 18 years) were seen in 2018. Referring clinicians included general dental practitioners (n = 54; 49%), secondary care medical and dental specialties (n = 33; 30%), community dental services (n = 15; 14%), and general medical practitioners (n = 9; 8%). Medical comorbidities were noted in 62 patients (23%). Idiopathic recurrent aphthous stomatitis (n = 65; 24%,), mucocele (n = 24; 9%), oral Crohn disease/orofacial granulomatosis (n = 18; 7%), and geographic tongue (n = 11; 4%) were the most commonly presenting conditions. Malignancy was the primary diagnosis in only 1 patient (mucoepidermoid carcinoma). Investigations performed included imaging (n = 27; 11%), blood tests (n = 26; 10%), and biopsy procedures (n = 23; 9%). Management included the use of topical analgesics (n = 71; 27%), topical corticosteroids (n = 94; 35%), topical calcineurin inhibitors (n = 19; 7%), and systemic immunomodulation (n = 22; 8%). <h3>Conclusions</h3> Similarity to world workshop conclusions was noted, with a predominance of benign oral mucosal disease within this patient demographic. Roughly 1 in 10 patients required investigation by imaging, blood testing, or biopsy. Although the world workshop data represented mostly transient conditions with an infectious or traumatic etiology, within this cohort, there was a greater representation of the oral manifestations of systemic disease, which may well represent the tertiary nature of referral to this unit.