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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Infections, continued

Oral Candidiasis
White plaques or pseudomembranes are noted on the surface of the tongue and/or the buccal, labial, and gingival mucosa.

Removal of the plaques shows underlying raw, red, bleeding mucosa. Oral surfaces may become painful, which can interfere with feeding.

Oral Candidiasis is common in infants, but triggers for all age groups include systemic antibiotic use, inhaled steroids, diabetes, xerostomia, and poor oral hygiene.

Xerostomia: Abnormal dryness of the mouth due to insufficient saliva production.

Oral Candidiasis can be treated with topical antifungal agents, such as Nystatin or Clotrimazole.If symptoms persist or recur shortly after discontinuation of the antifungal agent, consider re-infection from bottles, pacifiers, or breastfeeding (with maternal breast colonization) or resistance to antifungal medication. 

Strawberry Tongue
Strawberry Tongue refers to an inflamed tongue. It presents as either a diffusely erythematous tongue with prominent fungiform papillae or a tongue covered by a white membrane except for the fungiform papillae that appear red.

Fungiform Papilla: Any of numerous papillae on the upper surface of the tongue that are flat-topped and noticeably red from the richly vascular stroma and usually contain taste buds .

Strawberry Tongue is associated with Group A Beta Hemolytic Strep and Kawasaki syndrome.

Group A Beta Hemolytic Strep causes erythematous and enlarged tonsils with white exudates, anterior cervical lymphadenopathy, and fever.

Clinical presentation of Kawasaki syndrome is 5 days of fever associated with other clinical criteria, including oral mucosal findings such as a strawberry tongue.

Fast Facts
The major morbidity of primary HSV infection is dehydration.
Treatment for viral infections with oral manifestations is generally only supportive care.
Consider immunodeficiency in a child who has frequent or persistent candidal infections after 1 year of age.
A strawberry tongue is commonly seen with GABHS infections and Kawasaki Syndrome.
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