Gums / Hand, Foot, And Mouth Disease / Herpangina
There is a reason I didn’t become a dentist. Teeth are weird. And what is weirder is a mouth without teeth like babies’ mouths, all gums. When babies are born sometimes they have little white spheres on the edges of gums. These are not teeth and are called Epstein pearls. They are collections of mucosal membrane debris from the gums that are very healthy and will naturally fall off and be swallowed by babies with no issue.
A condition that we look out for that is very common with babies is called thrush, and it will affect the inside of the mouth, coating the tongue and gums. Most babies get thrush at some point, and a lot of the time, it is a super mild case that we don’t even notice. The baby’s saliva takes care of the candida yeast that is coating parts of the mouth with no issue. But sometimes, it grows too much and can cause this white film to start covering the tongue and gums.
The tricky thing is that thrush looks a lot like dried milk on the tongue. So the test I do in clinic that you can do at home to see if that white stuff is thrush or just dried milk is rather simple:
Take a tongue depressor or small spoon, anything you can gently scrape the top of the tongue with
If you are unable to scrape the white stuff off or if you can but underneath it looks like normal light-pink tongue, then you got dried milk on the tongue
If you scrape it off and the white stuff comes off in a sheet and the tongue looks beefy red and irritated, you got thrush and you should let your pediatrician know so they can give baby mouth drops to get rid of this because it loves to spread and makes the mouth not feel great
It also means that you need to sterilize all bottles and pacifiers by cleaning them in super hot water to get rid of the candida. If baby is breastfeeding, mom will often be able to tell that the baby has thrush before you even look in the mouth because mom’s nipples will also be infected causing redness, pain, and a burning sensation even when baby is not breastfeeding. This is why if baby is being treated for thrush, we also usually prescribe a topical medicine for mom to put on her nipples to get rid of the infection as well. If we don’t, then mom and baby will just keep giving the candida yeast back and forth to each other in a not-super cycle.
Do we need to brush baby’s gums?
Nah, not really; they take care of themselves. If you try to brush them, it will not be super comfortable for baby and will make them hate brushing their teeth when they are a bit older. Baby’s saliva is super strong and does a great job of cleaning the gums on their own.
When kiddos are older, the gums can be a place where infections and sores can occur. Canker sores are classic small sores/ulcerations on the gums, tongue, or cheeks. They usually run in families as the canker sores are often the result of a herpes virus (no don’t worry, not that herpes virus) that lives in people’s nerves forever once they get infected. Most of the time, the body’s immune system does a great job at preventing the herpes virus from coming out of its hibernating nerve home. But if someone is sick from another infection, overly tired, stressed, or had an injury to their mouth or gums, then the herpes virus can get activated, and boom! You get canker sores. These are no fun and usually take a week or so to go away. If your kiddo has a canker sore, cold milky things for food and drink will make them feel better. Anything warm, spicy, acidy, or sharp (Cap’n Crunch, I am looking at you) will irritate these sores and sting.
Another classic kid infection of the gums is hand, foot, and mouth disease and its close cousin herpangina. Hand, foot, and mouth (like the name implies) involves a rash on the hands, feet, and in and outside the mouth (also usually on the butt, but no one wants to say hand, foot, mouth, and butt at an infectious disease lecture). The sores in the mouth with hand, foot, and mouth are also painful like canker sores but usually improve a lot faster, but it is still important to avoid those irritating foods and drinks and stick with cold milky things. Honestly, the only real reason kids with hand, foot, and mouth ever go to the hospital is that they refuse to drink anything because families are trying to push the usual sick-kiddo fluids like Pedialyte, Gatorade, or apple juice that just make the mouth feel awful. If a kiddo refuses to drink, then they will get dehydrated and may need IV fluids to perk them up. So if I see a kiddo in the clinic with hand, foot, and mouth, the first thing I tell parents is that your main job is to keep kiddo hydrated while their body is taking care of this disease. And if all a kiddo wants to do for a week is drink milkshakes, that is fine with me. They are good calories, will keep them hydrated, and the cold milky nature of milkshakes will give them great mouth pain relief while the mouth sores are there.
Herpangina is like hand, foot, and mouth but really just affects the mouth and will usually not have rashes on the hands, feet, or butt. Herpangina will also usually affect the gums more than other parts of the mouth to the point that sometimes it can make the kiddo’s gums bleed. If that happens, the pediatrician can give a medicine that will help get rid of the virus that causes herpangina, but usually, most kids don’t need that medicine and recover well over a week on their own.