By B. Vasco. Georgia Southwestern State University.

To insert it buy generic ginette-35 2 mg menstruation yahoo answers, a short-acting neuromuscular paralysing agent needs to be used cheap ginette-35 2 mg with amex breast cancer hashtags, when this wears off the patient then breaths spontaneously. Occasionally, a longer-acting neuromuscular paralysing agent is selected to enable the anaesthetist to ventilate the patient artificially. However, the use of a laryngeal mask instead of an endotracheal tube is gaining in popularity because it avoids the use of the paralysing agent reducing postoperative muscle pain. If conservation is required it is prudent to use a rubber dam, as good isolation is essential for a high standard of operative dentistry (Fig. For surgical procedures, local anaesthesia infiltration (2% lignocaine with 1 : 80,000 adrenaline) reduces bleeding and aids visibility during surgery while reducing the risk of cardiac dysrhythmias. Once the treatment is complete the patient is placed in the recovery position and wheeled to a recovery suite. The recovery from such extensive anaesthesia is such that the patient may not be able to return home for several hours. These patients have a medical problem that constitutes a significant increased risk, so anaesthetists advise that they are treated in a hospital operating theatre, which is always close to the facilities of an intensive care unit. Key Points • There are different types of dental anaesthesia, dependent on the complexity and length of time for the planned dental procedure. Most patients can be treated using local anaesthesia and good behaviour management. A significant minority of patients will require some form of sedation to enable them to undergo dental treatment. All techniques require careful and systematic assessment of the patient before being used. Dentists and their staff require careful training and regular updates in the techniques of anaesthesia and sedation for children. Child taming: how to manage children in dental practice (Quintessentials series number 9). Adverse sedation events in pediatrics: a critical incident analysis of Pediatrics, 105, 805-14. H160 that highlights the need for appropriate training, facilities and resuscitation skill. A randomised double blind Anaesthesia 57, 860-crossover trial of oral midazolam for paediatric dental sedation. The complications and contraindications to the use of local anaesthesia in children are also discussed. It should not be forgotten, however, that these drugs can be used as diagnostic tools and in the control of haemorrhage. It relies on the latent heat of evaporation of this volatile liquid to reduce the temperature of the surface tissue to produce anaesthesia. This method is rarely used in children as it is difficult to direct the stream of liquid accurately without involving associated sensitive structures such as teeth. In addition, the general anaesthetic action of ethyl chloride should not be forgotten. Topical anaesthetic agents will anaesthetize a 2-3 mm depth of surface tissue when used properly. The following points are worth noting when using intraoral topical anaesthetics: 1.

This was pro- ness was due to a dominant gene alteration there would be a vided within a sensitive environment away from the perceived 50/50 chance of passing this on to any children proven ginette-35 2 mg menopause relief products. This view buy ginette-35 2mg low cost menstruation breastfeeding, although derived from well-meaning intentions, is seen as insulting by many culturally Potential outcomes of Deaf people. As such this work has been discussed among genetic research British, European, and American deaf studies academics and lay people for over a hundred years since (45). For families who test positive for a specific gene alteration that Another key event in history that involved deaf people could cause deafness, it is possible to identify whether hearing related to Hitler’s regime in the Second World War. In the Nazi parents or siblings are also carriers of such a gene alteration and programme, that advocated the eugenic pursuit of the perfect to offer more specific information about the chances of having Ayrian Race, Hitler ordered deaf children and adults to be ster- deaf children. It could also offer a quick and early diagnosis of ilised so that they could not pass on deafness to their children, deafness in a newborn baby in addition to the audiological test- and this happened to 16,000 to 17,000 deaf people. Therefore, as more work is to this, other deaf people were killed as part of “Operation T4” done on the molecular genetics of deafness, more accurate the Nazi programme designed to “wipe out” disabled citizens information can be offered to families. Again, the incorrect assumption was made that deafness Identifying the genetic processes that interplay within the is always inherited and also another assumption was that deaf inner ear may lend itself eventually to gene therapies for deaf- people will pass it on to their children. This could replace the need for cochlear implants in chil- deaf children are born to hearing parents. Given the historical context to the misuse of genetic It has also been suggested that, within the next 50 years, hair knowledge, it is not surprising that d/Deaf people are often sus- cell regeneration within the cochlear will be possible (43). Deaf and often a sense that genetics services in the past have “devalued” hard-of-hearing people and parents of deaf children will surely have the role of Deaf people in society. With this in mind, it is Attitudes of deaf people and their families towards issues surrounding genetics 167 therefore imperative that genetic counsellors and geneticists are “demand” that: “all genetic counsellors should receive Deaf aware- mindful of the historical context within which they practice in ness training to ensure a clear understanding of the Deaf community the present day. If asked often differing beliefs about appropriate medical intervention in for advice, the society will ensure that the family receives positive relation to this. Deaf people may be sensitive to technology that information about deafness in order to enable them to make an aims to “cure” deafness and, as such, there has been clear resis- informed choice” (53). These groups are a powerful force that aims to Wheeler, from the Deafness Research Foundation, United help prevent discrimination and promote acceptance of States, believes that there is still compatibility between the deafness, whether perceived from the medical or cultural preservation of the Deaf community and search for a cure/effec- perspective. He suggests that by removing Attitudes towards genetics may sometimes be seen as link- communication barriers, so that sign-language users have equal ing in with cultural identity. Those Deaf people who are against access to “learning and enjoyment of life,” a better quality of life the eugenic practices of the past will often have negative views will be achieved. At the same time those who wish to use treat- towards modern day genetics services (54). However, the real argument from been well documented over the last ten years, the following many Deaf people is that as most deaf children are born into gives an overview of some of this work. Such hearing people, with their igno- rance of the Deaf World, will make decisions for their deaf child according to their “hearing” perspective. Therefore, such deaf Attitudes towards genetics children are “cured” of their deafness before they are old enough to make choices for themselves, so missing the oppor- The views of a collective group of culturally Deaf people tunity to be part of a community they could have naturally attending a conference called “Deaf Nation” at the University belonged to. Delegates were something that many Deaf people aim to educate hearing peo- asked to complete a questionnaire which asked for their views ple about, so that hearing parents are able to make informed about genetic technology and how they felt about its use with decisions about their child’s future. Of the 87 delegates who completed questionnaires, ness has largely been ignored in the past (49). This situation is 55% thought that genetic testing for deafness would “do more improving but still has a long way to go to create a working harm than good”; 46% thought that its potential use “devalued partnership between parents of deaf children, the Deaf commu- d/Deaf people,” and 49% were concerned about new discover- nity, and professionals working in deafness (50). Here, the attitudes of d/Deaf, hard-of-hear- their feelings about new discoveries in genetics. The following ing, and deafened adults as well as hearing parents of deaf chil- are a selection of these. Participants were collected Some participants felt that new discoveries in genetics from medical and educational sources, social services, charities, would be positive: and support groups for the deaf, i.

Useful in evaluating immune status or diagnosing viral infections where culture is difficult or impossible cheap 2 mg ginette-35 fast delivery menstrual headaches. Lymphs (%) 18–38 42–72 37–73 23–53 18–42 Newborns: A few benign immature B cells may be seen (“baby” or “kiddie” lymphs) generic ginette-35 2mg with mastercard pregnancy ovulation calendar. Liver & spleen may be reactivated (extramedullary hematopoiesis) if bone marrow fails to keep up with demand. Sickle cells (drepanocytes) Crescent, S or C shaped, boat shaped, Sickle cell anemia. Teardrops (dacryocytes) Teardrop shaped Myelofibrosis, thalassemia & other anemias. Staining Hypochromia Central pallor >1/3 cell diameter Iron deficiency anemia, thalassemia. May be artifact due to delay in spreading drop of blood or smear that’s too thick. Usually accelerated or & megaloblastic only 1 per cell abnormal anemias, sickle cell erythropoiesis anemia Cabot rings Wright’s Reddish purple May be part of mitotic Rapid blood regen- Megaloblastic anemia, rings or figure-8s spindle, remnant of eration, abnormal thalassemia, microtubules, or erythropoiesis postsplenectomy fragment of nuclear membrane Pappenheimer Wright’s (siderotic Small purplish blue Iron particles Faulty iron Sideroblastic anemias, bodies granules with granules. Amino acid sequence of globin sequence of globin chain, not in amount of globin chains is normal, but underproduction of 1 or more globin produced. Note: Some hematologists refer to all qualitative & quantitative hemoglobin abnormalities as hemoglobinopathies. Pappenheimer bodies, basophilic stippling β –thalassemia major ↓β-chain production. More often normocytic normochromic but included here because must be considered in differential Dx of microcytic anemia. May be transient Microcytic, hypochromic (due to iron deficiency) macrocytosis when↑retics reach circulation. Can be 48–72 hr before full extent of hemorrhage is evident (after fluid from extravascular spaces moves into circulation to expand volume). Toxic granulation Dark-staining granules in cytoplasm of neutrophils Infection, inflammation. Vacuolization Phagocytic vacuoles in cytoplasm of neutrophils Septicemia, drugs, toxins, radiation. Hypersegmentation >5 % of segs with 5-lobed nuclei or any with >5 lobes One of 1st signs of pernicious anemia. Pelger-Huët anomaly Most neutrophils have round or bilobed nuclei Inherited disorder. Auer rods Red needles in cytoplasm of leukemic myeloblasts & Rules out lymphocytic leukemia. Variant lymphocytes 1 or more of following: large size, elongated or indented Viral infections (e. Myelodysplastic Premalignant hematopoietic stem Refractory anemia, More common in elderly. Rare in older nous, acute from 1–200 cells, Howell-Jolly bodies, children & teens. Acute lymphoblastic Acute lymphocytic ↑in 50% of Small, homogeneous blasts in Peak incidence 2–5 yr. Waldenström’s macroglobulinemia Malignant lymphocyte–plasma cell proliferative disorder. Microhematocrit Screening for Microhematocrit tubes centrifuged at Values may be slightly higher than calcu- (packed cell anemia 10,000-15,000 rpm for 5 min. Reticulocyte count Assess rate of Blood smear stained with new Miller ocular can be used to facilitate count- erythropoiesis methylene blue. Follow up with hgb elec- Hemoglobin S produces turbid solution that obscures trophoresis.

Furthermore purchase ginette-35 2 mg overnight delivery the women's health big book of exercises pdf, there were no differences between 1983 and 1993 2mg ginette-35 women's health center in joliet, in the proportion of 15-year-olds with pockets between 3. These data suggest that the gingival condition of children in the United Kingdom has deteriorated over the 10 years between 1983 and 1993, whereas the periodontal status of 15-year-olds has not changed. Certainly, changes in gingival health do not mirror the dramatic improvement in the prevalence of caries over the same period. This trend was reversed by 1993 when between 10 and 20% more children of all ages had plaque deposits. The onset of puberty and the increase in circulating levels of sex hormones is one explanation for the increase in gingivitis seen in 11-year-olds. Oestrogen increases the cellularity of tissues and progesterone increases the permeability of the gingival vasculature. Oestradiol also provides suitable growth conditions for species of black pigmenting organisms which are associated with established gingivitis. Histopathology The inflammatory infiltrate associated with marginal gingivitis in children is analogous to that seen in adults during the early stages of gingival inflammation. The dominant cell is the lymphocyte, although small numbers of plasma cells, macrophages, and neutrophils are in evidence. Research findings have not yet determined unequivocally whether the lymphocyte population is one of unactivated B cells or is T-cell dominated. The relative absence of plasma cells, which are found in abundance in more established and advanced lesions in adults, confirms that gingivitis in children is quiescent and does not progress inexorably to involve the deeper periodontal tissues. Key Points Chronic gingivitis: • plaque-associated; • lymphocyte-dominated; • complex flora; • linked to the onset of puberty. Microbiology The first organisms to colonize clean tooth surfaces are the periodontally harmless, Gram-positive cocci that predominate in plaque after 4-7 days. After 2 weeks, a more complex flora of filamentous and fusiform organisms indicates a conversion to a Gram-negative infection, which, when established, comprises significant numbers of Capnocytophaga, Selenomonas, Leptotrichia, Porphyromonas, and Spirochaete spp. These species are cultivable from established and advanced periodontal lesions in cases of adult periodontitis. This suggests that the host response (rather than the subgingival flora) confers a degree of immunity to the development of periodontal disease in children, thus preventing spread of the contained gingivitis to deeper tissues. Manual versus powered toothbrushes The treatment and prevention of gingivitis are dependent on achieving and maintaining a standard of plaque control that, on an individual basis, is compatible with health. Toothbrushing is the principal method for removing dental plaque, and powered toothbrushes now provide a widely available alternative to the more conventional, manual toothbrushes for cleaning teeth. There is considerable evidence in the literature to suggest that powered toothbrushes are beneficial for specific groups: patients with fixed orthodontic appliances⎯for whom there is also evidence that powered toothbrushes are effective in reducing decalcification; children and adolescents; and children with special needs. It remains questionable whether children who are already highly motivated with respect to tooth cleaning will benefit from using a powered toothbrush. A systematic review evaluating manual and powered toothbrushes with respect to oral health has made some important conclusions. Compared to manual toothbrushes, rotating/oscillating designs of powered toothbrushes reduced plaque and gingivitis by 7-17% although the clinical significance of this could not be determined. Powered brushes, therefore, are at least as effective and equally as safe as their manual counterparts with no evidence of increased incidence of soft tissue abrasions or trauma. No clinical trials have looked at the durability, reliability, and relative cost of powered and manual brushes so it is not possible to make any recommendation regarding overall toothbrush superiority. Gingival enlargement occurs in about 50% of dentate subjects who are taking the drug, and is most severe in teenagers and those who are cared for in institutions.

For having a continuous cheap 2mg ginette-35 amex women's health center upland, solid level of antibodies example purchase 2 mg ginette-35 breast cancer quotes tumblr, when bone is surgically reshaped, it against the virus. Respiratory failure occurs because of the failure of the exchange of oxygen and carbon restless leg syndrome An uncomfortable dioxide in tiny air sacs in the lung (alveoli), failure (creeping, crawling, tingling, pulling, twitching, of the brain centers that control breathing, or fail- tearing, aching, throbbing, prickling, or grabbing) ure of the muscles required to expand the lungs that sensation in the calves that occurs while sitting or can cause respiratory failure. The result is an uncontrollable ical conditions can lead to respiratory failure, urge to relieve the uncomfortable sensation by including asthma, emphysema, chronic obstructive moving the legs. The leg pain typically eases medication, such as cyclosporine, chlorambucil, and with motion of the legs and becomes more notice- cyclophosphamide. A small area called the macula in the retina contains special retinoblastoma A malignant eye tumor usually light-sensitive cells that allow clear perception and seen in children, that arises in cells in the develop- central vision. The retina is filled with tiny blood ing retina that contain cancer-predisposing muta- vessels. The sporadic form of retina has torn, the vitreous liquid can pass through retinoblastoma has later onset and typically leads to the tear and accumulate behind the retina. Retinal vasculitis ranges in sever- often requires removal of the eye (enucleation). Retinal vasculitis by itself is painless, but many of the diseases that cause it can also cause retinoic acid syndrome A disorder due to the painful inflammation elsewhere, such as in the joints. Further definition of fluid around the lungs and heart, and hypoxia (lack the blood vessel condition can be determined with a of oxygen) that develops in some patients receiving special X-ray dye test (angiogram) of the retina. It usually develops within 30 Diseases that cause retinal vasculitis include Behcet’s days of treatment. Steroids and chemotherapy can be syndrome, systemic lupus erythematosus, antiphos- used to treat retinoic acid syndrome. In addition, some retinopathy Any disease of the retina, the light- related diseases require immunosuppression with sensitive membrane at the back of the eye. See retrograde intrarenal surgery A procedure for also dextrocardia; Kartagener syndrome. The approach was to find a gene product and then try to stone can be seen through the scope, manipulated or identify the gene itself. Reye’s syndrome A sudden and sometimes fatal disease of the brain (encephalopathy) that is accom- retropubic prostatectomy Surgical removal of panied by degeneration of the liver. Early diagnosis and control of the increased intracranial pressure can prevent death or brain Rett syndrome A neurological disease that affects damage. Preventing Reye’s syndrome is the reason girls only and is one of the most common causes of why physicians no longer recommend giving chil- mental retardation in females. The hallmark of Rett syndrome Rh factor An antigen found in the red blood cells is the loss of purposeful hand use and its replace- of most people. Other symp- to be Rh positive (Rh+), and those who do not are toms include slowed brain and head growth, Rh negative (Rh-). Rh typing is also important during ity of cases are sporadic and result from a new muta- abortion, miscarriage, pregnancy, and birth, as tion in the girl with Rett syndrome. Organs appear as if in mirror baby that leads to hemolytic disease of the newborn. The patient is felt to muscle is broken down, releasing muscle enzymes have underlying psychological causes for these and electrolytes from inside the muscle cells.

Moreover buy ginette-35 2mg women's health clinic rockingham, it would be quite misleading to present the relation- ship between ‘doctors’ and ‘philosophers’ in terms of interaction between ‘science’ and ‘philosophy’ best 2mg ginette-35 pregnancy outfits, the ‘empirical’ and the ‘theoretical’, the ‘practi- cal’ and the ‘systematical’, the ‘particular’ and the ‘general’, or ‘observation’ and ‘speculation’. To do this would be to ignore the ‘philosophical’, ‘spec- ulative’, ‘theoretical’ and ‘systematic’ aspects of Greek science as well as the extent to which empirical research and observation were part of the activities of people who have gone down in the textbooks as ‘philosophers’. Thus Empedocles, Democritus, Parmenides, Pythagoras, Philolaus, Plato, Aristotle, Theophrastus, Strato, but also later thinkers such as Sextus Em- piricus, Alexander of Aphrodisias, Nemesius of Emesa and John Philoponus took an active interest in subjects we commonly associate with medicine, such as the anatomy and the physiology of the human body, mental ill- ness, embryology and reproduction, youth and old age, respiration, pulses, fevers, the causes of disease and of the effects of food, drink and drugs on the body. As we shall see in chapter 3, according to one major, authori- tative ancient source, the Roman author Celsus (first century ce), it was under the umbrella of ‘philosophy’ (studium sapientiae) that a theoretical, scientific interest in health and disease first started, and it was only when the physician Hippocrates ‘separated’ the art of healing from this theoret- ical study of nature that medicine was turned into a domain of its own for the first time – yet without fully abandoning the link with ‘the study of the nature of things’, as Celsus himself recognises when reflecting on developments in dietetics during the fourth century bce. This perception of the early development of medicine and its overlap with philosophy was more widely shared in antiquity, both by medical writers and by ‘philosophers’. This is testified, for example, by ancient historiographical and doxographical accounts of the history of medicine and philosophy, which tend to provide an illuminating view of the ‘self-perception’ of ancient thinkers. Introduction 11 of their own subject, medical authors such as Galen – who wrote a trea- tise advocating the view that the best doctor is, or should be, at the same time a philosopher – and the so-called Anonymus Londiniensis (the first-century ce author of a medico-doxographical work preserved on pa- pyrus) treated Plato’s views on the human body and on the origins of diseases as expounded in the Timaeus on a par with the doctrines of ma- jor Greek medical writers; and Aristotle and Theophrastus continued to be regarded as authorities in medicine by medical writers of later antiq- uity such as Oribasius and Caelius Aurelianus. Conversely, as we shall see in chapter 6, a philosopher such as Aristotle commented favourably on the contributions by ‘the more distinguished doctors’ to the area of ‘natural philosophy’. And in the doxographical tradition of ‘Aetius’,¨ in the context of ‘physics’ or ‘natural philosophy’, a number of medi- cal writers such as Diocles, Herophilus, Erasistratus and Asclepiades are cited alongside ‘philosophers’ such as Plato, Aristotle and the Stoics for their views on such topics as change, the soul, the location of the ruling part of the soul (see chapter 4), dreams, respiration, monstrosities, fertility and sterility, twins and triplets, the status of the embryo, mules, seventh-month children, embryonic development, and the causes of old age, disease and fever. It is no co- incidence that Aristotle’s comments on the overlap between ‘students of nature’ and ‘doctors’ are made in his own Parva naturalia, a series of works on a range of psycho-physiological topics – sense-perception, memory, sleep, dreams, longevity, youth and old age, respiration, life and death, health and disease – that became the common ground of medical writers and philosophers alike. And, not surprisingly, Aristotle makes similar re- marks in his zoological works concerning questions of anatomy, such as the parts of the body and structures like the vascular system, and embryology, especially the question of the origins of life, the mechanisms of repro- duction and the ways in which inherited features are passed on from one generation to another, the question of the male and female contribution to the reproductive process, the origin of the semen, questions of fertility and infertility (see chapter 9), stages of embryonic development, the way the embryo is nourished, twins and triplets, and suchlike. This whole area was referred to in later antiquity as ‘the nature of man’, particularly man’s physical make-up, ranging from the lowest, most basic level of ‘principles’ 19 See Runia (1999). We perceive this ‘agenda’ in texts as early as the Hippocratic works On Fleshes, On the Nature of Man and On Regimen, or in such later works as Nemesius’ On the Nature of Man, Vindicianus’ On the Nature of the Human Race and in the treatise On the Seed, preserved in a Brussels manuscript and attributed to Vindicianus, and there are similar points of overlap in the doxographical tradition. Even a philosopher like Plato, who seems to have had very little reason to be interested in mundane matters like disease or bodily waste products, deals at surprising length and in very considerable detail with the human body and what may go wrong with it, using an elaborate clas- sification of bodily fluids and types of disease (physical as well as mental) according to their physiological causes. Plato was of course not a doctor, but he was clearly aware of the medical doctrines of his time and took them sufficiently seriously to incorporate them into this account of the nature of the world and the human body as set out in the Timaeus. Yet interaction was not confined to matters of content, but also took place in the field of methodology and epistemology. As early as the Hip- pocratic medical writers, one finds conceptualisations and terminologi- cal distinctions relating to such notions as ‘nature’ (phusis), ‘cause’ (aitia, prophasis), ‘sign’ (semeion¯ ), ‘indication’ (tekmerion¯ ), ‘proof’ (pistis), ‘faculty’ (dunamis), or theoretical reflection on epistemological issues such as causal explanation, observation, analogy and experimentation. This is continued in fourth-century medicine, with writers such as Diocles of Carystus and Mnesitheus of Athens, in whose works we find striking examples of the use of definition, explanation, division and classification according to genus and species relations, and theoretical reflection on the modalities and the ap- propriateness of these epistemological procedures, on the requirements that have to be fulfilled in order to make them work. In Hellenistic medicine, authors such as Herophilus and Erasistratus made important theoretical points about causation, teleological versus mechanical explanation, and horror vacui, and in the ‘sectarian’ debates between Empiricists, Dogma- tists and Methodists major theoretical issues were raised about the nature of knowledge and science. Subsequently, in the Imperial period, we can observe the application and further development of logic and philosophy of science in writers such as Galen (chapter 10) and Caelius Aurelianus (chapter 11). And again, it is by no means the case that the medical writers Introduction 13 were exclusively on the receiving end: theories about causation or inference from signs constitute good examples of areas in which major theoretical and conceptual distinctions were first formulated in medical discourse and subsequently incorporated in philosophical discussions. To the Greek thinkers, areas such as those mentioned above represented aspects of natural and human reality just as interesting and significant as the movements of the celestial bodies, the origins of earth- quakes or the growth of plants and trees, and at least equally revealing of the underlying universal principles of stability and change. Nor were their interests in the medical area limited to theoretical study or the pursuit of knowledge for its own sake without extending to ‘clinical’ or ‘therapeutic’ practice.

Treatment other than reassurance is often unnecessary; however discount ginette-35 2mg overnight delivery breast cancer 24, topical steroids (Adcortyl in Orabase or Corlan pellets) may be prescribed in severe cases discount 2 mg ginette-35 with visa womens health ukiah ca. Older children may benefit from the use of antiseptic rinses to prevent secondary infection. In the absence of a history of major aphthous ulceration any ulcer lasting for longer than 2 weeks should be regarded with suspicion and biopsied. Similarly, conditions such as epidermolysis bullosa and erythema multiforme can produce oral ulceration in children. The major vesiculobullous conditions such as pemphigus and pemphigoid are rare in young patients. Epidermolysis bullosa is a term that covers a number of syndromes, some of which are incompatible with life. In older children effective oral hygiene may be difficult as even mild trauma can produce painful lesions. The oral lesions of erythema multiforme usually affect the lips and anterior oral mucosa (Fig. The pathogenesis of the condition is still unclear, however, precipitating factors include drug therapy and infection. Treatment includes the use of steroids and oral antiseptic and analgesic rinses to ease the pain. It is normally symptomless, although some patients complain of discomfort with spicy foods. The condition is benign and requires no treatment apart from reassurance to the child and parent. Mucoceles are caused by trauma to minor salivary glands or ducts and are often located on the lower lip. They are the commonest non-infective cause of salivary gland swelling in children. They are present in about 80% of neonates and disappear within a few weeks of birth. They are derived from epithelial remnants remaining from fusion of the mandibular processes. They are normally found in the sternomastoid region, although they can present in the floor of the mouth. It consists of granular cells covered by epithelium and is thought to be reactive in nature. It presents as multiple small elevations of the oral mucosa especially in the lower lip. Colour varies from pink to red depending upon the degree of vascularity of the lesion. It consists of an inflammatory cell infiltrate and mature fibrous tissue, occasionally a calcified variant is found. They are probably a reaction to chronic trauma, especially from a sub-gingival calculus. They are divided into cavernous and capillary variants, although some lesions contain elements of both. The cavernous haemangioma is a hazard during surgery if involved within the surgical site. Intraoral involvement may interfere with the timing of eruption of the teeth (both early and delayed eruption have been reported). The cystic hygroma is a variant that appears as a large neck swelling, which may extend intraorally to involve the floor of the mouth and tongue.