Diagnosis and Management of Riga-fede Disease in a Healthy 7-month-old Child: A Case Report.

Abstract

Background: Riga-Fede disease (RFD) presents as oral mucosal ulceration in anatomical juxtaposition to sharp dental surfaces.

Case presentation: A 7-month-old healthy male presented to the pediatric dentist for an emergency appointment. His mother was concerned about episodic, recurrent, and excessive bleeding from his mouth for three weeks. She reported that her son would often wake up in "a pool of blood". The pediatrician assessed the patient when oral bleeding first started and prescribed magic mouthwash. This did not resolve the problem. The mother then took the child to an urgent care clinic, where she was referred to a pediatric dentist. The pediatric dentist noted a sublingual traumatic, granulomatous ulcer on the ventral surface of the tongue, extending up to the tip of the tongue. The mandibular primary central incisors had recently erupted. The pediatric dentist established a clinical diagnosis of RFD. Incisal edges were smoothened with dental polishing tips on a slow-speed handpiece and topical fluoride varnish was applied to the teeth. The size of the ulceration decreased over two weeks. However, in three weeks, there was another bleeding episode. The pediatric dentist smoothened the incisal edges again, followed by a fluoride varnish application. Eight weeks after the initial dental intervention, the lesion resolved completely without further bleeding.

Discussion: The details of this case report highlight the maternal concerns, interprofessional educational touchpoints, scope for interprofessional collaborative care, and noninvasive management of Riga-Fede disease.

Conclusion: In neurotypical patients, conservative dental management by smoothening sharp dental surfaces can resolve RFD. RFD should be differentiated from viral illnesses which present with oral ulcerations.