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Pedo > Gingi & Perio in Children > Flashcards

Gingi & Perio in Children Flashcards

1
Q

What are 3 differences in anatomy of periodontium in children compared to adults?

A
  1. More reddish colour
  2. Lower prevalence of periodontal disease
  3. Enhanced rate of progression of periodontal disease
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2
Q

Why are children’s periodontium more reddish than adults?

A
  • Increased vascularity of marginal gingiva
  • Thinner epithelium
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3
Q

Why is there lower prevalence of periodontal diseases in children compared to adults?

A

Junctional epithelium is thicker => less permeable to toxins => more resistant to inflammation

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4
Q

Why is there enhanced progression of perio disease in children compared to adults?

A
  • PDL space wider, less fibrous and more vascular
  • Alveolar bone has larger marrow spaces, greater vascularity and fewer trabeculae
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5
Q

What are 3 classes of dental biofilm-induced gingivitis?

A
  1. Associated with bacterial dental biofilm only
  2. Dental biofilm-induced gingivitis with modifying factors
  3. Drug-induced gingival enlargements
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6
Q

What are potential modifying factors of dental biofilm-induced gingivitis? (relevant to children)

A

Systemic factors:
- Sex steroid hormones (puberty, menstrual cycle etc)
- Hyperglycemia

Local factors
- Plaque retentive restorations

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7
Q

What are 4 drugs associated with drug-induced gingival enlargements?

A
  1. Phenytoin
  2. Cyclosporine
  3. Nifedipine (and other Ca2+ channel blockers)
  4. Valproate
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8
Q

What is the Mx of drug-induced gingival enlargement?

A
  • Plaque control + improve OH
  • Control inflammation – NSAIDs
  • Alternate drug choices
  • Surgical intervention
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9
Q

What is the proposed pathophysiology of drug induced-gingival enlargements?

A
  • Increased inflammatory cytokines
  • Increased fibroblasts
  • Increased collagen accumulation
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10
Q

Drug-induced gingival enlargements are more prevalent in which age group and which location in the mouth?

A
  • Higher prevalence in younger age groups
  • More often in anterior
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11
Q

What are some conditions that fall under gingivitis – non dental biofilm induced?

A
  1. Mechanically-induced gingival trauma
  2. Primary herpetic gingivostomatitis (HSV-1)
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12
Q

What are the clinical characteristics of primary herpetic gingivostomatitis?

A

Prodrome of 2-4 days
- fever, malaise, headaches, cervical lymphadenopathy

Oral: generalised gingival inflammation, vesicles that rupture into ulcers

Resolves in 10-14 days

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13
Q

What is the management for primary herpetic gingivostomatitis?

A
  • Oral acyclovir within first 72h
  • Symptomatic care (anti-pyretics, hydration advice, soft diet)
  • Prevention of secondary infection: CHX mouthwash
  • Review: 7-10 days later (take immune status into consideration)
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14
Q

What are possible complications from primary herpetic gingivostomatitis?

A

Meningitis, encephalitis

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15
Q

What are the features of necrotising periodontal disease?

A
  • Necrosis and ulceration in the interdental papillae
  • Pseudomembrane formation
  • Gingival bleeding
  • Halitosis
  • Pain
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16
Q

What is a predisposing factor for necrotising periodontal disease?

A

Impaired host immune system:
- Severe malnutrition
- Poor OH
- Inadequate sleep

17
Q

What are the treatment phases for necrotising periodontal disease?

A
  1. Acute phase
    - US scaling, remove superficial plaque + calculus
    - Metronidazole + CHX
  2. Control local or systemic factors: ScRD
  3. Correct altered gingival topography
  4. Maintenance
18
Q

What are the complications of necrotising periodontal disease?

A
  • Progresses to necrotising ulcerative periodontitis
  • Spread as necrotising stomatitis or noma
19
Q

What diseases fall under periodontitis? (in relation to children)

A
  • Necrotising periodontal diseases
  • Periodontitis (early onset)
  • Periodontitis as a manifestation of systemic disease
20
Q

How does early onset periodontitis present in children?

A

Localised first molar/ incisor presentation

21
Q

What are 5 categories of systemic diseases that can manifest as periodontitis?

A
  1. Genetic disorders
  2. Metabolic and endocrine disorders
  3. Hematologic/immunologic conditions
  4. Connective tissue disorders
  5. Inflammatory conditions
22
Q

What are some genetic disorders that can lead to periodontitis?

A
  • Down’s syndrome (Trisomy 21)
  • Papillon-Lefevre
23
Q

What are some metabolic and endocrine disorders that can lead to periodontitis?

A
  • Hypophosphatasia – also leads to premature exfoliation of primary teeth
  • Diabetes mellitus – increased risk and earlier onset of periodontitis
24
Q

What are some immunologic / hematologic conditions that can lead to periodontitis?

A
  • Langerhan cell histiocytosis – also results in gross bone destruction (floating teeth on x-ray) => hypermobility of teeth => exfoliation
  • Leukemia – also presents with gingival enlargement
25
Q

What are some mucogingival deformities and conditions?

A
  • Traumatic occlusion
  • High frenal attachments
26
Q

What should you take note of as part of visual inspection during clinical periodontal assessment in children?

A
  • Observe shape of gingival margins and contour
  • Record plaque using disclosing agents to identify sites where it may be contributing to gingivitis and/or caries
27
Q

Which are the 6 index teeth?

A

16, 11, 26, 36, 31, 46 (all 6s, 11, 31)

28
Q

What do pink/red areas of plaque disclosing agent mean?

A
  • Thin deposit of plaque
  • Surface has been cleaned recently
  • Biofilm is immature
29
Q

What do blue/purple areas of plaque disclosing agent mean?

A
  • Thick deposit of plaque
  • Have not been cleaned in the past 48+ hours
  • Complex biofilm has developed
  • Causes gingivitis
30
Q

What do light blue areas of plaque disposing agent mean?

A
  • Indicate acid production from plaque bacteria
  • Biofilm has pH of 4.5 or lower
  • High risk biofilm
31
Q

What kind of toothbrush should children use?

A
  • Small head
  • Medium texture bristles
  • Some evidence of powered toothbrush with oscillation action being more effective, but good technique with manual toothbrush is sufficient
32
Q

When can children start brushing on their own?

A
  • When child can tie shoelace = old enough to brush
  • Supervised toothbrushing to at least 7 years old
33
Q

What is the recommendation for flossing for children?

A

At around 10 years old, children should be efficient at flossing or using IDBs

34
Q

When should you refer a child to specialist? (context of gingival diseases)

A
  • Unexplained premature exfoliation
  • Gross mobility of primary teeth
  • Red, edematous gingivae
  • Suppuration with no dental cause (no overhanging resto, no biofillm/plaque)

Pedo (15 decks)

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