Gingi & Perio in Children Flashcards
What are 3 differences in anatomy of periodontium in children compared to adults?
- More reddish colour
- Lower prevalence of periodontal disease
- Enhanced rate of progression of periodontal disease
Why are children’s periodontium more reddish than adults?
- Increased vascularity of marginal gingiva
- Thinner epithelium
Why is there lower prevalence of periodontal diseases in children compared to adults?
Junctional epithelium is thicker => less permeable to toxins => more resistant to inflammation
Why is there enhanced progression of perio disease in children compared to adults?
- PDL space wider, less fibrous and more vascular
- Alveolar bone has larger marrow spaces, greater vascularity and fewer trabeculae
What are 3 classes of dental biofilm-induced gingivitis?
- Associated with bacterial dental biofilm only
- Dental biofilm-induced gingivitis with modifying factors
- Drug-induced gingival enlargements
What are potential modifying factors of dental biofilm-induced gingivitis? (relevant to children)
Systemic factors:
- Sex steroid hormones (puberty, menstrual cycle etc)
- Hyperglycemia
Local factors
- Plaque retentive restorations
What are 4 drugs associated with drug-induced gingival enlargements?
- Phenytoin
- Cyclosporine
- Nifedipine (and other Ca2+ channel blockers)
- Valproate
What is the Mx of drug-induced gingival enlargement?
- Plaque control + improve OH
- Control inflammation – NSAIDs
- Alternate drug choices
- Surgical intervention
What is the proposed pathophysiology of drug induced-gingival enlargements?
- Increased inflammatory cytokines
- Increased fibroblasts
- Increased collagen accumulation
Drug-induced gingival enlargements are more prevalent in which age group and which location in the mouth?
- Higher prevalence in younger age groups
- More often in anterior
What are some conditions that fall under gingivitis – non dental biofilm induced?
- Mechanically-induced gingival trauma
- Primary herpetic gingivostomatitis (HSV-1)
What are the clinical characteristics of primary herpetic gingivostomatitis?
Prodrome of 2-4 days
- fever, malaise, headaches, cervical lymphadenopathy
Oral: generalised gingival inflammation, vesicles that rupture into ulcers
Resolves in 10-14 days
What is the management for primary herpetic gingivostomatitis?
- 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)
What are possible complications from primary herpetic gingivostomatitis?
Meningitis, encephalitis
What are the features of necrotising periodontal disease?
- Necrosis and ulceration in the interdental papillae
- Pseudomembrane formation
- Gingival bleeding
- Halitosis
- Pain
What is a predisposing factor for necrotising periodontal disease?
Impaired host immune system:
- Severe malnutrition
- Poor OH
- Inadequate sleep
What are the treatment phases for necrotising periodontal disease?
- Acute phase
- US scaling, remove superficial plaque + calculus
- Metronidazole + CHX - Control local or systemic factors: ScRD
- Correct altered gingival topography
- Maintenance
What are the complications of necrotising periodontal disease?
- Progresses to necrotising ulcerative periodontitis
- Spread as necrotising stomatitis or noma
What diseases fall under periodontitis? (in relation to children)
- Necrotising periodontal diseases
- Periodontitis (early onset)
- Periodontitis as a manifestation of systemic disease
How does early onset periodontitis present in children?
Localised first molar/ incisor presentation
What are 5 categories of systemic diseases that can manifest as periodontitis?
- Genetic disorders
- Metabolic and endocrine disorders
- Hematologic/immunologic conditions
- Connective tissue disorders
- Inflammatory conditions
What are some genetic disorders that can lead to periodontitis?
- Down’s syndrome (Trisomy 21)
- Papillon-Lefevre
What are some metabolic and endocrine disorders that can lead to periodontitis?
- Hypophosphatasia – also leads to premature exfoliation of primary teeth
- Diabetes mellitus – increased risk and earlier onset of periodontitis
What are some immunologic / hematologic conditions that can lead to periodontitis?
- Langerhan cell histiocytosis – also results in gross bone destruction (floating teeth on x-ray) => hypermobility of teeth => exfoliation
- Leukemia – also presents with gingival enlargement
