gingival and perio health in children

Question 1

What does the survey of children’s dental health in the Uk 2013 show?

Answer 1

Visible plaque-
46% of 5 year olds (parental brushing)
71% of 8 year olds (mixed dentition, don’t like brushing exfoliating teeth)
50% of 15 year olds

Calculus detected-
9% of 5 year olds (more saliva? Spaced teeth?)
28% of 8 year olds
46% of 15 year olds (ortho? Retainers?)

BOP
40% of 15 year olds had an area

Question 2

Why might young children have calculus?

Answer 2

Enamel defect
Amelogenesis imperfecta
V sensitive teeth w rough enamel

Molar incisor hypermineralisation
Large calculus deposits

PEG feeding- calculus deposits (maybe learning defects, can’t swallow water/toothpaste, less saliva)

Question 3

What are other findings relating children?

Answer 3

Any perio pocketing- mild

Gingivitis less prevalent on left side of mouth

No social differences

Generally no gender significant differences apart from plaque and calculus in 12 year olds
72% B and 55% G- plaque
46% B and 31% G- calculus

Question 4

How is perio screening done in children?

Answer 4

Not done for <7years
Codes 0-2 for 7-11 years
Codes 0-4* for 12-17 years

Question 5

What are gingival disorders in children?

Answer 5

Chronic gingivitis (plaque induced)
Gingival hyperplasia
Traumatic lesions
Acute gingivitis (infective)

Question 6

What is chronic gingivitis?

Answer 6

Common
Reversible
Painless, red, swelling, no loss of function, bleeding
Cultivable flora similar to adults
Exacerbated- exfoliating teeth, malocclusion, ortho

Question 7

What are challenges to tooth brushing?

Answer 7

Cleft lip/palate- retroclined teeth
Abnormal tooth morphology
Ortho appliances
Sensitive teeth (AI)
Learning disabilities (autism, Downs etc)
Physical disabilities (cerebral palsy etc)

Question 8

What is localised gingival recession?

Answer 8

Still and cleft
Usually labial to lower incisors
10% of kids <10years
Associated w malaligned teeth, self inflicted injury, tooth brushing habits
Need to educate and improve plaque control, ortho therapy?

Question 9

What is gingival hyperplasia?

Answer 9

Drug induced
Phenytoin (anti-epileptic)
Cyclosporin (immunosuppressant)
Nifedipine (calcium channel blocker)

Question 10

What is cyclosporin?

Answer 10

Used to prevent graft rejection
Gingival hyperplasia in 30%
Selective immunosuppressant- inhibits T lymphocyte proliferation
Exacerbated by poor OH
Affects fibroblasts promoting protein synthesis and collagen formation
Recurs after gingival surgery

Question 11

What are some differential diagnoses to gingival hyperplasia?

Answer 11

Sarcoid- granulomatis disease, interdental papillae overgrow

Cyclic neutropenia- inherited condition, low WBCs, immunocompromised

Question 12

What types of traumatic gingival injuries are there?

Answer 12

A- superimposed upon a pre existing source of irritation

B- secondary to another established habit

C- complex aetiology, physical manifestation of underlying emotional disturbance (resistant to conventional treatment)

Question 13

What are acute gingival conditions and infections?

Answer 13

Acute herpetic gingivostomatitis
Necrotising ulcerative gingivitis
Hand, foot and mouth
Herpengina

Question 14

What is acute herpetic gingivostomatitis?

Answer 14

Common
HSV type I infection
Can present as sub clinical infection, febrile illness, encephalitis meningitis
5-7 day incubation period

Signs/symptoms- pyrexia (>39C), lymphadenopathy, malaise, irritability, profuse salivation, refusal to eat, sore throat and mouth, symptoms- 7-10 days

Clinical features- multiple little ulcers on soft tissues, erythematous gingiva, occasional EO lesions, salivation, lymphadenopathy

Recurrence as herpes labialis 30%

Management- fluid and soft diet, analgesics, antipyrexics, isolation of eating/drinking utensils, OHI (chlorhexidine and sponges, soft toothbrush), rest, reassurance, review

Not acyclovir (antiviral) unless immunocompromised

Question 15

What is necrotising ulcerative gingivitis/periodontitis?

Answer 15

Affects young adults/ HIV +ve in Western countries

Children in developing countries- underlying malnutrition and infections

Necrosis and ulceration (interdental papillae, gingivae bleed profusely, distinct halitosis)
Broad anaerobic infection
Can rapidly spread to facial tissues

Treatment- OHI, hydrogen peroxide mouthwash, metronidazole 3 days

Cancrum oris (noma)

Question 16

What are systemic conditions that may present w gingival changes?

Answer 16

HIV
Crohn’s disease
Leukaemia 
Langerhans cell histocytosis
Scurvy

Question 17

What are clinical features of aggressive periodontal disease in children?

Answer 17

0.1% white caucasians
2.6% black Africans
Onset around puberty

Tooth mobility/drifting/perio abscesses
Rapid perio attachment loss, usually incisors and first permanent molars (may be self arresting)

Often positive family history
Healthy otherwise

Actinomyces elevated
Phagocyte abnormalities, hyper responsive macrophage phenotype, elevated levels of PGE2 and IL-1beta

Management- referral to perio team, standard mechanical therapy, systemic/local drug therapy (metronidazole and amoxycillin tds 1 week), maintenance therapy, perio surgery

Question 18

What are systemic/genetic conditions in which perio disease is exacerbated?

Answer 18

Insulin dependant diabetes 
Down syndrome
Papillon-lefevre syndrome (hyperkeratosis of hands and feet)
Ehlers-Danlos syndrome
Langerhans cell histocytosis
Neutropenias
Hypophosphatasia