Gingival and Periodontal Disease in Childhood

Question 1

Classification of Periodontal Disease

Answer 1

Periodontal health, gingival disease and conditions
Periodontitis
Other conditions affecting the periodontium

Question 2

Periodontal health, gingival diseases and conditions

Answer 2

Periodontal health and gingival health
Gingivitis: dental biofilm induced
Non-dental biofilm induced

Question 3

Chronic gingivitis

Answer 3

Plaque induced
Increases in incidence from childhood to adolescence (80% at 11-13 years)
Pseudopocketing esp during mixed dentition phase
Potentially a key role in predicting future attachment loss

Question 4

Mouthbreathing

Answer 4

Fibrotic response
Requires gingivoplasty
Prevention - meticulous plaque control, chlorhexidine gel

Question 5

Drugs-induced gingival overgrowth

Answer 5

Organ transplants (cyclosporins)
Cardiac anomalies (calcium channel blockers)
Epilepsy (phenytoin)

Question 6

Blood dyscrasias

Answer 6

Leukaemia
Thrombocytopenia
Coagulation disorders

Question 7

Primary herpetic gingivostomatitis

Answer 7

HSV-1
10-14 day incubation
Fever and lymphadenopathy
Gingival inflammation, ulceration, pain

Question 8

Gingival trauma

Answer 8

Direct local irritation of soft tissues –> localised acute inflammatory reaction can begin –> gingival enlargement/fibrous epulis

Question 9

Periodontitis

Answer 9

Necrotising periodontal disease
periodontitis
periodontitis as a manifestation of systemic disease

Question 10

Necrotising Periodontal Diseases risk factors

Answer 10

Smoking
Stress
Poor oral hygiene
Immunodeficiency

Question 11

Necrotising Periodontal Diseases HPC

Answer 11

Pain
Bleeding on brushing
Foul taste
Halitosis

Question 12

Necrotising Periodontitis - Tx

Answer 12

Plaque control
Elim of risk factors
gentle debridement
metronidazole 200mg tid 5 days
scaling
tendency for recurrence

Question 13

Periodontitis

Answer 13

Stages (based on severity and complexity of management)
Extent and distribution (localised/generalised/molar-incisor distribution)
Grades: evidence of risk of rapid progression; anticipated tx response

Question 14

Localised aggressive periodontitis

Answer 14

Circumpubertal onset
Family history
Higher prevalence in some ethnic groups
Classical presentation affecting permanent incisors or first molars

Question 15

Tx of localised aggressive periodontitis

Answer 15

Plaque control
Smoking cessation advice
Sub-gingival scaling and root planing
Local delivery antimicrobials (minocycline/doxycycline)

Question 16

Dentomycin

Answer 16

2% minocycline hcl
repeat placement after 14 days

Question 17

Perio as a manifestation of systemic disease

Answer 17

Down syndrome
Papillon-Lefevre syndrome
Cyclic neutropenia
Agranulocytosis
Leucocyte adhesion deficiency
Hypophosphatasia
Ehlers Danlos Syndrome
Chediak-Higashi Syndrome

Question 18

Periodontitis and Down Syndrome

Answer 18

Gingivitis almost always present in deciduous dentition
Periodontitis common post puberty
Increased plaque retention
Level of disease often exceeds expectations given plaque levels
Underlying neutrophil disorder (chemotaxis, phagocytosis, intracellular killing)

Question 19

Papillon-LeFevre Syndrome

Answer 19

Palmar-Plantar Hyperkeratosis
Mutation in Cathepsin C gene
Generalised rapid destruction of periodontal attachment

Question 20

Gingival health and orthodontic tx

Answer 20

Access for interprox tooth cleaning reduced
Banding further compromises periodontal health at the gingival sulcus
Gingival enlargement of palatal mucosa with URAs
Bodily movement less likely to lead to relocation of supra-gingival plaque