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BCS > Gingival and periodontal health in children: an overview > Flashcards

Gingival and periodontal health in children: an overview Flashcards

1
Q

Visual assessment of plaque 2013 (national statistics)

A

Visible plaque present in:

  • 46% of 5 year olds
  • 71% of 8 year olds
  • 50% of 15 year olds
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2
Q

Visual assessment of calculus 2013 (national statistics)

A

Calculus detected in

  • 9% of 5 year olds
  • 28% of 8 year olds
  • 46% of 15 year olds
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3
Q

Exceptions: children who would not have plaque or calculus

A

Children who are fed only by a gastrostomy tube (PEG)

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4
Q

Gingival bleeding on probing (BPE for 6 teeth) amongst 15 year olds

A

Present in 40%

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5
Q

Periodontal pocketing

A

Predominantly in mild category 3.5-5.5mm

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6
Q

Gingivitis less prevalent where?

A

Left than right side of mouth

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7
Q

Differences according to social class

A

No

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8
Q

Differences between boys and girls

A

Generally no significant differences except plaque & calculus scores for 12 year olds

  • 72% of boys and 56% of girls had visible plaque
  • 46% of boys and 31% of girls had visible calculus
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9
Q

Gingival disorders in children

A
  1. Chronic gingivitis (plaque-induced)
  2. Gingival hyperplasia
  3. Traumatic lesions
  4. Acute gingivitis (infective)
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10
Q

Chronic Gingivitis

A

Common
Reversible with improved oral hygiene
Painless, red, swelling of gingiva, no loss of function
Cultivable flora similar to that in adults
-gram +ve rods and cocci
-gram -ve anaerobic rods and spirochaetes
May be exacerbated by exfoliating teeth, malocclusion or presence of orthodontic appliances

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11
Q

Challenges to toothbrushing

A

Retroclined teeth in cleft lip and palate pxs
Abnormalities of tooth morphology
Orthodontic appliances
Sensitive teeth - amelogenesis imperfect
Physical disabilities e.g. Cerebral palsy, hemiplegia
Learning disabilities e.g. Down syndrome, autism

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12
Q

Localised gingival recession

A

Stillman’s cleft
10% of children < 10 years of age
Usually labial to lower incisors
Associated with malaligned teeth, self-inflicted injury, toothbrushing habits
Need to educate and improve plaque control, orthodontic therapy

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13
Q

Gingival hyperplasia: drug induced

A

Phenytoin (anti-epileptic)
Cyclosporin (immunosuppressant)
Nifedepine (calcium channel blocker)

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14
Q

Cyclosporin

A

Selective immunosuppressant - inhibits T lymphocyte proliferation
Used mainly to prevent graft rejection
Gingival hyperplasia in around 30% of cases
Hyperplasia is exacerbated by poor OH
Effects fibroblasts promoting protein synthesis and collagen formation
Recurs after gingival surgery

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15
Q

Gingival hyperplasia: systemic disease

A

Carcoid

Cyclic neutopenia

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16
Q

Traumatic gingival injury: self-inflicted injury

A

Type A: injuries superimposed upon pre-existing source of irritation
Type B: injuries are secondary to another established habit
Type C: injuries are of complex aetiology and are a physical manifestation of an underlying emotional disturbance - resistant to conventional treatment

17
Q

Acute gingival conditions and infections

A

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

18
Q

Acute herpetic gingivostomatitis

A

Common in childhood
HSV type I infection
Can present as subclinical infection, febrile illness, encephalitis/ meningitis
5-7 day incubation period

19
Q

Signs/ symptoms of AHGS

A 
Pyrexia, >39 degrees C
Lymphadenopathy
Malaise and irritability
Profuse salivation
Refusal to eat
Sore throat and mouth
Symptoms for 7-10 days
20
Q

Clinical features of AHGS

A 
Multiple small irregular ulcers on gingiva, tongue and palate
Erythematous gingiva
Occasional extra-oral lesions
Salivation
Lymphadenopathy
Recurrence as herpes labialis in 30%
21
Q

Management of AHGS

A

Symptomatic and supportive

  • fluids & soft diet
  • analgesics & antipyrexics
  • isolation of eating/ drinking utensils
  • OHI - chlorhexidine and sponges, soft toothbrush
  • rest
  • reassurance and review
  • not acyclovir (unless immunocompromised)
22
Q

Who does necrotising ulcerative gingivitis/ periodontitis affect?

A

Affects young adults and HIV+ in Western contries (0.7-7%)
-risk factors = smoking and stress
More commonly affects children in developing countries - with underlying malnutrition and infections (HIV) up to 20%

23
Q

Necrotising ulcerative gingivitis: symptoms, clinical and treatment

A

Characterised by necrosis and ulceration -usually interdental papillae, gingivae bleed profusely, distinctive halitosis
Broad anaerobic infection
Treatment with oral hygiene, hydrogen peroxide mouthwash, metronidazole 3-days
Can spread rapidly to facial tissues –> cancrum oris

24
Q

Systemic conditions that may present with gingival changes e.g. bleeding, ulceration

A 
HIV
Chrons' disease
Leukaemia
Langerhans' cell histiocytosis
Scurvy
25
Q

Periodontal disease in children

A

Loss of tooth tissue attachment very uncommon in children

26
Q

Clinical features of aggressive periodontal disease in children

A

~0.1% of white Caucasians and 2.6% of black Africans may suffer from localised aggressive forms of periodontitis
Onset ~ puberty
May present with tooth mobility, drifting or periodontal abscess
Rapid periodontal attachment loss, usually incisors and first permanent molars
Often a positive family history
Healthy apart from periodontitis
Progression of attachment loss and bone loss may be self-arresting

27
Q

Clinical features of aggressive periodontal disease in children (Microbiology)

A 
Amounts of microbial deposits inconsistent with severity of destruction
Elevated proportions of A. actinomyecetemcomitans and in some populations, P.gingivalis
Phagocyte abnormalities (host defence defects): hyper-responsive  macrophage phenotype, including elevated levels of PGE2 and IL-1β
28
Q

Management of aggressive periodontal disease in children

A

Refer to specialist: early diagnosis and interventions critical for better outcome

  • standard mechanical periodontal therapy
  • systemic or local drug therapy (metronidazole AND amoxicillin tds 1 week)
  • maintenance therapy
  • periodontal surgery
29
Q

Systemic/ genetic conditions in which periodontal disease is exacerbated

A 
Insulin-dependant diabetes
Down syndrome
Papillion-lefevre syndrome
Enlers-Danlos syndrome
Langerhans' cell histocytosis
Neutropenias
Hypophosphatasia
30
Q

Papillion-Lefevre syndrome

A 
Itchy feet (hyperkeratosis of soles)
Loose teeth (generalised gingival recession)
Hyperkeratosis of palms of hands

BCS (35 decks)

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