Paediatric Perio

Question 1

What are the classifications in the 2017 world workshop?

Answer 1

Periodontal health

Gingivitis - plaque biofilm induced

Gingival diseases and conditions non-plaque biofilm induced

Necrotising periodontal disease

Periodontitis

Periodontitis due to systemic disease

Systemic disease affecting periodontal condition

Periodontal abscesses and endo-perio lesions

Mucogingival deformities/conditions

Traumatic occlusal forces

Tooth and prosthesis related factors

Question 2

What is classed as periodontal health?

Answer 2

Normal function due to being free of inflammatory disease and free from physical or mental consequences of any past states

Question 3

Clinically how is periodontal health seen in children?

Answer 3

Plaque one sextant only

BOP 10%>

No inflammation or calculus

GM mm coronal to CEJ

0.5-3mm deep gingival sulcus on fully erupted tooth

Question 4

How can someone have reduced periodontium but periodontal health?

Answer 4

Non-perio patient who has had crown lengthening surgery or recession

Perio patient with stable periodontitis

Question 5

How does plaque induced biofilm cause gingivitis?

Answer 5

Plaque causes inflammatory cells to infiltrate into gingival connective tissue

Junctional epithelium migrates allowing for apical migration of plaque causing further inflammation, gingival pocket or false pocket

Question 6

What clinically determines if someone has plaque induced gingivitis?

Answer 6

Inflammation, BOP, most apical extension of junctional epithelium is CEJ

NO PERIODONTAL ATTACHMENT LOSS

Question 7

What can cause non-dental biofilm induced gingivitis?

Answer 7

Genetics

Trauma

Systemic disease such as immunological conditions

Drug induced - Ca channel blockers or immunosuppressants

Infections - viral/fungal etc

Question 8

Give some aetiologies of necrotising gingivitis

Answer 8

Fusiformspirochaetal microbial

Smoking

Immunosuppression

Stress

Malnourishment and poor diet

Tooth malposition

HIV

Question 9

Give some features of necrotising gingivitis

Answer 9

Pain

Necrosis of papillae (punched out)

Ulceration

Spontaneous bleeding

Fever

Question 10

What are some predisposing factors (local risk factors - to oral cavity) that can contribute to progression of disease of periodontium?

Answer 10

Malocclusion e.g. misaligned teeth

Traumatic injury to periodontal ligament

Plaque retentive factors
- orthodontics
- enamel defects
- restoration margins
- Incompetent lips causing oral dryness

Question 11

What are some systemic risk factors that can predispose someone to periodontal disease

Answer 11

Uncontrolled diabetes

Pregnancy and puberty

Smoking

Vitamin C deficiency

Leukaemia

Question 12

What caused each of these cases? What leads to this diagnosis?

Answer 12

A = leukaemia

• not too much plaque vs amount of swelling = systemic issue

B = cyclic neutropenia

• same as A

Question 13

What is this condition and some aetiological factors?

Answer 13

Gingival overgrowth

• medications such as cyclosporine, phenytoin or CCBs
• periodontitis or gingivitis
• autoimmune disease

(Greater incidence in puberty)

Question 14

Give some treatments for gingival overgrowth

Answer 14

• rigorous home care
• regular PMPR
• possible surgery especially if drug induced

Question 15

When should one refer a patient?

Answer 15

Where extent of condition is inconsistent with the level of oral hygiene observed

Unexplained

• gingival enlargement
• inflammation
• bleeding
• mobility

Question 16

Describe periodontitis

Answer 16

A chronic multi factorial disease affecting the tissues of the periodontium

Associated with microbial imbalance and plaque biofilm

Question 17

What are the 4 main identifiers of periodontal disease

Answer 17

Apical migration of junctional epithelium past CEJ

Loss of periodontal attachment

Junctional epithelium becomes pocket epithelium (thin and ulcerated)

Alveolar bone loss

Question 18

Give some features of necrotising PERIODONTAL disease

Answer 18

Necrosis of the papilla

Spontaneous bleeding

PDL loss and rapid bone loss (diff to gingivitis)

Fever

Question 19

What is necrotising stomatitis?

Answer 19

Progression of necrotising into the soft tissues, not just the gingiva

• due to severely systemically compromised patients

Question 20

What determines if periodontitis is molar-incisor pattern if generalised

Answer 20

Generalised is >= to 3 teeth with periodontal disease other than incisors and first molars

Question 21

What systemic diseases may cause periodontitis as a manifestation of systemic disease

Answer 21

Neutropenia’s

Papillon lefevre syndrome (PLS)

Down syndrome

Leukocyte adhesion deficiency syndrome

Question 22

What are the stages of recording periodontal condition when screening for peridontal disease

Answer 22

1. Gingival condition and sBPE
2. OH status, plaque amount
3. Calculus present
4. Assess local and systemic risk factors

Question 23

What ages use sBPE

What ages use BPE

When do you use codes 0-2 and codes 0-*?

Answer 23

sBPE = 7-18

BPE 18+

Codes 0-2 used for ages 7-11

Codes 0-* used ages 12+

Question 24

How manage code 1? When recall?

Answer 24

OHI, 1 year or routine recall

Question 25

How manage code 2? When recall?

Answer 25

OHI, supragingival PMPR, modify PRF

Recall 1yr or routine recall

Question 26

How manage code 3?

Answer 26

OHI, sub and supra gingival PMPR, modify PRF, appropriate radiographic assessment

Recall 3 months and 6ppc sextant with code 3

Question 27

How manage code 4 or *

Answer 27

OHI, modify PRF, supra and subgingival PMPR, full periodontal assessment including FM6PPC and radiographs and consider referral as this is unusual for paediatric patient