Paediatric Perio Flashcards
What are the classifications in the 2017 world workshop?
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
What is classed as periodontal health?
Normal function due to being free of inflammatory disease and free from physical or mental consequences of any past states
Clinically how is periodontal health seen in children?
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
How can someone have reduced periodontium but periodontal health?
Non-perio patient who has had crown lengthening surgery or recession
Perio patient with stable periodontitis
How does plaque induced biofilm cause gingivitis?
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
What clinically determines if someone has plaque induced gingivitis?
Inflammation, BOP, most apical extension of junctional epithelium is CEJ
NO PERIODONTAL ATTACHMENT LOSS
What can cause non-dental biofilm induced gingivitis?
Genetics
Trauma
Systemic disease such as immunological conditions
Drug induced - Ca channel blockers or immunosuppressants
Infections - viral/fungal etc
Give some aetiologies of necrotising gingivitis
Fusiformspirochaetal microbial
Smoking
Immunosuppression
Stress
Malnourishment and poor diet
Tooth malposition
HIV
Give some features of necrotising gingivitis
Pain
Necrosis of papillae (punched out)
Ulceration
Spontaneous bleeding
Fever
What are some predisposing factors (local risk factors - to oral cavity) that can contribute to progression of disease of periodontium?
Malocclusion e.g. misaligned teeth
Traumatic injury to periodontal ligament
Plaque retentive factors
- orthodontics
- enamel defects
- restoration margins
- Incompetent lips causing oral dryness
What are some systemic risk factors that can predispose someone to periodontal disease
Uncontrolled diabetes
Pregnancy and puberty
Smoking
Vitamin C deficiency
Leukaemia
Give some treatments for gingival overgrowth
- rigorous home care
- regular PMPR
- possible surgery especially if drug induced
When should one refer a patient in paediatric perio?
Where extent of condition is inconsistent with the level of oral hygiene observed
Unexplained
- gingival enlargement
- inflammation
- bleeding
- mobility
Describe periodontitis
A chronic multi factorial disease affecting the tissues of the periodontium
Associated with microbial imbalance and plaque biofilm
What are the 4 main identifiers of periodontal disease
Apical migration of junctional epithelium past CEJ
Loss of periodontal attachment
Junctional epithelium becomes pocket epithelium (thin and ulcerated)
Alveolar bone loss
Give some features of necrotising PERIODONTAL disease
Necrosis of the papilla
Spontaneous bleeding
PDL loss and rapid bone loss (diff to gingivitis)
Fever
What is necrotising stomatitis?
Progression of necrotising into the soft tissues, not just the gingiva
- due to severely systemically compromised patients
What determines if periodontitis is molar-incisor pattern if generalised
Generalised is >= to 3 teeth with periodontal disease other than incisors and first molars
What systemic diseases may cause periodontitis as a manifestation of systemic disease
Neutropenia’s
Papillon lefevre syndrome (PLS)
Down syndrome
Leukocyte adhesion deficiency syndrome
What are the stages of recording periodontal condition when screening for peridontal disease
- Gingival condition and sBPE
- OH status, plaque amount
- Calculus present
- Assess local and systemic risk factors
What ages use sBPE
What ages use BPE
When do you use codes 0-2 and codes 0-*?
sBPE = 7-18
BPE 18+
Codes 0-2 used for ages 7-11
Codes 0-* used ages 12+
How manage code 1? When recall?
OHI, 1 year or routine recall
How manage code 2? When recall?
OHI, supragingival PMPR, modify PRF
Recall 1yr or routine recall
How manage code 3?
OHI, sub and supra gingival PMPR, modify PRF, appropriate radiographic assessment
Recall 3 months and 6ppc sextant with code 3
How manage code 4 or *
OHI, modify PRF, supra and subgingival PMPR, full periodontal assessment including FM6PPC and radiographs and consider referral as this is unusual for paediatric patient
What can contribute to gingival hyperplasia / overgrowth?
Systemic disease
- leukaemia
- lymphoma
- crohns
Infections
- hand foot and mouth
- HSV1 HSV2
Trauma
- physical
- burn / chemical
Drug induced
- CCB’s
- methotrexate
- phenytoin
