Paediatric Periodontology Flashcards
What is the 2017 World Workshop Classification of Periodontal and Peri-implant Diseases and Conditions?
- periodontal health, gingival diseases and conditions
- periodontal health
- gingivitis: dental biofilm-induced
- gingival diseases and conditions: non-dental biofilm-induced
- periodontitis
- necrotising periodontal disease
- periodontitis
- periodontitis as a manifestation of systemic disease
- other conditions affecting the paeriodontium
- systemic diseases or conditions affecting supporting tissues
- periodontal abscesses and endo-perio lesions
- mucogingival deformities and conditions
- traumatic occlusal forces
- tooth and prosthesis related factors
Please - periodontal health
Give - gingivitis
Greg - gingival diseases and conditions
Nine - necrotising periodontal disease
Percy - periodontitis
Pigs - periodontitis as a manifestation of systemic disease
Straight - systemic diseases/conditions affecting tissues
Past - periodontal abscess/endo-perio lesion
Meal - mucogingival deformities/conditions
Time - traumatic occlusal forces
Tonight - tooth and prosthesis related factors
What is periodontal health for children?
- state free form inflammatory periodontal disease
- allows individual to function normally
- avoids physical or mental consequences due to current or past disease
- absence of gingival inflammation and calculus
- no more than one sextant with plaque
- gingival margin several mm coronal to CEJ
- gingival sulcus 0.5-3mm deep on fully erupted tooth
- alveolar crest 0.4-1.9mm apical to CEJ (teenagers)
- <10% bleeding on probing
What may result in a reduced paeriodontium in periodontal health?
- non-periodontal patient
- crown lengthening surgery
- recession
- periodontal patient
- stable periodontitis
What is plaque biofilm-induced gingivitis on an intact or reduced periodontium?
- occurs as supra gingival plaque accumulates on the teeth
- inflammatory cell infiltrate develops in gingival CT
- junctional epithelium becomes disrupted
- allows for apical migration of plaque
- increased gingival sulcus depth
- gingival pocket
- false pocket
- pseudopocket
- process is reversible
- most apical extension of junctional epithelium is CEJ
- no periodontal attachment loss
What are non-dental biofilm-induced gingival diseases?
- manifestations of systemic conditions
OR - pathologic changes limited to gingival tissues
- sub-classifications exist
- genetic/development disorders
- specific infections
- inflammatory and immune conditions and lesions
- reactive processes
- neoplasms
- endocrine
- nutritional and metabolic
- traumatic lesions
- gingival pigmentation
What is necrotising gingivitis?
- fusiformspirochaetal microbial aetiology
- risk factors
- developing countries
- smoking
- immunosuppression
- stress
- malnourishment
- poor diet
- root proximity
- tooth pal position
- HIV positive status
- features
- pain
- necrosis of interdental papillae
- ulceration
- spontaneous bleeding
- secondary foetor oris
- pseudomembrane may be present
- potential lympadenopathy
- fever
- may manifest in teenagers
- potential to progress to necrotising periodontitis
What are predisposing factors for other conditions affecting the periodontium?
- local risk factors
- malocclusion
- instancing or rotated teeth
- rotated occlusion
- traumatic dental injury
- damage to PDL
- dental plaque-biofilm retentive factors
- tooth anatomy
- talon cusp
- cingulum
- enamel pearl - restoration margins/overhangs
- cavities
- orthodontic/prosthodontic appliances
- incompetent lip seal
- tooth anatomy
What are the modifying factors for other conditions affecting the periodontium?
- smoking
- metabolic factors
- diabetes type 1
- pharmacological agents
- cyclosporin
- nutritional factors
- vitamin C deficiency
- increased sex steroids
- puberty
- pregnancy
- haematological conditions
- leukaemia
What is gingival overgrowth?
- related to
- systemic and metabolic factors
- genetic factors
- hereditary gingival fibrzomatosis - local factors
- side effects produced by some medications
- cyclosporin
- phenytoin
- calcium channel blockers
- greater incidence of overgrowth seen in puberty
- severity more intense in children than adults
- treatment
- rigorous home care
- excellent oral hygiene - frequent appointments for PMPR
- surgery
- especially for drug induced overgrowth
- rigorous home care
What is periodontitis in paediatrics?
- chronic multifactorial inflammatory disease
- associated with dysbiotic plaque biofilms
- progressive destruction of tooth supporting apparatus
- 4 key features
- apical migration
- junctional epithelium moves beyond CEJ - loss of attachment
- of periodontal tissues to cementum - transformation of junctional epithelium to pocket epithelium
- often thin and ulcerated - alveolar bone loss
- apical migration
- early clinical sign in teenagers
- > 1mm loss of attachment
- similar pathogens to adults
- porphyromonas gingival
- prevotella intermedia
- aggregatibacter actinomycetemcomitans (AA)
- tannerella forsythia
- in primary dentition
- some evidence of bone loss around primary teeth
- in mixed dentition
- be aware of also pocketing around erupting permanent dentition
How is a periodontitis diagnosis formed?
- staging
- interproximal bone loss at worst site of loss
- grading
- rate of progression
- assessment of current periodontal status
- risk assessment
- smoking
- poorly controlled diabetes
What is necrotising periodontitis?
- can be an extension of necrotising gingivitis
- features
- necrosis/ulceration of the interdental papilla
- bleeding of gingival tissues
- periodontal ligament loss and rapid bone loss
- pseudomembrane formation
- lymphadenopathy
- fever
What systemic conditions can manifest as periodontitis in paediatric patients?
- papillon-lefevre syndrome (PLS)
- neutropenias
- chediak-higashi syndrome
- leucocyte adhesion deficiency syndrome (LAD)
- ehlers-danlos syndrome
- langerhan’s cell hustocytosis (LCH)
- hypophosphatasia
- Down’s syndrome
How are periodontal conditions recorded?
- periodontal screening should be a routine and essential part of history and clinical examination
- gingival condition
- gingival colour
- contour
- swelling
- recession
- suppuration
- inflammation
- presence
- location - marginal bleeding
- oral hygiene status
- description of plaque status
- describe surfaces covered by plaque
- easily visible?
- detectable only on probing?
- asses if any calculus present
- chart location
- assess local risk factors
- plaque retention factors
- low renal attachments
- malocclusion
- incompetent lip seal
- labial and palatal gingivitis - mouth breathing
- palatal gingivitis
What is a basic periodontal examination and how is it carried out for children?
- screening tool
- guide to a provisional diagnosis
- does not consider historical attachment loss or bone loss
- for all children 7-18 years old
- simplified to 6 teeth
- 16, 11, 26, 36, 31, 46
- only codes 0, 1 and 2 for 7-11 years old
- all codes for 12-17 years old
- quick
- easy
- well tolerated
- avoid false pocketing - WHO 621 probe
- 20-25g force application
- probe parallel to root surface and walked around margin
- simplified to 6 teeth
