Perio Flashcards
how common is gingivitis in the primary dentition?
- uncommon
- -young children have less plaque than aldults
what is the prevalence of gingivitis at age 4-5?
50%
*almost 100% at puberty (declines after then stays constant)
what is the peak age of gingivitis at puberty for boys? girls?
boys = 10 yrs girls = 13 yrs
what does gingivitis associated with puberty resemble/
pregnancy gingivitis
*related to inc in steroid hormones
what are some local factors for gingivitis?
- crowded teeth
- ortho appliances
- mouthbreathing
- erupting primary and perm teeth
to treat gingivitis, kids under what age should be assisted by their parents when brushing?
8-10
what can longstanding gingivitis lead to?
chronic inflammaroty gingival enlargement (localized/generalized)
what are the common sites for chronic gingival enlargemnt?
- around ortho appliances
- areas dried by mouth breathing
what drugs often cause drug-induced gingival overgrowth/
- phenytoin (anti convulsant)
- cyclosporine (transplant pts)
- Ca++ channel blockers (hypertension)
how is drug-induced gingival overgrowth different from chronic inflammatory?
fibrous, firm, pale pink, often with LITTLE TENDENCY TO BLEED
- starts at interdental papilla and gradually spreads to margin
- can become extreme enough to cover crowns
- happens slowly
- appears to be genetic
what happens if the medications that cause drug-induced gingival overgrowth cannot be discontinued?
may be surgically removed but will recur.
surgery indecated when:
-appearance is unacceptable
-interferes with comfortable function
-produces perio pocket that cannot be maintained
the most severe cases of drug-induced gingival overgrowth are seen in what types of patients/
those with intellectual disabilities
where is the most common place for defects of the attached gingiva to arise?
mandib incisors when they erupt labial to the alveolar ridge
what problems do defects of the attached gingiva cause for the pts?
makes labially erupted teeth difficult to clean, particularly once recession has occured, leaving them even more vulnerable to periodontitis and attachment loss
loss of attachment and recession that occurs with labially malpositioned tooth is sometimes termed what?
stipping
what is the tx for defects of the alveolar ridge?
gingival graft and ortho movement of teeth
what is a max frenum penetratin the incisive papilla accomplanied by
large midline diastema
*common finding in children
when should you tx a max frenum prenetrating incisive papilla?
- can be delayed until perm teeth present to allow natural close of diastema
- older children = better cooperation
- if ortho tx is planned, postpone surgical tx until diastema has been closed
commonly called “tongue-tied”
ankyloglossia
what is the indication for tx for ankyloglossia
- normal mobility is limited (speech, feeding)
- if tongue cannot be protruded or touch upper alveolar process
what is the tx for ankyloglossia?
simple frenectomy
20% of 14-17 year olds have attachment loss of greater than ____mm at more than ____ sites
- 2mm
- 1 sites
*number and severity of affected sites inc with age
when is chronic perio most easily stopped?
in adolescnesce when attachment loss is minimal and deep pockets have not formed
how many kids younger than 18 try their first cig every day?
3,900
*over 950 of them will become regular smokers
type of perio problem that most commonly affects younger ppl
aggresive perio
- localized affects young pts
- generalized affects young adults
how is the localized form of aggresive perio characterized?
loss of attachment and bone around perm incisors and 1rst perm molars
*attachment loss is rapid, occuring at 3X rate of adult onset disease
when is LAP usually found?
early adolescence
*may first be noticed after mild trauma luxates tooth
in LAP, do pts usually have more plaque and inflammation than other kids?
yes
what is the prevalence of LAP?
1% in the US
*most commonly seen in the AA pop
does LAP have an genetic component?
yes, at least some cases appear to be inherited as an autosomal dominant trait
*linked to neutrophil chemotactic defect
what is the tx of LAP?
SRP combined with systemic antibiotic therapy and monitoring systemic antibiotic choice
- some reattachment can be seen after antibiotic therapy
- localized surgical intervention often necessary for residual effects
early onset of periodontitis characterized by localized loss of attachment in the PRIMARY dentition
*occurs in kids without evidence of systemic disease
prepubertal localized aggressive perio
where does LPP most often occur in the mouth
molar area, localized, bilateral symmetrical loss of attachment occurs
which pop is most often affected by LPP?
AA
when is LPP most often dx?
late primary dentition or early transitional dentition
*may progress to LAP in perm
what is LPP believed to be the result of?
bacterial infection combined with specific, but minor host immunological defecits
what is the tx of LPP?
- antibiotic therapy with local therapies
- tertracylines, metronidazole, amox, azith
who does GAP affect most?
young adults
where does GAP affect most?
may affect the entire dentition and is not self limiting
*heavy amounts of plaque and calculus and inflammation
is GAP associated with A. actino?
no
how should GAP be tx?
aggressively with local therapy and systemic antibiotics
rapid onset of PAINFUL gingivitis with interproximal marginal necrosis and ulceration
NUG/P
what is the peak incidence for NUG/P?
late teens adn early twenties in North america and europe
-younger in less developed countries
what are the predisposing factors for NUG/P?
- malnutrition
- viral infections
- stress
- lack of sleep
*associated with high levels of spirochetes and P. intermedia
what is the tx for NUG/P
- local debridement
- antibiotic therapy with penicillin or metro indicated when temp change
early loss of attachment in kids may often be associated with what?
systemic disease
*defects in immune system
is there a correlation between perio problems and diabetes pts?
yes, probably due to impaired immune fuctions
what % of teens with diabetes have perio disease?
10-15%
is there a correlation btw down syndrome and perio problems?
yes, may be first seen in primary dentition and most develop by 30 yrs old
*minor immune function may be responsible
what is a common perio finding for down syndrome?
severe recession in the mandib ant region associated with a high frenum attachment and shallow vestibule also a common finding
genetic disorder in which the enzyme BONE ALKALINE PHOSPHATASE is deficient or defective
hypophosphatasia
*dx by finding of low alkaline phosphatase levels in serum sample
what are the symptoms of hypophosphatasia?
- premature loss of deciduous teeth
- sever bone abnormalities leading to neonatal teeth
- the earlier the symptoms the more severe the disease
- in the more comon mild forms, the early loss of primary teeth may be the only symptom (odonto-hypophosphatasia)
how does early tooth loss occur in hypophosphatasia?
result of defective cementum formation that results in weakened attachment of tooth to bone
how are the teeth affected in hypophosphatasia?
in the order of formation
- typically primary incisors are exfoliated before the age of 4
- perm dentition is normal
what is the tx for hypophosphatasia?
-strensiq (replacement therapy approved less than 2 weeks ago)
what is the dx for hypophasphatasia?
good for perm dentition
rare, recessive genetic disease that involves the surface glycoproteins on leukocytes to be defective, resulting in poor migration to infection sites and impaired phagocytic function.
leukocyte adhesion deficiency (LAD)
when does LAD appear?
early primary dentition
what are the symptoms of LAD?
bone loss rapid around nearly all teeth and inflammation
*requires scrupulous oral hygiene measures
reduced numbers or the disappearance of neutrophils form the blood and bone marrow
neutropenia
how is neutropenia dx?
finding depressed neutrophils on a differential blood count
what oral issues are associated with neutropenia?
severe gingivitis and pronounced alveolar bone loss
what is the tx of neutropenia?
- rigorous local measures to control plaque
- pts may not be able to maintain level of oral hygiene necessary to prevent disease
rare genetic disorder that has onset of severe perio or transitional dentition along with severe inflammaiton and rapid bone loss
*easily identified hyperkeratosis of the palms and soles of feet
papillon leFevre syndrome
what is the tx of papillon-LeFevre syndrome?
- aggressive local measures to control plaque
- antibiotic therapy has worked in kids
previously known as histocytosis X, this rare disorder of childhood has a typical presentation of infiltration of bones, skin, liver, and other organs with histocytes
histocytosis
*teeth may be left “floating in air” and eventually exfoliated
what % of histocytosis pts have intitial infiltrates seen in the oral cavity,
10-20% usually in the mandible
what is the tx for histocytosis?
-local measures such as radiation, surgery, and chemotherapy
what is the px for histocytosis?
disseminated = poor with mortality rates exceeding 60%
mild = excellent
most common form of childhood cancer
leukemia
type of leukemia that is the most common and has the best px
ALL
accounts for about 20% of childhood leukemias and has a poorer long term survival
AML
which type of leukemia may be associated with gingival enlargements, bluish leasions, and systemic fever?
AML
what is the incidence for calculus for kids and teens?
kids = 10%
teens = 1/3 of teens
where is calculus most often seen in kids?
lingual side of mandib incisors followed by buccal of max molars
probing where provides screening for LJP?
incisors and perm molars
what are a normal finding of probing kids teeth?
transient deep pockets
*can be distinguished from true attachment loss by locating the cemneto enamel jx
what are the normal crestal height of bone in relation to CEJ in kids?
in 1-2 mm
