Perio In Children Flashcards
New periodontal diagnoses
Perio health
Gingivitis : biofilm
Gingival disease and conditions : non dental biofilm
Necrotising perio
Perio
Perio as manifestation of systemic disease
Systemic disease affecting perio tissues
Perio abscess and endo-perio lesions
Mucogingival deformities and conditions
Traumatic occlusal forces
Tooth and prosthesis related factors
Healthy periodontium in children
Free from inflammatory perio
<10% BOP
Gginvial margin several MM coronal to CEJ
Gingival sulcus up to 3mm deep on fully erupted tooth alveolar crest 0.4-1.9mm apical to CEJ
Why is reduced periodontum seen in children
Non perio
- recession
-crown lengthening surgery
In perio patient
-stable perio
Types of gingivitis
- plaque biofilm-induced gingivitis
- intact periodontium
- reduced periodontium
2.non plaque biofilm induced gingivitis/gingival lesions
How does plaque induced gingivitis occur
Plaque accumulates
Inflammatory cell infiltrate in connective tissue
Junction all epithelium disrupted
Apical migration of plaque and increase sulcus depth
Forms false pocket
Most apical part of junctional epithelium at CEJ - no loss of attachment
How does non dental biofilm gingivitis occur
- genetic
-infections
-inflammatory/immune conditions
-neoplasms
-endocrine
-traumatic lesions
Features of necrotising gingivitis
- pain
- necrosis of interdental papillae
- punched out appearance
- ulceration
- spontaneous bleeding
- secondary foetor oris
- pseudomembrane may be present
- +/- lymphadenopathy
- fever
- may manifest in teenagers
- may progress to necrotising periodontitis
Aetiology of necrotising gingivitis
Fusiform spirochaetal microbial aetiology
Opportunistic infection
Risk factors
- smoking
-immunosupression
-poor diet
-malnourishment
What are biofilm plaque retentive factors
Tooth anatomy - pearl , talon, defects
Overhangs
Ortho/pros appliances
Incompetent lip seal
Systemic risks of necrotising ulcerative gingivitis
- smoking (tobacco)
- metabolic factors (hyperglycaemia/diabetes type 1)
- pharmacological agents (cyclosporin)
- nutritional factors (vitamin C deficiency)
- increased sex steroids (puberty, pregnancy)
- haematological conditions (leukaemia)
What is gingival overgrowth related too
- systemic and metabolic diseases
- genetic factors (eg hereditary gingival fibromatosis)
- local factors
- side effects from medications - cyclocsporin, phenytoin and calcium channel blockers)
Treatment of gingival overgrowth
- rigorous home care
- frequent appointment for professional mechanical plaque removal PMPR
- +/- surgery, especially with drug induced gingival overgrowth
What is periodontitis
Chronic multifactorial inflammatory disease
Dysbiotic plaque biofilm
Progressive destruction of tooth
Key features of perio
- apical migration of junctional epithelium beyond CEJ
- loss of attachment of periodontal tissues to cementum
- transformation of junctional epithelium to pocket epithelium (thin and ulcerated)
- alveolar bone loss
Pathogens found in perio
- prophyromonas gingivalis
- prevotella intermedia
- aggregatibacter actinomycetemcomitans
- tannerella forsthis (associated with subsequent clinical attachment loss in 2 year long study in adolescents)
What is early signs of perio in teens classified as
classified as >1mm loss of attachment (of cementum to PDL)
What is necrotising periodontitis
Extension of necrotising gingivitis
Features
- necrosis/ulceration of interdental papilla
- bleeding of gingival tissues
- periodontal ligament loss and rapid bone loss
- psuedomembrane formation
- lymphadenopathy
- fever
What is necrotising stomatitis
- severe inflammatory condition
- necrosis extends beyond gingiva to soft tissues, leadings to bone denudation
- severely systemically compromised patients
When can false pocketing occur children
Erupting permanent dentition
Features of molar incisor pattern
- rapid attachment loss and bone destruction
- patient is otherwise healthy
- onset around puberty
- family history
- 0.1% caucasians and 2.6% African ancestry
How may perio present as a manifestation of systemic disease
- papillon - lefervre syndrome
- neutropenias
- chediak-higashi syndrome
- leucocyte adhesion deficency syndrome
- ehler-danlos syndrome
- down syndrome
- langerhans cell histocytosis
- hypophosphatasia
What is simplified BPE
Age 7-18
Only 6 teeth
Who 621 probe
Same force
What is plaque score
Plaque levels show toothbrushing habits
Scoring out of 10
10 best 4 worst
What is recall perio for score 3 or above
3 months
Which scores are used in simplified BPE
7-11 - 0,1,2
12-17 0,1,2,3,4 *
