Perio in children & adolescents

Question 1

What are the features of a healthy periodontium in children & adolescents?

Answer 1

• Marginal tissues more vascular
• Less connective tissue fibres
• Less keratinisation (looks redder)
• Gingival sulcus 0.5-3mm on a full erupted tooth /6-7mm in erupting permanent tooth
• Perio ligament space =wider, less fibrous, more vascular
• Alveolar bone = arger marrow spaces, fewer trabeculae, more vascularity (enhances rate of disease)

Question 2

What are the signs of perio in child <7 yrs

Answer 2

• unexplained premature exfoliation
• gross mobility of primary teeth
• Red oedematous gingivae
• Suppuration with no dental cause

Question 3

Where would you do a BPE in a child?

Answer 3

UR6 UR1 UL6

LR6 LL6 LR1

Question 4

What is the proportion of children in the population to have severe attachment loss on multiple teeth?

Answer 4

0.2-0.5%

Question 5

What are the local contributing factors for a child to dental plaque induced gingival disease?

Answer 5

• Partially erupting teeth
• Exfoliating deciduous teeth
• Calculus
• Crowding
• Mucosal factors (frenum/ recession)
• Restorations
• Ortho
• Mouth breathing / incompetent lips

Question 6

What are the systemic modifying factors for plaque induced gingival disease?

Answer 6

• Changes in Gonadotrophic hormone (oestrogen & progesterone hormone levels)
• Diabetes - alteration in levels of insulin modifies gingival response to plaque, hyperglycaemic state induces hyper-reactive over secretion of inflammatory mediators (IL-1)

Question 7

How would you manage plaque induced gingivitis in children?

Answer 7

• Involve carer (supervise brushing to atleast 7 yrs)
• Advice home disclosing
• Ask child to “colour” plaque chart
• Involve child in Plaque score - set targets (older children will understand %)
• Regular appts to maintain motivation
• Dentition is constantly changing - modify OHI at each appts
• Assess maturity, manual dexterity and motivation before ID aids