Perio in Pediatrics - part 2 Flashcards
localized aggressive periodontitis (LPP)
localized loss of attachment in the PRIMARY dentition
who is affected by localized aggressive periodontitis (LPP)?
occurs in children w/o evidence of systemic disease
where does localized aggressive periodontitis (LPP) most commonly manifest?
in molar area
which race is most commonly affected by localized aggressive periodontitis (LPP) in US?
African-Americans
clinical features of localized aggressive periodontitis (LPP)
- localized, usually bilaterally symmetrical, loss of attachment
- heavier than average plaque deposits
- mild to moderate inflammation
- calculus may be present
when is localized aggressive periodontitis (LPP) commonly 1st dx’d?
in late primary dentition or early transitional dentition
what causes localized aggressive periodontitis (LPP)?
believed to be result of bacterial infection combined with specific, but minor, host immunologic deficits
tx of localized aggressive periodontitis (LPP)
abx therapy combined with debridement
why is tetracycline contraindicated for tx’ing localized aggressive periodontitis (LPP)?
because of potential for staining of developing permanent teeth
abx used to tx localized aggressive periodontitis (LPP)
- metronidazole and amoxicillin
2. azithromycin
defects in immune system that result in susceptibility to infection
neutropenia
hypophosphatasia causes developmental defects in what?
attachment apparatus
leukemia
invasion of neoplastic cells
T/F: there is increased risk and earlier onset of periodontitis in diabetes mellitus types 1 & 2
true
what percent of teenagers with type 1 diabetes have significant perio disease?
10-15%
T/F: poor metabolic control increases risk of periodontitis and periodontitis may worsen glycemic control in diabetic pts
true
Down syndrome
3 copies of chromosome 21
T/F: pts with Down syndrome have high plaque levels but severity of perio disease out of proportion to local factors
true
various minor immune deficits particularly what may be responsible for increased susceptibility to periodontitis in Down syndrome pts
neutrophil fxn
what is common in Down syndrome pts?
shallow anterior mandibular vestibule and frenum pull
hypophosphatasia
genetic disorder in which enzyme, bone alkaline phosphatase is deficient or defective
how is hypophosphatasia dx’d?
by finding low alkaline phosphatase levels in serum sample
in mild forms of hypophosphatasia, what may be the 1st clinical sign?
loss of primary teeth
early tooth loss is result of what in pts with hypophosphatasia?
result of defective cementum formation that results in weakened attachment of tooth to bone
T/F: roots of pts with hypophosphatasia are resorbed
false, not resorbed
T/F: teeth of pts with hypophosphatasia are affected in the order of formation so that those that form the earliest are most likely to be involved and the most severely affected
true
when are primary incisors exfoliated?
at 1-2 years of age
T/F: permanent dentition may be normal for pts with hypophosphatasia
true
who is affected by hypophosphatasia?
fair Caucasian children
leukocyte adhesion deficiency (LAD)
group of rare, recessive genetic syndromes affects how white blood cells (leukocytes) respond and travel to site of wound or infection
leukocyte adhesion deficiency (LAD) is susceptible to what?
bacterial infections
clinical features of leukocyte adhesion deficiency (LAD)
- absence of pus at infection sites
- recurrent otitis media and other bacterial infections of soft tissues
- perio disease symptoms manifested in primary dentition
- inflammation and bone loss
what can be curative of leukocyte adhesion deficiency (LAD)?
bone marrow transplant
neutropenia
suppressed neutrophil counts in blood and bone marrow
how is neutropenia dx’d?
depressed neutrophils count on differential blood count
clinical features of neutropenia
increased susceptibility to recurrent infections
- severe gingivitis and pronounced alveolar bone loss
- rapidly progressing
tx for neutropenia
rigorous local measures to control plaque
T/F: Papillon-LeFèvre syndrome is a rare genetic disorder
true
clinical features of Papillon-LeFèvre syndrome
- severe inflammation and rapid bone loss characteristic
2. easily identified hyperkeratosis of the palms of the hands and soles of feet
tx for Papillon-LeFèvre syndrome
- consist of aggressive local measures to control plaque
2. successful tx outcomes in children have been reported with antibiotic therapy
Langerhans Cell Histiocytosis (LCH)
rare disorder of childhood that has infiltration of bones, skin, liver and other organs with hystiocytes
10-20% of Langerhans Cell Histiocytosis (LCH) cases have initial infiltrates occur where?
jaw usually mandible
clinical features of Langerhans Cell Histiocytosis (LCH)
- gingival enlargement
- ulceration
- mobility of teeth with alveolar expansion
- discreet, destructive lesions of bone on radiographs
how might Langerhans Cell Histiocytosis (LCH) appear on radiographs?
teeth may be left “floating in air” and eventually exfoliated
what might Langerhans Cell Histiocytosis (LCH) be mistaken for?
prepubertal periodontitis
how is Langerhans Cell Histiocytosis (LCH) diagnosed?
bx
tx for Langerhans Cell Histiocytosis (LCH)
- local measures such as radiatio nand surgery to remove lesions
- systemic chemotherapy for disseminated cases
px for disseminated early onset of Langerhans Cell Histiocytosis (LCH)
guarded
px of mild, localized Langerhans Cell Histiocytosis (LCH)
excellent
what is the most common form of childhood cancer?
leukemia
what is the most common leukemia?
acute lymphoblastic leukemias (ALL)
T/F: acute lymphoblastic leukemias (ALL) has the best px
true
acute myeloid leukemia (AML) accounts for what percent of childhood leukemias?
20%
T/F: acute myeloid leukemia (AML) has poorer longterm survival rate
true
acute myeloid leukemia (AML) but not acute lymphoblastic leukemias (ALL) may present with what?
gingival enlargement caused by infiltrates of leukemic cells
clinical features of AML and ALL
- lesions are bluish red and may invade bone
2. pt may have fever, malaise, gingival or other bleeding and bone or joint pain
how is acute myeloid leukemia (AML) dx’d?
by complete blood cell count
T/F: calculus not as common in young pts as in adults
true
calculus is present in what percent of children and teenagers?
~10% of children and approx. 1/3 of teenagers
what are the most common sites for calculus?
- lingual of mand incisors
2. buccal of maxillary molars
probing which teeth provides screening for LJP?
permanent incisors and 1st permanent molars
erupting teeth can be probed all the way down to where?
CEJ
T/F: transient deep pockets are a normal finding in transitional dentition
true
transient deep pockets can be distinguished from true attachment loss by locating what?
CEJ
what is the normal crestal height in children?
1-2 mm of CEJ
