Periodontal diseases in children and adolescents part 1 Flashcards
Describe the periodontium of the deciduous dentition
- High labial frenum attachment
- Pale pink or pigmented
- 1-2 mm probing depths
- Keratinized tissue is thinner
- Junctional epithelium is thicker
- Loss of attachment and true pockets rare
Describe the normal physiological changes that occur in the periodontium of a child
- Significant changes occur in the periodontium as the permanent teeth erupt
- Most changes are physiological in nature but must be distinguished from disease of the gingiva that may occur at the same time
- Occasionally an eruption cyst may occur, most common sites are primary first molars and permanent first molars.
List the 7 local factors contributing to gingivitis in children & adolescents
- Erupting teeth
- Restoration overhangs
- Calculus (covered by plaque)
- Crowding
- Mouth breathing
- Orthodontic appliances
- Poor oral hygiene
List the 3 systemic factors contributing to gingivitis in children & adolescents
- Hormonal changes like puberty and pregnancy
- Poorly controlled diabetes
- HIV or other immune disorders
Describe gingivitis induced by biofilm, how it appears physiologically and mention two risk factors for it
Description
• Tooth eruption does not cause gingivitis. Plaque around an erupting tooth contributes to gingivitis
How it appears physiologically
• Gingiva may appear red as the gingival margins have not yet keratinised and sulcus development is incomplete
Two risk factors
• Exfoliating and severely carious primary teeth often contribute to gingivitis caused by plaque accumulation as a result of pain during brushing or food impaction in areas of cavitation
• Junctional epithelium migrates under resorbing tooth which can create a space for bacteria to proliferate.
Discuss which children/ adolescents are more likely to have calculus
- Uncommon in children but increases with age.
- Higher incidence in patients with disabilities, cystic fibrosis or kidney disease, children fed with nasogastric tubes.
Discuss the negative consequences of mouth breathing
- Chronic drying of tissue
- Tacky plaque-hard to remove
- Red inflamed and enlarged gingiva
- May be ENT and/or orthodontic problem
Discuss the causes of mucogingival problems in children (4)
- Some mucogingival problems may start during the primary dentition as a consequence of developmental aberrations in eruption and deficiencies in the thickness of the periodontium
- A high frenum attachment may also be a factor in the development of mucogingival problems if there is excess tension at the marginal tissues
- Late-erupting canines in a crowded dentition may be displaced buccally, erupting into or near unattached gingiva or mucosa, increasing the risk of insufficient gingival tissue width and recession
- Recession may also be associated with an anterior open bite as a result of the labial inclination of the teeth
- Can also result from factitious habits, like self-inflicted trauma from a fingernail or excessive toothbrushing by either the parent or the child
Discuss which areas are most susceptible to mucogingival problems
- During the mixed dentition, recession is most often found on the facial aspect of mandibular permanent incisors secondary to rotations or labial positioning related to space problems
- Although erupting permanent lower incisors often show minimal attached gingiva, gingival width often increases as the teeth erupt
- The maxillary canine region is also prone to localized gingival recession
Describe the microbiology of disease in children
- The composition of the oral microflora changes as the child matures
- A study analysing dental plaque in children found that 71% of 18- to 48-month-old children were infected with at least one periodontal pathogen (68% P. gingivalis and 20% T. forsythia)
- A moderate correlation also has been found between T. forsythus in children and periodontal disease in their mothers
- T. forsythus also has been associated with gingival bleeding in children
- Children between the ages of 2 and 18 years had detectable levels of P. gingivalis in their plaque. 75% showed similar levels of Actinobacillus actinomycetemcomitans
- The presence of P. gingivalis was most strongly associated with the progression of gingivitis and the onset of periodontitis in healthy children
• Experimental gingivitis models in children have demonstrated increased subgingival levels of Actinomyces, Capnocytophaga, Leptotrichia, and Selenomonas pathogens that are generally not seen in adult gingivitis
Describe biofilm induced gingivitis in terms of its histological characteristics
- Bleeding and increased pocket depth not found as often unless hypertrophy or hyperplasia is present
- Chronic gingivitis is associated with a loss in the collagen and an infiltrate of manly lymphocytes, PMNs, leukocytes
- In children gingivitis is dominated by T lymphocytes
- As JE is thicker it is thought to reduce the ability for bacterial toxins to penetrate the underlying tissues and initiate an inflammatory response.
Describe gingivitis mediated by systemic risk factors (puberty gingivitis) in terms of its physiological characteristics
- Marginal gingivitis increases as a child matures, peaking between 9 to 14 years old and then decreasing slightly after puberty
- Gingival disease that behaves in such a manner is often referred to as pubertal (or puberty) gingivitis
- The most frequent manifestation is bleeding and inflammation in interproximal areas
- Inflammatory gingival enlargement may also be noted in both genders, but it generally subsides after puberty
- This response is caused by hormonal changes that increase the vascular and inflammatory response to dental plaque, and this modifies the reactions of dental plaque microbes.
Explain gingivitis mediated by local risk factors (orthodontic appliances) and its physiological effects
- Gingival enlargement can be related to the presence of fixed orthodontic appliances, which complicate plaque removal
- Gingival changes can occur within 1 to 2 months of insertion of appliance, generally transient, rarely produce long-term damage tissues
- The fact that most orthodontic treatment is provided to individuals during puberty, when they are subject to the inflammatory changes associated with puberty gingivitis, may exacerbate the observed effect
Explain plaque control for children with periodontitis
- Manual dexterity affects the ability of a child to perform expected procedures
- Each child requires an individualized home care program on the basis of his or her ability to actually perform the requested activities
- For young children, plaque control should be a shared responsibility between children and their parents
- For children who are less than 7 years old, parents should be asked to assist with toothbrushing
- More refined brushing techniques can be introduced during adolescence
- Mechanical toothbrushes with rotary heads have been shown to be effective for plaque removal as soon as children are able to tolerate the vibrating sensation, because many children initially dislike the feeling of the rotary movement
- Mechanical toothbrushes are especially recommended for physically challenged children and individuals with fixed orthodontic appliances.
- Flossing is usually not indicated for children during the primary dentition stage, because most children have interdental spacing throughout most of their arches
- However, as interdental contacts develop, flossing should be added to the home care routine
- Studies have demonstrated both a decrease in gingival bleeding and the quantity of microbes associated with periodontal disease when tooth and tongue brushing are combined with flossing
- Again, limitations in manual dexterity may necessitate parental assistance with flossing during the mixed dentition stage
- Adolescents with sufficient manual dexterity can be expected to floss on their own
- Antimicrobial mouth rinses for chemical plaque control are not indicated for very young children because of the risk of ingestion of chemical agents
- However, rinses may be indicated for older children who demonstrate the ability to expectorate after rinsing.
