PERIODONTAL SCREENING AND MANAGEMENT IN KIDS Flashcards
What is the 2017 World Workshop classification (of paediatrics) divided into?
- periodontal health, gingival diseases and conditions
- periodontitis
- other conditions affecting the periodontium
what is the mnemonic for remembering the classification of periodontal conditions 2017?
Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight
What is the definition of periodontal health?
A state:
- free from inflammatory periodontal disease
- that allows an individual to function normally
- that avoids physical or mental consequences due to current or past disease
what are the features of healthy peridontium?
- gingival margin several mm coronal to the CEJ
- gingival sulcus 0.5mm-3mm deep on fully erupted tooth
- in teenagers = alveolar crest is situated between 0.4mm-1.9mm apical to CEJ
what can cause a reduced periodontium in a non-periodontal patient?
- crown lengthening surgery
- recession
how much bleeding on probing would suggest periodontal health?
<10% BOP
what are the 2 overall types of gingivitis?
- plaque biofilm-induced gingivitis
- non plaque biofilm-induced gingivitis / gingival lesions
how does plaque biofilm-induced gingivitis occur?
supragingival plaque accumulates on teeth:
- an inflammatory cell infiltrate develops in gingival connective tissue
- junctional epithelium becomes disrupted
- allows apical migration of plaque and increase in gingival sulcus depth
** false pocketing in gingivitis !!!!
what can cause non-dental biofilm-induced gingivitis?
- manifestations of systemic conditions
- pathological conditions limited to gingival tissues
what is an example of genetic disorders that predispose a patient to non-dental biofilm-induced gingivitis?
hereditary fibromatosis
what is an example of manifestations of systemic disease disorders that predispose a patient to non-dental biofilm-induced gingivitis?
granulomatous inflammation
what is an example of drugs that predispose a patient to non-dental biofilm-induced gingivitis?
- anti-retro-viral meds
- immunosuppressants
what are the features of necrotising gingivitis?
- pain
- necrosis of interdental papillae “punched out” appearance
- ulceration
- spontaneous bleeding
- halitosis
- lymphadenopathy (maybe)
- fever (maybe)
what are the aetiological risk factors of necrotising gingivitis?
- smoking
- immunosuppression
- stress
- malnourishment
- poor diet
what socioeconomic factor can contribute to the likelihood of developing necrotising gingivitis?
developing country / poverty
what local factors can contribute to development of necrotising gingivitis? (aetiology)
- unusual root proximity
- tooth malposition
what systemic factor can cause necrotising gingivitis?
HIV positive status
what medications can cause gingival overgrowth?
- cyclosporin
- phenytoin
- calcium channel blockers
what other things can gingival overgrowth be related to?
- puberty (alongside dental plaque)
- hereditary gingival fibromatosis
- systemic and metabolic diseases
how is gingival overgrowth treated?
- rigorous home care
- frequent appointments for PMPR
- may need surgery
if a condition is inconsistent with level of oral hygiene observed, what would you do?
urgent referral to physician for haematinic screening!
what are the 4 main distinguishing features of periodontitis?
- APICAL MIGRATION of junctional epithelium beyond CEJ
- LOSS OF ATTACHMENT of periodontal tissues to cementum
- transformation of JUNCTIONAL EPITHELIUM -> POCKET EPITHELIUM (thin and ulcerated)
- ALVEOLAR BONE LOSS
what is periodontitis?
- a chronic multifactorial inflammatory disease
- associated with dysbiotic plaque biofilms
- characterised by progressive destruction of the tooth-supporting apparatus
what is the early clinical sign of periodontitis in teenagers?
> 1mm loss of attachment (of cementum to PDL)
what are the pathogens typically found in teenager periodontitis patients?
- porphyromonas gingivalis
- prevotella intermedia
- aggregatibacter actinomycetemcomitans
what are the features of necrotising periodontitis?
- necrosis/ulceration of the interdental papilla
- bleeding of the gingival tissues
- periodontal ligament loss & rapid bone loss
- pseudomembrane formation
- lymphadenopathy
- fever
what is necrotising stomatitis?
a sever inflammatory condition
- necrosis extends beyond gingiva to soft tissues leading to bone denudation (erosion)
- seen in severely systemically compromised patients
what should you be aware of when assessing the periodontal health of a child in the mixed dentition stage?
FALSE POCKETING occurs around erupting permanent dentition
what are the features of molar incisor pattern periodontitis in adolescents?
- rapid attachment loss and bone destruction
- patient is otherwise healthy
- onset around puberty
- family history related
What systemic diseases may periodontitis be a manifestation of?
- Papillon-Lefevre Syndrome (PLS)
- Neutropenia’s
- Down syndrome
- Leucocyte adhesion deficiency syndrome (LAD)
When considering a patients gingival condition, what things will you assess?
- gingival colour
- contour
- swelling
- recession
- suppuration
- inflammation (presence and location)
When assessing the oral hygiene status of a paediatric patient, what would you note?
- Plaque status
- Description of surfaces covered by plaque (easily visible? detectable only on probing?)
- assess any calculus present
What local risk factors may play a part in paediatric periodontal disease?
- plaque retention factors (misshaped teeth etc)
- low frenal attachments
- malocclusions
- incompetent lip seal
- mouth breathing
how can an incompetent lip seal increase the periodontitis risk?
- Reduced upper lip coverage —> labial and palatal gingivitis
- Increased lip separation
what screening tool aids in the provisional diagnosis of periodontal health. gingivitis or periodontitis?
BPE (basic periodontal examination)
when should a BPE be carried out in children?
A simplified BPE should be carried out in all co-operative children aged 7-18 years old
- only on 6 teeth!!
how is a simplified BPE carried out?
- performed with a WHO 621 probe
- carried out on 16, 11, 26, 36, 31, 46
- 20-25g force application (same as adults)
what are the BPE codes possible for children ages 7-11?
0 = healthy
1 = bleeding after gentle probing (black band visible)
2 = calculus or plaque retention factor
what BPE codes are possible for kids aged 12-17?
0 = healthy
1 = BOP & black band visible
2 = calculus or plaque retention factor & black band visible
3 = pocketing 4mm-5mm (black band partially visible)
4 = pocketing >6mm (black band disappears)
* = furcation involvement
what are the different SDCEP plaque scores used in paediatric dentistry?
- 10/10
- 8/10
- 6/10
- 4/10
what would a plaque score of 10/10 indicate in paediatric dentistry?
perfectly clean tooth
what would a plaque score of 8/10 indicate in paediatric dentistry?
line of plaque around the cervical margin
what would a plaque score of 6/10 indicate in paediatric dentistry?
cervical 1/3rd of crown covered
what would a plaque score of 4/10 indicate in paediatric dentistry?
middle 1/3rd of crown covered
if a patient has a BPE score of 3 what are the following steps?
- 6 point pocket chart in that sextant
- radiographs taken
if a patient has a BPE score of 4 what are the following steps?
- full mouth 6PPC
- radiographs
what oral health messages should be delivered to paediatric patients to ensure good prevention?
- advice on affective toothbrushing
- fluoride advice
- smoking cessation advice PARAMOUNT in teenagers
what is step one of the S3 treatment guidelines?
building foundations for optimal treatment outcomes
- focuses on behaviour change/motivation to control plaque
- PMPR
- risk factor control
what is step two of the S3 treatment guidelines?
Cause-related Therapy
- aims to control the subgingival plaque biofilm & calculus by subgingival PMPR
what is step three of the S3 treatment guidelines?
Management of non-responding sites (>4mm with BOP or >6mm)
- aim to gain access to further subgingival instrumentation
give examples of when you should refer a paediatric perio patient?
- Grace C or Stage IV periodontitis
- Periodontal disease as a direct manifestation of systemic disease
- Extensive medical history that will affect treatment
