soft tissue and perio problems in children

Question 1

chronic gingivitis

Answer 1

1) below 5% at age 3, 50% at age 6, 90% at age 11
2) always associated with plaque
- chronic oral hygiene
3) does not necessarily lead to adult periodontitis
4) treatment is consistent plaque removal

Question 2

contributing factors

Answer 2

1) poor oral hygiene
2) malposed teeth
3) mouth breathing
4) open bite
5) lip incompetence
6) rough margins

Question 3

competitive inhibition

Answer 3

s. mutans can be antagonistic with some perio pathogens

Question 4

pubertal gingivitis

Answer 4

1) age 9-14
2) bacterial flora
- prevotella intermedia
- increased estrogen and progesterone
3) worsened by oral hygiene
4) treatment is improved OH, more recalls, remove orthodontic appliances

Question 5

necrotizing ulcerative gingivitis

Answer 5

1) diagnostic
- gingival bleeding
- pain
- necrosis of IPX papillae
- no attachment loss
- malaise
- lymphadenopathy
- fetor ex oris

Question 6

who gets NUG

Answer 6

1) poor OH
2) emotions stress
3) fatigue
4) decreased resistance to infection
5) smoking
6) malnutrition

Question 7

NUG treatment

Answer 7

1) improve OH
2) 0.12% chlorohexidine rinse
3) antibiotics only if secondary infection
4) eliminate risk factors

Question 8

acute primary herpetic gingivostomatitis

Answer 8

1) first exposure is
- subacute in 80-90%
- acute in 10-20%
2) acute means a miserable patient, but not a serious infection

Question 9

stage 2 APHG

Answer 9

1) severe gingivitis
2) vesicular lesions anywhere in the mouth and perioral
3) vesicles erupt and form ulcers wiht red halo

Question 10

APHG treatment

Answer 10

1) analgesics
2) bland food
3) anesthetizing mouth rinse
4) antibiotics
5) supportive

Question 11

gingival enlargement with ortho appliance

Answer 11

1) without inflammation
2) anterior facial
3) present with good OH
4) etiology
- reaction or allergy to appliances
- tissue compression during space closure
5) treatment (none if OH is good)

Question 12

pericoronitis

Answer 12

1) food or plaque accumulation under operculum of erupting tooth
2) mandibular permanent molars
3) painful inflammation of operculum

Question 13

treatment of pericoronitis

Answer 13

1) irrigate with warm saline
2) ibuprofen and soft foods for 3 days
3) excise if persistent
–
severe
1) antibiotics unless immediate drainage visible,
2) excision

Question 14

drug induced gingival enlargement

Answer 14

1) fibrotic overgrowth
2) papillary areas
3) facial of anterior teeth
–
1) dilantin (seizures)
2) cyclosporin (immunosuppressant)
3) calcium channel blockers (nifedipine)

Question 15

treatment of drug induced gingival enlargement

Answer 15

1) OH
2) drug substitution
3) surgical intervention
4) positive pressure appliance

Question 16

aggressive periodontitis

Answer 16

1) new term for diseases in tounger patients
2) can occur in primary or permanent dentition
3

Question 17

local aggressive periodontitis

Answer 17

1) 0.2% adolescents
2) mainly permanent 1st molars and incisors
3) devastating consequences in children
4) radiographic severed angular bone loss of incisors and first molars
4) assoc. with actinobacillus actinomycetemocomitans
5) neutrophils with chemotactic defects
6) can occur in primary dentition
7) root planing and improve oral hygiene are not effective alone
8) treatment aimed at elimination of A. a

Question 18

necrotizing ulcerative periodontitis

Answer 18

1) same symptoms of NUG and loss of attachment
2) treat as adult chronic periodontitis with antimicrobial therapy

Question 19

diabetes

Answer 19

1) type 1
- 10% risk of periodontitis
2) type 2
- 1% risk
3) delayed wound healing

Question 20

treat for diabetic periodontitis

Answer 20

1) OH and monitor
2) medical manage diabetes
3) minimize risk of infection
4) consider post op antibiotics

Question 21

trisomy 21

Answer 21

1) premature loss of perm lower incisors is common
2) recession
3) short roots
4) traumatic anterior occlusion (class III)
5) systemic immune factors
6) severe and rapid periodontitis
7) malocclusion may worsen it

Question 22

recurrent herpes labialis

Answer 22

1) primary herpetic gingivostomatitis
2) stress, trauma, Uv
3) virus is dormant in TG ganglion
4) vesicles erupt on perioral areas and attached mucosa
5) ulcers with red halos

Question 23

treatment of recurrent herpes

Answer 23

1) benzocaine topical
2) antiviral ointment
- effective if in prodromal stage
3) delay non emergent dental care
4) cry to avoid contact until all ulcers are crusted and dry

Question 24

aphthous ulcers

Answer 24

1) autoimmune
2) stress, trauma, foods, sodium lauryl sulfate
3) vesicles that erupt leaving ulcerations with red halos
4) avoid triggers
5) treat with benzocaine in patients >2 yrs
6) topical corticosteroids
7) systemic corticosteroids if severe (can increase risk of candidiasis)

Question 25

localized recession

Answer 25

1) most common in mandibular anterior
2) associated with minimal attached gingiva
- high frenum, malposed teeth
3) often due to teeth erupting outside of the eruptive trench
4) extract over retained primary teeth
5) prophylactic graft esp before ortho

Question 26

ankloglossia

Answer 26

1) high frenum on mandibular alveolar ridge and ventral tip of tongue
2) laser frenectomy
3) traditional surgical excision and sutures
- more risk of infection
4) nursing issues, speech issues, gingival recession, mouth breathing, risk factor for sleep disorder breathing

Question 27

mucocele

Answer 27

1) cyst like structure on lower lip
2) translucent blue, fluid filled
3) severed or blocked salivary duct
4) sometimes transient, sometimes recurs
5) treatment
- surgery
- high risk of recurrent
- 40% spontaneously resolve

Question 28

ranula

Answer 28

1) large mucocele on the floor at the mouth, may swell at meal times

Question 29

dental abscess

Answer 29

1) infection due to caries or trauma
- pulpal necrosis
2) treat with reducing infection source
3) extract or pulp therapy
4) no antibiotics if prompt drainage or definitive treatment
5) consider antibiotics in the presence of swelling

Question 30

facial cellulitis

Answer 30

1) dental, bone, or perio infection
2) IV antibiotics

Question 31

cheek biting

Answer 31

1) initially bleeding and ragged
- yellow and sloughed tissue
2) looks worse than it is
3) typically no pain, scarring or permanent damage
4) reassure patient, OH, antibiotics if pus or fever

Question 32

candidiasis

Answer 32

1) overgrowth of oral floral
2) immunosuppression, steroids, antibiotics, etc.
3) white plaques with erythematous mucosa
4) antifungals (nystatin)
4) treat underlying cause (Ex. rinse with water after each puff of steroid)