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Gingivitis and Periodontal Disease Flashcards

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1
Q

Anatomy of the Periodontium in children compared to adults

A
  1. More red
  2. Lower prevalence of periodontal disease: Junctional epithelium is thicker -> Less permeable to toxins -> More resistant to inflammation
  3. Enhanced rate of progression of periodontal disease
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2
Q

Why is gingiva in children more red?

A

Increased vascularity of marginal gingiva and thinner epithelium

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3
Q

Why is there a lower prevalence of periodontal disease in children?

A

Junctional epithelium is thicker -> Less permeable to toxins -> More resistant to inflammation

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4
Q

Why is there an enhanced rate of progression of periodontal disease?

A

PDL space is wider, less fibrous, and more vascular. Alveolar bone has larger marrow spaces, greater vascularity and fewer trabeculae

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5
Q

Criteria for Gingival Health

A

Probing attachment loss: No

Probing pocket depths ≤ 3mm

Bleeding on probing: <10%

No radiographic bone loss

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6
Q

Criteria for Gingivitis

A

Probing attachment loss: No

Probing pocket depths ≤ 3mm

Bleeding on probing: ≥10%

No radiographic bone loss

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7
Q

Describing Gingivitis

A

Extent: Localised or generalised

Severity: Mild, moderate or severe

e.g. Generalised moderate gingivitis, biofilm-induced, intact periodontium

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8
Q

Examples of modifying factors

A
  1. Systemic factor
    - Sex steroid hormones
    - Hyperglycemia
  2. Local factors
    - Dental plaque biofilm retention factors
  3. Drug-induced gingival enlargements
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9
Q

Drugs associated with gingival enlargement

A

Phenytoin, cyclosporine, nifedipine

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10
Q

Clinical characteristics of drug-induced gingival enlargement

A

Higher prevalence in younger age groups

More often in anterior

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11
Q

Proposed pathophysiology of drug-induced gingival enlargement

A
  1. Increase inflammatory cytokines
  2. Increase fibroblasts
  3. Increase collagen accumulation
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12
Q

Management of drug-induced gingival enlargement

A
  1. Plaque control
  2. Control inflammation
  3. Alternate drug choice
  4. Surgical intervention
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13
Q

Complication of drug-induced gingival enlargement

A

Retained primary teeth

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14
Q

Examples of mechanically induced gingival trauma

A

Self-inflicted or habitual: Nails, toys, toothpicks, zips

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15
Q

Etiology of Primary Herpetic Gingivostomatitis

A

HSV-1

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16
Q

Clinical Characteristics of Primary Herpetic Gingivostomatitis

A
  1. Prodrome of 2-4 days: Fever, malaise, headaches, cervical lymphadenopathy
  2. Generalised gingival inflammation, vesicles that rupture into ulcers.
  3. Resolves in 10-14 days
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17
Q

Management of Primary Herpetic Gingivostomatitis

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A
  1. Oral acyclovir within first 72 h
  2. Symptomatic care: Anti-pyretics, hydration advice, soft diet
  3. Chlorhexidine mouthwash to prevent secondary infection
  4. Review 7-10 days later
18
Q

Complication of Primary Herpetic Gingivostomatitis

Study These Flashcards
A

Meningitis, encephalitis

19
Q

Differential Diagnosis of Primary Herpetic Gingivostomatitis

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A
  1. HFMD
  2. Herpangina
20
Q

Predisposing factors of Necrotizing Periodontal Disease

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A

Impaired host immune system: HIV, stress, malnutrition

21
Q

Clinical Features of Necrotizing Periodontal Disease

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A
  1. Necrosis and ulceration in interdental papillae
  2. Pseudomembrane formation
  3. Gingival bleeding
  4. Halitosis
  5. Pain
22
Q

Treatment of Necrotizing Periodontal Disease

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A
  1. Scale away superficial plaque and calculus
  2. Reduce stress, remove overhanging margins
  3. Gingival flap surgery if needed
23
Q

Complications of Necrotizing Periodontal Disease

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A

Progress to necrotizing ulcerative periodontitis or spread as necrotizing stomatitis or noma

24
Q

What is the implicated infecting agent in early onset periodontitis?

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A

A.actinomycetemcomitans

25
Periodontitis as Manifestations of Systemic Diseases - Genetic Disorders
Trisomy 21, Papillon-Lefevre, Chediak Higashi
26
Periodontitis as Manifestations of Systemic Diseases - Metabolic and Endocrine Disorders
Hypophosphotasia, diabetes mellitus
27
Periodontitis as Manifestations of Systemic Diseases - Hematologic/immunologic conditions
Cyclic neutropenia, Leukocyte adhesion deficiency, Langerhan cell histiocytosis, Leukemia
28
Periodontitis as Manifestations of Systemic Disorders - Connective Tissue Disorders
Ehlers Danlos syndrome, Systemic lupus erythematosus
29
Periodontitis as Manifestations of Systemic Disorders - Inflammatory conditions
Epidermolysis bullosa, Inflammatory bowel disease
30
Why does Down Syndrome lead to higher susceptibility of periodontal disease?
1. Defective phagocytic function 2. Possible defect in collagen 3. Inappropriate regulation of matrix metalloproteinases 4. Poor OH
31
What is Papillon-Lefevre Syndrome?
1. Autosomal recessive 2. Deficiency in cathepsin C-central coordinator of activation of many proteases in immune cells 3. Palmoplantar keratosis 4. Premature exfoliation of most primary teeth by 4 years old and permanent teeth by 18 years old
32
Management of Papillon-Lefevre Syndrome
Plan for prosthesis and good OH
33
What is Hypophosphatasia?
1. Deficiency of serum alkaline phosphatase 2. Increased urinary excretion of phosphoethanolamine and defective bone and tooth mineralization -> Cementum hypoplasia/aplasia -> Premature exfoliation of primary teeth
34
What is Langerhan Cell Histiocytosis?
Abnormal proliferation of langerhan cells and infiltration to bones, skin, liver and other organs
35
Oral Manifestation of Langerhan Cell Histiocytosis
1. Mandible 2. Granulomas -> Gross bone -> Destruction (floating teeth) -> Hypermobility of teeth -> Premature exfoliation
36
Oral Manifestations of Leukemia
Gingival enlargement due to infiltrates of leukemic cells
37
Examples of Mucogingival Deformities and Conditions
1. Traumatic occlusion 2. High frenal attachments
38
Clinical Periodontal Assessment in Children
1. Visual inspection - Observe shape of gingival margins and colour - Assess height of interproximal crestal bone on radiographs - Record plaque disclosing agents to identify sites where it may be contributing to gingivitis or caries 2. Routine screening for mixed and early permanent dentitions 3. If it is challenging to probe, screen six index teeth #16, #11, #26, #26, #31, #46
39
Recommendations for toothbrush
1. Small-headed toothbrush 2. Medium texture bristles 3. Powered toothbrush with rotation oscillation action 4. Supervised toothbrushing to at least 7 years old
40
When should children start flossing?
10 years old
41
When should you refer a child to a specialist dentist?
1. Unexplained premature exfoliation 2. Gross mobility of primary teeth 3. Red oedematous gingiva and/or suppuration with no dental cause

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