Periodontal disease in children Flashcards
What are the risk factors for gingivitis and periodontitis?
Microbial plaque
Plaque retentive factors, e.g. calculus, restoration margins, ortho appliances
Malocclusion
Crowding
Irregular teeth
Mouth breathing and incompetent lips
Ectopic eruption of teeth
Trauma
Leukaemia
Immunosuppression
Hormones - can cause onset of perio
Under 16s may smoke
SSCs poorly adapted margins
Diabetes type I
Vit C deficiency
Phenytoin, cyclosporin, nifedipine
3 components of periodontal examination
Med and dental history
Radiographic assessment
Clinical exam/chart
What is the modified BPE?
Used after eruption of incisors and first permanent molars
WHO 621 probe
6 sites per tooth: all 6s, UR1 and LL1
Codes up to 2 in 7-11
Full range in 12-19
Pockets detected, should do full mouth assessment
Pockets likely in primary due to resorbing teeth and higher bone crest levels
Describe the dental biofilm associated with gingivitis
- dental plaque only
- modifying factors, endocrine system
- puberty associated gingivitis
- diabetes mellitus associated gingivitis
- blood disorders e.g. leukaemia
- gingival disease modified by meds
- malnutrition (vit C def)
Drug induced gingival hyperplasia
Similar effect irrespective of which drug is used
Anterior part of mouth is most affected
Aesthetics, eating and speaking impaired
Risk factors, presence of plaque and gingival inflammation
Recurrence of inflammation even if gum surgery is carried out (gingivoplasty/gingivectomy)
Gingival diseases of viral origin
Primary herpetic gingivostomatitis
- acute infectious disease caused by herpesvirus
- child develops febrile illness, headache and pain
- Usually between 2-5 years of age
Tx of gingival disease of bacterial and viral origin
Brushing with a soft, multi-tufted brush
Systemic antibiotic therapy - metro 200-250mg 3x/day for 3 days
CHX 0.2% mouthwash for 1m over 7 days (swab to apply topically for smaller children)
Oxidising mouth rinse, H2O2 (3%)
Mechanical debridement with US scaler (self limiting, review in 7-10 days)
When does gingivitis become periodontitis?
Local or generalised inflammation of the gingivae extending into the adjacent attachment apparatus
CAL and destruction of periodontal bone and PDL
Caused by plaque but progression is modified by individual susceptibility and host’s individual response
Diagnostic features of perio
Localised first molar/incisor show interproximal attachment loss on at least two permanent teeth
Plaque levels low
Can have onset of 13-14y or older
Interpret CAL of 1-2mm
Presence of plaque/subgingival calculus
Pockets of 4-5mm
Initial subclinical lesion occurs within the first 4 days of plaque accumulation
Perio and associated systemic disorders
Associated with haematological disorders
Acquired neutropenia
Leukaemias and associated thrombocytopenia
Neutropenia
May be idiopathic
Viral origin manifestations
Pain
ID papilla necrosis
Bleeding
Odour
Predisposing factors - stress, HIV, infection, poor diet, immunosuppresion
How does Downs syndrome effect periodontal disease?
Can begin in primary dentition which continues into permanent dentition
increased prevalence and severity of periodontal disease in children of older age gps
How does neutropenia cause perio?
Ulceration and necrosis of gingival margin
Bleeding from gums and attached gingiva
Lesions can show deep periodontal pockets and extensive, generalised bone loss
Bone resorption may be seen in the deciduous dentition
Leukaemia and perio
Leukaemia = 30% of childhood cancers
Leukaemia and perio
Leukaemia = 30% of childhood cancers
Acute lymphoblastic leukaemia most common
Gingival swelling is a feature of acute monocytic leukaemia (young people)
Gingival bleeding is due to thrombocytopenia
