Periodontology in Paediatrics

Question 1

Describe the mnemonic

Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight

Answer 1

P - periodontal health
intact periodontium or reduced periodontium

G - Gingivitis: dental biofilm induced
intact periodontium
reduced periodontium

G - Gingival diseases and conditions that are not biofilm induced

N - Necrotising periodontal diseases

P - periodontitis

P - Periodontitis as a manifestation of systemic disease

S - systemic diseases or conditions that affect the periodontal supporting tissues

P - periodontal accesses and endodontic periodontal lesions

M - mucogingival deformities and conditions

T - traumatic occlusal forces

T - tooth and prosthesis related factors

Question 2

Describe a healthy periodontium

Answer 2

• gingival margin may be several millimetres coronal to the CEJ
• gingival sulcus may be 0.5-3mm deep
• alveolar crest is 0.4-1.9mm apical to the CEJ in teenagers

Question 3

What is the biologic width

Answer 3

the area/distance between the CEJ and the alveolar bone crest

Question 4

What are the potential diagnosis of a healthy periodontium

Answer 4

intact periodontium or reduced periodontium

Question 5

What to we need in order to diagnose periodontal health

Answer 5

• do a BPE

- <10% bleeding on probing

Question 6

What are the types of gingivitis

Answer 6

1. dental biofilm - induced (localised or generalised)

2. Non-dental biofilm induced

Question 7

Outline the steps of gingivitis caused by the dental biofilm

Answer 7

• As supra-gingival plaque accumulates on the teeth, an inflammatory cell infiltrate develops in gingival connective tissue
• This causes the junctional epithelium to become disrupted
• This allows apical migration of plaque and an increase in the gingival sulcus depth
• This gives rise to a gingival pocket, also called a false pocked or pseudo pocket

Question 8

is there loss of attachment in gingivitis

Answer 8

there is no periodontal loss of attachment

Question 9

what is the diagnosis of 10-30% bleeding on probing

Answer 9

localised gingivitis

Question 10

what is the diagnosis of over 30% bleeding on probing

Answer 10

generalised gingivitis

Question 11

describe the appearance, aetiology and risk factors of Necrotising Ulcerative Gingivitis

Answer 11

appearance

• blunted papillae
• malodour
• painful gingivae
• no attachment loss

Aetiology
- Fusiform and spirochete bacteria

Risk factors

• smoking, stress, immunosuppression, poor diet
• HIV positive
• common in developing countries
• trench mouth

Question 12

Describe pubertal gingivitis

Answer 12

• increased inflammatory response to plaque mediated by hormonal changes during puberty
• can progress to early periodontitis
• local and systemic factors and influence progression

Question 13

when do you diagnose non-dental biofilm-induced gingivitis

Answer 13

when the main etiological agent for gingivitis is not plaque

Question 14

Describe two drugs which can cause drug induced gingivitis

Answer 14

cyclosporin
- immunosuppressant used in patients with underlying immune conditions, such as crohn’s, or post organ transplants

Phenytoin
- anti epileptic medicine used in children with epilepsy

Question 15

What systemic diseases can lead to gingivitis

Answer 15

• agranulocytosis
• cyclic neutropenia
• crohn’s
• Sarcoidosis
• Granulomatosis

Question 16

What are examples of non biofilm induced gingivitis

Answer 16

infective 
genetic 
trauma 
systemic manifestations 
drug induced

Question 17

what is the treatment of gingivitis

Answer 17

• rigorous oral hygiene/home care
• frequent scaling
• surgery may be necessary if drug induced (refer to a specialist)

Question 18

What are the 4 main distinguishing features of periodontitis?

Answer 18

1. Apical migration of junctional epithelium beyond the CEJ
2. Loss of attachment of periodontal tissues to cementum
3. Transformation of junctional epithelium to pocket epithelium (often thin and ulcerated)
4. Alveolar bone loss

Question 19

What pathogens can cause periodontitis

Answer 19

• porphyromonas gingivalis
• prevotella intermedia
• aggregatibacter actinomycetemcomitans (AA)

Question 20

What should you look for when accessing the gingival condition

Answer 20

• gingival colour
• contour
• swelling
• recession
• suppuration
• inflammation (presence and location)

Question 21

what are some local risk factors for periodontal disease in children

Answer 21

• plaque retention factors
• low feral attachments
• malocclusion
• incompetent lip seal
• mouth breathing

Question 22

what age do you use a simplified BPE

Answer 22

all co-operative children aged 7 - 11 years old

Question 23

what probe do you use for a simplified BPE and how much pressure

Answer 23

WHO CPITN probe
(community periodontal index of treatment needs)

20-25g force

Question 24

what teeth do we carry out a simplified BPE on

Answer 24

16, 11, 26, 36, 31, 46

Question 25

what codes can be used for children aged 7- 11

Answer 25

codes 0, 1 and 2

Question 26

when do you do a full BPE on children

Answer 26

any patient 12 years and older

Question 27

what do you do if there are scores of 3 or 4 in BPE

Answer 27

6 point pocket chart (localised if 3, full if 4) check alveolar bone level (BW's for posteriors, periodicals for anteriors

Question 28

what should you encourage in patients with periodontal disease

Answer 28

- good toothbrushing - emphasis the need to clean all surfaced (brush Dj app is good) Standard toothbrushing and fluoride advice given to all patients - supervised/ assisted brushing up to 7 years old - disclosing tablets can be helpful - fluoride mouthwash of 225ppm should be recommended for patients undergoing appliance therapy