Puberty

Question 1

State the stages of development during puberty (ages):
10 - 21 years
10 - 13 years 
14 - 17 years
18 - 21 years

Answer 1

• Starts at ages 10 to 21 years
• Early adolescence 10 to 13 years
• Middle adolescence 14 to 17 years
• Late adolescence 18 to 21 years

Question 2

Discuss the 2 major mental changes that occur for those going through puberty and its relevance to dental care

Answer 2

Psychological and social changes:
• Independence from parents
• Adoption of peer codes/lifestyles
• Increased importance to body image and self interest
• Establishment of sexual, ego, vocational and moral identities

Anxiety:
• Health problems, substance abuse, social issues, family arguments, school performance etc.

Relevance to dental care:
• Important for professional to understand patterns of growth and development

Question 3

Discuss the concept of periodontal diseases in children, when it is diagnosed and with a special focus on the responsible pathogen

Answer 3

Description
• Severe bone loss involving 1st molars and incisors, with proximal surface attachment loss on at least 2 permanent teeth

Diagnosed:
• Often circumpubertal (around puberty)

Pathogen:
• Actinobacillus actinomycetemcomitans

Question 4

Discuss the oral conditions often associated with puberty/ adolescence (7)

Answer 4

• Oral manifestations of STI’s
• Effects of tobacco, cocaine or other drug use
• Potential effects of oral contraceptives
• Oral findings of anorexia or bulimia
• Traumatic injury to teeth & oral structures
• Body piercings in orofacial regions
• Possibility of periodontal disease in children (bone loss on 1st molars and incisors with proximal surface attachment loss)

Question 5

State the causes of characteristic oral manifestations experienced during puberty

Answer 5

• During puberty, an increased level of hormones, such as progesterone and possibly oestrogen, cause increased blood circulation to the gums.
• This may cause an increase in the gum’s sensitivity and lead to a greater reaction to any irritation, including food particles and plaque

Question 6

Discuss the oral side- effects of contraceptives and its dental management

Answer 6

• Gingivitis is similar to that described for pregnancy
• Exaggerated response to dental biofilm and other local irritants
• More exudate in inflamed tissues than with pregnancy

Dental management
• Medical history: should include their use
• Inform patient and explain need for exceptional personal oral care and regular professional care

Question 7

Discuss the oral side- effects of the menstrual cycle (6)

Answer 7

• Vigorous immune response to local irritants
• Unusual gingival bleeding
• Gingival inflammation, triggered by imbalance and increase in sex hormones (progesterone and estrogen) which modify immune response
• Increased permeability of microvasculature
• Production of prostaglandins (PGE2)
• PMN chemotaxis enhanced

Question 8

Discuss the role of the Oral Health Therapist when treating patients during puberty

Answer 8

• Focus on dental biofilm control
• Impact of Care: Information, education and guidance will form attitudes and health behavior practices

Patient Approach:
○ Each situation requires own approach
○ Be attentive; show interest
○ Do not lecture or admonish; highlight positive
○ Give information with scientifically based explanations