Periodontal Problems in Kids

8/13/2019 Periodontal Problems in Kids

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Periodontal Problems

inChildren

Based on a presentation by D. F. Duperon,Chair, Pediatric Dentistry, UCLA(adapted by Callum Durward)


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Normal Gingiva in Children

In contrast to adults:

Round and/or rolledmargins

Greater sulculardepth

Epithelium thinner


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Normal Gingiva in Children cont.

Less stippling

Decreased fiber

density May be pigmented

Loss of attachment

and true pocketsrare


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Periodontal Conditions AffectingChildren and Adolescents

1. Gingivitis

Swelling, redness, bleeding

Not painful

Plaque induced

Can be cured by improved oral hygiene(not scaling!)


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Marginal Gingivitis

Marginal gingivitis


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What factors contribute togingivitis in childhood and

adolescence?LOCAL FACTORS

Erupting teeth

Poor oral hygiene

Restoration overhangs

Calculus (covered by plaque)

Crowded teeth

Mouth breathing

Orthodontic appliances


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Mouthbreathing:

Chronic drying oftissue

Tacky plaquehardto remove

Red, inflamed andenlarged gingiva

May be ENT and/ororthodontic problem


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Gingivitis cont.

SYSTEMIC FACTORS

Hormonal changes eg pregnancy andpuberty

Diabetesif poorly controlled

HIV or other immune disorders


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2. Primary Herpetic Gingivo-Stomatitis (H.S.V. Type 1*)

@ *Can also be Type 2


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Symptoms and signs:

Fever (>38oC)

Anorexia and malaise

Sub-mandibular gland swelling Reddened bleeding gingiva

Multiple vesicles and painful ulcers on gingivaand soft oral tissues

Lasts 10-14 days

Primary infections may be mild or sub-clinicalin many children

@


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Secondary Herpes Infections

Virus becomes latent in TG ganglion or basalganglia of brain

Secondary infection usually presents as

herpes labialis (cold sore) on the lip Reactivated by eg trauma, heat, hormones,

sunlight, stress, immunosuppression,(theadmistration of agents that significantly interfere with the ability of theimmune system to respond to antigenic stimulation by inhibiting

cellular and humoral immunity)concurrent infectionVirus can also infect finger of child or dental

therapist (if not wearing gloves)


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Treatment:

Drink plenty of fluids Soft bland diet Paracetamol

Antiviral agents (only in some severe cases) egAcyclovir

Antibiotics for secondary infections Gentle cleaning (may not be able to use toothbrush if

very painful)can use mouth rinses (eg CHX,

Difflam or Na bicarbonate/salt)wipe around mouthwith cotton wool if too young to rinse

IN SEVERE CASES WHERE THE CHILD IS NOTDRINKING (or is immunocompromised) MAY NEEDTO ADMIT TO HOSPITAL


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3. ANUG

Acute Necrotizing Ulcerative Gingivitis

SIGNS ANDSYMPTOMS:

Ulceration ofinterdental papillae(very painful)

Foul breath

Rapid Progression Fever

Lymphadenopathy


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Predisposing Factors

Adolescents and young adults

Poor OH, calculus

Stress, poor nutrition, reduced

immunity eg HIVNote:caused by bacteriagram negative

fusiform bacilli and spirochaetes


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ANUG Treatment

Investigate possibleunderlying medicalproblem

Local debridement

Mouth-rinse eg CHXor H202

Antibiotics: Amoxycillin

Metronidazole(Flagyl)

Advanced ANUG


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4. Gingival Enlargements:

Drug induced - Dilantin, Cyclosporin, calcium channelblockers (eg Nifedipine), Vigabactrin, Na valproate

Inflammatorychronic gingivitis

(puberty/pregnancy) Congenitalhereditary gingival fibromatosis,

mocopolysaccharoidoses

Haematologicalleukaemia, aplastic anaemia, vit C

deficiency (scurvy) Other Conditions

Eruption cysts

Opercular flaps


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Dilantin Hyperplasia

Dilantin (phenytoin) used in epilepsytreatment

Incidence: 662%.

Begins between 2 weeks to 3 months.

Dose and duration not significant.

Worsens with poor oral hygiene.

Occurs only on attached gingiva.


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Adolescent Patient


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Treatment:

Discontinue Dilantin (Dr must decide ifalternatives acceptable).

Increase home care. OHI, chlorhexidine, and flossing

Periodontal surgery.


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Cyclosporin A

Often used in children who have hadtransplants

An anti-rejection drug

Up to 100% of children on this drug getgingival enlargement


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Cyclosporin AGingival Enlargement

Moderate enlargement. Will require surgery.


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Treatment:

Discontinue and substitute drug.

Increased hygiene and plaque control.

Chlorhexidine mouthwash.

Gingivectomy.


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Pre-operative Cyclosporine

Severity increased by inflammation from brackets


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Immediate post operative

One-week post operative Two-week post operative


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5. Other gingival conditions:a. Eruption Cysts:

Treatment:

None if not causing

problemsusuallyresolvespontaneously

Incise tissue over

crown (after topical)refer for this


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b. Acute Allergic Reaction

To any allergen:

Latex

Nickel Cinnamon and other

spices

Treatment: Remove allergen

Allergy to a type of chewing gum


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c. Pyogenic Granuloma

Associated with a local irritant

Hormonal changes predisposes


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6. Periodontal bone loss causingpremature tooth loss

Unexplained premature tooth loss must beinvestigated!

Childhood Hypophosphatasia. Papillon Le Fevre Syndrome. Cyclic or Familial Neutropenia. Histiocytosis X. Iatrogenic.(originating as a result of professional care; for eg an

iatrogenic dermatisis ).

Juvenile periodontitis (pre-pubertal andpubertal forms)


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a. Childhood Hypophosphatasia

A metabolic disorder

Low serum alkaline phosphatase.

Excretion of Phosphoethanolamine.

Elevation of serum phosphorus.

@


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Hypophosphatasia - Dentalfindings:

Premature loss ofprimary teeth (oftenbefore age 2).

Minimalinflammation

Loss of alveolar

bone.Abnormal or

absence ofcementum.


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b. Papillon Le-Fevre Syndrome

Hereditary condition

Premature tooth loss

Severe inflammationand bone loss

Both deciduous andpermanent teeth

Edentulous by 16yrs

Intensive therapy

has little effect@


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Papillon Le-Fevre Syndromeextensive periodontal disease in young patients accompanied by keratotic lesion.

HyperkeratosisPalmaris.

HyperkeratosisPlantaris.

c s ocy os s = anger ans


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c. s ocy os s = anger ansCell Histiocytosis a group of disease characterized byabnormal histiocyte activity.includes a chronic disseminated type and a chroniclocalized type.

Includes several diseases.

All have a proliferation of Langerhans

cells. Infiltrating histiocytosis of hard and/or

soft tissues.

Premature resorption of bone and lossof primary teethon X-ray appear tobe floating in air.


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Histiocytosis X.

2 year-old male: Mesial cusp of first perm. molar


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Histiocytosis X.

3 year-old male.


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d. Familial Neutropenias

Can be chronic, cyclic or intermittentforms

May suffer from: Recurrent pneumonia.

Skin and other infections.

Mouth ulcerations.

Periodontal disease.

May improve once they reachadolescence.


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Chronic (familial) Neutropenia

8 year-old female


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Cyclic Neutropenia

Periodic episodes of fever and oralulcerations.

Periods of profound neutropenia.

Onset by 10 years of age.

19-21 day cycle.

Course: usually benign.


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Cyclic Neutropenia

17 year-old female


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Acquired Neutropenia

9 year-old male


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7. Self-induced Trauma

3 year-old male


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Fingernail Trauma.


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Toothbrush trauma

Toothbrushing injury in a psychotic child


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Self Mutilation

Congenital insensitivity to pain

Lesch-Nyhan syndrome (hereditary disorder of purinemetabolism characterized by mental retardation ,self-mutilation of the fingers and lip bybiting, impaired renal function ,and abnomal physical development.)

8 J il P i d i i


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8. Juvenile Periodontitis(includes pre-pubertal and pubertal forms)

Prevalence: 0.1 to 0.76%.

Higher in some ethnic groups eg Black males.

Localized or generalized. Lack of clinical gingival inflammation.

Mobility and migration.

Vertical bone loss especially around first

molars and incisors.Actinobacillus Actinomycetemcomitans (AA)

and Capnocytophagia

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Classic juvenile periodontitis

Caution! First sign may be mobile teeth!

Begin periodontal probing in children at10 years of age.

Check PBWs for bone loss


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Classic Juvenile Periodontitis

11 year-old African-American female


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Treatment:

Local debridement.

Periodontal surgery.

Antibiotics: Amoxycillin, metronidazole,tetracyclines.


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One year post operativePre-opertative

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Periodontal Problems in Kids