Pediatric Dentistry: Gingival & Periodontal Disease

Gingiva and Periodontium

• Gingiva: mucosal tissue covering alveolar processes of maxilla and mandible, extending from mucobuccal fold to neck of each tooth
• Anatomy: papillary (interdental papilla), marginal (surrounds neck of tooth), and attached (between marginal gingiva and mucobuccal fold)

Morphological Differences between Adult and Pediatric Gingiva

• Adult: pale pink, firmly bound to alveolar bone, stippling varies from fine to coarsely grained, sharp knife-like edge gingival margin
• Pediatric: more reddish, flabby, lack of stippling, rounded and rolled margins, greater depth of gingival sulcus, presence of interdental clefts

Gingival Histology

• Epithelium: thinner and less keratinized
• Lamina propria: shorter connective tissue papillae, less fibers
• Cementum: thinner, less dense
• Periodontal membrane: wider, fiber bundles less dense with fewer fibers, greater blood supply
• Alveolar bone: thinner lamina dura, fewer trabeculations, wider marrow spaces, decreased degree of mineralization, greater blood supply

Gingivitis and Periodontitis in Children

• Gingivitis is more common and transient, while periodontitis is rare and chronic
• Why gingivitis rarely progresses to periodontitis in prepubertal children:
  • More anabolic activity due to increased metabolism
  • Altered composition of dental plaque
  • Absence of bacteria responsible for periodontal disease

Definition and Classification of Gingivitis and Periodontitis

• Gingivitis: inflammation involving gingival tissues next to the tooth, characterized by inflammatory exudates, edema, and destruction of collagenous gingival fibers
• Periodontitis: inflammation of the gingiva and deeper tissues of the periodontium, characterized by pocket formation and destruction of supporting alveolar bone
• Classification:
  • Simple gingivitis
  • Chronic non-specific gingivitis
  • Gingival diseases modified by systemic factors
  • Acute gingival disease
  • Gingival diseases associated with the endocrine system

Gingival Diseases

• Eruption gingivitis: temporary type of gingivitis associated with eruption, subsides after eruption
• Gingivitis associated with poor oral hygiene: mild, reversible type of gingivitis due to lack of good oral hygiene practices
• Allergy and gingival inflammation: increased gingival inflammatory reaction in allergic children, especially during pollen season

Periodontitis as a Manifestation of Systemic Disease

• Neutropenia
• Papillon-Lefèvre Syndrome
• Leukemia
• Diabetes mellitus
• Down syndrome
• Hypophosphatasia
• Histocytosis X

Prepubertal Periodontitis

• Usually seen in children less than 11 years of age
• No or very little dental plaque or calculus
• Disease progression is rapid and destructive, primarily affecting primary molars and incisors
• Usually associated with systemic disease

Aggressive Periodontitis

• Common in children
• Types: localized or generalized
• Clinical picture: rapid attachment and bone loss, little or no tissue inflammation, very little dental plaque or calculus
• Microorganisms: Porphyromonas gingivalis, Actinomycetem comitans, Fusobacterium nucleatum, Bacteroids
• Treatment: systemic antibiotics (Metronidazole + Tetracyclines), PDL surgery

Periodontitis as a Manifestation of a Genetic Disorder

• Papillon-Lefèvre syndrome or Hyperkeratosis palmoplantaris: rare genetic disorder, associated with severe gingival inflammation and exfoliation of primary and permanent teeth, hyperkeratosis of palms and soles
• Treatment: complete denture