Pediatric Dentistry: Gingival & Periodontal Disease

Study Notes

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)

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

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 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

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

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

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

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

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