W9-Gingival Disease in Childhood.pdf

1.12.2023 Gingival Diseases in Childhood Assisst. Prof. Ece RAKUNT TOPTAŞ School of Dental Medicine Department of Periodontology Istanbul [email protected] 1 Newman and Carranza`s Clinical Periodontology Newman Takei Klokkevold Carranza Chapter 21 2 1 1.12.2023 Learning Outcomes 1....

1.12.2023 Gingival Diseases in Childhood Assisst. Prof. Ece RAKUNT TOPTAŞ School of Dental Medicine Department of Periodontology Istanbul [email protected] 1 Newman and Carranza`s Clinical Periodontology Newman Takei Klokkevold Carranza Chapter 21 2 1 1.12.2023 Learning Outcomes 1. Periodontium of the Primary Dentition 2. Gingival Diseases of Childhood 3. Periodontal Diseases of Childhood 4. Therapeutic Considerations for Pediatric Patients 3 Periodontium of the Primary Dentition ØIn the edentulous infant, the gingival tissues have thick gingival mucosa ØA high labial frenum attachment is normal in almost 85% of infants; it will diminish in size with normal development. ØThe tissues are pale pink (but they are pink to a lesser degree than the attached gingiva of adults) 4 2 1.12.2023 Periodontium of the Primary Dentition Stippling appears at about 3 years of age (It has been reported for 56% of children between 3 and 10 years of age) The interdental gingiva is broad buccolingually and narrow mesiodistally, which is consistent with the morphology of the primary dentition Gingival sulcular depth is shallower in the primary dentition than in the permanent dentition. Probing depths range from 1 to 2 mm, with increasing depth from anterior to posterior The gingival width normally increases with age as children transition from the primary to the permanent dentition. 5 Periodontium of the Primary Dentition Radiographically, the lamina dura is prominent in the primary dentition, with a wider periodontal space than in the permanent dentition. The marrow spaces of the bone are larger, and the crests of the interdental bony septa are flat, with bony crests within 1 to 2 mm of the cementoenamel junction 6 3 1.12.2023 Periodontal Changes Associated With Normal Development Ø Before the eruption of a primary or permanent tooth, the gingiva reveals a bulge that is firm and pink or blanched as a result of the underlying tooth crown. Ø There may be eruption cyst. It is bluish or deep red enlargement of the gingiva over the erupting tooth filled with blood. The most common sites of these cysts are the primary first molars and the permanent first molars. Many resolve without treatment, but they can be marsupialized if they are painful or interfere with occlusion 7 Periodontal Changes Associated With Normal Development 1. Relation of Periodontal Status to Malocclusion: 2. Mucogingival Problems: High frenulum attachment and gingival recession • Crowding in the mixed dentition can often make plaque and food removal more difficult, increasing the likelihood of gingivitis. • Rotations/labial positioning during the mixed dentition (lower anterior region) • Late-erupting canines can be displaced buccally, erupting into or near unattached gingiva or mucosa and increasing the risk of insufficient gingival tissue width and recession • Self habits like fingernail pressure and excessive toothbrushing 8 4 1.12.2023 Gingival Diseases of Childhood Plaque-Induced Gingivitis: Ø Change in color, size, consistency and texture of the gingiva similar to adults Ø Red, linear inflammation with swelling, increased vascularization and gingival hypertrophy (pdeudopocket) Ø Gingivitis is highly prevalent among children, its severity usually is less intense than that found in adults. Ø Similar oral hygiene conditions produce less severe forms of disease in children compared with adults. Ø Primary cause of gingivitis is dental plaque, related to poor oral hygiene Ø Calculus deposits are uncommon in infants and toddlers, but they can increase with age 9 Gingival Diseases of Childhood Eruption Gingivitis: Ø Gingiva around erupting teeth may appear red because gingival margins have not yet keratinized fully and sulcus development is incomplete Ø Tooth eruption does not directly cause gingivitis but plaque accumulation increases around these teeth Ø There is pain during brushing 10 5 1.12.2023 Gingival Diseases of Childhood Puberty Gingivitis Ø The incidence of gingivitis increases as a child matures, peaking when he or she is 9 to 14 years old and then decreasing slightly after puberty Ø The most frequent signs of puberty gingivitis is bleeding, inflammation in interproximal areas and gingival enlargement Ø The altered gingival response during this developmental stage is thought to be the result of hormonal changes 11 Gingival Diseases of Childhood Drug Induced Gingival Enlargement Ø Drugs using to treat conditions that are seen childhood like organ transplantation, epilepsy, cardiac anomalies, increase the prevalence of gingival enlargement Ø Cyclosporine, phenytoin, and calcium channel blockers Cyclosporine-induced gingival hyperplasia. (B) The same patient 1 year after gingivectomy and 6 months after the dosage of cyclosporine was decreased to one-half of the initial dosage 12 6 1.12.2023 Gingival Diseases of Childhood Gingival Changes Related to Orthodontic Appliances Ø Gingival enlargement can be related to the presence of fixed orthodontic appliances, which complicate plaque removal. Ø Gingival changes can occur within 1 to 2 months of appliance placement. Ø The most orthodontic treatment is provided to individuals during puberty, when they tend to have inflammatory changes associated with puberty gingivitis. This may exacerbate the effect. Gingival Diseases in Childhood© Dr. Fatma ONER 13 Gingival Diseases of Childhood Mouth Breathing ØMouth breathing and lip incompetence (gingiva is not covered with the lip) , together referred to as an open mouth posture ØIt is associated with increased plaque and gingival inflammation. ØThe area of inflammation is often limited to the gingiva of the maxillary incisors. 14 7 1.12.2023 Non–Plaque-Induced Gingival Lesions v Primary Herpetic Gingivostomatitis Ø The most common clinical manifestation of primary herpes simplex virus infection Ø Acute-viral infection occurs early during childhood (ages 1-3) Ø Symptoms are; ü Significant gingival inflammation and ulceration of the attached gingiva, tonque, palate and lips ü Discomfort on swallowing ü Oral and peri-oral ulceration Ø Treatment is; ü Maintain fluid intake ü Analgesics for discomfort and fever ü Topical antiviral preparation to limit the symptoms 15 • Periodontal Diseases of Childhood Ø Aggressive Periodontitis Ø Gingival Manifestation of Systemic Disease in Children; Systemic diseases that result in periodontitis occur more frequently in children than adults ü Type-1 diabetes mellitus • Premature tooth loss • Appears around the time of puberty and become progressively worse as children mature into adulthood. ü Leukemia • Acute lymphocytic leukemia accounts for most cases among children who are younger than 7 years of age. • Leukemia must be considered as part of the differential diagnosis for children who have acute gingival enlargement, ulceration, bleeding, and infection !!!!! 16 8 1.12.2023 Periodontal Diseases of Childhood Ø Neutrophil Disorders ü Neutrophil disorders impair defenses against infections, ü Many neutrophil disorders are genetic, (neutropenia, Chédiak–Higashi syndrome, leukocyte adhesion deciency, Papillon– Lefèvre syndrome, and Cohen syndrome) ü The diagnosis of the systemic disorder usually occurs before any signs of periodontal destruction appear. ü Disease management includes oral hygiene measures, mechanical debridement, antimicrobial therapy, and supportive care ü Treatment success is unpredictable because of the impact of systemic disease. 17 Periodontal Diseases of Childhood Ø Congenital Anomalies ü Down syndrome is congenital condition that is diagnosed before the expression of periodontal disease. üPeople with Down syndrome experience a high prevalence of severe aggressive periodontitis during early adulthood. 18 9 1.12.2023 Therapeutic Considerations for Pediatric Patients Ø Medical and dental histories should be recorded for each child (from parents) Ø If there isn`t sign of aggressive periodontitis, periodontal indices do not need to be recorded during the primary dentition Ø More explicit periodontal assessments should begin during mixed dentition, when children have permanent incisors and first molars (with notes made regarding gingival health, bleeding on probing, and degree of calculus. ) Ø This quick screening usually is sufficient for children up to the age of 11 years. Ø Between the ages 12 to 19 years, when most individuals have a full permanent dentition, pocket depths of more than 4 mm should be recorded. 19 Therapeutic Considerations for Pediatric Patients Ø Calculus deposits are uncommon in infants and toddlers. Supragingival plaque removal with the use of simple rubber-cup coronal polishing or a toothbrush is usually sufficient during the primary dentition. Ø If calculus deposits are evident, selective supragingival scaling can be performed. Ø For children younger than 7 years of age, parents should assist with toothbrushing Ø Mechanical toothbrushes with rotary heads are effective for plaque removal. The use of these devices can be encouraged as soon as children are able to tolerate the vibrating sensation Ø Flossing is usually not indicated for children during the primary dentition stage because most children have interdental spacing when interdental contacts develop, flossing should be added to the home care routine. Ø Antimicrobial mouth rinses for chemical plaque control are not indicated for very young children because of the risk of ingestion of chemical agents. 20 10 1.12.2023 Conclusion ØThe periodontium of the primary dentition is different from permanent dentition. ØNormal development can result in changes to the periodontium. ØPlaque-induced gingivitis is very common in children, although it may be less intense than in adults. Ø With the exception of localized aggressive periodontitis, children rarely show signs of periodontitis. ØSome systemic disorders that are commonly associated with periodontal disease manifest initially during childhood 21 Thank you for listening 22 11