Pediatric gingivitis & periodontitis. PPT

December 13, 2011 | By | Reply More

Pediatric gingivitis & periodontitis. PPT

Pediatric gingivitis & periodontitis. PPT

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Dr. Md. Haider Ali Khan

Asstt. prof. of Dental Public Health

Dhaka Dental College



Gingivitis is an inflammatory process limited to the mucosal epithelial tissue surrounding the cervical portion of the teeth and the alveolar processes of gingiva.

Gingivitis is a reversible dental plaque-induced inflammation limited to the gingiva, and it is common in children as young as five years of age.



Periodontal diseases affect the dental supporting structures, primarily the gingiva and alveolar bone

Periodontitis is usually accompanied by gingivitis but involves irreversible destruction of the supporting tissues surrounding the tooth, including the alveolar bone



  • The initial stage of an acute exudative inflammatory response begins within 4 or 5 days of plaque accumulation. Both gingival fluid and transmigration of neutrophils increase.


  • Deposition of fibrin and destruction of collagen can be noted in the initial stage


  • As chronic local inflammation progresses, pockets develop where the gingiva separates from the tooth.


  •  These pockets deepen and may bleed during tooth brushing, flossing, and even normal chewing.


  • As this persistent inflammation continues, periodontal ligaments break down and destruction of the local alveolar bone occurs. Teeth loosen and eventually fall out.


Food accumulation around the teeth


Dental Plaque as a causative factor:

  • Plaque is yellowish gray deposition on the tooth surface
  • Many species of bacteria are involved to form plaque.
  • Plaque is made of bacteria, mucus, and small particles of food
  • Secondary colonization occur by intermolecular interaction
  • Plaque is responsible for both dental caries & gingivitis


Plaque causing gingivitis


Some Children are more prone to getting gingivitis than others:

  • Puberty
  • Vitamin C deficiency (scurvy)
  • Niacin (vitamin B3) deficiency (pellagra)
  • Poorly aligned teeth
  • Poorly fitted mouth appliances (such as retainers or crowns)
  •  Child with diabetes, AIDS, or leukemia.


Some medications are also associated with gingivitis:

  • Cyclosporine* (used to treat rheumatoid arthritis and other autoimmune diseases)
  • Phenytoin (used to control epilepsy and other seizures)
  • Calcium channel blockers such as nifedipine (used treat high blood pressure and other heart conditions)


Other causes


–   Inadequate plaque removal

–   Blood dyscrasias

–   Allergic reactions

–   Chronic debilitating disease

–   Poor nutrition

–   Lack of periodic dental examinations


 Age & Sex


  • Gingivitis is slightly more prevalent in males than in females because females tend to have better oral hygiene


  • Adults are most commonly affected.


  • Children from sub-Saharan regions of Africa may be at risk for ANUG because of poor living conditions.



Classification of gingivitis:

Based on clinical appearance





Based on etiology





-plaque induced)

Based on duration




Acute necrotizing ulcerative gingivitis (ANUG)

ANUG is a completely different syndrome caused by acute infection of the gingiva with organisms such as Prevotella intermedia, alpha-hemolytic streptococci, Actinomyces species, or any of a number of different oral bacteria.

ANUG may result in accelerated destruction of affected tissues, as well as local or systemic spread of infection.

Noma (cancrum oris) is a syndrome in which ANUG spreads beyond the gingiva. The infection invades local tissues of the mouth and face


ANUG may progress into the local soft tissues of the mouth, resulting in noma or cancrum oris, or may spread hematogenously to any other part of the body.


Eruption gingivitis:

  • This is common type gingivitis found during the eruption of permanent teeth


  • Eruption gingivitis occurs around erupting teeth due to non-physiologic position of emerging crowns and adjacent gingiva.


  •  When teeth are fully erupted, cervical contours will shield tissue from food impaction or other masticatory trauma.


Common pediatric periodontitis :

Localized juvenile periodontitis:

  • Localized juvenile periodontitis is a form of aggressive periodontitis which affects usually 12 to 16 year olds.


  • It is characterized by rapid periodontal pocketing at incisor and molar sites, low tissue inflammation and low caries rates but high plaque levels.


  • The etiology is related to high plaque levels of Actinobacillus actinomycetemcomitans  and occurs often in family members of the patient.


  • Treatments consist of periodontal scaling, systemic tetracycline and local irrigation with either Peridex (0.1% chlorhexidine), baking soda-salt-hydrogen peroxide solution or chloramine T.



Pre-pubertal periodontitis (PPP):

  • Pre-pubertal periodontitis is aggressive periodontitis which differs from Localized juvenile periodontitis  in that it affects the primary dentition (patients younger than 12)


  •  Genetic immune defects are usually present and familial patterns of occurrence are observed.


  • Treatment is similar to Localized juvenile periodontitis.




  • Chronic gingivitis

–     The most common complaint is bleeding gums. The patient usually notices this when toothbrushing or flossing.

–     Bleeding may be associated with eating, especially foods with a hard consistency, such as apples.

–     Patients have local findings along with minimal physical findings.

  • Acute necrotizing ulcerative gingivitis

–     Apparently spontaneous bleeding or bleeding in response to very minimal local trauma may occur.

–     ANUG also may produce local pain, malaise, and alterations in taste, such as a metallic flavor.

–     ANUG may produce foul breath.

–     Fever, halitosis, marked gingival edema, and ulceration, especially in the interdental papillae, may be present.

–     A grey pseudomembrane may be present.

–     Infection may spread to adjacent soft tissues of the mouth, with noticeable erythema, edema, tenderness, and induration of affected areas.



  • Gingivitis is not a direct significant threat to the health of a healthy individual, but it can contribute to illness and cause local and systemic complications.


  • The most common complication of chronic gingivitis is progression to periodontal disease and tooth loss.


  • Development of odontogenic abscesses by allowing a route of bacterial invasion into the periodontal space from the gingival pocket



  • Potential route of systemic spread of infection.


Periodontitis causing tooth exfoliation:

Others complication in children & Adults:



  • General measures

–   Remove irritating factors such as plaque, calculus, and faulty dentures.

–   Use a warm saline rinse that has bactericidal activity.

–   Antiseptive mouth washes, Chlorohexidine

–   Antibiotics & Analgesics(if required)


Management of ANUG

  • In patients with ANUG, treatment involves antibiotics, NSAIDs, and topical Xylocaine for pain relief.
  • Saline rinses and oral rinses with a hydrogen peroxide 3% solution also may be of benefit.
  • Patients with ANUG should be seen within 24-48 hours for reevaluation because of risk of local or systemic spread of infection.



Differential Diagnosis:

  • Severe acute Adrenocortical insufficiency: May result in severe morbidity and mortality when undiagnosed. More than 50 steroids are produced within the adrenal cortex, cortisol and aldosterone are  the most abundant and physiologically active.
  • HIV infection & AIDS: Gum bleeding persist after scalling, may associated with oral candidiasis
  • Acute herpetic gingivostomatitis: It only strikes people who have just caught herpes for the first time. Herpetic gingivostomatitis also turns the gums bright red, but it can be easily distinguished because it’s usually quite painful. There are dozens of tiny white or yellow sores visible in the gums and inner cheeks.



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Category: Dental, Pedodontics

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