Dr Saif Khan

Gingival diseases in children

Periodontium of decidous dentitionNormal gingiva of decidous dentition is pale

but less than permanent dention as epithelial layer is very thin and under lying vasculature can be appreciated.

Stippling appears at age of 3 yrs and occurs in 35% of children between 5-15 years of age

The interdental gingiva is broad buccolingually and narrow mesiodistally to conform to the morphology of decidous dentition

Gingival sulcus is shallower in decidous dentition

Mean sulcus depth is 2.1±0.2 mm

Attached gingiva is widest in incisor area, narrowing in cuspids and widening again in posterior molars.

The attached gingiva normally increases with age

The free gingival collar has fewer collagen bundles and is more easily retracted from decidous tooth surface.

Radiographically, lamina dura is prominent , with wider periodontal space than in permanent dentition

The marrow spaces of the bone are larger and crest of interdental bony septa are flat, with bony crest within 1-2 mm of CEJ

Physiologic gingival changes associated with tooth eruption

Preeruption bulge eruption cyst

Gingival margin On tooth eruption into oral cavity, the

gingival margin and sulcus develop and at this stage the gingival margin is rounded,edematous and reddened.

Types of gingival diseaseChronic marginal gingivitisMost prevalent type of gingival disease in

childhood

Gingiva presents with changes in color, size, consistency and surface texture

Presents as red linear inflammation with underlying changes like swelling, increased vascularization and hyperplasia

Bleeding and increased pocket depth are not found as often in children as in adults.

The inflammatory response in children is primarily

by T-lymphocytes and this is the reason why

gingivitis in children does not progress to

periodontitis as seen in adults which is primarily

mediated by B-lymphocytes and plasma cells

Puberty gingivitisDuring puberty, gingivitis and gingival

enlargement may be more prevalent and this called puberty gingivitis

Incidence of marginal gingivitis peaks at 11 to 13 years of age, then decreases slighly after puberty

Most common finding is gingival bleeding and inflammation in interproximal areas

Hormonal changes which occur during this stage magnify the inflammatory respone

Occurs both in males and females and the severity is reduced after puberty

The primary cause of gingivitis is dental plaque.

Samples of dental plaque in children showed that 71% of 18-48 months old children were infected with atleast one periodontal pathogen;68% with P gingivalis and 20% with T forsythia.

Gingival bleeding in children is associated with T forsythia

A moderate correlation was found between between T forsythia in child and periodontal disease in mother.

The presence of P gingivalis was most strongly associated progression of gingivitis and onset of periodontitis in healthy children

CalculusCalculus is uncommon in infants and toddler

but increases with age.

Age group Calculus formation(prevalance)

4-6yrs 9%7-9yrs 18%10-15yrs 33-43%Children with cystic fibrosis show

increased calculus formationChildren fed exclusively with nasogastric

tube show increased calculus formation due to lack of function and increased oral pH

Eruption gingivitisEruption gingivitis; gingivitis associated

with tooth eruption results from plaque acummulation around erupting teeth.

The gingivae around erupting teeth may appears reddened because gingival margin which is still non-kearinized and gingival sulcus has not yet fully developed.

Dental crowding in mixed dentition can lead to increased incidence of gingivitis.

Exfoliating and severe carious decidous teeth are often associated with gingivitis

Gingivitis is also increased in children having increased overjet and overbite,nasal obstruction and subsequent mouth breathing habit.

Mucogingival defectsAccording to Maynard and Wilson Mucogingival

problem start in primary dentition as a consequence or developmental aberration in eruption and deficiencies in thickness of periodontium.

Inadequate plaque control, excessive toothbrush trauma can lead to mucogingival problem.

Prevalance of mucogingival problem in children ranges from 1% to 19%.

Mucogingival problem can also result from factitious habit or excessive toothbrushing either by parent or child.

ACUTE GINGIVAL INFECTIONS1. Primary herpetic gingivostomatitis: 1-

3yrs of age, 99% are symptom free or symptom are usually attributed to teething

2. Candidiasis: usually overgrowth of candida after course of antibiotic or as a result of congenital or acquired immunodeficiency.

3. NUG: incidence low in children except in severe illness or chronic malnutrition. Children with down syndrome have tendency of developing NUG

Traumatic changes in periodontiumTraumatic changes accompany eruption of

succedenous teeth.

Shifting exfoliating teeth may lead to changes in occlusion leading trauma to periodontium of existing and erupting teeth.

Microscopic minor traumatic changes demonstrate compression, ischaemia and hyalinization of the periodontal ligament.

Ankyloses of teeth can also take place following injury.

Oral mucous membrane in childhood diseasesLesions of oral mucosa may be seen inRubeola(Rubella, Measles)Varicella(Chicken pox)DiptheriaScarlatina