periodontal problems in kids
TRANSCRIPT
-
8/13/2019 Periodontal Problems in Kids
1/49
Periodontal Problems
inChildren
Based on a presentation by D. F. Duperon,Chair, Pediatric Dentistry, UCLA(adapted by Callum Durward)
-
8/13/2019 Periodontal Problems in Kids
2/49
Normal Gingiva in Children
In contrast to adults:
Round and/or rolledmargins
Greater sulculardepth
Epithelium thinner
-
8/13/2019 Periodontal Problems in Kids
3/49
Normal Gingiva in Children cont.
Less stippling
Decreased fiber
density May be pigmented
Loss of attachment
and true pocketsrare
-
8/13/2019 Periodontal Problems in Kids
4/49
Periodontal Conditions AffectingChildren and Adolescents
1. Gingivitis
Swelling, redness, bleeding
Not painful
Plaque induced
Can be cured by improved oral hygiene(not scaling!)
-
8/13/2019 Periodontal Problems in Kids
5/49
Marginal Gingivitis
Marginal gingivitis
-
8/13/2019 Periodontal Problems in Kids
6/49
What factors contribute togingivitis in childhood and
adolescence?LOCAL FACTORS
Erupting teeth
Poor oral hygiene
Restoration overhangs
Calculus (covered by plaque)
Crowded teeth
Mouth breathing
Orthodontic appliances
-
8/13/2019 Periodontal Problems in Kids
7/49
Mouthbreathing:
Chronic drying oftissue
Tacky plaquehardto remove
Red, inflamed andenlarged gingiva
May be ENT and/ororthodontic problem
-
8/13/2019 Periodontal Problems in Kids
8/49
Gingivitis cont.
SYSTEMIC FACTORS
Hormonal changes eg pregnancy andpuberty
Diabetesif poorly controlled
HIV or other immune disorders
-
8/13/2019 Periodontal Problems in Kids
9/49
2. Primary Herpetic Gingivo-Stomatitis (H.S.V. Type 1*)
@ *Can also be Type 2
-
8/13/2019 Periodontal Problems in Kids
10/49
Symptoms and signs:
Fever (>38oC)
Anorexia and malaise
Sub-mandibular gland swelling Reddened bleeding gingiva
Multiple vesicles and painful ulcers on gingivaand soft oral tissues
Lasts 10-14 days
Primary infections may be mild or sub-clinicalin many children
@
-
8/13/2019 Periodontal Problems in Kids
11/49
Secondary Herpes Infections
Virus becomes latent in TG ganglion or basalganglia of brain
Secondary infection usually presents as
herpes labialis (cold sore) on the lip Reactivated by eg trauma, heat, hormones,
sunlight, stress, immunosuppression,(theadmistration of agents that significantly interfere with the ability of theimmune system to respond to antigenic stimulation by inhibiting
cellular and humoral immunity)concurrent infectionVirus can also infect finger of child or dental
therapist (if not wearing gloves)
-
8/13/2019 Periodontal Problems in Kids
12/49
Treatment:
Drink plenty of fluids Soft bland diet Paracetamol
Antiviral agents (only in some severe cases) egAcyclovir
Antibiotics for secondary infections Gentle cleaning (may not be able to use toothbrush if
very painful)can use mouth rinses (eg CHX,
Difflam or Na bicarbonate/salt)wipe around mouthwith cotton wool if too young to rinse
IN SEVERE CASES WHERE THE CHILD IS NOTDRINKING (or is immunocompromised) MAY NEEDTO ADMIT TO HOSPITAL
-
8/13/2019 Periodontal Problems in Kids
13/49
3. ANUG
Acute Necrotizing Ulcerative Gingivitis
SIGNS ANDSYMPTOMS:
Ulceration ofinterdental papillae(very painful)
Foul breath
Rapid Progression Fever
Lymphadenopathy
-
8/13/2019 Periodontal Problems in Kids
14/49
Predisposing Factors
Adolescents and young adults
Poor OH, calculus
Stress, poor nutrition, reduced
immunity eg HIVNote:caused by bacteriagram negative
fusiform bacilli and spirochaetes
-
8/13/2019 Periodontal Problems in Kids
15/49
ANUG Treatment
Investigate possibleunderlying medicalproblem
Local debridement
Mouth-rinse eg CHXor H202
Antibiotics: Amoxycillin
Metronidazole(Flagyl)
Advanced ANUG
-
8/13/2019 Periodontal Problems in Kids
16/49
4. Gingival Enlargements:
Drug induced - Dilantin, Cyclosporin, calcium channelblockers (eg Nifedipine), Vigabactrin, Na valproate
Inflammatorychronic gingivitis
(puberty/pregnancy) Congenitalhereditary gingival fibromatosis,
mocopolysaccharoidoses
Haematologicalleukaemia, aplastic anaemia, vit C
deficiency (scurvy) Other Conditions
Eruption cysts
Opercular flaps
-
8/13/2019 Periodontal Problems in Kids
17/49
Dilantin Hyperplasia
Dilantin (phenytoin) used in epilepsytreatment
Incidence: 662%.
Begins between 2 weeks to 3 months.
Dose and duration not significant.
Worsens with poor oral hygiene.
Occurs only on attached gingiva.
-
8/13/2019 Periodontal Problems in Kids
18/49
Dilantin Hyperplasia
Adolescent Patient
-
8/13/2019 Periodontal Problems in Kids
19/49
Dilantin Hyperplasia
Treatment:
Discontinue Dilantin (Dr must decide ifalternatives acceptable).
Increase home care. OHI, chlorhexidine, and flossing
Periodontal surgery.
-
8/13/2019 Periodontal Problems in Kids
20/49
Cyclosporin A
Often used in children who have hadtransplants
An anti-rejection drug
Up to 100% of children on this drug getgingival enlargement
-
8/13/2019 Periodontal Problems in Kids
21/49
Cyclosporin AGingival Enlargement
Moderate enlargement. Will require surgery.
-
8/13/2019 Periodontal Problems in Kids
22/49
Cyclosporin AGingival Enlargement
Treatment:
Discontinue and substitute drug.
Increased hygiene and plaque control.
Chlorhexidine mouthwash.
Gingivectomy.
-
8/13/2019 Periodontal Problems in Kids
23/49
Cyclosporin AGingival Enlargement
Pre-operative Cyclosporine
Severity increased by inflammation from brackets
-
8/13/2019 Periodontal Problems in Kids
24/49
Cyclosporin AGingival Enlargement
Immediate post operative
One-week post operative Two-week post operative
-
8/13/2019 Periodontal Problems in Kids
25/49
5. Other gingival conditions:a. Eruption Cysts:
Treatment:
None if not causing
problemsusuallyresolvespontaneously
Incise tissue over
crown (after topical)refer for this
-
8/13/2019 Periodontal Problems in Kids
26/49
b. Acute Allergic Reaction
To any allergen:
Latex
Nickel Cinnamon and other
spices
Treatment: Remove allergen
Allergy to a type of chewing gum
-
8/13/2019 Periodontal Problems in Kids
27/49
c. Pyogenic Granuloma
Associated with a local irritant
Hormonal changes predisposes
-
8/13/2019 Periodontal Problems in Kids
28/49
6. Periodontal bone loss causingpremature tooth loss
Unexplained premature tooth loss must beinvestigated!
Childhood Hypophosphatasia. Papillon Le Fevre Syndrome. Cyclic or Familial Neutropenia. Histiocytosis X. Iatrogenic.(originating as a result of professional care; for eg an
iatrogenic dermatisis ).
Juvenile periodontitis (pre-pubertal andpubertal forms)
-
8/13/2019 Periodontal Problems in Kids
29/49
a. Childhood Hypophosphatasia
A metabolic disorder
Low serum alkaline phosphatase.
Excretion of Phosphoethanolamine.
Elevation of serum phosphorus.
@
-
8/13/2019 Periodontal Problems in Kids
30/49
Hypophosphatasia - Dentalfindings:
Premature loss ofprimary teeth (oftenbefore age 2).
Minimalinflammation
Loss of alveolar
bone.Abnormal or
absence ofcementum.
-
8/13/2019 Periodontal Problems in Kids
31/49
b. Papillon Le-Fevre Syndrome
Hereditary condition
Premature tooth loss
Severe inflammationand bone loss
Both deciduous andpermanent teeth
Edentulous by 16yrs
Intensive therapy
has little effect@
-
8/13/2019 Periodontal Problems in Kids
32/49
Papillon Le-Fevre Syndromeextensive periodontal disease in young patients accompanied by keratotic lesion.
HyperkeratosisPalmaris.
HyperkeratosisPlantaris.
c s ocy os s = anger ans
-
8/13/2019 Periodontal Problems in Kids
33/49
c. s ocy os s = anger ansCell Histiocytosis a group of disease characterized byabnormal histiocyte activity.includes a chronic disseminated type and a chroniclocalized type.
Includes several diseases.
All have a proliferation of Langerhans
cells. Infiltrating histiocytosis of hard and/or
soft tissues.
Premature resorption of bone and lossof primary teethon X-ray appear tobe floating in air.
-
8/13/2019 Periodontal Problems in Kids
34/49
Histiocytosis X.
2 year-old male: Mesial cusp of first perm. molar
-
8/13/2019 Periodontal Problems in Kids
35/49
Histiocytosis X.
3 year-old male.
-
8/13/2019 Periodontal Problems in Kids
36/49
d. Familial Neutropenias
Can be chronic, cyclic or intermittentforms
May suffer from: Recurrent pneumonia.
Skin and other infections.
Mouth ulcerations.
Periodontal disease.
May improve once they reachadolescence.
-
8/13/2019 Periodontal Problems in Kids
37/49
Chronic (familial) Neutropenia
8 year-old female
-
8/13/2019 Periodontal Problems in Kids
38/49
Cyclic Neutropenia
Periodic episodes of fever and oralulcerations.
Periods of profound neutropenia.
Onset by 10 years of age.
19-21 day cycle.
Course: usually benign.
-
8/13/2019 Periodontal Problems in Kids
39/49
Cyclic Neutropenia
17 year-old female
-
8/13/2019 Periodontal Problems in Kids
40/49
Acquired Neutropenia
9 year-old male
-
8/13/2019 Periodontal Problems in Kids
41/49
7. Self-induced Trauma
3 year-old male
-
8/13/2019 Periodontal Problems in Kids
42/49
Fingernail Trauma.
-
8/13/2019 Periodontal Problems in Kids
43/49
Toothbrush trauma
Toothbrushing injury in a psychotic child
-
8/13/2019 Periodontal Problems in Kids
44/49
Self Mutilation
Congenital insensitivity to pain
Lesch-Nyhan syndrome (hereditary disorder of purinemetabolism characterized by mental retardation ,self-mutilation of the fingers and lip bybiting, impaired renal function ,and abnomal physical development.)
8 J il P i d i i
-
8/13/2019 Periodontal Problems in Kids
45/49
8. Juvenile Periodontitis(includes pre-pubertal and pubertal forms)
Prevalence: 0.1 to 0.76%.
Higher in some ethnic groups eg Black males.
Localized or generalized. Lack of clinical gingival inflammation.
Mobility and migration.
Vertical bone loss especially around first
molars and incisors.Actinobacillus Actinomycetemcomitans (AA)
and Capnocytophagia
@
-
8/13/2019 Periodontal Problems in Kids
46/49
Classic juvenile periodontitis
Caution! First sign may be mobile teeth!
Begin periodontal probing in children at10 years of age.
Check PBWs for bone loss
-
8/13/2019 Periodontal Problems in Kids
47/49
Classic Juvenile Periodontitis
11 year-old African-American female
-
8/13/2019 Periodontal Problems in Kids
48/49
Classic Juvenile Periodontitis
Treatment:
Local debridement.
Periodontal surgery.
Antibiotics: Amoxycillin, metronidazole,tetracyclines.
-
8/13/2019 Periodontal Problems in Kids
49/49
Classic Juvenile Periodontitis
One year post operativePre-opertative