PERIODONTAL

DISEASES IN
CHILDREN
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INTRODUCTION

Periodontal disease is defined as

the disease of supporting tissue of
the teeth caused by specific
microorganism [group of specific
organism], malocclusion, chronic
trauma resulting in progressive
destruction of the periodontal
ligament & alveolar bone with pocket
formation, recession or both.
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CLASSIFICATION

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Periodontitis

[A] Chronic periodontitis (slow onset)

 Localized
 Generalized
[B] Aggressive periodontitis (early onset)

 Localized aggressive periodontitis

(New term for localized juvenile periodontitis)
 Generalized aggressive periodontitis
(New term for generalized juvenile periodontitis)
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[C] Incidental attachment loss

[D] Necrotizing ulcerative periodontitis

(due to stress, smoking)

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[E] Systemic disease forms

 Leukocyte disorders
 Neutropenia
 Chediak-Higashi syndrome
 Leucocyte adhesion deficiency syndrome
 Papillon-Lefevre syndrome
 Down syndrome

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 Diabetes mellitus
 Hypophosphatasia
 Histiocytosis X
 Ehlers-Danlers syndrome
 Juvenile hyaline fibromatosis of gingiva
 Acquired immunodeficiency syndrome
 Virus-associated hemophagocytic syndrome
 Malnutrition

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CLASSIFICATION OF

PERIODONTAL DISEASE

(AMERICAN ACADEMY OF PEDIATRIC DENTISTRY)

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[A] Adult onset periodontitis

[B] Early onset periodontitis

 Generalised prepubertal periodontitis

 Localised juvenile periodontitis
 Localised prepubertal periodontitis
 Generalised juvenile periodontitis
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[C] Systemic diseases associated with
periodontal disease

 Hypophosphatasia
 Leucocyte adhesion defect
 Papillon-lefevre syndrome
 Down syndrome
 Chediak-Higashi syndrome
 Langerhans cell histiocytosis
 Acute leukemia
 Insulin-dependent diabetes mellitus
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[D] Drug induced gingival overgrowth

[E] Anatomical periodontal problems

 Mucogingival defects
 Localized gingival recessions
 High labial frenum attachments

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PERIODONTAL
DISEASES &
CONDITIONS
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PREPUBERTAL
PERIODONTITIS

 Localized

 Generalized

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 LOCALIZED PREPUBERTAL
PERIODONTITIS

Clinical features
 Onset at about 4 years of age in
healthy children
 Rapid bone loss at the affected sites

Etiology
 Functional abnormalities in neutrophils
or monocytes but not both
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 Affected site harbours actinobacillus
actinomycetemcomitan, prevotella intermedia
& porphyromonous gingivalis

Treatment
 Local debridement
 Antibiotic therapy
 Improved oral hygiene

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GENERALISED
PREPUBERTAL
PERIODONTITIS
Clinical features
 Occurs in children with persistent
infection & delayed wound healing
 Alveolar bone destruction is more rapid

Etiology
 Functional abnormalities occur in both
neutrophils & monocytes
 The generalized type has been associated
with leukocyte adhesion deficiency
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TREATMENT

 Antibiotic therapy
 Extraction of affected teeth

SEQUELAE

 Prepubertal periodontitis involving primary

teeth will advance to periodontitis of
permanent dentition
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 EARLY ONSET OF PERIODONTITIS
is the accepted term for both types of juvenile
riodontitis ; localised & generalised

ALISED TYPE
appears to be self limiting & affects mainly permanent first molars
cisors in adolescents
one loss is rapid & is not commensurate with amount of local
ants present such as plaque & calculus

OLOGY
usceptible individuals has both functional defects involving
utrophils & high virulent strains of actinobacillus actinomycetem-
mitans & bacteriodes species

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 TREAMENT
--Self limiting
--No treatment required

GENERALISED JUVENILE PERIODONTITIS.

is reffered as severe periodontitis & rapidly prodressive
eriodontitis

NICAL FEATURES
More common in young adults involving permanent
ntition
ccurs in presence of marked gingival inflammation & gross plaque
cumulation

TIOLOGY:-
Subgingival plaque from affected site harbours high percentage
Of porphyromonas gingivalis
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 TREATMENT
Medical debridment
-- Antiobiotic therapy
TETRACYCLINE 1gm/day FOR 14 TO 21 DAYS
OR
AMOXICILLIN 1gm/day + METRONIDAZOLE
750mgm/day FOR 7 DAYS

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SYSTEMIC DISORDERS
ASSOCIATED
WITH PERIODONTAL DISEASES
LEUKAEMIA:- This neoplastic disorder results in
abnormal & uncontrolled proliferation of immature leukocyte

ORAL MANIFESTATION:-
(i) Gingival enlargement with ulceration
(ii) Thinning of lamina dura
(iii)Destruction of periodontal ligament
(iv)Tooth migration

CLIC NEUTROPENIA:- It is characterised by rhythmic reduction

polymorphonuclear neutrophils in 21 days cycle

ORAL MANIFESTATION
(i) Alveolar bone loss around primary level
(ii) Severe ulcerative gingivitis
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CYCLIC NEUTROPENIA

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HYPOPHOSPHATASIA:- It is characterised
by low serum alkaline phosphatase & reciprocal
change in urine phosphoethanol amine level

ORAL MANIFESTATION:-
(i) Premature mobility & loss of primary teeth
[Incisors are affected more than molars]
(iI) Acementogenesis
(iii) Dentinal dysplasia
(Iv) Enlarged pulp chamber

PAPILLON LEFEVRE SYNDROME:- This is autosomal

recessive disorder manifested in hyperkeratosis palmoplantaris
[palms of hand & soles of feet]

ORAL MANIFESTATION:-
(i) Premature loss of both primary & permanent teeth
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 HISTOCYTOSIS X
It is non lipidreticuloendotheliosis marked
by multiple hard & soft tissue lesions
containing
histocytes & eosinophils

ORALMANI

ACRODYNIA
t is also called pinks or swifts diseases

ETIOLOGY
Due to excessive exposure to merqury

ORAL MANIFESTATION
(i) Glossitis
(ii) Premature erruption
(iii) Exfoliation of teeth www.FourthMolar.com
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DIABETES MELLITUS &
CHRONIC GRANULOMATOUS
DISEASES

Patient is more susceptible to periodontal desiases becaus

decreased immunity

DOWN SYNDROME:-

It is a genetic condition arising form trisomy of

chromosome 21.Patient is susceptible to periodontal
diseases because of specific immune defect involving t
lymphocyte
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IODONTAL DISEASES AFFECTING
NERAL HEALTH
(i) Periodontal diseases can affect the onset &
progression of congestive heart diseases by
increasing the blood viscosity
(ii) Severe periodontal diseases have been shown to
cause increased insulin resistance & thus worsen the
glycemic control in both diabetic as well as non-
diabetic individuals
(iii) Pregnant ladies suffering form periodontitis are
more likely to deliver preterm low birth weight
babies
(iv) Dental plaque may also serve as reservoir of
organisms with a potential to cause respiratory
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diseases like pneumonia
REASONS WHY CHILDREN ARE LESS
SUSPECTIBLE TO PERIODONTAL DISEASES

The greater metabolic activity in children in whom

anabolism is dominant over catabolism may offer the
peridontium greater resistance to break down
The oral flora is different in children,late establishment of
spirochetes and bacteroides which have been
associated with the development of gingivitis in children
may delay the onset of periodontal disease
The composition and metabolism of plaque found in
children may be responsible for its reported lower
irritation potential

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