PERIODONTAL DISEASES IN CHILDREN

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.

CLASSIFICATION

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)

[C] Incidental attachment loss

[D] Necrotizing ulcerative periodontitis (due to stress, smoking)

[E] Systemic disease forms

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

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

CLASSIFICATION OF PERIODONTAL DISEASE

(AMERICAN ACADEMY OF PEDIATRIC DENTISTRY)

[A] Adult onset periodontitis

[B] Early onset periodontitis

Generalised prepubertal periodontitis

Localised juvenile periodontitis

Localised prepubertal periodontitis Generalised juvenile periodontitis

[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

[D] Drug induced gingival overgrowth

[E] Anatomical periodontal problems

Mucogingival defects
Localized gingival recessions

High labial frenum attachments

PERIODONTAL DISEASES & CONDITIONS

PREPUBERTAL

PERIODONTITIS
Localized

Generalized

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

 Affected site harbours actinobacillus actinomycetemcomitan, prevotella intermedia & porphyromonous gingivalis

Treatment
Local debridement Antibiotic therapy Improved oral hygiene

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

TREATMENT Antibiotic therapy Extraction of affected teeth SEQUELAE Prepubertal periodontitis involving primary teeth will advance to periodontitis of permanent dentition

EARLY ONSET OF PERIODONTITIS

It is the accepted term for both types of juvenile Periodontitis ; localised & generalised

LOCALISED TYPE -- It appears to be self limiting & affects mainly permanent first molars & Incisors in adolescents -- Bone loss is rapid & is not commensurate with amount of local Irritants present such as plaque & calculus

ETIOLOGY -- Susceptible individuals has both functional defects involving Neutrophils & high virulent strains of actinobacillus actinomycetemComitans & bacteriodes species

TREAMENT --Self limiting --No treatment required

GENERALISED JUVENILE PERIODONTITIS.

It is reffered as severe periodontitis & rapidly prodressive Periodontitis

CLINICAL FEATURES -- More common in young adults involving permanent dentition Occurs in presence of marked gingival inflammation & gross plaque Accumulation ETIOLOGY:-- Subgingival plaque from affected site harbours high percentage Of porphyromonas gingivalis

TREATMENT
Medical debridment -- Antiobiotic therapy TETRACYCLINE 1gm/day FOR 14 TO 21 DAYS OR AMOXICILLIN 1gm/day + METRONIDAZOLE 750mgm/day FOR 7 DAYS

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

CYCLIC NEUTROPENIA:ORAL MANIFESTATION

It is characterised by rhythmic reduction Of polymorphonuclear neutrophils in 21 days cycle

(i) Alveolar bone loss around primary level (ii) Severe ulcerative gingivitis

CYCLIC NEUTROPENIA

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

HISTOCYTOSIS X
It is non lipidreticuloendotheliosis marked by multiple hard & soft tissue lesions containing histocytes & eosinophils
ORALMANI

ACRODYNIA
It 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

DIABETES MELLITUS & CHRONIC GRANULOMATOUS DISEASES Patient is more susceptible to periodontal desiases because of 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

PERIODONTAL DISEASES AFFECTING GENERAL 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 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