GINGIVAL DISEASES IN CHILDHOOD

GINGIVAL DISEASES IN CHILDHOOD

INTRODUCTION

•PERIODONTIUM IS A CONSTITUENT OF GINGIVA, ALVEOLAR

MUCOSA,PERIODONTAL LIGAMENT & ALVEOLAR BONE.

•GINGIVA FORMS AN IMPORTANT PART OF THE PERIODONTIUM, THE

SUPPORTING STRUCTURE OF THE TOOTH.

• EFFECTS OF PERIODONTAL DISEASES OBSERVED IN ADULTS HAVE

THEIR INCEPTION EARLIER IN LIFE.

•THE PREVALENCE OF GINGIVITIS IN CHILDREN HAS BEEN REPORTED

TO BE AS HIGH AS 99 %.
FEATURES OF NORMAL PERIODONTIUM
IN CHILDREN

NORMAL PERIODONTIUM IN CHILD INCLUDES

GINGIVA

ALVEOLAR MUCOSA

PERIODONTAL LIGAMENT

ALVEOLAR BONE
GINGIVA
IT IS PART OF ORAL MUCOSA THAT COVERS THE ALVEOLAR PROCESSES
OF JAWS AND SURROUNDS THE NECK OF THE TEETH.

DIVIDED ANATOMICALLY INTO-

MARGINAL GINGIVA
PAPILLARY GINGIVA (INTERDENTAL GINGIVA)
ATTACHED GINGIVA

THE INTERDENTAL CLEFT AND RETROCUSPID PAPILLA ARE TWO

UNIQUE FEATURES SEEN IN GINGIVA OF CHILDREN

GINGIVA IS PALE PINK AND MAY BE EITHER SMOOTH OR STIPPLED.

INTERDENTAL GINGIVA IS BROAD FACIO LINGUALLY AND TENDS TO BE

RELATIVLY NARROW MESIO DISTALLY

MEAN GINGIVAL SULCUS DEPTH FOR PRIMARY DENTITION IS 2.1mm ±

0.2mm
NORMAL GINGIVA OF 3 &HALF YEAR OLD CHILD
 ALVEOLAR MUCOSA
RED IN COLOUR, EASILY MOVABLE &DIFFERENTATED FROM REMAINING
TISSUE BECAUSE OF ITS THIN EPITHELIUM AND ABSENCE OF KERATIN.
IT INCREASES IN WIDTH WITH AGE AND ERUPTION OF THE TEETH

PERIODONTAL LIGAMENT
THERE ARE FEWER FIBRES PER UNIT AREA LEADING TO A WIDER,
LESS DENSE PERIODONTAL LIGAMENT SPACE.

ALVEOLAR BONE
MORE ELASTIC AND
PLIABLE
LESS CALCIFIED HAS ABUNDANT BLOOD SUPPLY
FEWER TRABECULAE AND LARGER BONE MARROW SPACES
PHYSIOLOGIC GINGIVAL CHANGES ASSOCIATED
WITH TOOTH ERUPTION.

PRE ERUPTION BULGE:

BEFORE CROWN APPEAR IN THE ORAL CAVITY, THE

GINGIVA PRESENCE A BULGE THAT IS FIRM AND
CONFORMS TO THE CONTOUR OF UNDERLYING
CROWN

FORMATION OF GINGIVAL MARGIN:

IT IS EDEMATOUS, ROUNDED AND SLIGHTLY REDDENED

NORMAL PROMINENCE OF GINGIVAL MARGIN

DURING PERIOD OF MIXED DENTITION, IT IS NORMAL FOR MARGINAL

GINGIVA AROUND PERMANENT TEETH TO BE QUITE PROMINENT,
PARTICULARLY IN MAXILLARY ANTERIOR REGION.
GINGIVAL DISEASES IN CHILDHOOD

DURING CHILDHOOD A VARIETY OF BIOLOGICAL

CHANGES TAKE PLACE WHICH MAY BE IMPORTANT TO
THE OCCURANCE OF GINGIVAL DISEASES

THESE INCLUDES NORMAL EXFOLIATION OF PRIMARY

TEETH AND ERUPTION OF PERMANENT DENTITION, AS
WELL AS CHANGES IN ORALMICROFLORA,HORMONAL
CHANGES etc.
 RISK FACTORS
LOCAL SYSTEMIC
CALCULUS HORMONES(PUBERTY)
SUBGINGIVAL OVERHANGING DRUGS
RESTORATIONS
MALNUTRITION INCLUDING VITAMIN
MALOCCLUSIONS AND PROTEIN DEFICIENCY
ORTHODONTIC APPLIANCES METABOLIC DISORDERS
ABNORMAL ORAL HABITS HEREDITY AND GENETIC FACTORS
INCOMPETENT LIPS SMOKING
ERUPTION OF TEETH
VIRAL, BACTERIAL AND FUNGAL
XEROSTOMIA INFECTIONS
 CLASSIFICATION OF GINGIVAL DISEASE IN CHILDREN

AMERICAN ACADEMY OF PEDIATRIC DENTISTRY CLASSIFICATION OF

GINGIVAL DISEASE

SIMPLE GINGIVITIS

CHRONIC INFLAMATORY GINGIVAL ENLARGEMENT

GINGIVAL ABCESS

PERICORONITIS

ACUTE NECROTISING ULCERATIVE GINGIVITIS

SIMPLE GINGIVITIS (PLAQUE INDUCED GINGIVITIS)

EARLY FEATURES –ALTERATION IN COLOR OF FREE OR MARGINAL GINGIVA.

COLOR CHANGES FROM PINK TO RED.

LOSS OF STIPPLINGS

GINGIVAL BLEEDING IN 60% OF CASES

GINGIVITIS IN CHILDREN IS HIGHLY REVERSIBLE

ON SLIGHT IRITATION THERE IS BLEEDING FROM SULCUS

ETIOLOGY:MOSTLY PLAQUE DEPENDENT.

LOCAL FACTORS:POOR ORAL HYGIENE

CROWDING OF TEETH
ORTHODONTIC APPLIANCES
MOUTH BREATHING
ERUPTION OF TEETH
CHRONIC MARGINAL GINGIVITIS ASSOCIATED WITH
PLAQUE & MATERIA ALBA.
MOUTH BREATHING- RELATED GINGIVITIS:
SLICK ,SWOLLEN&RED GINGIVITIS OF ANTERIOR
FACIAL GINGIVA
MARGINAL GINGIVITIS:DIFFUSE ERYTHEMATOUS
ALTERATION OF THE FREE GINGIVAL MARGIN
ERUPTION GINGIVITIS:
-THIS IS INFLAMMATION AROUND THE ERUPTION TEETH.

-ACCOMPANYING SENSITIVITY & TOOTH POSITION LEADS TO POOR ORAL

HYGIENE.

-AS PLAQUE ACCUMULATES, INFLAMMATION CONTINUES TO WORSEN.

-SYMPTOMS SUBSIDE WITH ATTAINMENT OF NORMAL OCCLUSAL POSITION

OF TOOTH.

MANAGEMENT: GOOD ORAL HYGIENE MAINTANANCE.

PROMINENT MARGINAL GINGIVA ON CERVICAL THIRD OF
PARTIALLY ERUPTED MAXILLARY ANTERIOR TEETH.
GINGIVITIS ASSOCIATED WITH TOOTH ERUPTION
PUBERTY ASSOCIATED GINGIVITIS:

-PUBERTY IS A COMPLEX PROCESS OF

ENDOCRINOLOGICAL EVENTS THAT PRODUCE CHANGES IN
THE PHYSICAL APPEARANCE AND BEHAVIOUR.

-THE INCIDENCE AND SEVERITY OF GINGIVITIS ARE

INFLUENCED BY VARIETY OF FACTORS.
PLAQUE
DENTAL CARIES
MOUTH BREATHING
CROWDING OF THE TEETH
TOOTH ERUPTION
RISE IN STEROID HORMONE LEVELS
PUBERTY GINGIVITIS: ERYTHEMATOUS GINGIVITIS
THAT AROSE AT TIME OF INITIAL MENSES.
CHRONIC INFLAMMATORY GINGIVAL ENLARGEMENT:

CLINICAL FEATURES:

-BALLOONING OF INTERDENTAL PAPILLA & SOMETIMES MARGINAL GINGIVA.

-GINGIVA APPEAR RED OR BLUISH RED.

-SOFT & FRIABLE GINGIVA WITH A SMOOTH & SHINY SURFACE.

-BLEEDS EASILY.
CHRONIC HYPERPLASTIC GINGIVITIS:
DIFFUSE ENLARGEMENT AND ERYTHEMA OF
MARGINAL & PAPPILARY GINGIVA.
CHRONIC GINGIVITIS:BRIGHT RED GINGIVA IS
BLUNTED,RECEDED,DUE TO TOTAL LACK OF ORAL
HYGIENE
ETIOLOGY:

-PROLONGED EXPOSURE TO DENTAL PLAQUE.

-POOR ORAL HYGIENE.

-CERVICAL CAVITIES.

-OVERHANGING RESTORATION.

-IMPACTION

-ORTHODONTIC THERAPY INVOLVING REPOSITIONING OF

TEETH.

-MOUTH BREATHING.
TREATMENT:-
-ORAL PROPHYLAXIS

-SOUND ORAL HYGIENE PRACTISES ARE TO BE FOLLOWED TO

PREVENT ITS RECURRENCE.

-GINGVECTOMY:RARELY DONE.
GINGIVAL ABSCESS:

-SUDDEN ONSET.
-LOCALISED PAINFUL LESION OF MARGINAL OR INTER DENTAL GINGIVA.
-EARLY STAGE- RED SWELLING WITH A SMOOTH SHINY SURFACE.
-24 TO 48HRS-FLUCTUANT AND POINTED LESION WITH SURFACE ORIFICE
FROM WHICH A PURULENT EXUDENT IS EXPRESSED.
-ADJACENT TEETH ARE OFTEN SENSITIVE TO PERCUSSION.

ETIOLOGY:

-FOREIGN SUBSTANCE- TOOTHPATSE BRISTLE,

PIECE OF APPLE CORE etc,
TREATMENT:

-UNDER TOPICAL ANAESTHESIA FLUCTUANT AREA OF LESION IS INCISED

WITH A BARK-PARKER BLADE AND INCISION IS GENTLY WIDENED TO PERMIT
DRAINAGE.
-AREA IS WASHED WITH WARM WATER AND COVERED WITH GAUZE PAD.
-AFTER 24 HRS LESION IS GENERALLY REDUCED IN SIZE.
-TOPICAL ANAESTHETIC IS APPLIED AND AREA IS SCALED.
-IF RESIDUAL SIZE OF LESION IS TOO GREAT-IT IS REMOVED SURGICALLY.
PERICORONITIS:
-IT IS INFLAMMATION OF GINGIVA COVERING PARTIALLY ERUPTED TOOTH.
-MOST COMMON-ERUPTING THIRD MOLARS, ALSO SEEN DURING ERUPTION
OF FIRST AND SECOND MOLARS IN CHILDREN.
-LEADS TO FOOD TRAP AND AN ENVIRONMENT CONDUCIVE TO BACTERIAL
GROWTH.
-PERICORONAL FLAP BECOMES INFLAMMED AND SWOLLEN.

TREATMENT:

-DEBRIDEMENT.
-ANTIBIOTIC THERAPY.
-SURGICAL REMOVAL.
PERICORONITIS:PAINFUL ERYTHEMATOUS
ENLARGEMENT OF THE SOFT TISSUES OVERLYING
THE CROWN OF PARTIALLY ERUPTED RIGHT
MANDIBULAR MOLAR
DRUG INDUCED GINGIVAL ENLARGEMENT:
CLINICAL FEATURES :
-PATIENTS VARIATIONS IN PATTERN OF ENLARGEMENT.
-TENDENCY TO OCCUR MORE OFTEN IN ANTERIOR GINGIVA.
-HIGH PREVELANCE IN YOUNGER AGE GROUPS.
-ONSET WITHIN THREE MONTHS OF USE.

PHENYTOIN :

-USED IN CHRONIC REGIMEN FOR CONTROL OF EPILEPTIC SEIZURES.

-GINGIVAL ENLARGMENT- 50% PATIENTS.

MECHANISM:
-GROWTH OF GENETICALLY DISTINCT POPULATION OF GINGIVAL
FIBROBLAST RESULT IN ACCUMULATION OF CONNECTIVE TISSUES BECAUSE
OF REDUCED CATABOLISM OF COLLAGEN MOLECULE.
PHENYTOIN RELATED GINGIVAL HYPERPLASIA
CALCIUM CHANNEL BLOCKERS:

-IN 1984 CALCIUM CHANNEL BLOCKERS WERE FIRST

LINKED TO GINGIVAL ENLARGEMENTS.
-COMMONLY USED AS ANTI-HYPERTENSIVE,
ANTI-ARRHYTHMIC AND ANTI-ANGINAL AGENTS.

CYCLOSPORINE:

-USED IN ORGAN TRANSPLANT REJECTION.

-AFFECTS 25-30% OF PATIENTS.
-STIMULATES FIBROBLASTS PROLIFERATION.
CYCLOSPORINE RELATED GINGIVAL HYPERPLASIA
NIFEDIPINE RELATED GINGIVAL HYPERPLASIA
ACUTE NECROTISING ULCERATIVE GINGIVITIS [ANUG]

-ANUG IS INFLAMMATORY DESTRUCTIVE DISEASE OF THE GINGIVA, WHICH

PRESENT CHARACTERISTIC SIGNS AND SYMPTOMS.

SYNONYMS:

-ULCERATIVE GINGIVITIS.
-ACUTE NECROTISING GINGIVITIS.
-VINCENTS INFECTION.
-FUSO- SPIROCHETAL DISEASE.
-TRENCH MOUTH.

ORAL SIGNS:

-PUNCHED OUT, CRATER LIKE DEPRESSIONS AT THE CREST OF INTER DENTAL

PAPILLAE.
-SURFACE OF GINGIVAL CRATES IS COVERED BY A GRAY,
PSEUDOMEMBRANOUS SLOUGH, DEMARCATED FROM THE REMAINDER OF THE
GINGIVAL MUCOSA BY A PRONOUNCED LINEAR ERTHEMA.
-SPONTANEOUS GINGIVAL HAEMORRHAGE.
-FETID ODOUR.
-INCREASED SALIVATION.
ACUTE NECROTIZING ULCERATIVE GINGIVITIS: TYPICAL LESIONS
WITH SPONTANEOUS HEMORRHAGE
ACUTE NECRITISING ULCERATIVE GINGIVITIS: TYPICAL
LESIONS HAVE PRODUCED IRREGULAR GINGIVAL CONTOUR
ORAL SYMPTOMS:
-EXTREMELY SENSITIVE TO TOUCH.
-CONSTANT RADIATING, GNAWING PAIN.
-PAIN INTENSIFIED BY EATING SPICY OR HOT FOODS.
-METALLIC FOUL TASTE .
-PATIENT IS CONSCIOUS OF AN EXCESSIVE AMOUNT OF PASTY SALIVA.

EXTRAORAL AND SYSTEMIC SIGNS AND SYMPTOMS:

-MILD AND MODERATE STAGES – LOCAL LYMPHADENOPATHY

SLIGHT ELEVATION IN TEMP.
-SEVERE CASES – HIGH FEVER
INCREASED PULSE RATE
LEUKOCYTOSIS
LOSS OF APPETITE
GENERAL LASSITUDE
DENTAL MANAGEMENT:
-LOCAL DEBRIDEMENT.

-SUBGINGIVAL CURETTAGE.

-MILD OXYGENATING SOLUTIONS.

-ANTIBIOTIC THERAPY : PENICILLINS / ERYTHROMYCIN &

METRONIDAZOLE.

-NSAIDS USED FOR PAIN.

-THERE WILL BE RESPONSE WITHIN 24-48 DAYS & ACUTE SYMPTOMS

MAY SUBSIDE & ULCERS WILL HEAL IN 10-14 DAYS .

-GINGIVAL MARGIN BECOME THICKENED BY FIBROUS REPAIR &

PAPILLAE RETAIN CONCAVE SHAPE OF HEALED ULCERS.
GINGIVAL DISEASE ASSOCIATED WITH
MALNUTRITION:

-SEVERE VITAMIN-C DEFICIENCY (SCURVY) WAS

EARLIEST NUTRITIONAL DEFICIENCY TO BE EXAMINED IN
ORAL CAVITY.

-GINGIVA IS BRIGHT RED, SWOLLEN, ULCERATED AND

SUSCEPTBLE TO HAEMORRHAGE.

MANAGEMENT:
-ADEQUATE VITAMIN-C SUPPLEMENT.
SCURVY:BRIGHT RED , ULCERATED GINGIVA.
GINGIVAL DISEASE ASSOCIATED WITH
HEREDITY:

-BENIGN, NON-INFLAMMATORY FIBROTIC ENLARGEMENT

OF MAXILLARY AND /OR MANDIBULAR GINGIVA
ASSOCIATED WITH A FAMILIAL AGGREGATION HAS BEEN
DESIGNATED BY TERM GINGIVOMATOSIS ELEPHANTIASIS.

-SLOWLY PROGRESSIVE GINGIVAL ENLARGEMENT

DEVELOPS UPON ERUPTION OF PERMANENT DENTITION.

-ENLARGED GINGIVA IS NON HAEMORRHAGIC AND FIRM.

-THERE IS ACCUMULATION OF SPECIFIC POPULATION OF

GINGIVAL FIBROBLASTS RESULTING IN AN ABNORMAL
ACCUMULATION OF CONNECTIVE TISSUE.
GINGIVAL FIBROMATOSIS:FIBROTIC GINGIVAL
HYPERPLASIA WITH RESULTANT DELAYED
OF TEETH ERUPTION
GINGIVAL FIBROMATOSIS:SIGNIFICANT FIBROTIC
GINGIVAL HYPERPLASIA WITH DELAYED ERUPTION
OF NUMEROUS TEETH
ACUTE HERPETIC GINGIVOSTOMATITIS:
-TYPE 1 OF HERPES SIMPLEX VIRUS IS RESPONSIBLE FOR MOST
OROPHARYNGEAL INFECTIONS, INCLUDING ACUTE HERPETIC GINGIVO-
STOMATITIS
-HIGHEST INCIDENCE – INFANTS AND CHILDREN YOUNGER THAN 6YEARS OF
AGE.

MECHANISM
VIRUS MOVES THROUGH NERVES TO NEURONAL GANGLION WHERE IT
REMAINS DORMANT UNTILL REACTIVATED BY VARIOUS STIMULI INCLUDING
TRAUMA, EXPOSURE TO SUNLIGHT OR U.V. LAMPS, FEVER, STRESS, FATIGUE
, ALLERGY.

SYMPTOMATIC INFECTION IS CHARACTERISED BY:

FEVER
MALAISE
HEADACHE
IRRITABILITY
DYSPHAGIA
LYMPHADENOPATHY
ACUTE HERPETIC GINGIVOSTOMATITIS: TYPICAL ERYTHEMA
ACUTE HERPETIC GINGIVOSTOMATITIS: VESICLES ON THE GINGIVA
ORAL CAVITY LESIONS CAN AFFECT
LIPS
TONGUE
BUCCAL MUCOSA
GINGIVA
PALATE
TONSILS
PHARYNX

-INITIALLY THE GINGIVAL INFLAMMATION IS CHARACTERISED BY:

DIFFUSE ERYTHMATOUS SHINY APPEARANCE WHICH PRECEDS BY
APPEARANCE OF VESICLES.
VESICLES VARY IN SIZE AND ARE USUALLY DISCRETE, SPHERICAL SACS
WHICH RUPTURE TO FORM SMALL, RAGGED AND PAINFUL ULCERS
COVERED BY A GREY MEMBRANE AND SURROUNDED BY AN
ERYTHMATOUS ELEVATED HALO.
ULCER PERSISTS FOR 7-10 DAYS AND HEALS SPONTANEOUSLY.
GINGIVAL LESIONS ASSOCIATED WITH CHICKEN POX:
VARICELLA IS A HERPES VIRUS INFECTION WHICH PRIMARILY
AFFECTS INDIVIDUALS UNDER AGE OF 15 YEARS
IN ORAL CAVITY:
SMALL ULCERS DEVELOP
LESIONS ARE FOUND MOST OFTEN ON PALATE, GINGIVA
AND BUCCAL MUCOSA
ULCERS ARE USUALLY NOT PAINFUL.

GINGIVAL LESIONS ASSOCIATED WITH MONO NUCLEOSIS:

CAUSED BY EPSTEIN BARR VIRUS

COMMON SIGNS AND SYMPTOMS:

FATIGUE
MALAISE
HEADACHE
FEVER
SORE THROAT
ENLARGED TONSILS
LYMPHADENOPATHY
IN ORAL CAVITY:
GINGIVAL BLEEDING
PETECHIAE OF SOFT PALATE
ULCERATION OF GINGIVA AND BUCCAL MUCOSA
PERICORONITIS

SOFT TISSUE LESIONS ASSOCIATED WITH HERPANGINA:

COXSACKIE GROUP A VIRUSES ARE ASSOCIATED
VESICULAR AND ULCERATIVE LESIONS FORM ON HARD PALATE,
TONGUE AND BUCCAL MUCOSA WITH SMALL %ON LIPS ,GINGIVA,
PHARYNX AND TONGUE.
SORE MOUTH RESULTS IN DIFFICULTY IN EATING.
DISEASE IS SELF LIMITING AND REGRESSES IN 1-2 WEEKS.
GINGIVAL LESIONS ASSOCIATED WITH SEXUALLY
TRANSMITTED BACTERIAL DISEASES
-2 COMMON BACTERIAL DISEASES THAT ARE TRANSMITTED BY
SEXUAL CONTACT ARE SYPHILLIS AND GONORRHEA.
-SYPHILLIS CAUSED BY T.PALLIDIUM AND CAN AFFECT THE ORAL
CAVITY.
-ORAL LESIONS ARE PRESENT ON THE LIPS, TONGUE, PALATE,
GINGIVA AND TONSILS.
-LESIONS IN ORAL CAVITY VARY FROM AN ELEVATED AND ULCERATED
NODULE TO PAINLESS,GRAY-WHITE PATCHES COVERING ULCERATED
AREAS TO FORM NODULAR MASSES THAT MAY IN DUE COURSE
ULCERATE.

GONORRHEA CAUSED BY N. GONNORHOEA.

-GINGIVA BECOMES ERYTHEMATOUS AND EDEMATOUS WITH
PAPILLARY NECROSIS,THE TONSILS AND OROPHARYNX ARE OTHER
SITES FREQUENTLY AFFECTED BY GONNORHOEA.
GINGIVAL DISEASES ASSOCIATED WITH SYSTEMIC
DISEASES

(1)LEUKEMIA ASSOCIATED GINGIVITIS:

-IT IS A PROGRRESIVE,MALIGNANT HAEMATOLOGICAL DISORDER
CHARACTERISED BY AN ABNORMAL PROLIFERATION AND
DEVELOPMENT OF LEUCOCYTES AND PRECURSORS OF LEUCOCYTES
IN BLOOD AND BONE MARROW.
-ACUTE LYMPHOBLASTIC LEUKEMIA CONSTITUTES 80%OF ALL
CHILDHOOD LEUKEMIAS
-ORAL MANIFESTATIONS INCLUDES:
-CERVICAL ADENOPATHY
-PETECHIAE
-MUCOSAL ULCERS
-GINGIVAL INFLAMMATION AND ENLARGEMENT
SIGNS OF INFLAMMATION IN GINGIVA INCLUDES SWOLLEN , GLAZED
AND SPONGY TISSUES WHICH ARE RED TO DEEP PURPLE IN
APPEARANCE.
LEUKEMIA:DIFFUSE GINGIVAL ENLARGEMENT
(2)LINEAR GINGIVAL ERYTHEMA:
- MANIFESTATIONS OF HIV INFECTION IN GINGIVA IS KNOWN AS
LINEAR GINGIVAL ERYTHEMA.

- 2-3MM MARGINAL BAND OF INTENSE ERYTHEMA IN FREE

GINGIVA, IT MAY EXTEND INTO ATTACHED GINGIVA.
- IT MAY ALSO EXTEND INTO ALVEOLAR MUCOSA.
- LINEAR GINGIVAL ERYTHEMA DOES NOT RESPOND TO
CONVENTIONAL SCALING, ROOT PLANING AND PLAQUE CONTROL.
- THERE IS REDUCED PROPORTION OF T-CELL AND
MACROPHAGES AND INCREASED PROPORTION OF
IMMUNOGLOBULIN G, PLASMA CELL AND POLYMORPHONUCLEAR
LEUCOCYTES.
- HOST CELL RESPONSES AND UNUSUAL MICROBIODATA
MAY BE RESPONSIBLE FOR REFRACTORY NATURE OF THIS
LESION TO CONVENTIONAL PERIODONTAL TREATMENT OF
GINGIVITIS.
HIV ASSOCIATED GINGIVITIS:BAND OF ERYTHEMA INVOLVING THE
FREE GINGIVAL MARGIN
CONCLUSION:
-GINGIVAL DISEASES ARE A DIVERSE FAMILY OF COMPLEX
AND DISTINCT PATHOLOGICAL ENTITIES WHICH ARE RESULT OF
VARIETY OF PROCESSES.

- WHILE GINGIVAL DISEASE CAN AFFECT INFANTS OR YOUNG

OR ADULTS, THE PHENOTYPE AND/OR ONSET OF DIFFERENT GINGIVAL
DISEASE APPEARS TO BE PRE-REQUISITE FOR DESTRUCTION OF
CONNECTIVE TISSUE ATTACHMENT APICAL TO CEMENTOENAMEL
JUNCTION.

- THEREFORE, THE IDENTIFICATION AND TREATMENT OF

GINGIVAL DISEASE IS AN IMPORTANT FIRST STEP IN PREVENTING
MORE SERIOUS PERIODONTAL AILMENTS IN CHILDREN, ADOLESCENTS
AND YOUNG ADULTS.
REFERENCE:

•CARRANZA’S CLINICAL PERIODONTOLOGY-pg308-313

•TEXTBOOK OF PEDIATRIC DENTISTRY-S.G.DAMLE
pg207-219
•TEXTBOOK OF PEDODONTICS-SHOBHA TANDON
pg655-674
•ORAL & MAXILLOFACIAL PATHOLOGY –NEVILLE.
pg137-140,239,712.
•PERIODONTAL AND GINGIVAL HEALTH &DISEASES-
ENRIQUE BIMSTEIN.pg 31-48