periodontal diseases in children pedo
TRANSCRIPT
PERIODONTALDISEASES 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.
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 juvenilePeriodontitis ; 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 actinomycetem-Comitans & bacteriodes species
TREAMENT --Self limiting--No treatment required
It is reffered as severe periodontitis & rapidly prodressive Periodontitis
CLINICAL FEATURES-- More common in young adults involving permanentdentition– Occurs in presence of marked gingival inflammation & gross plaque Accumulation
ETIOLOGY:--- Subgingival plaque from affected site harbours high percentage Of porphyromonas gingivalis
GENERALISED JUVENILE PERIODONTITIS.
TREATMENTMedical 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:- It is characterised by rhythmic reduction Of polymorphonuclear neutrophils in 21 days cycle
ORAL MANIFESTATION(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