Pediatric dentistry
Gingival diseases associated with endocrine system.
1.Puberty gingivitis is a distinctive type of gingivitis that occasionally develops in children in the prepubertal and pubertal period.
2.gingival enlargement in the anterior segment occurred with regularity in the prepubertal and premenarcheal period, as well as in pubescence.
3.The gingival enlargement was marginal in distribution, it was characterized by prominent bulbous interproximal papillae far greater than gingival enlargements associated with local factors.
4. Girls tended to reach their maximum gingivitis experience earlier than boys. initial high prevalence of gingivitis tended to decline with age. The enlargement of the gingival tissues in puberty gingivitis is confined to the anterior segment and may be present in only one arch. The lingual gingival tissue generally remains unaffected.
Treatment of puberty gingivitis.
1. improved oral hygiene, removal of all local irritants, restoration of carious teeth, and dietary changes necessary to ensure an adequate nutritional status.
2. Severe cases of hyperplastic gingivitis that do not respond to local or systemic therapy should be treated by gingivoplasty.
Surgical removal of the thickened fibrotic marginal and interproximal tissue has been found effective. Recurrence of any hyperplastic tissue will be minimal if adequate oral hygiene is maintained.
Gingival lesions of genetic origin.
Hereditary gingival fibromatosis (HGF) is:
1. characterized by a slow, progressive, benign enlargement of the gingival tissue, Genetic and pharmacologically induced forms of gingival enlargement are known.
2. The most common genetic form, HGF, usually has an autosomal dominant mode of inheritance.
3. the gingival tissues usually continue to enlarge with eruption of the permanent teeth until the tissues essentially cover the clinical crowns of the teeth.
4. The dense fibrous tissue often causes displacement of the teeth and malocclusion.
5. The condition is not painful until the tissue enlarges to the extent that it partially covers the occlusal surface of the molars and becomes traumatized during mastication.
6. histologically described as
a) a moderate hyperplasia of the epithelium, with hyperkeratosis and elongation of the ret pegs. The increase in tissue mass is primarily the result of an increase and thickening of the collagenous bundles in the connective tissue stroma.
b) The tissue shows a high degree of differentiation, and a few young fibroblasts are present.
Treatment
Surgical removal of the hyperplastic tissue achieves a more favorable oral and facial appearance. However, hyperplasia can recur within a few months after the surgical procedure and can return to the original condition within a few years. Although the tissue usually appears pale and firm, the surgical procedure is accompanied by excessive hemorrhage. Therefore quadrant surgery is usually recommended.
Drug induced gingival over growth.
The most important drugs cause over growth of gingival are phenytoin, cyclosporine, nifedipine.
phenytoin
1. is anticonvulsant drug used in treatment of epilepsy.
2.Gingival over growth occur in about 50 % of patient taken this drug.
3. the exact mechanism by which it cause Gingival over growth is unclear, but this may reflect the over production of collagen and this may be brought by the action of the drug on groups of fibroblasts that have the potential to synthesize large amount of protein.
Cyclosporine
1. is an immunosuppreseant drug that widely used in organ transplant patient to prevent graft rejection.
2. about 30% of patient taken this drug produce Gingival over growth, with children been susceptible more than adults.
3. the exact mechanism of this over growth is unknown.
Nifedipine
1. it is calcium- channel blocker that used for the control of cardiovascular diseases.
2. the rate of Gingival over growth occur in about 10-15% of patient taken this drug.
Clinical features of gingival over growth.
1.The first sign appear after3 -4 months of drug administration.
2.The inter dental papilla become nodular before enlarging more diffusely to encroach upon the labial tissues.
3. the anterior part of the mouth is most severely and frequently involved so that the patient appearances become so abundant that oral function particularly eating and speech become impaired.
Management of gingival over growth.
1. strict program of oral hygiene instruction, scaling, and polishing must be implemented.
2. severe cases of gingival over growth need to be surgically excised (gingivectomy ) and then recon toured ( gingivoplasty ) to produce an architecture that allow adequate access for cleaning.
3. follow up program is essential to ensure a high standard to detect an recurrence of the over growth.
Ascorbic acid deficiency gingivitis.
1. Scorbutic gingivitis is associated with vitamin C deficiency and differs from the type of gingivitis related to poor oral hygiene.
2. The involvement is usually limited to the marginal tissues and papillae.
3.The child with scorbutic gingivitis may complain of severe pain, and spontaneous hemorrhage will be evident.
4. management include replacement of V.C and oral hygiene maintenance.
Periodontal diseases in children.
1. Periodontitis, an inflammatory disease of the gingiva and deeper tissues of the periodontium, is characterized by pocket formation and destruction of the supporting alveolar bone.
2. Bone loss in children can be detected in bite-wing radiographs by comparing the height of the alveolar bone to the cementoenamel junction, distances between 2 and 3 mm can be defined as questionable bone loss and distances greater than 3 mm indicate definite bone loss.
Early onset periodentirtis.
EOP can be viewed as three categories of periodontitis that may have overlapping etiologies and clinical presentations: (1) a localized form (localized juvenile periodontitis. (2) a generalized form (generalized juvenile periodontitis. (3) a prepubertal category that is thought to have both localized and generalized forms (localized and generalized prepubertal periodontitis).
Prepubertal periodontitis
1. Prepubertal periodontitis of the primary dentition can occur in a localized form but usually is seen in the generalized form.
2. Localized prepubertal periodontitis (LPP) is localized attachment loss and alveolar bone loss only in the primary dentition in an otherwise healthy child.
3.The exact time of onset is unknown, but it appears to arise around or before 4 years of age, when the bone loss is usually seen on radiographs around the primary molars and/or incisors.
4. plaque accumulation is minimum, gingival inflammation may be seen.
5. premature loss of primary is common and all teeth may be lost by the age of 3 years.
6. Micro-organisms predominating in the gingival pockets include Actinobacillus actinomycetemcomitans (Aa), Porphyromonas (Bacteroides) gingivalis, Bacteroides melaninogenicus, Prevotella intermedia, Capnocytophaga sputigena, and Fusobacterium nucleatum.
Treatment depends on:
1. early diagnosis, dental curettage, root planing, prophylaxis, oral hygiene instruction, restoration of decayed teeth.
2. removal of the primary teeth that have lost bony support, and more frequent recalls.
3.Use of antimicrobial rinses (chlorhexidine) and therapy with broad-spectrum antibiotics are effective in eliminating the periodontal pathogens. A)Amoxicillin (Augmentin) has been used in children (250-mg liquid three times a day for 10 days)
B) tetracycline (250-mg elixir twice a day for 10 days), or a derivative, is an effective antibiotic against Aa and other gram-negative anaerobic microorganisms, its use should be considered in the treatment .
The child s parents should be made aware of the potential for pigmentation change in the developing permanent teeth and an increased susceptibility to oral candidiasis as a result of tetracycline therapy.
(Localized juvenile periodontitis).
1. occurs in otherwise healthy children and without clinical evidence of systemic disease.
2. It is characterized by the rapid and severe loss of alveolar bone around more than one permanent tooth, usually the first molars and incisors
3. It appears self limiting.
4. Progression of bone loss is three to four times faster than in adult periodontitis.
5. it is not thought to be a single disease entity. The probable causative microbial species are Actinobacillus actinomycetemcomitans (Aa), or Aa in combination with Bacteroides-like species.
6. A variety of neutrophil defects have been reported in patients with LJP.
Treatment.
Successful treatment depends on early diagnosis, dental curettage, prophylaxis, oral hygiene instruction, removal of the severely mobile teeth and use broad spectrum antibiotics.
Generalized aggressive periodontitis.
1. seen at around puberty.
2. affected the entire dentitions.
3. caused by non motile, facultative, an aerobic, gram negative rod P. gingivalis.
4. management early diagnosis, dental curettage, root planning, prophylaxis, oral hygiene instruction, removal of the severely mobile teeth and use broad spectrum antibiotics
Papillion- lefevere syndrome:
1.it cause is unknown, familial tendency is present.
2. characterized by palmer- planter hyperkeratosis ,premature loss of primary and permanent dentitions, ectopic calcifications of the flax cerebri.
3. patient show increase susceptibility to infection.
4. it is an autosomal- recessive trial with prevalence of about 1-4 per million of the population.
5. management include tetracycline therapy followed and extraction followed by complete denture.