Histopathology
The inflammatory infiltrate associated with marginal gingivitis in children is
analogous to that seen in adults during the early stages of gingival inflammation. The
dominant cell is the lymphocyte, although small numbers of plasma cells,
macrophages, and neutrophils are in evidence. Research findings have not yet
determined unequivocally whether the lymphocyte population is one of unactivated B
cells or is T-cell dominated. The relative absence of plasma cells, which are found in
abundance in more established and advanced lesions in adults, confirms that gingivitis
in children is quiescent and does not progress inexorably to involve the deeper
periodontal tissues.
Key Points
Chronic gingivitis:
- plaque-associated;
- lymphocyte-dominated;
- complex flora;
- linked to the onset of puberty.
Microbiology
The first organisms to colonize clean tooth surfaces are the periodontally harmless,
Gram-positive cocci that predominate in plaque after 4-7 days. After 2 weeks, a more
complex flora of filamentous and fusiform organisms indicates a conversion to a
Gram-negative infection, which, when established, comprises significant numbers of
Capnocytophaga, Selenomonas, Leptotrichia, Porphyromonas, and Spirochaete spp.
These species are cultivable from established and advanced periodontal lesions in
cases of adult periodontitis. This suggests that the host response (rather than the
subgingival flora) confers a degree of immunity to the development of periodontal
disease in children, thus preventing spread of the contained gingivitis to deeper
tissues.
Manual versus powered toothbrushes
The treatment and prevention of gingivitis are dependent on achieving and
maintaining a standard of plaque control that, on an individual basis, is compatible
with health. Toothbrushing is the principal method for removing dental plaque, and
powered toothbrushes now provide a widely available alternative to the more
conventional, manual toothbrushes for cleaning teeth.
There is considerable evidence in the literature to suggest that powered toothbrushes
are beneficial for specific groups: patients with fixed orthodontic appliances⎯for
whom there is also evidence that powered toothbrushes are effective in reducing
decalcification; children and adolescents; and children with special needs. It remains
questionable whether children who are already highly motivated with respect to tooth
cleaning will benefit from using a powered toothbrush. It is possible that, particularly
in children, any improved plaque control as a consequence of using a powered
toothbrush may result from a 'novelty effect' of using a new toothbrush rather than
because the powered toothbrush is more effective as a cleaning device.