PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

Anterior teeth with narrow zones of KG are frequently encountered in children, as the
width of KG varies greatly during the mixed dentition. For example, when permanent
teeth erupt labially to their predecessors they frequently appear to erupt through
alveolar mucosa with a complete absence of KG (622HFig. 11.8). When the tooth has fully
erupted an obvious width of KG is present.

The width of KG alone should not be the sole indicator of potential sites of gingival
recession in children. The position of a tooth in the arch is a better guide as studies
have shown that, of those permanent incisors with recession, about 80% are displaced
labially. Aggravating factors such as gingivitis or mechanical irritation from excessive
and incorrect toothbrushing further increase the likelihood of recession.

Gingival recession is also a common periodontal complication of orthodontic therapy
when labial tipping of incisors is undertaken. When roots move labially through the
supporting envelope of alveolar bone the potential for recession increases.

When gingival recession occurs in children, a conservative approach to treatment
should be adopted. The maximum distance from the gingival margin to the CEJ
should be recorded. Overenthusiastic toothbrushing practices are modified and a scale
and polish given if necessary. The recession must then be monitored carefully until
the permanent dentition is complete. Longitudinal studies of individual cases have
shown that, as the supporting tissues mature, the gingival attachment tends to creep
spontaneously in a coronal direction to cover at least part of the previously denuded
root surface. This cautious approach is preferred to corrective surgical intervention to
increase the width of KG.

Key Points
Gingival recession:

• narrow keratinized gingiva;


• local trauma;


• post orthodontics;


• conservative treatment approach.

623H

Fig. 11.8 Lower central incisors that have

erupted somewhat labially to the partially

erupted There is only a minimal width of

keratinized gingiva buccal to the.

11.8 CHRONIC PERIODONTITIS

A number of epidemiological studies (624HTable 11.2) have investigated the prevalence of
chronic periodontitis in children. The variation in prevalence between studies is
considerable and attributable to different methods of diagnosing attachment loss and