PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

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  1. Periodontal diseases in children - P. A. Heasman and P. J. Waterhouse


11.1 INTRODUCTION


Periodontal diseases comprise a group of infections that affect the supporting
structures of the teeth: marginal and attached gingiva; periodontal ligament;
cementum; and alveolar bone.


Acute gingival diseases⎯primarily herpetic gingivostomatitis and necrotizing
gingivitis⎯are ulcerative conditions that result from specific viral and bacterial
infection. Chronic gingivitis, however, is a non-specific inflammatory lesion of the
marginal gingiva which reflects the bacterial challenge to the host when dental plaque
accumulates in the gingival crevice. The development of chronic gingivitis is
enhanced when routine oral hygiene practices are impaired. Chronic gingivitis is
reversible if effective plaque control measures are introduced. If left untreated the
condition invariably converts to chronic periodontitis, which is characterized by
resorption of the supporting connective tissue attachment and apical migration of the
junctional epithelia. Slowly progressing, chronic periodontitis affects most of the
adult population to a greater or lesser extent, although the early stages of the disease
are detected in adolescents.


Children are also susceptible to aggressive periodontal diseases that involve the
primary and permanent dentitions, respectively, and present in localized or
generalized forms. These conditions, which are distinct clinical entities affecting
otherwise healthy children, must be differentiated from the extensive periodontal
destruction that is associated with certain systemic diseases, degenerative disorders,
and congenital syndromes.


Periodontal tissues are also susceptible to changes that are not, primarily, of an
infectious nature. Factitious stomatitis is characterized by self-inflicted trauma to oral
soft tissues and the gingiva are invariably involved. Drug-induced gingival
enlargement is becoming increasingly more prevalent with the widespread use of
organ transplant procedures and the use of long-term immunosuppressant therapy.
Localized enlargement may occur as a gingival complication of orthodontic treatment.


A classification of periodontal diseases in children is given in 604HTable 11.1.


11.2 ANATOMY OF THE PERIODONTIUM IN CHILDREN


Marginal gingival tissues around the primary dentition are more highly vascular and
contain fewer connective tissue fibres than tissues around the permanent teeth. The
epithelia are thinner with a lesser degree of keratinization, giving an appearance of
increased redness that may be interpreted as mild inflammation. Furthermore, the
localized hyperaemia that accompanies eruption of the primary dentition can persist,
leading to swollen and rounded interproximal papillae and a depth of gingival sulcus
exceeding 3 mm.


During eruption of the permanent teeth the junctional epithelium migrates apically
from the incisal or occlusal surface towards the cementoenamel junction (CEJ). While
the epithelial attachment is above the line of maximum crown convexity, the gingival

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