(gingivoplasty) to improve tissue architecture and facilitate subgingival cleaning.
Key Points
Necrotizing ulcerative gingivitis⎯treatment:
- intense oral hygiene;
- remove predisposing factors;
- mechanical debridement;
- metronidazole.
611H
Fig. 11.3 A 5-year-old Ethiopian boy
with necrotizing ulcerative gingivitis.11.4 CHRONIC GINGIVITIS
National Surveys (1973, 1983, and 1993) of children's dental health in the United
Kingdom show that the prevalence of chronic gingivitis increases steadily between
the ages of 5 and 9 years and is closely associated with the amount of plaque, debris,
and calculus present (612HFig. 11.4). For example, in 1993, 26% of 5-year-olds had some
signs of gingivitis, and the proportion increased to 62% at the age of 9. The
prevalence of gingivitis peaks at about 11 years and then decreases slightly with age
to 15 years. In terms of gingivitis, there has been no improvement over the decades
between surveys. Indeed, in 1993, between 11 and 14% more children of all ages
between 6 and 12 years had signs of gingivitis when compared with 1983. These
differences were not maintained with increasing age, however, as 52% of 15-year-
olds had gingivitis in 1993 compared with 48% in 1983. Furthermore, there were no
differences between 1983 and 1993, in the proportion of 15-year-olds with pockets
between 3.5 and 5.5 mm (9 and 10%, respectively). These data suggest that the
gingival condition of children in the United Kingdom has deteriorated over the 10
years between 1983 and 1993, whereas the periodontal status of 15-year-olds has not
changed. Certainly, changes in gingival health do not mirror the dramatic
improvement in the prevalence of caries over the same period. Children's mouths
tended to be cleaner in 1983 than in 1973. This trend was reversed by 1993 when
between 10 and 20% more children of all ages had plaque deposits. Levels of calculus
were similar in both surveys.
The onset of puberty and the increase in circulating levels of sex hormones is one
explanation for the increase in gingivitis seen in 11-year-olds. Oestrogen increases the
cellularity of tissues and progesterone increases the permeability of the gingival
vasculature. Oestradiol also provides suitable growth conditions for species of black
pigmenting organisms which are associated with established gingivitis.