children, as periodontal disease is very uncommon in this age group. The presence of
colour change (redness), swelling, ulceration, spontaneous bleeding, or recession
(Figs. 3.12 and 3.13.) should be carefully noted, and the aetiology sought.
Key Point
The presence of profound gingival inflammation in the absence of gross plaque
deposits, lateral periodontal abscesses, prematurely exfoliating teeth, or mobile
permanent teeth may indicate a more serious underlying problem, warranting further
investigation.
During inspection of the gingival tissues, an assessment of oral cleanliness should
also be made, and the presence of any plaque or calculus deposits noted. A number of
simple oral hygiene indices have been developed to provide an objective record of
oral cleanliness. One such index, the oral debris index (Green and Vermillion, 1964),
requires disclosing prior to an evaluation of the amount of plaque on selected teeth
(first permanent molars, and upper right and lower left central incisors) as shown in
Fig. 3.14.
Systematic periodontal probing is not routinely practised in young children, unless
there is a specific problem (see Chapter 11). However, it is prudent to carry out some
selective probing for teenagers in order to detect any early tissue attachment loss,
which may indicate the onset of adult periodontitis.
Teeth
Following assessment of the oral soft tissues, a full dental charting should be
performed. A thorough knowledge of eruption dates for the primary and permanent
dentition is essential as any delayed or premature eruption may alert the clinician to a
potential problem. However, simply recording the presence or absence of a tooth is
not adequate: closer scrutiny of each tooth's condition, structure, and shape is also
required. Suggested features to note are briefly listed below:
- caries⎯is it active/arrested, restorable/unrestorable? Check for the presence of a
chronic sinus associated with grossly carious teeth; - restorations⎯are they intact/deficient?
- fissure sealants⎯are they intact/deficient?
- tooth surface loss⎯note any erosion/attrition, site, extent (Fig. 3.15);
- trauma⎯note extent, site, or signs of loss of vitality;
- tooth structure⎯record any enamel opacities/hypoplasia (are defects localised/
generalised?) (Figs. 3.16, 3.17, and 3.18); - tooth shape/size⎯note presence of double teeth, conical teeth, macrodontia/
microdontia, talon cusps, deep cingulum pits (Fig. 3.19); - tooth number⎯any missing/extra teeth?
- tooth mobility⎯is it physiological or pathological?
- tooth eruption⎯are there any impactions, infraoccluded primary molars, or
ectopically erupting first permanent molars?
Occlusion