This article reviews periodontal disease and gingival disease and also explores issues relating to mucogingival defects such as gingival hyperplasia, gingival recession, and exposure of impacted canines.
Key Points
- •
Maintenance and preservation of teeth and prevention of tooth loss are the main desired outcome of periodontal treatment.
- •
Minimal treatment for the maximum result outlines the main philosophy behind pediatric periodontics.
- •
A team approach must be considered for success in treating children.
- •
Close communication with pediatric dentists and other specialists, such as orthodontists, endodontists, and oral surgeons, are key to a successful outcome.
Introduction
Gingivitis and periodontitis are two different disease entities. Gingivitis is an inflammation of surrounding tissue without any bone loss, and periodontitis is inflammation with attachment loss. Typically, periodontitis is described as an irreversible process characterized by bone loss, while gingivitis is described as a reversible process limited to gingival tissue inflammation. The prevalence of periodontal disease in children and adolescents is relatively low, about 0.2% to 0.5%. However, gingival disease and varying degrees of gingivitis are extremely common.
Although nomenclature for gingival disease and mucogingival disease has stayed the same over time, periodontal disease in children has gone through many different names over the last decade: periodontosis, prepubertal periodontitis, juvenile periodontitis and most currently aggressive periodontitis.
This article is divided into 2 subsets: periodontal disease and gingival disease, and mucogingival defects such as gingival hyperplasia, gingival recession, and exposure of impacted canines. Issues relating to trauma will also be visited briefly ( Box 1 ).
- I.
Gingival diseases
- A.
Dental plaque-induced gingival diseases a
- 1.
Gingivitis associated with dental plaque only
- a.
Without other local contributing factors
- b.
With local contributing factors (see VIII.A)
- a.
- 2.
Gingival diseases modified by systemic factors
- a.
Associated with the endocrine system
- 1.
Puberty-associated gingivitis
- 2.
Menstrual cycle-associated gingivitis
- 3.
Pregnancy-associated gingivitis and pyogenic granuloma
- 4.
Diabetes mellitus-assocated gingivitis
- 1.
- b.
Associated with blood dyscrasias
- 1.
Leukemia-associated gingivitis
- 2.
Other
- 1.
- a.
- 3.
Gingival diseases modified by medications
- a.
Drug-influenced gingival diseases
- 1.
Drug-influenced gingival enlargements
- 2.
Drug-influenced gingivitis
- a.
Oral contraceptive-associated gingivitis
- b.
Other
- a.
- 1.
- a.
- 4.
Gingival diseases modified by malnutrition
- a.
Ascorbic acid-deficiency gingivitis
- b.
Other
- a.
- 1.
- B.
Nonplaque-induced gingival lesions
- 1.
Gingival diseases of specific bacterial origin
- a.
Neisseria gonorrhea- associated lesions
- b.
Treponema pallidum- associated lesions
- c.
Streptococcal species-associated lesions
- d.
Other
- a.
- 2.
Gingival diseases of viral origin
- a.
Herpesvirus infections
- 1.
Primary herpetic gingivostomatitis
- 2.
Recurrent oral herpes
- 3.
Varicella zoster infections
- 1.
- b.
Other
- a.
- 3.
Gingival diseases of fungal origin
- a.
Candida species infections
- b.
Linear gingival erythema
- c.
Histoplasmosis
- d.
Other
- a.
- 4.
Gingival lesions of genetic origin
- a.
Hereditary gingival fibromatosis
- b.
Other
- a.
- 5.
Gingival manifestations of systemic conditions
- a.
Mucocutaneous disorders
- 1.
Lichen planus
- 2.
Pemphigoid
- 3.
Pemphigus vulgaris
- 4.
Erythema multiforme
- 5.
Lupus erythematosus
- 6.
Drug-induced
- 7.
Other
- 1.
- b.
Allergic reactions
- 1.
Dental restorative materials
- a.
Mercury
- b.
Nickel
- c.
Acrylic
- d.
Other
- a.
- 2.
Reactions attributable to
- a.
Toothpastes/dentifrices
- b.
Mouth rinses/mouthwashes
- c.
Chewing gum additives
- d.
Foods and additives
- a.
- 3.
Other
- 1.
- a.
- 6.
Traumatic lesions (factitious, iatrogenic, accidental)
- a.
Chemical injury
- b.
Physical injury
- c.
Thermal injury
- a.
- 7.
Foreign body reactions
- 8.
Not otherwise specified
- 1.
- A.
- II.
Chronic periodontitis b
- A.
Localized
- B.
Generalized
- A.
- III.
Aggressive periodontitis b
- A.
Localized
- B.
Generalized
- A.
- IV.
Periodontitis as a manifestation of systemic diseases
- A.
Associated with hematological disorders
- 1.
Acquired neutropenia
- 2.
Leukemias
- 3.
Other
- 1.
- B.
Associated with genetic disorders
- 1.
Familial and cyclic neutropenia
- 2.
Down syndrome
- 3.
Leukocyte adhesion deficiency syndromes
- 4.
Papillon-Lefèvre syndrome
- 5.
Chediak-Higashi syndrome
- 6.
Histiocytosis syndromes
- 7.
Glycogen storage disease
- 8.
Infantile genetic agranulocytosis
- 9.
Cohen syndrome
- 10.
Ehlers-Danlos syndrome (types 4 and 8)
- 11.
Hypophosphatasia
- 12.
Other
- 1.
- C.
Not otherwise specified
- A.
- V.
Necrotizing periodontal diseases
- A.
Necrotizing ulcerative gingivitis (NUG)
- B.
Necrotizing ulcerative periodontitis (NUP)
- A.
- VI.
Abscesses of the periodontium
- A.
Gingival abscess
- B.
Periodontal abscess
- C.
Pericoronal abscess
- A.
- VII.
Periodontitis associated with endodontic lesions
- A.
Combined periodontic–endodontic lesions
- A.
- VIII.
Developmental or acquired deformities and conditions
- A.
Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis
- 1.
Tooth anatomic factors
- 2.
Dental restorations/appliances
- 3.
Root fractures
- 4.
Cervical root resorption and cemental tears
- 1.
- B.
Mucogingival deformities and conditions around teeth
- 1.
Gingival/soft tissue recession
- a.
Facial or lingual surfaces
- b.
Interproximal (papillary)
- a.
- 2.
Lack of keratinized gingiva
- 3.
Decreased vestibular depth
- 4.
Aberrant frenum/muscle position
- 5.
Gingival excess
- a.
Pseudopocket
- b.
Inconsistent gingival margin
- c.
Excessive gingival display
- d.
Gingival enlargement (See I.A.3. and I.B.4.)
- a.
- 6.
Abnormal color
- 1.
- C.
Mucogingival deformities and conditions on edentulous ridges
- 1.
Vertical and/or horizontal ridge deficiency
- 2.
Lack of gingiva/keratinized tissue
- 3.
Gingival/soft tissue enlargement
- 4.
Aberrant frenum/muscle position
- 5.
Decreased vestibular depth
- 6.
Abnormal color
- 1.
- D.
Occlusal trauma
- 1.
Primary occlusal trauma
- 2.
Secondary occlusal trauma
- 1.
- A.
The periodontal conditions are categorized mainly into gingival diseases and periodontal diseases.
a Can occur on a periodontium with no attachment loss or on a periodontium with attachment loss that is not progressing.
b Can be further classified on the basis of extent and severity. As a general guide, extent can be characterized as Localized = ≤30% of sites involved and Generalized = >30% of sites involved. Severity can be characterized on the basis of the amount of clinical attachment loss (CAL) as follows: Slight = 1 or 2 mm CAL, Moderate = 3 or 4 mm CAL, and Severe = ≥5 mm CAL.
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