Periodontal disease in children
Introduction :
- From birth to adulthood, the periodontium of children and adolescents is constantly evolving.
- A better understanding of the child’s periodontium in both healthy and diseased states allows the practitioner to
differentiate pathological processes from normal changes related to age and/or dental eruption, to detect risk situations and to prevent periodontal disorders in adulthood.
- The periodontium of children is a more fragile terrain but with greater restorative potential than that of adults.
- Child’s particularities
The child has a particular autonomy, physiology, and psychology. He is not a miniature adult.
- Periodontium in children
- The periodontal tissues of young children differ from those of adults in their appearance and in their resistance to the development of periodontal diseases.
- Periodontal architecture is closely linked to the evolution of the dentition, which extends from the eruption of the first temporary incisor (6 months) to the occlusion of the second permanent molar (14 years). It is therefore important to know its specificities in order to differentiate pathological processes from normal functional and architectural changes.
- Support
- Caring for a young child in the dental practice necessarily involves behavior management.
- Psychological approach :
- The layout of the office must be taken into account.
dental, the waiting room as well as the treatment area which must be designed to suit the child.
- The practitioner will listen to what the parents and child say, focusing on a child-centered relationship. There must be a dialogue with the child, and parents are not excluded because we need their cooperation.
- Using vocabulary that the child understands is important.
- Care must be carried out in the presence of the accompanying person and with their assistance.
- The child is treated in the development phase:
It can be in temporary, mixed, or permanent dentition. Special pharmacological and interventional precautions must be taken into account.
- Etiologies of periodontal diseases in children:
- Local:
- Dental biofilm:
- Local:
The flora associated with periodontal disease shifts from a predominance of Gram-positive forms to a more complex flora including Gram-negative bacteria and spiral forms.
- Tartar :
Less significant in children, represented by a well-tolerated blackish border above the gingival surface.
- Cavities:
Common in children due to lack of brushing and sugary diets. Proximal caries promote plaque retention and lead to periodontal complications.
- Dental malpositions:
Promote food retention and plaque buildup in hard-to-reach areas.
- Contribute to occlusal imbalance and promote premature contacts and parafunctions.
- Orthodontic appliances:
- Promote plaque retention and traumatize periodontal tissues (excessive forces).
- Mucogingival defects:
- Traumatic insertions of brakes and bridles: Pull the tissues apically (risk of recession)
- Lack of attached gum and hinders hygiene
- Dysfunctions and parafunction:
- Mouth breathing: Promotes plaque buildup through dry mouth;
- Unilateral chewing: Common in children with decayed or loose teeth;
- Atypical swallowing;
- Thumb sucking;
- Bruxism: Causes occlusal overloads
- General:
- General illnesses: Uncontrolled diabetes, Down syndrome
- Hormonal changes during puberty
- Vitamin C deficiency
- Certain medications
- Genetic factors of early-onset periodontitis
- Periodontal pathologies in children:
- Gum diseases:
- Plaque-induced gingivitis:
- Gum diseases:
- Gingivitis induced solely by plaque:
- The severity of gingivitis is less in children.
- Tooth eruption, exfoliation of temporary teeth, orthodontic appliances and mouth breathing can aggravate gum inflammation;
- Gingivitis modified by systemic factors:
- Puberty/menstrual cycle associated gingivitis: Increased steroid hormone levels aggravate gingival inflammation initially induced by bacterial plaque, causing
edematous and hemorrhagic gingivitis;
- Diabetes-associated gingivitis: Children with poorly controlled type 1 diabetes have severe gingival inflammation. This is a pathology to suspect in cases of persistent gingivitis.
- Associated with hematological disorders: immune depression in acute leukemias, which are predominant in children, promotes the appearance of gingivitis characterized by: gingival hyperplasia due to
Infiltration of leukemic cells, ulcerations, bleeding, and sometimes dental mobility are associated with this disease.
- Gingivitis modified by taking medication:
- Three groups of drugs are associated with gingival hyperplasia: anticonvulsants (phynetoin), immunosuppressants (ciclosporin), calcium channel blockers.
- Gingivitis modified by malnutrition:
- Vitamin C deficiency, although rare, should not be underdiagnosed. Gum hypertrophy, bleeding, and ulcerations can be manifestations of vitamin C deficiency.
- Non-plaque induced gingivitis:
- Fungal origin: Candidal infections:
- Occurs mainly in children with systemic illness: immunodeficiency, diabetes, endocrinopathy, antibiotic and corticosteroid therapy, xerostomia, etc.
- Characterized by whitish lesions disseminated throughout the oral mucosa.
- Viral origin: Acute herpetic gingivostomatitis:
- Caused by herpes simplex virus type I.
- Common in children 2 to 4 years old.
- Often asymptomatic, but can cause gingivostomatitis, painful, hemorrhagic, associated with numerous vesicular eruptions;
- General signs may be associated: fever, asthenia, dysphagia, hypersalivation.
- Hereditary origin: Hereditary gingival fibromatosis
- It is a gingival pathology of genetic origin characterized by a slow and progressive proliferation of the keratinized gum;
- Clinically, the gum remains normal in color and firm in consistency and is neither hemorrhagic nor painful.
- Periodontitis:
- Chronic periodontitis:
- Mainly affects adults due to its slow progression over time.
- Currently, no data in the literature are available on this clinical entity affecting children and adolescents.
- Aggressive periodontitis:
- Children and adolescents are susceptible to aggressive periodontitis.
- characterized by loss of attachment, rapid alveolysis;
- Localized aggressive periodontitis can begin very early, sometimes before the age of 2.
- Generalized aggressive periodontitis is most often associated with systemic disease.
- Periodontitis as a manifestation of systemic diseases:
- Associated with hematological disorders:
- Acquired neutropenia: Symptoms vary from gingivitis to early-onset periodontitis.
- Leukemia: Gingivitis can develop into periodontitis with loss of attachment and mobility.
- Associated with genetic disorders:
All major syndromes with phagocytic dysfunction (Leukocyte adhesion deficiency, Down syndrome, Papillon-Lefèvre syndrome, Chediak-Higashi syndrome, cyclic neutropenia)
, are always accompanied by severe periodontitis with early onset that can affect both sets of teeth, leading to premature exfoliation of temporary and permanent teeth.
- Necrotizing periodontal diseases:
- Low incidence during childhood.
- It is not linked to the sole presence of bacterial plaque, but to predisposing factors, to transient (stress, malnutrition) or permanent (HIV, systemic diseases) immunodepression.
- Therapeutic approach in children:
- Oral hygiene:
- It is the first checkpoint for oral diseases.
- Twice-daily brushing with an age-appropriate fluoride toothpaste is the most effective preventative measure for carious lesions and gingivitis.
- Dental brushing techniques:
- From 6 months to 1 year: Parents can be advised to clean teeth with a sterile compress;
- From 1 to 3 years: It is the parents who do the brushing:
- Before the age of 2: brush once in the evening, without toothpaste because the child will tend to swallow it;
- From the age of 2, two brushings per day will be necessary: one in the morning and one in the evening before bedtime.
- From 4 to 6 years old:
- The child begins to become independent, he brushes himself under the supervision of the parents:
- Recommended vertical or circular brushing technique (2 times/day)
- From 6 years old:
- Effective brushing twice a day for 2 minutes.
- Roller or circular brushing technique.
- Initial periodontal therapy
- Supragingival scaling and root planing are no different from those for adults. They can be performed on temporary or mixed dentition.
- In cases of aggressive periodontitis, systemic antibiotic therapy combining amoxicillin and metronidazole is recommended.
- Restorative treatments, endodontics, extractions, prostheses;
- Rehabilitation of disturbed functions.
- Re-evaluation:
- It is carried out at 8 to 12 weeks to decide on the continuation of the treatment;
- If there is a persistent periodontal pocket greater than 4 mm with bleeding on probing, a corrective phase is indicated.
- Surgical treatments:
- This phase occurs once the periodontal infection is controlled in order to reconstruct functional and aesthetic dental and periodontal anatomy.
- Gingivectomies allow for the restoration of gingival anatomy favorable to good plaque control and their indications are limited.
- Sanitation surgeries take place in the treatment of aggressive periodontitis when periodontal pockets greater than 5 mm persist after re-evaluation.
- It is also possible to combine regeneration or filling techniques for intraosseous lesions of aggressive periodontitis or those following dentoperiodontal trauma, which is common in young people.
- Maintenance phase:
- Its aim is to prevent the recurrence of the disease, reduce the risk of tooth loss, and diagnose and treat new dental and oral pathologies. Apart from the form and severity of the disease, which determine the frequency of visits, these also depend on the patient, their availability, their observance and their compliance.
- In case of periodontal risk, a rate of 3 to 4 visits per year is necessary.
CONCLUSION
Periodontal disease in children can develop into severe periodontitis in adults. It is therefore necessary to identify children, families, or populations most susceptible to periodontal disease, in order to monitor them regularly and prevent the development and worsening of periodontal pathology.
Periodontal disease in children
Wisdom teeth can cause infections if not removed in time.
Dental crowns protect teeth weakened by cavities or fractures.
Inflamed gums can be a sign of gingivitis or periodontitis.
Clear aligners discreetly and comfortably correct teeth.
Modern dental fillings use biocompatible and aesthetic materials.
Interdental brushes remove food debris between teeth.
Adequate hydration helps maintain healthy saliva, which is essential for dental health.