The child’s periodontium

The child’s periodontium

1. Introduction :

The periodontium of children was long misunderstood. However, despite the latest advances in research, the periodontium still has many gray areas. (Nevertheless, it is accepted that in children, periodontal tissues differ from those in adults in their clinical appearance and physiology). 

2. The periodontium in deciduous dentition: 

There is no difference between the components of the superficial periodontium in children, adolescents and adults (gingival oral epithelium, sulcular oral epithelium and junctional epithelium). However, the gingiva in children and adolescents is clinically different from that of adults and varies according to growth (thin epithelium thickness associated with rich vascularization at the level of the gingival lamina). 

1. Anatomical histology of the periodontium in children: 
   1. The anatomical features of the periodontium in children are as follows: 

• The gum is redder than that of adults. It is firm and elastic in consistency and has a smooth or finely grainy appearance. The graininess, which is less marked than in adults, only appears after the age of two. 
• The sulcus is less deep than that of the permanent tooth, which makes it less sensitive to anaerobic germs. 
• . The attached gingiva is more important in the maxilla than in the mandible, and it increases with age. The greatest height is at the level of the incisors, it can reach 6 mm and it decreases towards the temporary molars, where it is only 1 mm.
• The gingival papilla appears wider in children in the vestibulo-lingual direction, but narrower in the mesio-distal direction than in adults.

2. The histological characteristics are:

• The gingival epithelium is the thinnest and most translucent, because it is less keratinized, than in adults. In addition, cells of the pigment lineage are visible in the basal layer. This explains the racial gingival pigmentations. 
• Among the cells of the gingival corium: fibroblasts and fibrocytes are found in greater numbers than in adults. In addition, it has increased hydration and a greater quantity of soluble collagen. Finally, its more abundant capillary network gives the gum a redder color. 
• The density of the cementum and its thickness are less than those of permanent teeth. 
• In children, residues of Hertwig’s sheath or of the epithelium of the enamel organ are found in the desmodont. 
• We also note the presence of fewer collagen fiber bundles and greater vascularization than in adults. 
• The alveolar bone has a thinner cribriform plate than in adults. Similarly, the mineralization is less dense and the trabeculations are fewer. 
• Alveolar ridges may be convex or flat, especially if associated with diastemas, which are common in children.

The child’s periodontium

2. Physiology of the periodontium: 

• The eruption of temporary teeth is often accompanied by physiological gingival changes that should not be associated with gingivopathy. The gingiva is red, edematous, this is due to the emergence of the crown in the oral mucosa. 
• The alveolar bone undergoes significant remodeling at the time of eruption of temporary teeth, during the first occlusal contacts and during resorption. 
• When the gum is healthy, young children have a low volume of gingival fluid. Similarly, the pH is lower than that of young adults. Thus, older children would have a greater susceptibility to gingival inflammation. 
• Dental plaque is very discreet in children with temporary teeth, due to the composition of saliva being less rich in mineral salts. 
• Tartar is rarely observed in temporary teeth.

3. The periodontium of the mixed dentition to the young adult dentition of the adolescent:
   1. Anatomical histology of the periodontium:
      1. Anatomical features of the child’s periodontium:

This period extends over 6 years, from the development of the first molars and permanent lower incisors, to the insertion of the second permanent molar. The end of this period generally corresponds to the puberty period.

• The marginal gingiva is more inflammatory. It is described as thickened, flaccid and red. It reacts very quickly to local aggressions such as dental plaque but also orthodontic devices or iatrogenic fillings. 
• The depth of the sulcus increases in children and young adolescents. This increase is primarily related to age and, to a lesser extent, to the inflammatory reaction. 

2. The histological characteristics are:

Histologically healthy gingival status probably exists only in theory. Indeed, even in the presence of clinically healthy gingiva, histological sections reveal the presence of leukocytes migrating across the junctional epithelium. 

With age, and as the temporary tooth approaches exfoliation, the increase in sulcus depth is linked to a migration of the epithelial attachment under the resorbed surface. This epithelial attachment, a continuation of the permanent tooth in the oral cavity, is reconstituted from the reduced adamantine epithelium. 

The child’s periodontium

2. Physiology:

• Tooth eruption: Mixed dentition marks the transition from temporary teeth to permanent, adult teeth, also called 6-year teeth because they appear around the sixth year.

The latter does not require the loss of a temporary tooth, such as the second and third molars. 

Thus, the crown penetrates the oral mucosa at the time of eruption, which inevitably leads to changes in the marginal gingiva. 

Tooth eruption is divided into 3 stages which are accompanied by gingival changes. 

• First, there is an increase in localized gingival volume, giving an edematous appearance to the gum and a red color. 
• Then, during the eruptive phase, we observe the formation of a gingival margin with an edematous, red and rounded appearance. The sulcus can then reach up to 3 mm in depth following a false gingival growth linked to the adhesion of the marginal gingiva on the coronal bulge.
• Finally, there is acquisition of a normal height of the gingival margin. 

However, gingival inflammation is one of the mechanisms that allows tooth eruption.

• Tooth resorption: The resorption of temporary teeth is made up of successive, alternating stages, with phases of stability and even ankylosis, during which new intermediate fibers and new cementum temporarily reform. 

Resorption is influenced by local and general factors. 

At the time of exfoliation of a temporary tooth, inflammation of the superficial periodontium is constant. 

• Dental plaque: We have seen that the presence of plaque is very discreet in children with temporary teeth, in particular due to the composition of saliva which is less rich in mineral salts.

However, the presence of plaque increases significantly in mixed dentition and corresponds to the appearance of gingival infections. 

• Tartar: While it is almost absent in temporary teeth, it is found to be present in greater quantities in mixed teeth . In fact, 5% of children under 4 years old have tartar, while 15% between 4 and 12 years old. 
• The child’s periodontium

  Sensitive teeth react to hot, cold or sweet.
Sensitive teeth react to hot, cold or sweet.
Ceramic crowns perfectly imitate the appearance of natural teeth.
Regular dental care reduces the risk of serious problems.
Impacted teeth can cause pain and require intervention.
Antiseptic mouthwashes help reduce plaque.
Fractured teeth can be repaired with modern techniques.
A balanced diet promotes healthy teeth and gums.
 

The child’s periodontium