The child's periodontium - ToothHorizons.com

The child’s periodontium

Introduction.

A better understanding of the periodontium in children makes it possible to detect risk situations and prevent periodontal disorders in adults.

The periodontal architecture of the child 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).

Periodontal tissues in young children differ from those in adults in terms of their clinical and biological aspects.

II. Periodontium in temporary dentition:

The periodontium evolves with the temporary teeth and goes through 3 stages:

Maturation, Stability, Resorption

1. The gum

Highly vascularized,
Thinner, less keratinized epithelium
Lower height of adherent gum,
Junctional epithelium less high, more fragile
Sulcus depth 2 mm on average.

Free gingiva : Thicker and rounded appearance, linked to the morphology of the teeth (constricted necks) and the presence of diastemas

Attached gingiva In temporary dentition, the height of adherent gingiva is greater in the maxilla than in the mandible, it increases with age.

. HISTOLOGICALLY There is an absence of “orange peel” pitting because the connective tissue papillae of the lamina propria are shorter and flatter.

The alveolo-dental ligament:

Large especially in the furcation area, Highly vascularized, Numerous remains of Hertwig’s epithelial sheath
Communicates with the pulp connective tissue through the “pulpo-periodontal canals”
Communicates with bone marrow spaces.

Cement:

Less thickness and density,
Acellular at the coronal level and cellular at the apical level,
Zones of apposition and resorption.

The child’s periodontium

The alveolar bone:

Less mineralization,
Significant vascularization,
Large medullary spaces,
Very thin cortices,
Flat or convex alveolar ridges (diastemas)

III. Periodontal changes during eruption of temporary teeth

Due to its immature nature, the periodontium of the temporary tooth is somewhat fragile and offers little resistance to infection during the different phases of dentition, particularly at the time of dental eruption and resorption.

In fact, the local pre-eruptive inflammation results in pericoronal hyperemia marked by swelling of the gum which follows the contour of the underlying crown.

The passage of the tooth through the gum causes its contact with the septicity of the oral cavity, hence the need for clinical monitoring during this period of eruption.

VI. From mixed dentition to young permanent dentition:

This period spans 6 years, from the development of the first molars and permanent lower incisors to the eruption of the second permanent molars.

The end of this period generally corresponds to the puberty period.

1. Different Phases:

Transition 6-8 years (incisors and 1st molars)
Latency 8-9 years
Transition 9-12 years: Prepubertal period (premolars, canines and 2nd molars)
Pubertal period: intense reactivity

Many physiological variations linked to the eruption not to be confused with pathology!

The gum:

Numerous inflammatory cells, remnants of the eruption, (lymphocytes, macrophages, PNN, mast cells)
Rapid inflammatory reactions (plaque, ODF),
The sulcus has a maximum depth during eruption,
Increase in the height of adherent gingiva with age.
Densification of the collagen fibers of the chorion which fix the mucosa to the alveolar bone: appearance of surface granite

The alveolo-dental ligament: its thickness decreases with age, it is rich in fibroblasts with a high turnover.

Alveolar bone : with increasing mechanical stress, cortices and trabeculations thicken.

Cementum: cementogenesis presents a succession of phases of activity and rest, increase in its thickness.

NB: The periodontium is immature as long as the tooth is immature because it forms with root growth .

The child’s periodontium

V. Changes and evolution of gingival tissues during the eruption of permanent teeth:

At the external level, the gum will undergo changes, a significant reduction in its height during eruption then continuous growth throughout life, with a peak during the prepubertal period.

In fact, local pre-eruptive inflammation results in:

Pre-eruptive swelling: The gum has a firm and sometimes slightly paler swelling .
. Formation of the gingival margin: The often inflamed marginal gingiva is thick, curled, flaccid and red. It reacts very quickly to local aggressions (bacterial plaque, orthodontic devices, etc.).
dental resorption: the osteoclasts that appear in the environment of the dental structures nevertheless result in a destruction of the cementum and dentin and finally in the expulsion of the tooth. Several modifications occur during resorption:

Modification of root structures : Root length decreases; Widening of the apical orifice;

Periodontal changes: The epithelial attachment migrates to the regions undergoing resorption;

IV. CHILD’S ORAL ENVIRONMENT:

Saliva: it is approximately 8 to 10 ml/h in children, 4 ml/h in infants and 15 ml/h in adults).

. Gingival fluid : Its quantity increases with the degree of gingival inflammation .

Microbial flora:

At birth, the infant’s oral cavity is absolutely sterile.
Most often, germs found in the mouth are in a commensal state if oral hygiene conditions are good.
The amount and composition of plaque microorganisms differs in children, adolescents and adults.
Colonization by microorganisms changes under the influence of sex hormones and the proportion of Gram-negative bacteria increases during puberty.
Estrogens and progesterone may promote the establishment of anaerobic microbial flora in the sulcus during puberty.
The number of Prevotella intermedia and P. nigrescens increases during puberty.