10 Paediatric Periodontal And Soft Tissue Pathology

Front 1

Areas of interest within periodontium where primary and permanent dentitions differ

Back 1

• Papillary gingiva
• Marginal gingiva
• Attached gingiva
• Alveolar mucosa
• Alveolar bone
• Periodontal membrane

Front 2

primary VS permanent

Papillary gingiva

Back 2

Interdental saddle

Front 3

primary VS permanent

Marginal gingiva

Back 3

– Deeper sulcus
– Thicker, rounder free gingival margin

Front 4

primary VS permanent

Attached gingiva

Back 4

– Thinner, less keratinised
– Greater vascular
– Less connective tissue, less dense
– Less stippled (dev 2-3 y-o)
– Less width

Front 5

primary VS permanent

• Alveolar mucosa

Back 5

Redder since thinner epithelium
– Less keratinised, more vascular

Front 6

primary VS permanent

Alveolar bone

Back 6

Less calcified, more vascular, larger marrow space
Flatter interdental crest

Front 7

primary VS permanent

Periodontal membrane

Back 7

Wider periodontal space and less dense
since fewer fibers/unit area

Front 8

Influence of permanent tooth eruption

Active stage?

Back 8

Occurs until contact with antagonist
– Reduced epithelium

Front 9

Influence of permanent tooth eruption

Passive stage

Back 9

– Occurs when sulcular epithelium
changes after occlusion
– Occurs over 10 years period
– Increase crown length, decrease
sulcular depth
– Stabilise between 16-18 years of age

Front 10

Clinical appearance of gingivitis?

Back 10

Reddish and swollen marginal gingiva
– Interdental papillae protruding
– Bleeding tendency

Front 11

Puberty Gingivitis

Causes?

Back 11

•Hormonal changes esp female
adolescents

Front 12

Puberty Gingivitis

when does it subside?

Back 12

when hormonal changes end
approx 18 y-o

Front 13

Puberty gingivitis

Treatment?

Back 13

•Regular scaling
•Oral hygiene measure

Front 14

Modifying factors of periodontitis?

Back 14

Calculus
Defective restorations
Caries
Systemic diseases

Front 15

Systemic diseases that are modifying factors of periodontitis?

Back 15

– Diabetes mellitus
– Hypophosphatasia
– Histiocytosis-X
– Papillon-Lefevre syndrome

Front 16

Types of Periodontitis in children?

Back 16

Prepubertal
Juvenile

Front 17

What are the characteristics of prepubertal periodontitis?

Back 17

• Immediately after eruption of primary teeth
• Prevalence is <0.5%, ethnic difference
• Hereditary pattern in some cases

Front 18

What are the types of prepubertal periodontitis?

Back 18

localised and generalised

Front 19

Prepubertal periodontitis :
– Localized form :?

Back 19

Some primary teeth affected
Mild to moderate inflammation
Slow destruction
Healthy individual
No previous infection
Response to antibiotics

Front 20

Prepubertal periodontitis
– Generalized form?

Back 20

Severe/ all primary teeth involved
Severe sign of inflammation
May lead to premature loss of teeth
Previous infections
No response to antibiotics
Often associated with systemic conditions
Should be referred for medical
examination

Front 21

Features of Juvenile periodontitis

Back 21

• Early permanent dentition
• Male > female
• Rapid progressing, rapid bone loss
• Often preceded by bone loss in primary dentition
• Two forms
– Localised
– Generalised

Front 22

Juvenile periodontitis :
– Localized form

Back 22

» Moderate signs of inflammation
» Involved 2 or more teeth
» Usually first molars and incisors

Front 23

• Juvenile periodontitis :
– Generalized form

Back 23

» Severe signs of inflammation
» Involved 8 or more teeth

Front 24

Periodontitis
Treatment

Back 24

– Scaling and root planning, debridement
– Preventive program to reduce plaque accumulation
– Extraction of severely affected primary teeth
– Recall
– Referral

Front 25

White lesions and infections

Back 25

Inclusion cysts (gingival cyst of infants)
Geographic tongue

Front 26

Inclusion cysts?

Back 26

– One or multiple freely mobile nodular white lesions
– Small superficial keratin-containing cysts
– Asymptomatic, exfoliated spontaneously

Front 27

Geographic tongue?

Back 27

(migratory glossitis)
– Migratory desquamative area on dorsal, lateral of tongue
– Erosion or loss of papillae
– Appears to have white and red lesions
– No treatment
– May host other dermatologic
conditions

Front 28

Ulcerative lesions?

Back 28

• Aphthous ulcers
• Traumatic ulcer

Front 29

Compressible lesions

Back 29

• Eruption cyst
• Hemorrhagic cyst
• Gingival parulis
• Mucous retention cyst

Front 30

Types of Mucous retention cyst

Back 30

ranula
mucocele

Front 31

Nonhemorrhagic soft tissue lesions

Back 31

Congenital epulis

Front 32

Congenital epulis?

Back 32

– Unknown aetiology
– Single, elevated, smooth
– Benign tumour
– Maxilla
– Rare in mandible
– Surgery
– Low recurrent

Front 33

Vesticular-desquamative lesions and infections

Back 33

• Herpetic gingivo stomatitis
• Herpes labialis
• Vericella ulcer (chickenpox)
Vesticular-desquamative lesions and infections
• Herpes zoster
• Herpangina
• Hand Foot Mouth disease

Front 34

Explain herpes simplex virus infection in children, especially aetiology, clinical features (signs and symptoms), and management.

Back 34

Infection by HSV1 in children with peak age of 0 - 2. Incubation period 4-5days. Fever 1-2days, acute vesicles 3-7days followed by ulceration 10-14days. Managed with Antivirals, fluid maintenance, supportive, symptomatic treatments