Eruption gingivitis and pericoronitis in children

Its about a common phenomena of teething observed in children during eruption of deciduous and permanent teeth

1. ERUPTION GINGIVITIS & PERICORONITIS IN CHILDREN Prepared by : Dr.Afiqur Rahman Sourav Intern Doctor Department Of Paediatric Dentistry Dhaka Dental College Hospital

2. ERUPTION GINGIVITIS What is it? A transitory type of gingivitis is often observed in young children when the primary or permanent teeth are erupting . Often localized Associated with difficult eruption, Subsides after the teeth emerge into the oral cavity .

3. Name: Ubaidul Islam Age: 6 years 2months Address: Mirpur Date : 5 th November’14 ERUPTION GINGIVITIS

4. Incidence The greatest increase in the incidence of gingivitis in children is often seen in the 6- to 7-year age group when the permanent teeth begin to erupt. This inflammation is most commonly associated with the eruption of the first and second permanent molars, and the condition can be painful.

5. Causes of Eruption Gingivitis This increase in gingivitis apparently occurs because the gingival margin receives no protection from the coronal contour of the tooth during the early stage of active eruption, where Food debris, materia alba, and bacterial plaque often collect around and beneath the free tissue, partially cover the crown of the erupting tooth, and cause the development of an inflammatory process .

6. Clinical Features Pain Redness of the Gingiva Swelling of the Gingiva Bleeding on probing Anorexia & Dysphagia Mostly heals after complete eruption of the teeth In cases of Molar,if pericoronitis develops then pus discharge sometimes associated with Lymphnode enlargement and fever.

7. Treatment Mild eruption gingivitis requires no treatment other than improved oral hygiene. Painful eruption gingivitis is managed by Oral Hygiene Instruction along with Systemic Antibiotics and NSAIDs. The condition may be helped when the area is irrigated with a counterirritant, such as Peroxyl .

8. Sequele If it is Untreated and there is operculum covering the erupting tooth partially,it ma develop Pericoronitis and Pericoronal Abscess. pericoronitis

9. Pericoronitis What is it? Pericoronitis is defined as inflammation of the oral soft tissues surrounding the crown of a partially erupted tooth.

10. Cause The major cause is the food and debris impaction and microbial flora that develops in the distally located pseudopocket .

11. Clinical Features Red, swollen, suppurating lesion that is exquisitely tender with radiating pain to ear, throat and floor of mouth. It is usually associated with fever and lymph node enlargement. The diagnosis of pericoronitis is mainly clinical with three distinct diagnostic categories recognized: Acute pericoronitis, Sub‑acute pericoronitis, and Chronic pericoronitis .

12. Acute Pericoronitis Trismus , fever, pain, dysphagia, extraoral swelling , malaise, halitosis, pus discharge, sore throat, and anorexia. Pain may disturb sleep, lymphadenitis involving the deep cervical lymph nodes may be present.

13. Subacute Pericoronitis Pain, dysphagia, intraoral swelling, halitosis, pus discharge, sore throat. Associated pain is most often described as continuous, dull, and is occasionally sharp or throbbing. Unlike acute attacks, radiation of painful symptoms into adjacent muscles is rare. The individual does not have limited mouth opening. This is a distinguishing feature from acute pericoronitis .

14. Chronic Pericoronitis It is diagnosed based on a history of temporary dull aching low grade pain that typically lasts only 1‑2 days. Signs include palpable non‑tender submandibular lymph nodes and macerated buccal tissue consistent with cheek biting .

15. Complications Pericoronal abscess It may spreads posteriorly in oropharyngeal area. Dysphagia Involvement of lymph nodes- posterior and deep cervical. Peritonsillar abscess. Ludwig's angina

16. Treatment PERICORONITIS OPERCULECTOMY EXTRACTION (usually not done in children)

17. Preparation For Operculectomy Operculectomy is contra-indicated in Acute condition.So Acute condition is eliminated by- NSAIDs to relieve pain. -Acetaminophen, Ibuprofen etc. Systemic Antibiotics when Fever and Lymph Node Enlargement is present. -Penicillin, Erythromycin, Cephalosporins etc. Oral Hygiene Instructions.

18. Operculectomy Operculectomy is done in Three procedures: Scalpel Laser Electrocautary

19. Operculectomy

20. Thank You