GINGIVA IN CHILDREN

Hi, I am Dr Komal Ghiya, I am uploading some of my own presentations regarding dentistry for educational purposed and I hope you like this presentation on Gingiva health and disease.

1. GINGIVA:HEALTH AND DISEASE KOMAL GHIYA DEPARTMENT OF PEDODONTIA AND PREVENTIVE DENTISTRY

2. INDEX COMPONENTS OF PERIODONTIUM CLASSIFICATION DIFFERENTIATING FEATURES OF CHILDREN AND ADULTS GINGIVITIS IN CHILDREN PERIODONTAL DISEASES IN CHILDREN

3. COMPONENTS OF PERIODONTIUM

4. MARGINAL GINGIVA: TERMINAL EDGE OR BORDER OF THE GINGIVA SURROUNDING THE TEETH IN COLLAR LIKE FASHION GINGIVAL SULCUS: SHALLOW CREVICE OR SPACE AROUND THE TOOTH BOUNDED BY THE SURFACE OF THE TOOTH ON ONE SIDE AND THE EPITHELIUM LINING THE FREE MARGIN OF THE GINGIVA ON THE OTHER SIDE ATTACHED GINGIVA: CONTINUOUS WITH MARGINAL GINGIVA MUCOGINGIVAL JUNCTION: THE FACIAL ASPECT OF THE ATTACHED GINGIVA EXTENDS TO RELATIVELY LOOSE AND MOVABLE ALVEOLAR MUCOSA AND IS DEMARCATED BY MUCOGINGIVAL JUNCTION

5. CLASSIFICATION OF GINGIVAL DISEASE GINGIVAL DISEASE DENTAL PLAQUE INDUCED GINGIVAL DISEASE NON PLAQUE INDUCED GINGIVAL LESIONS CHRONIC PERIODONTITIS: LOCALIZED GENERALIZED AGGRESSIVE PERIODONTITIS LOCALIZED GENERALIZED

6. PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE ASSOCIATED WITH HEMATOLOGICAL DISORDERS ASSOCIATED WITH GENETIC DISORDERS NOT OTHERWISE SPECIFIED NECROTIZING PERIODONTAL DISEASES NECROTIZING ULCERATIVE GINGIVITIS NECROTIZING ULCERATIVE PERIODONTITIS ABSCESSES OF PERIODONTIUM GINGIVAL ABSCESS PERIODONTAL ABSCESS PERICORONAL ABSCESS

7. PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESIONS COMBINED PERIODONTIC-ENDODONTIC LESIONS DEVELOPMENTAL OR ACQUIRED DEFORMITIES AND CONDITIONS LOCALIZED TOOTH RELATED FACTORS THAT MODIFY OR PREDIPOSE TO PLAQUE INDUCED GINGIVAL DISEASES/PERIODONTITIS MUCOGINGIVAL DEFORMITIES AND CONDITIONS AROUND TEETH MUCOGINIGIVAL DEFORMITIES AND CONDITIONS ON EDENTULOUS RIDGES OCCLUSAL TRAUMA

8. DIFFERENTIATING FEATURES OF CHILDREN AND ADULTS CHARACTERISTICS CHILDREN ADULT COLOR PALE PINK CORAL PINK SURFACE SMOOTH STIPPLED GINGIVA THICK AND ROUND KNIFE EDGED FREE GINGIVA KERATINIZED SADDLE AREA NON KERATINIZED INTERDENTAL COL INTERDENTAL GINGIVA INTERDENTAL CLEFTS NOT PRESENT ATTACHED GINGIVAL RETROCUSPID PAPILLA RETROCUSPID PAPPILA NOT PRESENT SULCUS DEPTH 2.1-2.3 mm 2-3 mm ALVEOLAR MUCOSA RED,THIN,VASCULAR PINK PDL WIDE NARROW COLLAGEN BUNDLES MORE HYDRATED,LESS DIFFERENTAITED MORE DIFFERENTIATED

9. POLYPEPTIDE CHAINS NORMAL CROSS LINKING TIGHT CROSS LINKING GROUND SUBSTANCE LOW RATIO TO COLLAGEN TO GROUND SUBSTANCE GROUND SUBSTANCE TO COLLAGEN RATIO NORMAL FIBRES GINGIVAL FIBRES ARE IMMATURE MATURE AND ORGANIZED TRABECULAE THICK TRABECULAE WITH LARGE MARROW SPACES MORE TRABECULAE WITH LESS MARROW SPACES

10. GINGIVITIS IN CHILDREN STAGES DAYS VASCULAR CHANGES PREDOMINANT IMMUNE CELLS CLINICAL FINDINGS STAGE 1 2-4 Permeablity of vascular bed PMNs Gingival fluid flow STAGE 2 4-7 Vascular proliferation Lymphocytes Erthema,bleeding on probing STAGE 3 14-21 Stage2+blood statsis Plasma cells and b lymphocytes Change in color, size,texture etc STAGE 4 Month Degeneration Plasma cells Loss of connective tissue attachment and alveolar bone

11. ASSESSMENT OF GINGIVITIS AND PERIODONTITIS Indices for gingiva Papillary marginal attachment index Gingival index Sulcular bleeding index Papillary bleeding index Indices for periodontal diseases Russel’s periodontal index Periodontal disease index CPITN CPI Gingival periodontal index Gingival bone count index

12. TYPES OF GINGIVITIS IN CHILDREN PLAQUE INDUCED GINGIVITIS POOR ORAL HYGIENE,FOOD DEBRIS,PLAQUE ,MICROORGANISMS ALSO ACCUMULATE AND PROCESS OF INFLAMMATION ERUPTION GINGIVITIS AROUND AN ERUPTING PERMANENT TOOTH

13. GINGIVITS DUE TO HABIT MOUTHBREATHING HABIT

14. INFECTIVE GINGIVITIS HERPETIC GINGIVOSTOMATITIS: CHILDREN LESS THAN 3 YEARS HSV 1 PRODROMAL PHASE:MALAISE,FEVER,VOMITING,IRRITABILITY,VESICLES, ULCERS WITH ERYTHEMATOUS MARGINS SELF LIMITING MANAGEMENT:BED REST,PLENTY OF FLUID,MAINTENANCE OF GOOD ORAL HYGIENE ANALGESICS,TOPICAL ANESTHETIC GEL

15. ACUTE NECROTIZING ULCERATIVE GINGIVITIS STARTS AT INTERDENTAL PAPILLAE,SPREADING ALONG GINGIVAL MARGINS NECROTIC ODOUR TREATMENT: HYDROGEN PEROXIDE ORAL HYGIENE DIET

16. PUBERTAL GINGIVITIS PRIMARY DENTITION COMPARED WITH MIXED AND PERMANENT DENTITIONS HORMONAL GINGIVITIS

17. PLASMA CELL GINGIVITIS CHARACTERIZED BY DIFFUSE AND MASSIVE INFILTRATION OF PLASMA CELLS INTO SUBEPITHELIAL GINGIVAL TISSUE

18. PERIODONTAL DISEASES IN CHILDREN EARLY ONSET PERIODONTITIS LOSS OF ATTACHMENT >3 mm LACK OF PRECISE CRITERIA GENERALLY AGREED 1 st MOLAR AND INCISOR ,MUST BE AFFECTED AND UPTO ONE OR TWO OTHER TEETH MAY BE AFFECTED

19. LOCALIZED EARLY ONSET PERIODONTITIS HART et al DIAGNOSIS OF LOCALIZED EARLY ONSET PERIODONTITIS IS BASED ON ATTACHMENT LOSS OF MORE THAN 4 MM ON AT LEAST TWO PERMANENT 1 st MOLAR AND INCISORS NOT MORE THAN TWO OTHER PERMANENT TEETH ,WHICH ARE NOT 1 ST PERMANENT MOLARS OR INCISORS SHOULD BE AFFECTED DEEP POCKETS,PREMATURE AND EXCESSIVE MOBILITY OF MAXILLARY AND MANDIBULAR PRIMARY INCISORS AND 1 st PRIMARY MOLARS ARE SEEN

20. PREPUBERTAL PERIODONTITIS ASSOCIATED PLAQUE DEPOSITS ARE MODERATE AND THERE IS LITTLE INFLAMMATION OF GINGIVAE ,BUT BLEEDING UPON PROBING IS PRESENT AT AFFECTED SITES

21. JUVENILE PERIODONTITIS FIRST MOLAR AND INCISORS MOBILITY,BONE LOSS REGIONAL LYMPHADENOPATHY DEEP,DULL,RADIATING PAIN RADIOGRAPHIC FINDINGS AN ARC SHAPED LOSS OF ALVEOLAR BONE EXTENDING FROM DISTAL SURFACE OF THE SECOND PREMOLAR TO THE MESIAL SURFACE OF SECOND MOLAR

22. TREATMENT: SUBGINGIVAL IRRIGATION WITH IODINE AND HYDROGEN PEROXIDE AUGMENTATION OF SCALING AND ROOT PLANNING WITH SURGICAL THERAPY ANTIBIOTIC:TETRACYCLINE

23. NECROTIZING FORMS OF PERIODONTAL DISEASE CHARACTERIZED BY GINGIVAL NECROSIS PRESENTING PUNCHED OUT PAPILLAE WITH GINGIVAL BLEEDING AND PAIN HALITOSIS AND PSUEDOMEMBRANE FORMATION MAY BE SECONDARY DIAGNOSTIC FEATURES FUSIFORM BACTERIA ,OTHER ANAEROBIC GRAM NEGATIVE BACTERIA AND SPIROCHETES HAVE BEEN ASSOCIATED WITH THE GINGIVAL LESIONS RELATED FACTORS MAY INCLUDE EMOTIONAL STRESS,POOR DIET,CIGARETTE SMOKING,SEASONAL CHANGES AND HIV INFECTION.

24. CHARACTERIZED BY NECROSIS OF GINGIVAL TISSUES,PERIODONTAL LIGAMENT AND ALVEOLAR BONE LESIONS ARE COMMONLY OBSERVED IN INDIVIDUALS WITH SYSTEMC CONDITIONS INCLUDING BUT NOT LIMITED TO VIRAL INFECTIONS,SEVERE MALNUTRITION AND IMMUNOSUPPRESSION. NUP IS PRECEDED BY NECROTIZING ULCERATIVE GINGIVITIS WHICH IS AN ACUTE INFLAMMATORY CONDITION ASSOCIATED WITH A FUSOSPIROCHETAL MICROBIOTA

25. SCORBUTIC GINGIVITIS The gingival tissues are swollen, spongy, and bleed easily. Ecchymoses may be present in the palate, cheeks, or floor of the mouth. Necrosis and infection may be further complications. A pronounced hypochromic anemia and hyperkeratosis of hair follicles is often present. Biochemical assay of the plasma ascorbic acid level is a valuable test. The range considered essential for good health is 0.7mg per 100c.c. to 1.40mg per 100 c.c. The recommended daily allowances (intake) are 75mg. for males, and 70 to 150mg for female

26. GINGIVAL ENLARGEMENT INFLAMMATORY GINGIVAL ENLARGEMEN T ACUTE CHRONIC DRUG INDUCED GINGIVAL ENLARGEMENT ENLARGEMENTS ASSOCIATED WITH SYSTEMIC DISEASES CONDITIONED ENLARGEMENT PREGNANCY PUBERTY VITAMIN C DEFICIENCY NON SPECIFIC CONDITIONED ENLARGEMENT SYSTEMIC DISEASE CAUSING GINGIVAL ENLARGEMENT LEUKEMIA GRANULOMATOUS DISEASE

27. INFLAMMATORY GINGIVAL ENLARGEMENT ORIGINATES AS A SLIGHT BALLONING OF INTERDENTAL PAPILLA AND MARGINAL GINGIVA LOCALIZED OR GENERALZED PROGRESS SLOWLY DISCRETE SESSILE OR PEDUNCULATED MASS INTERPROXIMAL OR ATTACHED

28. DRUG INDUCED GINGIVAL ENLARGEMENT

29. PAPILLON LEFEVRE SYNDROME

30. DENTAL ASPECTS SWOLLEN,GINGIVAL,MIGRATION AND MOBITLITY OF TEETH,PERIODONTAL POCKETS,FETOR ORIS AND EXFOLIATION OF TEETH TREATMENT METICULOUS PLAQUE CONTROL ADMINISTRATION OF CHLORHEXIDIENE IN COMBINATION WITH SYSTEMIC ANTIBIOTIC THERAPY FOR ERADICATION OF KNOWN PERIODONTAL PATHOGENS IN CONJUNCTION WITH RETINOIDS

31. DOWN SYNDROME PERIODONTAL DISEASE VERY PREVALENT AND MORE SEVERE THAN IN AGE MATCHED CONTROLS ESPECIALLY IN LOWER ANTERIORS DIFFERENCES NOT EXPLAINED BY PLAQUE LEVELS RAPID PROGRESSION ONSET APPARENT IN DECIDUOUS DENTITION HYPOPHOSPHATASIA CEMENTUM HYPOPLASIA OR APLASIA PERIODONTAL DESTRUCTION MAY AFFECT DECIDUOUS DENTITION RESULTING IN PREMATURE EXFOLIATION, TOOTH LOSS VARIABLE EFFECTS ON PERMANENT DENTITION ,NOT NECESSARILY AS SEVERE

32. LEUCOCYTE DISORDERS:NEUTROPENIA,CHEDIAK HIGASHI SYNDROME,LEUCOCYTE ADHESION DEFICIENCY SYNDROME ULCERATIVE GINGIVITS PERIODONTITIS SEVERE GINGIVITIS ,PERIODONTITIS TOOTH LOSS DUE TO PERIODONTAL DESTRUCTION ULCERATION MUCOSA,TONGUE,HARD PALATE EARLY ONSET PREPUBERTAL PERIODONTITIS RAPID ATTACHMENT LOSS AND BONE LOSS SHORTLY AFTER ERUPTION OF DECIDUOUS DENTITION.EARLY EXFOLIATION

33. GINGIVAL AND PERIODONTAL ABSCESS ENLARGEMENT OF GINGIVA ,BUT THEY ALSO INVOLVE THE SUPPORTING TISSUE PERIODONTAL ABSCESS GINGIVAL ABSCESS LOCALIZED,PAINFUL,RAPIDLY EXPANDING LESION THAT IS USUALLY OF SUDDEN ONSET GENERALLY LIMITED TO MARGINAL GINGIVA OR INTERDENTAL PAPILLA IN EARLY STAGES IT APPEARS AS A RED SWELLING WITH SMOOTH ,SHINY SURFACE WITHIN 24-48 HOURS LESIONS USUALLY BECOME FLUCTUANT AND POINTED WITH A SURFACE ORIFICE FROM WHICH PURULENT EXUDATE MAY EXPRESS

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