Pedodontics III Al Azhar University Palestine Gaza Upload By: Lama El Banna lama1997bana@gmail.com Faculty of oral and dental medicine

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
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2. College of Dentistry
Pedodontic III
Gingival and Periodontal Problems in
Children -1-
Dr. Hazem El Ajrami
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3. • The gingiva is the mucous membrane that
extends from the cervical portion of the tooth
to the mucobuccal fold.
• The gingiva is divided into:
1. Papillary portion: occupying the inter-
dental space (inter-dental papilla).
2. Marginal portion: forming a collar of free
gingiva around the neck of each tooth.
3. Attached portion: attached to the
underlying alveolar bone by dense fibrous
tissue.
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5. • Normally, the gingiva should be pale pink
although the colour may be better related to the
individual. Brown pigmented areas are often
encountered in dark people. Healthy gingiva is
firmly bound down to the alveolar bone.
Stippling varies from fine to coarsely grained
appearance. In adult, healthy gingival margin
has a sharp knife like edge.
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6.  During childhood, the periodontal tissues
have the following characteristics:
 Gingiva:
1. More reddish: because of thinner and less
hornified epithelium and great vascularity.
2. Lack of stippling: because of the shorter
and flatter connective tissue papillae of the
lamina propria.
3. Flabbier, associated with decreased density
of the connective tissue of lamina propria.
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7. 4. Rounded and rolled margins, related to
hyperemia and edema that accompany
eruption.
5. Greater sulcular depth, relative to ease of
gingival retraction.
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8.  Cementum:
Thinner and less dense.
 Periodontal membrane:
1. Wider.
2. Fiber bundles are less dense with less
fibers per unit area.
3. Increased hydration, greater blood supply
and lymph drainage.
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9.  Alveolar bone:
1. Thinner lamina dura (radiographically).
2. Fewer trabculation.
3. Wider marrow spaces.
4. Decreased degree of mineralization.
5. Greater blood and lymph supply.
6. Flatter alveolar crest associated with
primary teeth.
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10. Gingivitis in Children
• Severe gingivitis is relatively uncommon in
children although large portion of children in
population has a mild reversible type of
gingivitis.
• Classification of lesions affecting the
periodontal tissues and oral mucosa in
children:
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11. I. Acute Lesions.
II. Chronic Gingivitis in Children .
III. Conditioned Gingival Enlargement.
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12. I. Acute Lesions:
1. Eruption Cyst or Eruption Hematoma.
2. Acute Gingival Problems Associated with
Eruption of Teeth:
A. Eruption gingivitis.
B. Pericoronitis.
3. Acute Gingival Problems Associated with
Exfoliation of Primary Teeth.
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13. 4. Acute Herpetic Infection.
5. Recurrent Aphthous Stomatitis.
6. Acute Necrotizing Ulcerative
Gingivostomatitis (ANUG).
7. Acute Oral Moniliasis (Candidiasis or
Thrush).
8. Acute Bacterial Gingivitis.
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14. I. Acute Lesions:
1. Eruption Cyst or Eruption Hematoma:
 Definition:
It is a type of dentigerous cyst
associated with erupting teeth, usually
erupting primary teeth.
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16.  Etiology:
 The cyst results from accumulation of blood
stained fluid in the detailed space about the
crown of the erupting tooth.
 The etiology is unknown but mechanical
trauma might be responsible.
 May occur in children of all ages including
the newborn.
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18. Clinical:
The cyst generally appears as a bluish
fluctuant swelling over an erupting tooth. The
color depends upon:
The amount of blood present within the
cavity.
The thickness of the overlying mucosa.
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20. Treatment:
Unnecessary.
However in rare cases, in which the cyst
apparently is responsible for undue delayed
eruption or excessive worry of the parents,
surgical excision of the overlying tissue to
expose the crown may be carried out.
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21. 2. Acute Gingival Problems Associated with
Eruption of Teeth:
A. Eruption gingivitis:
This is a type of localized
inflammation at the site of an erupting
tooth which subsides after the tooth
emerges into the oral cavity.
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22. B. Pericoronitis:
 Definition:
It is an acute inflammation of the
gingiva surrounding an erupting tooth, most
often lower third molar. In children, this
occurs related to an erupting lower second
primary molar or second permanent molar.
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24. Etiology:
It is due to accumulation of food debris and
bacteria under the gingival operculum of the
erupting tooth.
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25.  Clinical:
1) The gingival operculum becomes red,
swollen and painful.
2) With gentle pressure, a purulent exudate can
generally be discharged.
3) Swollen operculum may interfere with
closing to jaws & as a result may be further
traumatized by the opposing teeth.
4) There may be regional lymphadenopathy, in
severe cases this may be accompanied by
fever and general malaise.
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26.  Treatment:
1) Gentle debridement under the inflamed
operculum with a curette to:
A. Remove the debris.
B. Permit discharge of the purulent exudate
usually relieves some of the acute
symptoms.
2) Warm physiologic saline rinses are
prescribed.
3) Antibiotics may be necessary in the presence
of fever and lymphadenopathy.26

27. 4) Once the acute symptoms have subsided, it
may be necessary to surgically remove the
operculum if it was found creating a
retention area.
5) The condition improves when the occlusal
surface is completely uncovered and the
tooth reaches functional occlusion.
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28. 3. Acute gingival problems associated with
exfoliation of primary teeth:
 Etiology:
 Uneven resorption of the roots of primary
teeth can cause increased tooth mobility,
thus encouraging:
A.Food impaction.
B.Accumulation of deposits & mechanical
irritation of the underlying tissue by the
uneven, sharp, partially resorbed root
end.
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29.  Loss of function associated with gingival
enlargement, bleeding and discomfort may
result.
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30. Treatment:
Removal of the primary tooth in such
cases:
Eliminates the pathologic condition.
Improves the oral hygiene & encourages the
eruption of the underlying permanent tooth.
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31. 4. Acute Herpetic Infection:
 Etiology:
Herpes simplex virus.
 Types:
1) Primary.
2) Secondary (Recurrent Herpes Labialis).
 99 % of all cases of the primary infections
are of the subclinical type.
 1 % of all primary infections is of the
clinical type.
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32.  Onset:
Sudden Onset.
 Duration:
1) Disease is self limiting.
2) Its course is about 10-14 days.
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33. Age:
Primary infection rarely affects children
under the age of one year due to the
presence of maternal antibodies.
It occurs before five years of age & before
the formation of neutralizing antibodies.
It reaches its peak at the age of 3 years.
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34. Contagious or not:
Contagious.
Spread usually by direct contact.
Systemic findings:
Appear before the oral signs.
Usually severe.
They consist of high fever, irritability,
headache, anorexia, malaise. Probably
submaxillary gland involvement.
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35. Oral findings:
Fiery red diffuse inflammation throughout
the gingival and alveolar mucosa. Due to the
formation of multiple small yellow or white
liquid filled vesicles over a 4 to 5 days period
that will leave shallow painful ulcers 1 to 3 mm
in diameter covered with yellowish exudate.
The borders of these ulcers are inflamed. Ulcers
do not involve the tips of the interdental
papillae.
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36.  Treatment:
1) Mainly supportive and palliative, directed
towards the relief of the acute symptoms.
2) The elevated body temperature & the
discomfort in ingesting fluid usually result in
dehydration.
3) The child should be placed on a balanced diet
and the fluid intake increased.
4) Sour, hot, spicy or rough food should be
avoided.
5) Bed rest and isolation from other children in
the family, specially the very young, should
be recommended.36

37. 6) Analgesics are prescribed for relief of pain.
7) Surface anesthetics applied prior to meal time
will temporally relieve the pain & will allow
the child to take a soft diet.
8) Vitamin supplements is indicated during the
course of the disease. Control of the secondary
infection shortens the duration of the disease.
9) Oral oxytetracycline results in an improvement
after 3 to 5 days of its use.
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38. 10) Other tetracyclines should not be used
because of the problem of staining the
developing teeth.
11) Penicillin has no favorable effect.
12) The disease is self-limiting & the oral lesions
usually heal in 5 to 6 days without scar
formation.
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39. Recurrence:
After the initial attack, whether clinical or
subclinical, the disease may recur in the form
of small lesions usually outside the mouth,
e.g. on the lips (recurrent herpes labialis).
The recurrent form of the disease has been
related to conditions of emotional stress and
lowered tissue resistance resulting from
various types of trauma.
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40. Thank You
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