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201]
Review Article
Abstract
Periodontal diseases are among the most frequent diseases affecting children and adolescents. These include gingivitis, localized or generalized
aggressive periodontitis (a.k.a., early onset periodontitis) and periodontal diseases associated with systemic disorders. The effects of
periodontal diseases observed in adults have earlier inception in life period. Gingival diseases in a child may progress to jeopardize the
periodontium in adulthood. Therefore, periodontal diseases must be prevented and diagnosed early in the life. This paper reviews the most
common periodontal diseases affecting children: chronic gingivitis (or dental plaque-induced gingival diseases) and aggressive periodontitis.
In addition, systemic diseases that affect the periodontium in young children and necrotizing periodontal diseases are addressed. The
prevalence, diagnostic characteristics, microbiology, host- related factors, and therapeutic management of each of these disease entities are
discussed.
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Matsson performed a 21-day experimental gingivitis study GAgP, often considered to be a disease of adolescents and
comparing 6 children, aged 4 to 5 years, with 6 dental young adults, can begin at any age and often affects the entire
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students, aged 23 to 29 years. They found that the children dentition. Individuals with GAgP exhibit marked periodontal
developed gingivitis less readily than the adults. After 21 inflammation and have heavy accumulations of plaque and
days without plaque removal, the children had less gingival calculus. Subgingival sites from affected teeth harbor high
exudate and a lower percentage of bleeding sites than the percentages of non-motile, facultatively anaerobic, Gram-
adults. Also, the children had a smaller increase in gingival negative rods including Porphyromonas gingivalis .
crevicular leukocytes than the adults in response to plaque Neutrophils from patients with GAgP frequently exhibit
accumulation. The study hypothesized that children may suppressed chemotaxis as observed in LAgP with a
have a different vascular response than adults. concomitant reduction in GP-110. This suggests a
relationship between the two variants of aggressive
Steroid hormone-related gingivitis is associated with periodontitis. Alterations in immunologic factors such as
elevated sex hormone levels. Increased levels of estrogen and immunoglobulins are known to be present in aggressive
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progesterone during pregnancy, during puberty, or in patients periodontitis.
medicated with oral contraceptives have been reported to
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result in increased gingival vascularity and inflammation. Successful treatment of aggressive periodontitis depends on
Removal of local factors is the key to the management of early diagnosis, directing therapy against the infecting
steroid hormone-related gingivitis; however, it is often microorganisms and providing an environment for healing
necessary to surgically excise unresolved gingival that is free of infection. The majority of reports suggest that
overgrowth. Drug-influenced gingival enlargement has been the use of antibiotics is usually beneficial in the treatment of
observed in patients taking cyclosporin, phenytoin and LAgP. Metronidazole in combination with amoxicillin has
calcium channel blockers, with higher prevalence in also been utilized, especially where tetracyline-resistant A.
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children. actinomycetemcomitans are present. In GAgP patients who
have failed to respond to standard periodontal therapy,
II)Aggressive Periodontitis laboratory tests of plaque samples may identify periodontal
The primary features of aggressive periodontitis include a pathogens that are resistant to antibiotics typically used to
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history of rapid attachment and bone loss with familial treat periodontitis. It has been suggested that follow-up
aggregation. Secondary features include phagocyte tests after additional antibiotic or other therapy is provided
abnormalities and a hyperresponsive macrophage may be helpful in confirming elimination of targeted
phenotype. Aggressive periodontitis can be localized or pathogenic organisms.
generalized. Localized aggressive periodontitis (LAgP)
patients have interproximal attachment loss on at least two III) Chronic Periodontitis
permanent first molars and incisors, with attachment loss on Chronic periodontitis is most prevalent in adults, but can
no more than two teeth other than first molars and incisors. occur in children and adolescents. It can be localized (less
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than 30% of the dentition affected) or generalized (greater likely to have a decreased ability to move from the circulation
than 30% of the dentition affected) and is characterized by a to sites of inflammation and infection. Affected sites harbor
slow to moderate rate of progression that may include periods elevated percentages of putative periodontal pathogens such
of rapid destruction. Furthermore, the severity of disease can as A. actinomycetemcomitans, Prevotella intermedia,
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be mild (1 to 2 mm clinical attachment loss), moderate (3 to 4 Eikenella corrodens, and Capnocytophaga sputigena.
mm clinical attachment loss), or severe (≥ 5 mm clinical Treatment of periodontitis as a manifestation of systemic
attachment loss). Children and young adults with this form of disease in children is similar to the treatment of localized and
disease were previously studied along with patients having generalized aggressive periodontitis in the permanent
localized aggressive periodontitis and generalized aggressive dentition and has been reported to include surgical or non-
periodontitis. Therefore, published data are lacking for this surgical mechanical debridement and antimicrobial therapy.
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group.
V) Necrotizing periodontal diseases
IV) Periodontitis as manifestation of systemic diseases The two most significant findings used in the diagnosis of
These may include insulin dependent diabetes mellitus necrotizing periodontal diseases (NPD) are the presence of
(IDDM), Papillon-Lefe`vre syndrome, hypophosphatasia, interproximal necrosis and ulceration and the rapid onset of
neutropenia, Chediak-Higashi syndrome, leukemias, gingival pain. Patients with NPD can often be febrile.
histiocytosis X, acrodynia, acquired immunodeficiency Necrotizing ulcerative periodontitis sites harbor high levels
syndrome (AIDS), Down syndrome, and leukocyte adhesion of spirochetes and P. intermedia, and invasion of the tissues
deficiency. Cianciola et al. studied the association between by spirochetes has been shown to occur.
juvenile diabetes and periodontal diseases in young
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children. Children were found to have overt periodontitis Factors that predispose children to NPD include viral
often localized to first molars and incisors, although infections (including HIV), malnutrition, emotional stress,
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periodontitis was also found in a generalized pattern. lack of sleep, and a variety of systemic diseases. Treatment
Affected subgingival sites harbored involves mechanical debridement, oral hygiene instruction,
A. actinomycetemcomitans and Capnocytophaga sp. Oral and careful follow-up. Debridement with ultrasonics has
manifestations of leukemias in children are gingival been shown to be particularly effective and results in a rapid
hemorrhage, petechiae, lymphadenopathy, gingival decrease in symptoms. If the patient is febrile, antibiotics may
hyperplasia or hypertrophy, and gingival pallor. be an important adjunct to therapy. Metronidazole and
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penicillin have been suggested as drugs of choice.
Children with AIDS may develop an atypical form of acute
necrotizing ulcerative gingivitis (ANUG) however, no Conclusion
reports of prepubertal pediatric AIDS patients presenting Periodontal diseases are among the most frequent diseases
with alveolar bone loss exist. Due to a defective immune affecting children and adolescents. Dental clinicians must be
system, rampant and precocious periodontal disease is aware of the prevalence, diagnostic characteristics,
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prevalent among children with down syndrome. In Down's microbiology, host-related factors, and therapeutic
syndrome, the amount of periodontal destruction has been management of each of these disease entities. It is well known
shown to be positively correlated with the severity of the that the primary etiology of periodontal diseases is bacterial
neutrophil chemotaxis defect. plaque. However, patients affected by early onset
periodontitis (or aggressive periodontitis) often present with
Periodontitis as a manifestation of systemic disease in impaired immune function, mainly neutrophil dysfunction.
children is a rare disease that often begins between the time of Therefore, it is important when managing periodontal
eruption of the primary teeth up to the age of 4 or 5. The diseases in young individuals, the dentist should rule out
disease occurs in localized and generalized forms. In the systemic diseases that can affect host defense mechanisms. It
localized form, affected sites exhibit rapid bone loss and is believed that the best approach to manage periodontal
minimal gingival inflammation. In the generalized form, diseases is prevention, followed by early detection and
there is rapid bone loss around nearly all teeth and marked treatment. To achieve this, profound knowledge about
gingival inflammation. Neutrophils from some children with periodontics and pedodontics as well as intimate periodontal-
a clinical diagnosis of periodontitis as a manifestation of pedodontics interactions are essential.
systemic disease have abnormalities in a cell surface
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