上海第二医科大学 教 案课程名称 Pediatric dentistry 第 7 次课 2006 年 03 月 14 日教师姓名 汪 俊 职称 副教授 教研室 口腔儿童教研室 教学时数 2 学时授课题目 The periodontal disease in 教学对象 02 级七年制 children授课地点 101 教室 教学方式 大课授课方式，双语教学本课的重点、难点及对策：重点：1 Anatomy of periodontal tissue in children 2 The classification of periodontal disease in children 3 The clinical feature and treatment of Primary herpetic gingivitostomatitis本次课应用的教材教具参考书： Teaching material: Pediatric Dentistey Second Edition Richard R.Welbury OXFORD UNIVERSITY PRESS Teaching aid：multimedia
主要教学内容及时间分配：1 Periodontal diseases Periodontal disease comprise a group of infection that affect the periodontal tissue,we say the supporting structures of the teeth.2 Anatomy of the periodontium in children 2.1 Gingiva 2.1.1 Marginal gingival: For children,marginal gingival tissue around the primary dentition are more highly vascular and contain fewer connective tissue than tissues around the permanent teeth. The epithelia are thinner with a lesser degree of keratinization, giving an appearance of increased redness that may be interpreted as mild inflammation, and it’s easy for marginal gingiva to be affected 2.1.2 Attached gingival: The width of attached gingival is less variable in the primary dentition, so there is less mucogingival problem in the primary dentition 2.1.3 Junctional epithelium:There is some normal change that take place in junctional epithelium and we should not treat it as disease. 2.2.Periodontal ligament Periodontal ligament space is wider in children and is less fibrous and more vascular 2.3 Cementum Thinner 2.4 Alveolar bone Thinner cortical plates(皮质层） Larger marrow spaces（骨髓腔） Greater vascularity Fewer trabeculae 3 A classification of periodontal disease in children 3.1Gingival conditions Acute gingivitis Chronic gingivitis Gingival overgrowth Factitious（自伤性）gingivitis Mucogingival problems 3.2 Periodontal conditions Chronic periodontitis Early-onset periodontitis Prepubertal（青春期前的） periodontitis associated with systemic disease 4 Acute gingivitis
4.1 Primary herpetic gingivostomatitis（原发性疱疹性龈口炎） 4.1.1 Definition: An acute infectious disease of the gingiva caused by the herpesvirus 4.1.2 Pathogeny: Herpes simplex viruses (HSVs)(单纯疱疹病毒） 4.1.3 Transmission: HSV-1 is transmitted chiefly by contact with infected saliva, Infected saliva from an adult or another child is the mode of infection. whereas HSV-2 is transmitted sexually or from a mothers genital tract infection to her newborn.4.1.4 Prevalence: 4.1.5 Clinical features: 1) Age: 6 months to 3 years Age: 2) Incubation period(潜伏期): 1 week 潜伏期): 3) Prodrome: A Febrile（发烧的） illness B Headache, malaise, oral pain, mild dysphagia（吞咽困难） C Cervical lymphadenopathy(淋巴结病）4) Symptom A Gingivitis: Gingivitis is the most striking feature,with markedly swollen, erythe-matous, friable gums B Vesicular lesions: Vesicular lesions develop on oral mucosa ,lip and tongue , can occur anywhere in the oral cavity, on the perioral skin, on the pharynx 4.1.6 Prognosis Oral lesions heal without scarring 4.1.7 Course: Acute disease lasts 5-7 days, and the symptoms subside in 2 weeks. Viral shedding from the saliva may continue for 3 weeks or more. Adults also may develop acute gingivostomatitis, but it is less severe and is associated more often with a posterior pharyngitis. 4.1.8 Diagnosis: According to Clinical features,History and age 4.1.9 Treatment: The availability of effective chemotherapy underscores that the prompt recognition of the infection and early initiation of therapy are of utmost importance in the management of the disease. The goals of treatment are to make the patient comfortable and to prevent secondary infections or worsening systemic illness. It includes: 1) Pharmacotherapy(药物疗法 ) : A Antiviral treatment : B Symptomatic treatment 2) Supporting treatment: A Bed rest B Soft diet C Be kept well hydrated 4.1.10 Warnings to parent: A Children are highly contagious B No school, day care etc.
C Sterilize eating and drinking utensils D Disease is self-limiting; 10-14 days in duration4.2 Acute necrotizing ulcerative gingivitis(ANUG) 4.2.1 Aetiology: Broad anaerobic infection 4.2.2 Clinical features: A Necrosis and ulceration B Pre-existing gingivitis C Distinctive halitosis D Acute-chronic clinical course: 4.2.3 Treatment A Intense oral hygiene B Oxidant: hydrogen peroxide C Mechanical debridement D Metronidazole 5 Chronic gingivitis Prevalence: increases steadily between the ages of 5 and 9 years, peaks at 11 years and decrease slightly with age to 15 years. Etiology: Closely associated with the amount of plaque, debris and calculus present. 5.1 Eruptive gingivitis 5.2 Filth gingivtis(不洁性龈炎 ) 5.3 Crowding gingivitis (牙列拥挤性龈炎 ) 5.4 Puberty gingivitis(青春发育期龈炎 ) 5.5 Catarrh gingivitis (卡他性龈炎 ) 6 Drug-induced gingival overgrowth 6.1 cause 1) Phenytoin 2) Cyclosporin 6.2 Clinical feature: 1) The clinical changes of drug-induced overgrowth are very similar irrespective of the drug involved. 2) The first signs of changes are seen after 3-4months of drug administration. 3) Progress: The interdental papilla become nodular before enlarging more diffusely to encroach upon the labial tissue 4) Site:The anterior part is most severely and frequently involved 5) Sypmtom: with a good standard of oral hygiene, overgrowth gingiva is pink,firm and stippled, When there is a pre-exiting gingivitis the enlarged tissues compromise an already poor standard of plaque control.the gingiva
then exhibit the classical signs of gingivitis 6.3 Management 1)A strict programme of oral hygiene instruction, scaling and polishing must be implemented. 2) Severe cases of gingival overgrowth inevitably need to be surgically excised and then recontoured to procedure an architecture that allows adequate access for cleaning 3)A follow-up programe is essential to ensure a high standard of plaque control and to detect any recurrence of the overgrowth. 4)To modify or change the anticonvulsant therapy if phenytion-induced overgrowth is refractory 5)Indefinite oral care if there is no alternative. 7 Factitious gingivitis 7.1 Minor form Etiology: Rubbing or picking the gingiva using the fingernail, or from abrasive foods Management: correct the habit and remove the source of irritation 7.2 Major form The injuries are more severe and widespread , can involve the deeper periodontal tissues. Other areas of the mouth such as the lips and tongue may be involved. Extraoral injuries may be found on the scalp, limbs or face. Management A Dressing and protection of oral wounds B No lying with dentists C Psychological or psychiatric consultation8 Chronic periodontitis A number of epidemio-logical studies have investigated the prevalence ofchronic periodonditis in children. The prevalence of the study varied due to differentmethods of diagnosing and different cut-off value in different studies. Prevalence At 1-11%, The chronic periodontitis initiates and progresses during the early teenageyears9 Periodontal complications of orthodontic treatment10 Early-onset aggressive periodontal diseasePrepubertal periodontitis: mainly influences primary dentition immediately after primary the teeth have erupted. It includes generalized form and localized form:
Generalized form Treatment A Intense oral hygiene at frequent intervalsB Antibiotic C Extraction of the teeth
Summary： 1 Anatomy of periodontal tissue in children 2 The classification of periodontal disease in children 3 Primary herpetic gingivitostomatitis Pathogeny: Herpes simplex viruses (HSVs)本 Clinical feature: prodrome , symptom次课 Diagnosis and Treatment小结 4 Necrotizing ulcerative gingivitis要点 Clinical feature Management 5 Gingival overgrowth Clinical feature 6 Factitious gingivitis Minor type, Major type
7 Periodontal complications of orthodontic treatment 8 Early-onset aggressive periodontal disease 1 Anatomy of periodontal tissue in children本 2 The classification of periodontal disease in children次 3 The clinical feature and treatment of Primary herpetic课 gingivitostomatitis复习思考题