Anatomy of the periodontium in
For children,marginal gingival tissue around the primary
dentition are more highly vascular
contain fewer connective tissue than tissues around the
The width of attached gingival is less variable in the primary
there is less mucogingival problem in the primary dentition
There continue to be an apical shift when the teeth are fully
the gingival margins are frequently at different levels on adjacent
teeth that are at different stages of eruption.
Sometimes it gives an erroneous appearance that gingival recession
has occurred around those teeth that have been in the mouth
Stability is achieved at 12 years for 1 2 3 5 6, 16 years for the other
Periodontal ligament space is wider in children
It is less fibrous and more vascular
Thinner cortical plates
Larger marrow spaces
Primary herpetic gingivostomatitis
An acute infectious disease of the gingiva caused by the herpesvirus
Herpes simplex viruses Herpes simplex viruses (HSVs)
Two types exist: type 1 (HSV-1) and type 2 (HSV-2). Both are closely related but
differ in epidemiology
HSV-1 is transmitted chiefly by contact with infected saliva
Infected saliva from an adult or another child is the mode of infection.
HSV-2 is transmitted sexually or from a mother's genital tract infection to her
HSV infection appears to have increased worldwide in
the last 2 decades, making it a major public health
Many primary infections are asymptomatic, Herpes
simplex infections are asymptomatic in as many as
80% of patients,
Symptomatic infections may be characterized by
significant morbidity and recurrence.
Moreover, infections can cause life-threatening
complications, particularly in immunocompromised
6 months to 3 years
Headache, malaise, oral pain
Gingivitis is the most striking feature,
with markedly swollen, erythematous, friable gums
Vesicular lesions develop on oral mucosa ,lip and tongue
can occur anywhere in the oral cavity,
on the perioral skin,
on the pharynx
Diagnosis: According to Clinical features,History and age
Oral lesions heal without scarring
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
The availability of effective chemotherapy underscores that
the prompt recognition of the infection
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:
Antiviral treatment :
Overall, medical treatment of HSV revolves around specific
Patients should be advised about the potential for
autoinoculation if they touch the herpetic lesion and then
touch a mucous membrane or an eye.
Controlling autoinoculation can be a challenge if the patient
is a young child.
In situations in which constitutional effects such as fever
occur, symptomatic treatment can be used.
Analgesics, such as acetaminophen, may make the patient
Aspirin should be avoided in pediatric patients because of the
possibility of Reye syndrome.
Topical anesthetics and coating agents may make the patient
more comfortable and may aid in the consumption of food;
however, they do not speed healing.
Appropriate wound care is needed, and treatment for
secondary bacterial skin infections may be required
Supporting treatment :
Be kept well hydrated:
The patient should maintain fluid intake and a balanced diet
with the use of liquid food replacement if necessary
Warnings to parent:
No school, day care etc.
Children are highly contagious
Sterilize eating and drinking utensils
Disease is self-limiting; 10-14 days in duration
Acute necrotizing ulcerative
Broad anaerobic infection
Causative organism: Fusiform bacteria , Spirochaete
Other Gram-negative anaerobic organism
Necrosis and ulceration
Interdental papillae marginal gingival
Covered by yellowish-grey pseudomembranous slough,
Acute stage enters a chronic phase after 5-7days.
Recurrence of the acute condition is inevitable
Chronic gingivitis is a common condition.Untreated, gingivitis may
progress to gum disease or periodontal disease.
Gingivitis is painless in the early stages, but may lead to bleeding gums
and other oral problems.
Bleeding gums are only one sign of gingivitis.
Gums become red and swollen,
teeth may become loose or may eventually fall out.
increases steadily between the ages of 5 and 9 years, peaks at 11 years and
decrease slightly with age to 15 years.
Closely associated with the amount of plaque, debris and calculus
People at risk of scurvy include:
People with chronic malnutrition or those that eat less
than 2 servings of fruits/vegetables per day
Men who live alone (bachelor or widower scurvy)
People on peculiar diets or food fads
People with other medical conditions that may prevent the
intake and/or absorption of vitamin C
Severe dyspepsia. +
Signs & symptoms
Symptoms of scurvy generally develop after at least 3
months of severe or total vitamin C deficiency, they
Weakness & fatigue
Bruising easily & bleeding from weakening blood
vessel, connective tissue & bones due to collagen loss.
Hair, teeth loss & gingivitis .
Infants may be irritable, have pain when they
move, and lose their appetite. Infants do not gain
weight as they normally do.
In infants and children, bone growth is impaired, and
bleeding and anemia may occur.
• gums may swell and become red, soft and
spongy. Any slight friction may cause the
gums to bleed.
• Often this results in poor oral hygiene
and dental diseases
• The gum findings are most
• striking in the interdental and marginal
• become red, smooth, swollen, and shiny.
• Later thegums appear
purplish, sometimes even black and
Papillon Lefevre Syndrome
(Palmoplantar Keratoderma with
-Inherited as an autosomal recessive trait
-Mutation of the gene that produces the
enzyme Cathespin C.
-Greater frequency in consanguineous
-Children are born looking completely normal. They may have redness on
palms of hands and soles of feet.
-Teeth erupt in normal sequence, position, and time.
-At age 1, when primary teeth starting to erupt, the gum tissue is severely
inflamed and generalized aggressive periodontitis accompany the teeth.
-By age 4, the child has lost all of there primary dentition.
-Gingival tissue in mouth goes back to healthy & normal.
-Eruption of the permanent dentition begins at normal age and in normal
-Patient will loose their permanent teeth and be completely edentulous by age 14-
Increase of sex hormones in circulating levels
*sex hormones :
Increases the cellularity of tissues and provides suitable growth
condition for species associated with established gingivitis
Increases the permeability of the gingival vasculature
Good oral hygiene,
gum tends to bleed and hyperplasia
Bad oral hygiene
The infection of hemolytic streptococcus
soft and hematose gum,
no vesicles or ulcers
Etiology: Rubbing or picking the gingiva using the fingernail, or from abrasive
Management: correct the habit and remove the source of irritation
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.
A Dressing and protection of oral wounds
B No lying with dentists
C Psychological or psychiatric consultation
Riga–Fede disease is an oral condition
found, ararely, in newborns
that manifests as an ulceration on the ventral surface
of the tongue or on the inner surface of the lower lip.
It is caused bytrauma to the soft tissue from
erupted baby teeth.
It can be described as a sublingual traumatic
Although it begins as an ulceration, it may progress to
a large fibrous mass with repeated trauma
Drug-induced gingival overgrowth
The clinical changes of drug-induced overgrowth are very similar irrespective of
the drug involved.
The first signs of changes are seen after 3-4months of drug administration.
Progress: The interdental papilla become nodular before enlarging more
diffusely to encroach upon the labial tissue
Site:The anterior part is most severely and frequently involved
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
A strict programme of oral hygiene instruction, scaling and
polishing must be implemented.
Severe cases of gingival overgrowth inevitably need to be
surgically excised and then recontoured to procedure an
architecture that allows adequate access for cleaning
A follow-up programe is essential to ensure a high standard
of plaque control and to detect any recurrence of the
To modify or change the anticonvulsant therapy if
phenytion-induced overgrowth is refractory
Indefinite oral care if there is no alternative.
Periodontal complications of
Attachment and bone loss
Early-onset aggressive periodontal
fiery red,swollen,and haemorrhagic
hyperplastic with granular or nodularproliferation
Gross deposits of plaque
Progress: extremely rapidly, primary teeth loss:3-4 years
Bone loss: may be restricted to one arch
A Progresses more slowly
B Bone loss affects only incisor-molar teeth
C Plaque levels are low
A Intense oral hygiene at frequent intervals
C Extraction of the teeth
Oral hygiene is general index of health…
visit your dentist regularly…
prevention is better than cure