pbl peridontal problems in children

1. PBL : PERIDONTAL DISEASES IN
CHILDREN AND ADOLESCENCE
BY:
Mennat Allah Alkaram
Under supervision of:
Professor Nagwa Khattab

2. GINGIVAL DX : CLASSIFICATION
Plaque induced gingivitis
Non plaque induced gingivitis
Associated with dental plaque
only
Diseases modified by
Malnutrition.
Diseases modified by systemic
factors
Diseases modified by
medications
Disease of specific bacterial origin.
Diseases of genetic origin
Diseases of viral origin
Diseases of fungal origin
Manifestations of systemic condition.
Associated with eruption and
exfoliation
Miscellaneous gingival dx
Aphthus ulcer

3. • Puberty gingivitis:
at pubertal age
Anterior area
Papillae appear bulbous in shape
• Diabetes mellitus associated gingivitis : Hx of
uncontroled DM
Plaque induced gingivitis
HOW TO DIAGNOSE : KEY WORDS
Associated with dental plaque
only
Diseases modified by
Malnutrition.
Diseases modified by systemic
factors
Diseases modified by
medications
Associated with eruption and
exfoliation
In area of erupting tooth (at age of its eruption)
• Eruption Cyst(bluish),Eruption hematoma
(reddish
contains fluid.
upper:(central,E,6)
• Eruption Gingivitis : inflammation
• Pericronitis
• Drug induced gingivitis:
Niphedipin , cyclosporine, Ca channel blocker
Hx of seizures , transplantation , hypertension
• Scorbutic gingivitis:
Hx of vitamin c deficiency ( allergy)
Pain and hemorrhage
Petechiea and ecchymosis
• Bad oral hygien.

4. HOW TO DIAGNOSE : KEY WORDS
Non plaque induced gingivitis
Disease of specific bacterial origin.
Diseases of genetic origin
Diseases of viral origin
Diseases of fungal origin
Manifestations of systemic condition.
• Primary herpitic gingivostomatits:
Age: (1 – 10 y , peak at 3-5) why?
preceeded by a Prodrom
Vesicles rupture to form ulcers covered by
yellowish pesodomembrane.
• Hx of recurrence
• Prodrom
• Vesicles rupture into open ulcer then followed by
crust formation
• Hx of long term antibutic usage or
immunological disorder.
• White patches that can be rubbed of
leaving bleeding surface.
• Denture associated atrophoc fungal
infection
• Oral candidosis of new born
• Hereditary gingival fibromatosis:
non painful hard fibrous enlargment that
may cover the teeth.
• Acute streptococcal gingivostomatitis:
Smear culture reveal Streptococcal infection.
involves other oral mucus membranes.

5. Miscellaneous gingival dx
Aphthus ulcer:
Hx of recurrence
White ulcer surrounded by red
margin.

6. ERUPTION HEMATOMA / CYST
An 18 month infant came to your
practice with reddish inflamed
swelling around the erupting upper
first primary molar.
* What is your diagnosis? And how
to mange his condition?

7. DENTAL PLAQUE INDUCED GINGIVITIS
A 13 y old patent came to your clinic,
and on clinical examination you
noticed: reddish gingival margin
through out the whole mouth, bleeding
on probing and there was no
attachment loss. Patient reported bad
oral hygiene practice.
* What is your diagnosis and how to
mange the condition ?

8. PRIMARY HERPETIC GINGIVOSTOMATITIS
3 y old child came to your clinic complaining
from vesicular lesion developed on oral
mucosa, tongue and lips and hemorrhagic
crusting on the lip.
His mother reported a prodromal of fever,
malaise and fibril illness.
• Diagnoses and management.
• Etiology?

9. ACUTE CANDIDIASIS
2 week old infant presented with a
white pseudo membrane that can
be ripped off leaving hemorrhagic
surface.
 Diagnosis and management?

10. ACUTE STREPTOCOCCAL GINGIVOSTOMATITIS
 A 19-year-old male presented in department of
oral medicine with a chief complain is painful
ulcers on gingiva and lower lip. He also suffers
from throat pain. The ulcers are very painful
and bleed on any slight movement of tissues.
He had fever for 5 days. Upon examination, sub
mandibular lymph nodes were enlarged and
tender .The patient medical history is non
contributory.
Diagnosis , management and deferential
diagnosis..
Deferential : primary herpetic
gingivostomatitis

11. RECURRENT APHTHUS ULCER
 A 7y old female patient presented with
painful white ulcer surrounded by red
margin on lower lip mucosa. There was
a history of recurrence.
 Diagnosis and management?
 Precipitating factors?

12. PHENYTOIN – INDUCED GINGIVAL OVER GROWTH
A 15y old Caucasian male presented with a
chief complaint of: “my gum are swollen
and bleed”. He was first diagnosed with
epilepsy 12y ago. The patient did not brush
his teeth consistently.
 Diagnosis and management
 What is the causative drug?
 Other drugs that may cause the same
condition?
 Deferential diagnosis?
Ca channel blocker – immunosuppressor
cyclosporine

13. ERUPTION CYST / HEMATOMA
 A 6y old child presented with bluish
swelling in the upper left permanent 1st
molar area.
 Diagnosis and management.

14. SCORBUTIC GINGIVITIS
 At age 8 years an autistic boy
presented with a 3-month history of
progressively worsening ankle pain,
petechia and ecchymosis and
increasingly inflamed and bleeding
gingiva. The child’s diet was restricted
to a small number of foods and
excluded fruits and vegetables.
 Diagnosis the condition.

15. HEREDITARY GINGIVAL FIBROMATOSIS
 A 6y old boy presented with enlarged gingival
tissues that interfere with mastication . The
guardian reported that the condition starts
since birth and slowly progress. It’s not painful
except during mastication. Clinical
examination reveal a generalized fibrous
enlargement of gingival tissues that’s covering
the teeth.
 Diagnosis and management?

16. PUBERTY GINGIVITIS
A 13y old girl presented to your clinic
complaining from enlarged bleeding gum.
Clinical examination reveals gingival
enlargement in anterior segment, the lingual
aspect is un affected and no loss of attachment.
The patient said that she brushes her teeth
every when and while and not on regular daily
bases.
 Diagnosis and management?
 What’s the most likely cause for the condition?
 Deferential diagnosis?

17. PRIMARY HERPETIC GINGIVOSTOMTITIS
A 15m infant presented with small blisters up
to 1-2mm on oral mucosa , ulcers that’s
covered by yellowish pseudomembranous
surrounded by red margin.
 Diagnosis and management
 Deferential diagnosis?
Herpangina – Hand, foot, mouth disease

18. PERIODONTAL DISEASES

19. GENERALIZED AGGRESSIVE PERIODONTITIS
 A 16 y old patient presented with complaint of
generalized tooth mobility. Patient reported
that he brushes his teeth twice daily. Clinical
examination reveal severe generalized
attachment loss.
 Diagnosis and management?
 Describe the radiographic appearance?
Floating in air
appearance

20. HYPOPHOSPHATASIA
 a 24-month-old patient presented with
mobility of upper primary central and lateral.
The lower anterior are lost. The mother
reported that the lower 2 centrals were lost
at age of 9 months .
Radiograph on the upper anterior segments
reveals alveolar bone resorption and reduced
bone radio-opacity.
Diagnose the condition.

21. PAPILLON-LEFEVRE SYNDROME
 A 3 y old boy presented with oligodontia ( only
lower Es were there). Clinical examination reveal
a keratosis of hand palms and feet soul. The
mother reported that his tooth had erupted
normally on its chronological time and shaded
prematurely.
 Diagnosis? Cause of the condition?
 Prognosis and condition course?
 Management?
*Inherited autosomal recessive trite.
*1ry teeth erupt normally , lost at age of 4 max. , permanent
teeth erupt normally , lost at age of 14 max.

22. LOCALIZED AGGRESSIVE PERIODONTITIS
A 17 y old female presented with a
chief complaint of “bleeding gum on
brushing and swollen gingiva in a
specific areas” . Clinical examination
reveal a probing depth of 7 to 10 mm
in several teeth in all four quadrants
and good oral hygiene .
*Diagnosis and management?
*what is the etiologic agent ?
* what’s the most likely teeth to be
affected?
A.A bacteria
Anterior / first primary molars

23. ANUP
 A patient came to your clinic with punched out dental papilla,
pseudomembranous slough and foul odder.
 Diagnosis and management?
 What are the etiologic factors?
Stress – malnutrition –
bad oral hygiene –
smoking