Department of Pediatric Dentistry, Sepideh Dental Clinic, Iran
Received:August 27, 2021 Published: September 08, 2021
*Corresponding author: Mohammad Karimi, Department of Pediatric Dentistry, Sepideh Dental Clinic, Iran
Periodontal disease in children is a condition in which there are destruction and resorption of the supporting bone of the teeth, which has three types: local, diffuse, and pre-pubertal. The local type of severe bone resorption is symmetrically and bilaterally in the deciduous dental arch, which is not accompanied by inflammation of the gingival tissue and plaque. The causative agents are hereditary blood disorders along with bacterial agents. In the diffuse type, which occurs mostly in puberty and progressively, symptoms such as gingivitis, plaque, and calculus are evident. Treatment for these two conditions is surgery with the use of Tetracycline and sometimes Metronidazole. Local bone resorption is mainly the cause of systemic diseases such as blood disorders, leukemia, diabetes, and inherited Syndromic diseases. Gingival recession can be caused by chronic inflammation due to poor hygiene, the presence of orthodontic stimuli and movements, and oral habits. Sometimes gingival resorption is caused by self-harm for psychological reasons that the child damages the gingival tissues. The third category is the pre-pubertal type, which occurs at the age of 4 during or after the growth of mammary glands, which sometimes occurs early due to the severity of tooth decay. Treatment is early diagnosis, curettage, massage, and health education. Sometimes broad-spectrum antibiotics are necessary.
Keywords:Bone resorption; periodontal disease; gingivitis; poor oral; hygiene; inflammation; antibiotics
Gum disease or periodontal disease is a complication caused by bacteria and food particles that remain on the surfaces of the teeth. When these particles accumulate on the tooth surface, they form a hard, sticky layer called plaque on the tooth. In the next stage, these plaques become harder and become calcified (tartar) and at the same time, the formation of new plaques continues. Eventually, these factors will cause the gums to become red and swollen. If this condition persists and worsens, it can also damage the soft tissues and bones that support the teeth, leading to loosening of the teeth. Severe gum disease as a manifestation of systemic disease is not very common in children [1,2], but mild gum disease and inflammation without detectable loss of bone or clinical attachment, is very common in children [3-5]. The disease begins in early childhood and increases in early adolescence. In some cases, the disease may progress without any pain or symptoms. The causes can be due to poor oral hygiene [6,7], hormonal changes during puberty [8-11], hereditary blood disorders [12,13], inherited Syndromic diseases [12,13], bacterial agents, and infections [14-16], and systemic diseases such as diabetes [17-19]. Different types of gum disease can be prevented by correct diagnosis and timely application of different treatments.
Gum diseases can be completely painless, so it is important to be aware of the symptoms of the disease and to follow it closely, and carefully to prevent the disease from progressing. The most important of these symptoms are [20-24]:
a. Swelling, redness, tenderness, and bleeding gums
b. Bleeding gums when brushing or flossing
c. Persistent bad breath or bad odor in the baby’s mouth (treatment of bad breath in children will be done in different ways)
d. Loose or falling teeth
e. Tooth decays or gums recession
f. Obvious signs of pus accumulation and infection around the teeth, gums, and in the sulcus area.
g. A change in bite and jaw alignment
h. Changes in the position of the teeth
Adolescents may develop gum disease early in puberty. During this period, the levels of the hormone progesterone and possibly estrogen increases and leads to increase blood flow to the gums. Significant changes in steroid hormone levels during puberty can cause gingival inflammation [8,9]. Some studies indicate an uprising condition in inflammation of gingiva in puberty time in both genders [10,11]. As a result, the gums become more susceptible to bleeding and disease at this time.
a) The most important cause of mild gum disease in children is usually inflammation due to poor hygiene [6,7], the presence of orthodontic stimuli and movements [25,26], and oral habits such as mouth breathing (27) and nail-biting .
b) Having some diseases can increase the risk of gum disease in children. The most important of which are the following diseases:
c) Kindler syndrome, Type 1 diabetes, Down syndrome, Papillon, and Papillon- Lefebvre Syndrome, systemic disease such as blood disorders, leukemia [12,13,17-19]
d) Genetic and hereditary factors can also increase a child’s risk of gum disease [29,30]. So, if there is any family history of gum disease, parents should report that to the pediatric dentist.
a) Chronic mild gingivitis is a common disease in children [3-5]. This condition usually causes the gum tissue to swell, turn red, and the gums to bleed quickly . Severe gingivitis (periodontitis) can be both prevented and treated by brushing and flossing regularly and taking care of oral health. But if gingivitis is not treated in time, it can lead to more advanced and devastating forms of periodontal disease.
b) Aggressive gingivitis (invasive periodontitis) can affect young people who have health problems. Severe invasive periodontal disease (periodontitis) is more common in adolescents and young adults and mainly affects the first molar teeth and incisors . One of the hallmarks of this disease is severe jawbone damage . Interestingly, there are very little plaque and calculus on the patient’s teeth.
c) Severe invasive gingivitis (periodontitis) can occur near puberty and involve all parts of the mouth . This complication is associated with severe inflammation of the gums and the accumulation of plaque and a large area of calculus on the teeth. There is rapid bone loss around nearly all teeth and marked gingival inflammation . Eventually, it can cause the teeth to loosen and fall out.
If gingivitis is not treated, it can lead to gum recession which is the progressive and intensifying loss of gum tissue that is commonly seen in the cervical area of the tooth. Failure to treat this problem also leads to the appearance of tooth roots and pain and tenderness. Although the gingival recession is more common in adults over the age of 40 , children are not immune to the disease; Children may experience this condition at an early age . Smoking, hormones, incorrect brushing, poor oral hygiene, bruxism, or gum disease are some of the risk factors for the gingival recession in adults [37-41]. But the main cause of gingival recession in children is the abnormal eruption of teeth in the wrong place .
Periodontal disease is usually diagnosed based on the patient’s medical history and the results of the child’s physical examination. During the physical examination, the dentist examines the child’s gums and the sulcus areas for signs of periodontal disease. X-rays of teeth can help diagnose and treat periodontal disease. Treatment of gum diseases in children can be done using one or a combination of the following methods:
Scaling and cleaning teeth
In scaling, bacterial plaque and plaque on the surface of the teeth above and below the gum line are removed carefully. The scaling is done with the EMS Ultrasound system, with the additional use of the manual curettes. Based on the lifestyle of the children, their nutrition, the quality of their saliva, their gums, and their teeth, the patients should be put in a personalized recall program, which will help them maintain an excellent level of oral hygiene and reach the ultimate goal.
Even though there is some controversy about the usage of systemic antibiotics, two reviews have provided the benefits of antibiotic therapy for periodontitis treatment [42,43]. The most commonly prescribed antibiotics for the treatment of periodontitis include Penicillins (amoxicillin), Tetracyclines (Tetracycline, Doxycycline), Metronidazole, Macrolides (Spiramycin, Erythromycin, and Azithromycin), Clindamycin, and Ciprofloxacin. The most common combination antibiotic regimen reported is Metronidazole and Amoxicillin combined . These antibiotics are often used in combination with scaling and cleaning teeth to stop the spread of infection and inflammation in the mouth and to treat gingivitis. Antibiotics are available in a variety of forms, including mouthwashes and gels, fibers containing antibiotics, or oral intake. These gels are placed inside the gingival pockets to gradually destroy the bacteria and help the gums heal.
To treat advanced periodontal disease, the dentist may have to flap the area and clean the gingival sulcus area involved in the disease. In this case, after cleaning these infected parts, the dentist may apply the antibiotic gels to cover the infected area so that to have a better prognosis.
If the severity of the disease and the destruction of the gingival tissue is too great to be sutured, the dentist will remove part of the healthy gingival tissue from the patient’s palate and graft it onto the site of badly damaged. This connective tissue replaces the diseased tissue and helps to keep the teeth and improve their appearance. A gum graft surgery aims to extend keratinized tissue of the gums to cover tooth roots  which restores their firm placement within the jaw and prevents further damage.
Periodontal disease is a serious bacterial infection. It destroys the gums and supporting structures of the teeth. The buildup of plaque and calculus on the teeth is the main cause of periodontal disease. Poor oral hygiene habits allow plaque to grow in the mouth. Some factors may raise the risk of periodontal disease in children. These include certain genes, poor oral hygiene, autoimmune or systemic diseases, hormonal changes, etc. Periodontal disease can range from mild to severe. Most children with gum disease have the mildest form. Generally, gum disease isn’t painful. It causes the gums to become red, swollen, and sore. More advanced cases of gum disease are not common in children. Treatment will depend on the child’s symptoms, age, and general health. It will also depend on how severe the condition is. Good dental habits can prevent gum disease. Scaling and root planning, antibiotic therapy, and surgery are the suggested treatments.
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