Periodontal diseases in children: clinical diagnosis and treatment icon

Periodontal diseases in children: clinical diagnosis and treatment




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Practice4. Periodontal diseases in children: clinical diagnosis and treatment.

 

Importance of the subject. Children and adolescents are affected by a variety of periodontal diseases and conditions. Gingivitis is common, especially around puberty. Significant loss of periodontal attachment or alveolar bone is more unusual in young patients but can result from systemic diseases or occur as isolated dental disease. In addition, gingival anatomic problems, such as lack of attached gingiva, can arise during development and may necessitate early management.

 

The main goal: to be able to make clinical and differential periodontal diagnosis, to develop a treatment plan for management of periodontal diseases in children.

Specific objectives

Pre-practice skills and knowledge

 

Develop skill in:

1. Taking into account the predisposing and etiologic factors for periodontal diseases in children.

1. Finding among symptoms and patient case history indications of periodontal diseases in children.

 

2. Assessing the clinical features in periodontal examinations of a child to make a clinical diagnosis of periodontal diseases.

2. Identifying indications of periodontal diseases in objective examination of children taking into account their age peculiarities.

 

3. Making the differential diagnosis among periodontal diseases taking into account history, presenting complaints, clinical findings and some added periodontal examinations (radiographic, blood analysis, etc.)

3. Identifying the main signs of periodontal diseases during objective examination of children of different age.

 

4. Making a clinical diagnosis of periodontal diseases in children on the base of predominant clinical manifestations and results of added periodontal examinations.

4. Making an individual examination chart to diagnose most important clinical manifestations and interpret the results of target examination in children with periodontal diseases

 

5. Making differential diagnosis of periodontal disease and periodontal syndromes at idiopathic diseases in children.

5. Making tentative diagnosis of periodontal diseases in children. To make a differential diagnosis of periodontal diseases in children.

 

6. Deciding on a treatment plan depending on the clinical diagnosis of periodontal diseases, or syndrome, or idiopathic periodontal problems in children.

6. Determining principles of treatment of periodontal diseases in children.

 

 













 

^ Questions for self-assessment of prerequisite knowledge and skills

 

Q- 1. A child is 6 years old. Teeth formula:

 2 Fil

16 55 54 53 52 51 | 61 62 63 64 65 26

46 85 84 83 82 41 | 31 72 73 74 75 36

 С С

Hygienic index by Fedorov-Volodkina is 4 points. Depth of vestibulum fold is 5 mm. There are diastem, and threme between the teeth. Teeth cusps and cutting margins of the teeth are wearing away. What is the local risk factor for development of periodontal disease in such case?

  1. Pre-term teeth eruption

  2. Spacing between teeth

  3. Small vestibulum fold of the oral cavity

  4. Molar’s cusps are wearing away

  5. Very bad hygiene condition of the oral cavity

 

Q-2. Parents of a 5-years-old child complain about fever 37.8ºС, odour, and refuse of meal at their child. Intraoral examination: gum’s margin is ulcerated in the region of all the permanent molars that have been erupting. Gum’s margin is ulcerated and is covered with a dirty gray pluck. After the plaque removing a bleeding painful surface appears. Teeth are covered with layer of grayish-white plaque. What is tentative diagnosis in such case?

  1. Complicated eruption of 16,26,36,46 teeth

  2. Ulcerative-necrotic gingivitis

  3. Acute catarrhal gingivitis

  4. Periodontal syndrome

  5. Vincent’s stomatitis

 

Q-3. 12-year-old child is found to have gum’s level of lower canines is under the adjacent teeth. Visual inspection: there is gum’s retraction in the region of 33 and 43 teeth on 3 mm. without marked inflammation. These teeth are placed vestibularly. What is your tentative diagnosis in this case?

A. Ulcerative necrotizing gingivitis

  1. Chronic catarrhal gingivitis

  2. Acute catarrhal gingivitis

  3. V- shaped atrophic gingivitis

  4. Local periodontitis.

 

Q-4. Depth of vestibulum fold of oral cavity in a 12-years-old child is 6 mm. Lower lip frenum is attached between 31, 41 teeth in the region of gum’s papilla. The gum’s margin in the frontal part of lower jaw is hyperemic and swelled. Index PMA = 70%, and index by Green-Vermillion is 1.2 points. There is periodontal pocket between 31, 41 teeth, and its depth is 4 mm. What is the leading method of treatment in this case?

  1. Frenoplasty 

  2. Removing of teeth deposits

  3. Anti-inflammatory therapy

  4. Physiotherapy

  5. Sclerotic therapy 

 

Key answers:

Q.1- E; Q.2- B; Q.3- D; Q.4- A;

Recommended Reading

1. Paediatric Dentistry. / Edited by Richard R. Welbury. Second edition. Oxford, 2001. – p. 159-181

2. I. R. Pinkham, P.S. Casamassimo, H.W. Fields, D.I. McTigue, A.I. Novak Pediatric Dentistry. Infancy Through Adolescence Fourth Edition. Saunderes, 2005. – p. 414-422.

3. The “Periodontal diseases in children. Clinical periodontal diagnosis and management.” Lecture materials (as explained in Pediatric Dentistry Course).

 

Theory Topics For Target Activity Use.

1. Prevalence and classification of periodontal diseases in children.

2. Etiology, pathogenesis, clinical presentation, and treatment of catarrhal gingivitis in children.

3. Etiology, pathogenesis, clinic, and treatment of chronic hypertrophic gingivitis in children.

4. Etiology, pathogenesis, clinical and differential diagnosis, and treatment of acute necrotizing ulcerative gingivitis in children.

5. Desquamated and atrophic gingivitis in children. Etiology, pathogenesis, clinical diagnosis, and treatment

6. Localized periodontal disease in children. Etiology, pathogenesis, clinical, differential diagnosis, and treatment.

7. Generalized periodontal disease in children. Etiology, pathogenesis, clinical and differential diagnosis.

8. Treatment plan for generalized periodontal diseases in children.

9. Changes in periodontal tissues at X-histiocytosis (eosinophilic granuloma, Hend-Schuller-Christian disease, Letterer-Siwe disease). Clinical diagnosis and management.

10. Characteristic periodontal manifestations as a result of diabetes mellitus, cyclic neutropenia, Papillon-Lefevre syndrome. Management.

Test questions.

Q.1. A 12-year-old patient complains about gingival hemorrhage and tooth mobility. He has been suffering from this since the age of 4. Objectively: gums around all the teeth are hyperemic and edematous, bleed during instrumental examination. Tooth roots are exposed by 1/3 and covered with whitish deposit. 2-degree tooth mobility is present. Dentinogingival pouches are 4-5 mm deep. External examination revealed dryness and thickening of superficial skin layer on the hands and feet, there are also some cracks. What is the most likely diagnosis?

A. Localized periodontitis.

B. Letterer-Siwe disease.

C. Generalized periodontitis.

D. Papillon-Lefevre syndrome.

E. Hand-Schuller-Christian disease.

 

Q.2. A 16-year-old teenager complains about halitosis, general weakness, body temperature rise up to 37,6ºC. These symptoms turned up 2 days ago; the boy has a history of recent angina. Objectively: oral hygiene is unsatisfactory; teeth are covered with soft white deposit. Gums are hyperaemic, gingival papillae are covered with grayish coating. What is the most likely diagnosis?

A. Hypertrophic gingivitis.

B. Ulcerous-necrotic gingivitis.

C. Acute catarrhal gingivitis.

D. Desquamative gingivitis.

E. Chronic gingivitis.

 

Q.3. A13-year-old patient complains about gingival haemorrhage during tooth brushing. Objectively: gums around all the teeth are hyperemic and edematous, PMA index (papillary marginal alveolary index) is 46%, Green-Vermillion’s hygiene index is 2,5. Provisional diagnosis: exacerbation of chronic generalized catarrhal gingivitis. This patient should be recommended to use toothpaste with the following active component:

A. Microelement complex.

B. Chlorhexidine.

C. Calcium glycerophosphate.

D. Mono fluorophosphates.

E. Vitamins A, D, E.

 

Q.4. A 15-year-old patient complains about gingival haemorrhage during tooth brushing and eating solid food. Objectively: gingiva of the frontal part of mandible is hyperaemic, edematous, it bleeds on palpation. Oral mucosa as well as gingiva in other regions presents no changes. The patient has deep overbite. All teeth are stable except for the 41 and 31 (1-degree of mobility). Radiograph shows resorption of interalveolar walls per 1/3 of root length in area 31, 32, 41, 42 teeth. What is the most likely diagnosis?

A. Catarrhal gingivitis.

B. Localized periodontitis.

C. First-degree periodontitis.

D. Generalized first-degree periodontitis.

E. Initial generalized periodontitis.

 

Q.5. A group of practitioners conducts epidemiologic survey of certain age groups of population aimed at evaluation of periodontal diseases prevalence and treatment needs. These rates are studied by means of the following index:

A. CPITN (WHO index).

B. PMA (Parma).

C. PI (Russel index).

D. OHI-S (Green-Vermillion’s index).

E. PDI (Ramfjord index).

 

Q.6. An 11-year-old patient complains about tooth mobility and gingival haemorrhage. He has been suffering since he was 3 years old. Objectively: gums around all teeth are hyperemic, edematous, bleed during instrumental examination. Tooth roots are dehisced by 1/3 and covered with white deposits. There is the 2-th-degree of tooth mobility. Dentogingival pockets are 4-5mm depth. External examinations revealed dryness and thickening of palms, anterior third of forearms, sole surfaces; there are scratches. What is the most probable provisional diagnosis?

A. Letterer-Siewe disease.

B. Papillon-Lefevre syndrome.

C. Gaucher’s disease.

D. Hand-Schueller-Christian disease.

E. Niemann-Pick disease.

 

Q.7. A 13,5-year-old girl complains of gingival painfulness and haemorrhage during tooth brushing and eating, halitosis. She has been ill with angina for a week. Objectively: mucous membrane of gums in the area frontal teeth of her upper and lower jaws is hyperemic, edematous. Apices of gingival papillae are necrotic, they also bleed when touched. There is a thick layer of soft tooth plaque. What is the causative agent of this disease?

A. Herpes virus simplex.

B. Streptococci.

C. Staphylococci.

D. Anaerobic micro flora.

E. Yeast fungi.

 

Q.8. An 11-year-old girl complains about gingival haemorrhage during brushing and eating. She has been suffering from this for a year. Gums of both upper and lower jaws are edematous and congestive hyperemic. Hygienic state of oral cavity is unsatisfactory. Bite is edge-to-edge. Roentgenological examination of periodontium revealed no pathological changes. What is you diagnosis?

A. Acute catarrhal gingivitis.

B. Hypertrophic gingivitis.

C. Chronic catarrhal gingivitis.

D. Generalized periodontitis.

E. Localized periodontitis.

 

Q.9. An 18-year-old patient complains of gingival painfulness and haemorrhage, halitosis, temperature rise up to 38,6 ºC, general weakness, appetite loss. Objectively: mucous membrane of oral cavity is hyperemic and dry; tongue is covered with white plaque, gingival papillae are edematous, their apices have areas of necrotic deposits that can be easily removed leaving bleeding surface beneath. Submaxillary lymph nodes are enlarged, palpatory painful. What is the causative agent of this disease?

A. Pale treponema.

B. Candida fungi.

C. Herpes simplex virus.

D. Fusospirochetal symbiosis.

E. Streptostaphylococci.

 

Q.10. An 16-year-old patient complains about gingival enlargement, haemorrhage and pain during eating. Objectively: gingival edema, hyperemia, enlargement is up to 1/3 part of tooth crown length. Palpation causes intense haemorrhage and pain. What is the most probable diagnosis?

A. Acute conditions of initial generalized periodontitis.

B. Hypertrophic gingivitis, fibrous form.

C. Hypertrophic gingivitis, edematous form.

D. Chronic catarrhal gingivitis.

E. Acute catarrhal gingivitis.

 

Q.11. Which of the following statements is correct about the Down′s syndrome?

A. In Down′s syndrome, children are highly caries susceptible

B. The children have lower rate of periodontal diseases

C. Children suffer from high caries and low periodontal diseases

D. Children suffer from high periodontal diseases

E. Children have minimal rates of caries and periodontal problems

 

Q.12. Young boy is 7 years old. Intraoral exam: gingiva is hyperemic, and bleeds. All teeth are mobile; their roots are exposured and covered with plaque. Periodontal pockets are completely full of granulations. The child is monitored by pediatrician. As mother said, the boy is recently worse and has diabetes insipidus, exophthalmos. What disease should you propose in this child?

A. Cyclic neutropenia

B. Periodontal manifestation of diabetes mellitus

C. Hand-Schueller-Christian disease.

D. Niemann-Pick disease.

E. Letterer-Siewe disease.

 

Q.13. 15-year-old patient complains about pain, gingival haemorrhage, halitosis, raised body temperature up to 37,8ºC. Objectively: gums are apparently hyperaemic, edematous, bleed easily, periodontal pouches are 3-4 mm depth, contain purulent exudate. Orthopantomograph shows diffuse alveolar osteoporosis and Interdental resorption up to 1/3 height. What is the most likely diagnosis?

A. Exacerbation of chronic catarrhal gingivitis

B. Exacerbation of chronic generalized I-degree periodontitis

C. Exacerbation of chronic generalized II-degree periodontitis

D. Chronic generalized I-degree periodontitis

E. Chronic generalized II-degree periodontitis

 

Q.14. 18-year-old patient complains about gingival enlargement, pain and haemorrhage while eating solid food. Objectively: hyperaemia, gingival edema, gingival hypertrophy up to ½ of crown height in region 12, 13, 14 teeth. Formalin test is painless. What is the most likely diagnosis?

A. Chronic generalized II-degree periodontitis

B. Ulcerative necrotizing gingivitis

C. Exacerbation of chronic generalized I-degree periodontitis

D. Catarrhal gingivitis

E. Hypertrophic gingivitis

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