Periodontal Diseases

Gingivitis

Poor oral hygiene results in the accumulation of dental plaque at the tooth-gingival interface that activates an inflammatory response, expressed as localized or generalized reddening and swelling of the gingiva. More than half of American school children experience gingivitis. In severe cases, the gingiva spontaneously bleeds and there is oral malodor. Treatment is proper oral hygiene (careful tooth brushing and flossing); complete resolution can be expected. Fluctuations in hormonal levels during the onset of puberty can increase inflammatory responses to plaque. Gingivitis in healthy children is unlikely to progress to periodontitis (inflammation of the periodontal ligament resulting in loss of alveolar bone).

Aggressive Periodontitis in Children (Prepubertal Periodontitis)

Periodontitis in children before puberty is a rare disease that often begins between the time of eruption of the primary teeth and the age of 4 or 5 yr. The disease occurs in localized and generalized forms. There is rapid bone loss, often leading to premature loss of primary teeth. It is often associated with systemic problems, including neutropenia, leukocyte adhesion or migration defects, hypophosphatasia, Papillon-Lefèvre syndrome, leukemia, and Langerhans cell histiocytosis. However, in many cases, there is no apparent underlying medical problem. Nonetheless, diagnostic workups are necessary to rule out underlying systemic disease.

Treatment includes aggressive professional teeth cleaning, strategic extraction of affected teeth, and antibiotic therapy. There are few reports of long-term successful treatment to reverse bone loss surrounding primary teeth.