Gingivitis and periodontitis in children and adolescents
- Ann Griffen, DDS, MS
Ann Griffen, DDS, MS
- Section Editor — Pediatric Oral Health
- Professor of Pediatric Dentistry
- The Ohio State University
Chronic periodontitis affects most of the adult population to some degree, and it has its incipient beginning in adolescence. Other more serious and aggressive periodontal diseases also are seen occasionally in children, and some of these diseases are signs of systemic diseases or conditions. Definitive diagnosis usually requires a detailed dental examination, including intra-oral radiographs and periodontal probing, but signs can be recognized from visual inspection of the gingival and other oral structures.
Periodontal diseases affect the dental supporting structures, primarily the gingiva and alveolar bone (figure 1). They are caused by complex communities of bacteria that grow in a biofilm on the surface of the tooth (dental plaque). Bacteria elicit an inflammatory response that can result in tissue destruction. Both gingivitis and periodontitis occur in children and adolescents. Gingivitis is a reversible dental plaque-induced inflammation limited to the gingiva, and it is common in children as young as five years of age. Periodontitis is usually accompanied by gingivitis but involves irreversible destruction of the supporting tissues surrounding the tooth, including the alveolar bone (figure 1).
Some degree of periodontitis is seen in most adults, in whom chronic periodontitis is the major cause of tooth loss. Although chronic periodontitis often begins in adolescence, progression is slow, and cumulative signs of destruction are usually not noted before young adulthood. The more aggressive and rarer forms of periodontitis do produce destruction that is apparent during childhood. The prevalence of these diseases is probably less than 2 percent of the population. (See "Gingivitis and periodontitis in adults: Classification and dental treatment" and 'Aggressive periodontitis' below.)
The periodontal examination and the presentation and management of gingivitis and periodontitis in children and adolescents are reviewed here. Other soft tissue lesions, the periodontal manifestations of systemic conditions, and gingivitis and periodontitis in adults are discussed separately. (See "Soft tissue lesions of the oral cavity in children" and "Periodontal disease in children: Associated systemic conditions" and "Gingivitis and periodontitis in adults: Classification and dental treatment".)
Pediatric healthcare providers should be alert for signs of periodontal disease in children and adolescents. Detailed examination by a dentist is recommended every six months, but several of the signs of periodontal disease are apparent on visual inspection. Heavy plaque (picture 1) or calculus deposits (picture 2); enlargement or edema of the gingival tissues; redness, bleeding, or recession of the gingiva; abnormal change in tooth position; and premature tooth mobility or tooth loss are indications for referral for further evaluation. In addition, smoking status (both tobacco and marijuana) should be determined because smoking is a major risk factor for the development of periodontal disease [1-6]. Patients who smoke should be provided with information about the benefits and methods of quitting. (See "Benefits and risks of smoking cessation", section on 'Benefits of smoking cessation' and "Management of smoking cessation in adolescents", section on 'Interventions'.)
- Position paper: epidemiology of periodontal diseases. American Academy of Periodontology. J Periodontol 1996; 67:935.
- Grossi SG, Genco RJ, Machtei EE, et al. Assessment of risk for periodontal disease. II. Risk indicators for alveolar bone loss. J Periodontol 1995; 66:23.
- Genco RJ. Current view of risk factors for periodontal diseases. J Periodontol 1996; 67:1041.
- Thomson WM, Poulton R, Broadbent JM, et al. Cannabis smoking and periodontal disease among young adults. JAMA 2008; 299:525.
- Hujoel PP. Destructive periodontal disease and tobacco and cannabis smoking. JAMA 2008; 299:574.
- Torpy JM, Burke AE, Glass RM. JAMA patient page. Periodontal disease. JAMA 2008; 299:598.
- Nakagawa S, Fujii H, Machida Y, Okuda K. A longitudinal study from prepuberty to puberty of gingivitis. Correlation between the occurrence of Prevotella intermedia and sex hormones. J Clin Periodontol 1994; 21:658.
- Gusberti FA, Mombelli A, Lang NP, Minder CE. Changes in subgingival microbiota during puberty. A 4-year longitudinal study. J Clin Periodontol 1990; 17:685.
- Oliver RC, Brown LJ, Löe H. Periodontal diseases in the United States population. J Periodontol 1998; 69:269.
- Brown LJ, Oliver RC, Löe H. Periodontal diseases in the U.S. in 1981: prevalence, severity, extent, and role in tooth mortality. J Periodontol 1989; 60:363.
- Matsson L. Factors influencing the susceptibility to gingivitis during childhood--a review. Int J Paediatr Dent 1993; 3:119.
- Paster BJ, Boches SK, Galvin JL, et al. Bacterial diversity in human subgingival plaque. J Bacteriol 2001; 183:3770.
- Lamell CW, Griffen AL, McClellan DL, Leys EJ. Acquisition and colonization stability of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in children. J Clin Microbiol 2000; 38:1196.
- Tanner AC, Milgrom PM, Kent R Jr, et al. The microbiota of young children from tooth and tongue samples. J Dent Res 2002; 81:53.
- Bhat M. Periodontal health of 14-17-year-old US schoolchildren. J Public Health Dent 1991; 51:5.
- Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999; 4:1.
- Watanabe K. Prepubertal periodontitis: a review of diagnostic criteria, pathogenesis, and differential diagnosis. J Periodontal Res 1990; 25:31.
- Wara-aswapati N, Howell TH, Needleman HL, Karimbux N. Periodontitis in the child and adolescent. ASDC J Dent Child 1999; 66:167.
- Seymour RA, Heasman PA. Pharmacological control of periodontal disease. II. Antimicrobial agents. J Dent 1995; 23:5.
- Carranza FA. Prepubertal and juvenile periodontitis. In: Clinical Peridontology, WB Saunders, Philadelphia 1996. p.336.
- Aggressive periodontitis. In: Online Mendelian Inheritance in Man. Johns Hopkins University. http://omim.org/entry/170650 (Accessed on November 02, 2012).
- Boughman JA, Halloran SL, Roulston D, et al. An autosomal-dominant form of juvenile periodontitis: its localization to chromosome 4 and linkage to dentinogenesis imperfecta and Gc. J Craniofac Genet Dev Biol 1986; 6:341.
- Perez HD, Kelly E, Elfman F, et al. Defective polymorphonuclear leukocyte formyl peptide receptor(s) in juvenile periodontitis. J Clin Invest 1991; 87:971.
- Page RC, Beatty P, Waldrop TC. Molecular basis for the functional abnormality in neutrophils from patients with generalized prepubertal periodontitis. J Periodontal Res 1987; 22:182.
- Van Dyke TE, Levine MJ, Tabak LA, Genco RJ. Reduced chemotactic peptide binding in juvenile periodontitis: a model for neutrophil function. Biochem Biophys Res Commun 1981; 100:1278.
- Bowen TJ, Ochs HD, Altman LC, et al. Severe recurrent bacterial infections associated with defective adherence and chemotaxis in two patients with neutrophils deficient in a cell-associated glycoprotein. J Pediatr 1982; 101:932.
- Tinoco EM, Beldi MI, Campedelli F, et al. Clinical and microbiological effects of adjunctive antibiotics in treatment of localized juvenile periodontitis. A controlled clinical trial. J Periodontol 1998; 69:1355.
- Christersson LA, Zambon JJ. Suppression of subgingival Actinobacillus actinomycetemcomitans in localized juvenile periodontitis by systemic tetracycline. J Clin Periodontol 1993; 20:395.
- Haubek D, Ennibi OK, Poulsen K, et al. Risk of aggressive periodontitis in adolescent carriers of the JP2 clone of Aggregatibacter (Actinobacillus) actinomycetemcomitans in Morocco: a prospective longitudinal cohort study. Lancet 2008; 371:237.
- Shaddox LM, Huang H, Lin T, et al. Microbiological characterization in children with aggressive periodontitis. J Dent Res 2012; 91:927.
- Saxén L, Asikainen S. Metronidazole in the treatment of localized juvenile periodontitis. J Clin Periodontol 1993; 20:166.
- Haas AN, de Castro GD, Moreno T, et al. Azithromycin as an adjunctive treatment of aggressive periodontitis: 12-months randomized clinical trial. J Clin Periodontol 2008; 35:696.
- Shapira L, Schlesinger M, Bimstein E. Possible autosomal-dominant inheritance of prepubertal periodontitis in an extended kindred. J Clin Periodontol 1997; 24:388.
- Delaney JE, Kornman KS. Microbiology of subgingival plaque from children with localized prepubertal periodontitis. Oral Microbiol Immunol 1987; 2:71.
- Sweeney EA, Alcoforado GA, Nyman S, Slots J. Prevalence and microbiology of localized prepubertal periodontitis. Oral Microbiol Immunol 1987; 2:65.
- Schenkein HA, Gunsolley JC, Koertge TE, et al. Smoking and its effects on early-onset periodontitis. J Am Dent Assoc 1995; 126:1107.
- PERIODONTAL EXAMINATION
- Normal findings
- Clinical findings
- ACUTE NECROTIZING ULCERATIVE GINGIVITIS
- Clinical manifestations
- Aggressive periodontitis
- - Localized aggressive
- - Localized prepubertal
- - Generalized aggressive