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'.)