Overview of gingivitis and periodontitis in children and adolescents

INTRODUCTION

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). Gingivitis and periodontitis are the two main disease groups. The prevalence of gingivitis and chronic periodontitis is affected by age and oral hygiene. Gingivitis, a reversible dental plaque-induced inflammation of the gingiva, is a common occurrence in children as young as five years of age. Periodontitis, which is bacterially induced, 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. Almost 15 percent of the adult population is affected by advanced chronic periodontitis, which occurs equally in men and women [1] and is the major cause of tooth loss in adults. 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 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 '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 and the periodontal manifestations of systemic conditions are discussed separately. (See "Soft tissue lesions of the oral cavity in children" and "Systemic conditions associated with periodontal disease in children".)

PERIODONTAL EXAMINATION

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 periodontitis 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 [2-7]. Patients who smoke should be provided with information about the benefits and methods of quitting. (See "Patterns of tobacco use and benefits of smoking cessation" and "Management of smoking cessation".)