3. What is periodontal disease?

• Periodontal disease is an inflammation or infection of periodontal tissue. There are two main types of periodontal disease, gingivitis and periodontitis:
  

A. Gingivitis

• This is an inflammation or infection of the gums only.
• It can be recognised by:
  • A change in the colour of gums from pink to red or bluish red.
  • Swelling of the gum margins closest to the teeth.
  • Blood on the toothbrush during brushing.
  • It is the most common form of periodontal disease in children.
  • Up to 35% of children between the ages of 3 and 5 have at least some symptoms of gingivitis.
  • The incidence in adolescence may increase to 90%.

Gingivitis

B. Periodontitis

• This is a destructive infection that can affect all the periodontal tissues, that is, the gums, the underlying bone and the connecting tissues.
• About 20% of adolescents (14-17 years) develop adult periodontitis, but the disease is rare in young children.

Juvenile periodontitis

Gum loss between teeth

X-ray showing bone loss

• Early onset periodontitis
  • A small percentage of children (approximately 1%) develop this form of the disease.
  • It is a rapidly developing and very destructive form of periodontitis.
  • It is associated with a blood cell (leucocyte) disorder.
  • The disease may be localised to a few teeth or it may be generalised.
  • It is caused by specific bacteria, and is treated by a combination of antibiotic and surgical therapy.

Periodontitis (rapidly progressing)

X-ray showing bone los

4. What causes periodontal disease?

• Dental plaque is the major cause of gingivitis and periodontitis.
  • The bacteria in the plaque are the major offenders.
  • The effects of plaque can be even more damaging if the patient is in poor health, or has a low resistance to disease.
• Periodontal disease is unlikely to be transmitted from one person to another.
  

5. What are dental plaque, calculus and tartar?

• Dental plaque is a mass of bacteria and other organic material that accumulates on the teeth.
  • It can not be rinsed off, but it can be removed by brushing and flossing.
  • The longer that plaque is allowed to remain on teeth, the greater are the risks of gum disease.
  • Diets rich in soft, sticky, carbohydrate food with a high sugar content encourage plaque formation.
• If plaque is not removed, it can harden to form calculus, also called tartar.
  • Calculus causes gum problems. It should be removed by your dentist or hygienist, as brushing will not do so.
  • Calculus occurs more often in older children.

See Diet and Decay

6. What else can cause gingivitis and periodontitis?

• There are many causes of gingivitis and periodontitis:
  • Puberty can make children more vulnerable to inflammatory gingivitis.
  • Medical problems such as blood or genetic disorders, or diabetes can predispose children to periodontal disease.
  • Mouth breathing results in the drying of the mouth and gums, and can cause gingivitis.
  • Orthodontic appliances make oral hygiene more difficult and this can lead to inflamed gums.
  • Gum disease that is not related to dental plaque can be caused by viruses (herpes), fungi (candidiasis or thrush) or bacteria.
  • Medications such as anti-epileptic Dilantin, and anti-rejection Cyclosporin can cause gingival overgrowth in children.

Puberty gingivitis

Gingival overgrowth

After gum surgery

See Oral Medicine

7. What other periodontal problems can children develop?

• Periodontal problems are usually the result of infection or injury:
  • Gums can be injured by hot foods such as pizza, or damaged by excessive incorrect toothbrushing.
  • An abscess or gumboil can be caused by food particles being trapped between the gum and the tooth.
  • An infection can occur under a flap of loose gum around an erupting tooth.
  • This is dealt with by removing trapped food particles, which are usually the cause of the problem. Antibiotic treatment may be necessary.
  • Allergies to foods or some toothpastes can cause gingivitis.
  • Gum recession is sometimes seen around the lower front permanent teeth.
  • It occurs if the permanent teeth grow and erupt too far forward in the mouth.
  • It may also be the result of orthodontic treatment.
    

8. What can I do to protect my children from periodontal disease?

• Parents should start taking their children to the dentist by the age of three or four.
• Children should be taught and encouraged to brush and floss their teeth early on.
  Brushing should be supervised, or done for them until they are sufficiently competent to do it on their own.
• Provide a healthy diet for your children.
  Keep sweets (candies) and sweet drinks to a minimum!

9. How is gingivitis treated?

• Gingivitis can be treated and reversed by professional treatment and good oral hygiene.
  

10. How is gingival enlargement treated?

• Dental plaque plays a major part in the development of the problem and must be removed through good oral hygiene and professional cleaning.
• The enlargements may need to be reduced surgically.