Periodontal diseases in children

Periodontal consists of gums, alveolar bones, shingles and periodontal ligaments.

Gingivitis

The main treatment is proper oral hygiene (brushing with a toothbrush and flossing) that can solve the disease well (Photo: lanelabs) Poor dental hygiene leads to plaque accumulation on the surface of the teeth causes an inflammatory reaction, localized or widespread manifestations, redness and swelling in the gums. In severe cases, the gums suffer from natural bleeding and the mouth has a foul odor.

The main treatment is proper oral hygiene (brushing with a brush and flossing) can solve the disease well. Gingivitis in children who are strong at the age of puberty does not tend to develop periodontitis (inflammation of periodontal ligaments leading to the absorption of alveolar bone).

When gingivitis is not well resolved by oral hygiene, it is necessary to think about the condition of gingivitis of other diseases (leukemia, diabetes, neutropenia, vitamin C deficiency, or diseases management of hormonal disorders related to puberty or pregnancy, anti-epileptic drugs and transplant rejection drugs.

Periodontal inflammation before puberty

Periodontal inflammation in pre-pubertal children can lead to loss of baby teeth before full development, often with systemic diseases such as neutropenia, leukemia or non-movable, phosphatase-degrading disease, Papillon Lefèvre syndrome and X-linked histiocytosis disease. However, there are many cases of pediatric patients with systemic pathology. Treatment of the disease includes cleaning the teeth by a dentist, which may require tooth extraction or antibiotic use.

Localized young periodontitis

Localized young periodontal inflammation has clinical characteristics: rapid loss of alveolar bone, especially in the area around the incisors and molars of 1 permanently. The disease often comes with Actinobacillus infection. In addition, white blood cells of localized young periodontitis usually lose the function of dynamic orientation and phagocytosis.

If left untreated, the teeth will lose their ligaments and fall off. Treatment depends on the extent of the disease. Patients diagnosed with disease early on the disease are often treated to clean dead tissue on the spot, combining antibiotics and oral hygiene meticulously. The case of disease has spread widely with alveolar bone at the time of detection, needing full periodontal treatment, possible bone grafting itself. The prognosis depends on the level of disease at the time of detection and compliance with the treatment regimen.

The process of teething

The teething process can cause discomfort in the sites of teething such as child cramps, mild fever, excessive salivation; But many children do not show signs of discomfort when teething. Symptomatic treatment includes chewing a child with a cold ring and using a medicine to cool down and relieve pain. Symptoms similar to the above can also occur when a molar is permanent for 6 years of age.

Gingival hyperplasia caused by cyclosporine or phenytoin

When taking cyclosporine to prevent organ transplant rejection, or anti-epileptic phenytoin drugs and some calcium channel blockers can cause hyperplasia of the entire gum. Phenytoin and its metabolites have a direct stimulating effect on the fibroblasts in the gums, leading to increased collagen synthesis. Clinical studies have shown that phenytoin causes less gingival hyperplasia in patients with meticulous oral hygiene.

Gingival hyperplasia accounts for about 10-30% in patients taking phenytoin. Severe signs such as (1) gingival hypertrophy, sometimes covering the teeth, (2) redness of the gums, (3) secondary infection, resulting in abscess formation, (4) shifting of position the teeth, and (5) interfere with the growth of milk teeth and affect the permanent teeth. Treatment is mainly prophylactic, if possible, stop taking the drug in combination with regular oral examination and oral hygiene care. Severe gum hyperplasia requires surgical removal of the gum, but the disease can recur if the medication continues.

Inflammation around the crown

The inflammation of the gingivitis in the upper part of the growing crown usually occurs in the molars that are permanent at the lower jaw. The accumulation of dead tissue and bacteria in the gum slit facilitates inflammation. A similar condition is the abscess of the gum with the retention of the bacteria caused by orthodontic or prosthetic stitches. Jaw stiffness and intense pain can occur when there is inflammation. If left untreated, it can lead to facial inflammation and facial tissue cellulitis.

Treatment is mainly on-site intervention taking dead tissue, irrigating with warm salt water and using antibiotics. When acute inflammation is over, proceed with the extraction or removal of the gum to prevent recurrence. Early detection of the risk of large molars and removal of this tooth can prevent inflammation around the crowns here.

Ulcer necrosis of acute gums

Acute necrotic ulcers, also known as Vincent stomatitis or trench mouth disease (disease of stressed warriors living in trenches), is a periodontal disease with spirochetes and bacteria in the mouth. However, it is not clear whether these bacteria cause a secondary disease. Acute gum ulceration occurs mainly in adolescents and adults. The disease rarely occurs in healthy children in developed countries. The disease is common in children in South India and some countries in Africa, these are malnourished children. In these patients, lesions can spread to adjacent tissues causing necrotic tissue in the face (mouth gangrene or mouth ulcers).

Clinical manifestations of gingivitis ulceration include: (1) necrosis and gum tissue ulcer in the middle of the teeth, (2) with false membrane on the upper surface of the lesion, (3) bad breath, (4) swelling Neck lymph nodes, (5) fatigue and (6) fever. This can be confused with herpes gingivitis. Observation of tissue samples of acute gingivitis ulcer under black background microscope can recognize spirochetes.

Treatment of acute gum ulcer disease is divided into 2 doses; then use antibiotics (penicillin or erythromycin), clean dead tissue on the spot, use hydrogen peroxide (topical carbamide peroxide 10% in glycerol form), and use painkillers. Quick recovery after 48 hours of treatment. Then 2 should be carried out if after 1 disease back but leave irreversible damage in periodontal tissue.

Doctor PHAM HONG DUC