Periodontal disease is also initiated by bacteria in the plaque. As the plaque increases, the response to the bacterial products is tissue inflammation. Children generally only manifest the mild forms of gingival disease called gingivitis. The clinical presentation is usually puffy and red tissues surrounding the necks of the teeth. Bleeding of the tissues may be present. Fortunately, this inflammatory response is reversible with daily disruption of the biofilm. Localized and temporary alteration of gingival tissue in children may occur secondary to habits, trauma and during the transition from the primary dentition to the permanent dentition.

Seldom is there gingival disease with bone loss (periodontitis) in healthy children. When diagnosed it is associated with defects in neutrophil function (localized juvenile periodontitis and prepubertal periodontitis).

Gingival overgrowth can occur in children with certain medical diagnoses and their required medications. Examples are: seizure disorder (phenytoin), transplants (cyclosporins) and heart disease (calcium channel blockers). Children on these medications should be closely monitored by the dental team and appropriate daily hygiene and oral care intervention initiated.

Little data is available on the prevalence of periodontal disease of young children. Although commonly reported in children by clinicians, gingivitis (the most mild form of periodontal disease) is easily reversed in children with appropriate intervention. Gingival bone loss is uncommon. One study reported 7.6% of four year old low-income Hispanic children with bone resorption in addition to high rates of decay.

Gingivitis

• Gingival inflammation etiology: plaque accumulation, traumatic injury, pulpal condition, herpes simplex virus, systemic illnesses.

• Gingival tissues become red and swollen and will bleed on probing or brushing.

• Gingivitis rarely progresses to periodontitis in the preshooler.

Primary Herpetic Gingivostomatitis

Vesicular eruption may be seen on the skin, vermillion or oral mucous membranes. Intraorally, these lesions may appear on any mucosal surface, which is in contrast to the recurrent form of the disease whereby vesicular lesions are confined to the palate and gingiva. These lesions are accompanied by fever, malaise, decreased appetite, severe gingival inflammation, halitosis, headache and cervical lymphadenopathy. This systemic primary infection will usually last for 1-10 days and the lesions will heal without scarring. Symptoms should be treated palliatively. Patients should be encouraged to drink and eat to avoid dehydration and oral hygiene should be encouraged. It is unknown what percentage of children will develop recurrent herpetic lesions.

Localized Prepubertal Periodontitis Clinical Findings:

• effects on some of the primary teeth, if left untreated can progress to the mixed dentition

• rapid bone loss

• minimal plaque

• minor gingival inflammation despite abnormal probing depths

Consider abnormalities in host defense function, extensive interproximal caries and family history. Children may have chemotaxis dysfunction but show no history of recurrent or chronic infection. The reported prevalence of localized prepubertal periodontitis is 0.84% in the general population.

Generalized Prepubertal Periodontitis Clinical Findings:
severe gingival inflammation
rapid bone loss around nearly all the teeth (primary and perm teeth)
mobility
tooth loss

Autosomal recessive trait resulting in a profound abnormality of the CDll family leukocyte adherence receptors on the surface of the phagocytic blood cells

Affected children are highly susceptible to periodontal disease and other chronic or recurrent infections including those of the upper respiratory track, middle ear, and skin. The reported prevalence is between 7.7%-11% in selected populations.

Diseases that are associated with periodontitis in the prepubescent child are: Hypophosphasia, Papillon LeFevre, Langerhans Cell Histiocytosis, Diabetes, Neutropenia, Acrodynia, Leukocyte Adhesion Deficiency, Leukemia, Downs Syndrome and Acquired Immune Deficiency Syndrome (AIDS).