Enfermedades gingivales en niños y adolescentes: primera parte / Gingival diseases in children and adolescents: first part

Las características de los tejidos gingivales y periodontales son diferentes en niños y adolescentes. La clasificación actual de enfermedades gingivales incluye a las gingivitis producidas por el biofilm y a las no producidas por el biofilm de placa. Las gingivitis son reversibles. Las condiciones de riesgo individuales, de origen externo o de origen sistémico, influyen en el agravamiento. La prevención de la gingivitis está enfocada en el control de los factores de riesgo.

Gummy Smile and Short Tooth Syndrome--Part 1: Etiopathogenesis, Classification, and Diagnostic Guidelines.

Treating patients with "gummy smiles" and improving smile esthetics has become an integral part of dentistry. It is necessary to conduct an accurate diagnosis of what may be multiple causes that coexist simultaneously. Though all causes may not be resolved following treatment, they should be identified; otherwise it might not be possible to conduct an adequate order of treatment, which could involve multidisciplinary collaboration between various dental specialists, and may lead to unexpected and unacceptable final results. The authors propose a complete adult classification of the causes identified for gummy smile (GS) and short tooth syndrome (STS) to ascertain the etiopathogenetic origin(s). Used in combination with the proposed diagnostic procedure, which involves an "outside-in" evaluation of the patient, the classification system will enable clinicians to provide patients an accurate prediction of final results and determine the treatment required.

Comparing lifecourse models of social class and adult oral health using the 1958 National Child Development Study.

OBJECTIVE: To identify the lifecourse model that best describes the association between social class and adult oral health. METHODS: Data from 10,217 participants of the 1958 National Child Development Study were used. Social class at ages 7, 16 and 33 years were chosen to represent socioeconomic conditions during childhood, adolescence and adulthood, respectively. Two subjective oral health indicators (lifetime and past-year prevalence of persistent trouble with gums or mouth) were measured at age 33. The critical period, accumulation and social trajectories models were tested in logistic regression models and the most appropriate lifecourse model was identified using the structured modelling approach. RESULTS: The critical period model showed that only adulthood social class was significantly associated with oral health. For the accumulation model, a monotonic gradient was found between the number of periods in manual social class and oral health; and four out of eight social trajectories were found to be distinctive. Finally, the social trajectories model was not significantly different from the saturated model indicating that it provided a good fit to the data. CONCLUSION: This study shows the social trajectories model was the most appropriate, in terms of model fit, to describe the association between social class and oral health.

The impact of structured plaque control for patients with gingival manifestations of oral lichen planus: a randomized controlled study.

AIM: To evaluate the impact of a structured plaque control intervention on clinical and patient-centred outcomes for patients with gingival manifestations of oral lichen planus. MATERIALS AND METHODS: Eighty-two patients were recruited into a 20-week randomized controlled trial. The intervention was structured plaque control comprising powered tooth brushing and inter-dental cleaning advice. Control subjects continued with their normal dental plaque control regimen. The primary outcome measure was the oral health impact profile (OHIP) with secondary outcomes of pain, plaque index, mucosal disease score and cost-effectiveness. RESULTS: Overall, the intervention patients showed statistically significant improvements in OHIP sum ordinal and OHIP dichotomous scores compared with control. There were improvements in the functional limitation, psychological discomfort and physical disability domains at 4- and 20-weeks and in the psychological disability domain at 20-weeks. The intervention was successful in reducing plaque compared to control (p < 0.001) and improvements were observed using the mucosal disease indices at the 4- and 20-week follow-ups (p < 0.001). CONCLUSION: A structured plaque control intervention was effective in improving the oral health-related quality of life and clinically observed gingival lesions. This study provides evidence to include intensive plaque control within patients' initial and on-going management.

Influence of Environmental Tobacco Smoke on Gingival Pigmentation in Schoolchildren.

PURPOSE: To examine the relationship between environmental tobacco smoke (ETS) and oral pigmentation in schoolchildren. MATERIALS AND METHODS: Oral photographs of 117 systemically healthy, nonsmoking children and young adults (aged 10 to 21 years) were randomly selected from two rural schools. Closed-ended questionnaires were designed for this age group and used to record answers given by the subjects. The subjects were divided into two groups based on age: group 1 (10 to 14 years) and group 2 (15 to 21 years). There were 58 subjects in group 1 and 59 in group 2. Gingival pigmentation was classified using the Melanin Index Score (MIS) into MIS-0 (no pigmentation), MIS-1 (solitary unit(s) of pigmentation in papillary gingiva) and MIS-2 (continuous band extending from 2 neighbouring solitary units). RESULTS: In group 1, 17.24% of subjects displayed MIS-0 compared to only 5.08% in group 2. The difference between the groups was found to be statistically significant according to Student's t-test (p < 0.001). In group 2, 38.98% of subjects showed MIS-2 as compared to only 17.24% subjects in group 1. CONCLUSION: Despite the relatively small sample size, the results of the present study confirmed previously reported findings that ETS has an influence on both the prevalence and the severity of gingival pigmentation.

Clinical features of gingival lesions in patients with dystrophic epidermolysis bullosa: a cross-sectional study.

BACKGROUND: Gingival lesions in patients with dystrophic epidermolysis bullosa (DEB) are a common manifestation. However, their clinical features, frequency and severity are currently unknown. METHODS: Forty-five DEB patients were assessed by an oral medicine specialist, who analysed the presence/absence of four clinical signs (erythema, erosion/ulcer, atrophy, blister) on free and attached gingiva, using the Epidermolysis Bullosa Oropharyngeal Severity score. RESULTS: Twenty-eight (62.2%) out of 45 DEB patients showed different types of gingival lesions, whose presence/absence and total frequency/distribution were not significantly different between males and females (p=0.087 and p=0.091, respectively). Erythema was the most prevalent lesion (66.2%) and the recessive DEB severe generalized (RDEB-sev gen) reached the highest median disease activity score. A significant correlation was observed between the DEB subtypes and the disease activity median score (p<0.001), but not between age and total disease activity score in each group of DEB (p>0.05). Lastly, logistic regression showed that only gender (p=0.031) and RDEB-sev gen (p=0.001) were risks factors for the presence of gingival lesions. CONCLUSIONS: Gingival lesions in DEB patients are a relatively common entity and may have multiple clinical aspects, emphasizing the need for thorough attention and awareness among dentists.

Periodontal status of Szczecin citizens aged 35-44 years according to the Community Periodontal Index.

INTRODUCTION: The aim of the study was to identify the periodontal status of Szczecin citizens using the Community Periodontal Index (CPI), and to compare the results with those from selected European and world countries using the World Health Organization (WHO) database. MATERIAL AND METHODS: A sample of 250 patients was randomly selected using two-stage stratified sampling among people living in Szczecin aged 35-44 years. Participants were examined using the WHO CPI score at the Department of Periodontology, Pomeranian Medical University in Szczecin. Scores were compared with findings from previous research carried out in Poland and other countries. RESULTS: That only 4.4% of respondents had a healthy periodontium (5.76% of women and only 2.7% of men). Bleeding gums after probing (17.99%) and the presence of calculus (20.14%) were more frequently reported in women. The largest percentage of respondents (44.8%) had periodontal pockets 3.5-5.5 mm deep, with more women (45.32%) than men (44.14%). In contrast, more men (25.23%) had deep periodontal pockets at least 6 mm deep, with only 10.79% in women. A survey conducted across Poland in 1987 showed 0.7% of people with a healthy periodontium which rose to 6.3% in 1995. Compared to studies available in the WHO database, the number of people with a healthy periodontium, i.e. CPI = 0 is lower than in Japan (18%) and Spain (15%), but higher than in the United Kingdom (4%) and China (0%). CONCLUSIONS: Findings from the study indicate an increasing percentage of people in Poland suffering from periodontal disease. This brings us closer to results obtained in developed countries around the world.

Oral pre-trigeminal neuralgia pain: clinical differential diagnosis and descriptive study results.

AIMS: To better quantify oral pre-trigeminal neuralgia (PTN) symptoms, attempt to identify PTN symptoms that could reliably differentiate between PTN and odontogenic tooth pain, and determine whether an anesthetic test would reliably differentiate these disorders. METHODOLOGY: This was accomplished through a survey of symptom recall for 49 trigeminal neuralgia patients who had PTN tooth and/or gum pain. RESULTS: The variability of oral PTN symptoms, factors that worsened or improved them, and how dental anesthesia affected them, explain the reason for variations found in the literature. A throbbing pain quality is not in the literature, but present for 63% of respondents. CONCLUSIONS: No specific PTN symptom would reliably differentiate PTN from odontogenic tooth pain. The results also suggest that an anesthetic test would not be totally reliable for differentiating these disorders. A protocol is provided that should help practitioners identify the tooth pain source when there is no dental pathology.

Presencia de factores sistémicos en los distintos estados periodontales / The presence of systemic factors in the different periodontal conditions

Se escribe sobre la importancia de la infección que representa la enfermedad periodontal como iniciación o agravamiento de las alteraciones en losdistintos sistémas que conforman nuestro organismo, como también a la inversa las enfermedades sistémicas pueden facilitar la acción de la placa bacteriana al disminuir las defensas de los tejidos de soporte. El objetivo de éste trabajo es conocer la existencia de éstos factores sistémicos en cada unode los grados de evolución de la enfermedad gingivoperiodontal

Presencia de factores sistémicos en los distintos estados periodontales / The presence of systemic factors in the different periodontal conditions

Se escribe sobre la importancia de la infección que representa la enfermedad periodontal como iniciación o agravamiento de las alteraciones en losdistintos sistémas que conforman nuestro organismo, como también a la inversa las enfermedades sistémicas pueden facilitar la acción de la placa bacteriana al disminuir las defensas de los tejidos de soporte. El objetivo de éste trabajo es conocer la existencia de éstos factores sistémicos en cada unode los grados de evolución de la enfermedad gingivoperiodontal(AU)

Retrospective investigation of gingival invaginations : Part I: Clinical findings and presentation of a coding system.

Many orthodontic treatments involve tooth extraction. Gingival invagination is a common side effect after orthodontic extraction space closure leading to compromised oral hygiene and the space closure being hampered. Even the long-term stability of the orthodontic treatment result may be jeopardized. The aim of this study was to identify risk factors for the development of gingival invagination and possible implications on oral health and orthodontic treatment results.A total of 30 patients presenting 101 tooth extractions and subsequent orthodontic space closure were investigated to detect the presence of gingival invagination. The time required until active space closure, the thoroughness of space closure, and probing depths mesial and distal to the extraction site in addition to age, gender and the Periodontal Screening Index were investigated. A new coding system to describe the extent of gingival invagination is introduced for the first time here.Gingival invagination developed more frequently in the lower jaw (50%) than the upper (30%). Complete penetration occurred in the upper jaw in 6% of the patients and in the lower jaw in 25%. All patients without gingival invagination revealed complete space closure, whereas only 70% in the group with gingival invagination did so. The time until initiation of space closure took significantly longer in patients with gingival invagination (7.5 ± 1.4 months) than in patients without (3.3 ± 0.8 months). Probing depths of the adjacent teeth were significantly greater in regions with invaginations.Thus, the time required until space closure was initiated and the extraction site are important risk factors for the development of gingival invagination. The consequences of gingival invagination are instable space closure and deeper probing depths mesial and distal to the extractions. However, no statements concerning the mid- to long-term effects on oral health can be made.

Periodontal conditions in patients with oral lichen planus: a pilot study.

OBJECTIVE: To evaluate the periodontal status of patients with oral lichen planus and compare it with that of healthy controls. The association between periodontal condition and the extent of disease in oral lichen planus patients was also examined. METHOD AND MATERIALS: A descriptive clinical study was made of the periodontal condition of 80 consecutive patients with clinically and histologically diagnosed oral lichen planus and 40 healthy controls. Measurements were made of the Gingival Index, Plaque Index, and Community Periodontal Index of Treatment Needs (CPITN). RESULTS: Mean CPITN scores were significantly higher in oral lichen planus patients (2.8 ± 0.7) than in the healthy controls (1.1 ± 0.8) (P < .001).The patients with oral lichen planus showed no statistically significant difference in CPITN scores according to the extent of the lesions or their clinical form of presentation. CONCLUSION: The periodontal condition of the oral lichen planus patients was significantly worse than in the control group.

Destructive membranous periodontal disease (ligneous gingivitis): a literature review.

BACKGROUND: Destructive membranous periodontal disease, or ligneous gingivitis, is a rare condition involving nodular gingival enlargement with ulceration and periodontal tissue destruction. This review gives a brief account of the cases reported in the literature. An effort is also made to define the periodontal disease caused by plasminogen deficiency with a view to its potential inclusion in the classification of periodontal diseases. METHODS: A MEDLINE/PubMed and manual search was conducted to find papers describing ≥1 case of ligneous disease involving the oral mucosa. RESULTS: We identified 23 articles reporting 35 cases. For each patient, we analyzed various characteristics, including age, sex, age of onset, oral symptoms, histologic features, plasminogen levels (functional activity, plasma antigen), genetic features, treatment, and results of treatment during the reported follow-up. CONCLUSIONS: Ligneous gingivitis is a rare periodontal disorder closely associated with ligneous conjunctivitis and plasminogen deficiency. Its diagnosis may be supported by the finding of genetic mutations responsible for the condition. Research is focusing on the future development of an effective therapy capable of arresting the destructive evolution of the disease. Additional studies, investigating features such as probing depth and attachment loss, are needed for the appropriate classification of this periodontal disease.

Frictional keratoses on the facial attached gingiva are rare clinical findings and do not belong to the category of leukoplakia.

PURPOSE: To investigate the clinical and histologic features of frictional keratoses located exclusively on the facial attached gingiva and establish whether these belong to the category of leukoplakia. MATERIALS AND METHODS: Over a period of 15 years, 159 patients presenting with oral keratotic plaques, located exclusively on the facial attached gingival mucosa, excluding the edentulous alveolar ridge and retromolar pad area, were retrospectively selected. Clinical and histologic features and the symptoms and progression of these lesions were carefully assessed. RESULTS: The presence of oral frictional keratosis located exclusively on the facial attached gingival mucosa was clinically and immunohistologically diagnosed in 14 of 159 patients (8.8%). Eleven patients (78.5%) showed unilateral involvement, whereas 3 patients (21.5%) had bilateral involvement. The disappearance of the lesions was accomplished in only 9 of 14 patients, resulting from discontinuation of bad habits. Clinically, these lesions appeared as distinct, sharply demarcated, isolated, asymptomatic, homogeneous whitish-plaques that were neither removable nor painful. The plaques did not create discomfort, change shape, or develop into malignancy. Histologically, these plaques showed features superimposable to those present in benign alveolar ridge keratoses. CONCLUSION: The results highlighted that frictional keratoses on the facial attached gingival mucosa 1) are rare findings, 2) clinically appear as "true leukoplakia" but histologically have the same features as benign alveolar ridge keratoses, 3) have no propensity for malignant transformation, 4) have a good prognosis, and 5) have a specific cause, and resolution is accomplished if the frictional element is eliminated. Thus, these must be removed from the category of leukoplakia.

LPS induces greater bone and PDL loss in SPARC-null mice.

Individuals with periodontal disease have increased risk of tooth loss, particularly in cases with associated loss of alveolar bone and periodontal ligament (PDL). Current treatments do not predictably regenerate damaged PDL. Collagen I is the primary component of bone and PDL extracellular matrix. SPARC/Osteonectin (SP/ON) is implicated in the regulation of collagen content in healthy PDL. In this study, periodontal disease was induced by injections of lipopolysaccharide (LPS) from Aggregatibacter actinomycetemcomitans in wild-type (WT) and SP/ON-null C57/Bl6 mice. A 20-µg quantity of LPS was injected between the first and second molars 3 times a week for 4 weeks, whereas PBS control was injected into the contralateral maxilla. LPS injection resulted in a significant decrease in bone volume fraction in both genotypes; however, significantly greater bone loss was detected in SP/ON-null maxilla. SP/ON-null PDL exhibited more extensive degradation of connective tissue in the gingival tissues. Although total cell numbers in the PDL of SP/ON-null were not different from those in WT, the inflammatory infiltrate was reduced in SP/ON-null PDL. Histology of collagen fibers revealed marked reductions in collagen volume fraction and in thick collagen volume fraction in the PDL of SP/ON-null mice. SP/ON protects collagen content in PDL and in alveolar bone in experimental periodontal disease.

Effect of environmental tobacco smoke from smoker parents on gingival pigmentation in children and young adults: a cross-sectional study.

BACKGROUND: Non-smokers exposed to environmental tobacco smoke (ETS) absorb nicotine and other compounds just as smokers do, and as the exposure to ETS increases, the level of these harmful compounds in the body also increases. The ill effects of ETS range from gingival pigmentation to lung cancer and death. The exposure to ETS is difficult to quantitatively measure and has been approximated by self-reported estimates, primarily of the smoking history of spouses. However, the documentation of gingival pigmentation in non-smokers is meager and has remained contentious. We aimed to assess the effects of ETS from smoker parents on gingival pigmentation in children and young adults and assess the urine cotinine levels in these individuals. METHODS: A total of 153 non-smoking participants with ≥1 smoker parent were randomly selected from the outpatient Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate Research Center, Bangalore, India. These participants were divided into three groups based on age, and the smoking history of parents was established by an interview with participants and parents. The degree of gingival pigmentation of participants was assessed by using the gingival pigmentation index and a standardized digital oral photograph. A urine analysis was conducted to assess levels of cotinine. The κ statistic was performed for interexaminer agreement, and χ(2) and Fisher exact tests were used for statistical analyses. RESULTS: The prevalence of gingival pigmentation in passive smokers was statistically significant (P <0.05). Increased levels of urinary cotinine were observed in all three groups with the highest levels in group 3 (19 to 24 years old). CONCLUSION: This study depicts the effects of ETS on gingival melanin pigmentation.

Periodontal and gingival parameters in young adults with acute myeloid leukaemia in Kerala, South India.

PURPOSE: Patients presenting with leukaemic blast crisis with acute myeloid leukaemia (AML) may have gingival enlargements that interfere with oral hygiene. Few large cohort studies of gingival lesions have been carried out on AML patients. The aim of the present study was to assess gingival and periodontal pathology at the time of presentation, prior to chemotherapy, in a cohort of adult patients presenting at a cancer hospital in Kerala, a region located in southern India. MATERIALS AND METHODS: A total of 73 young adult patients (mean age 20.6 ± 2.3) who were diagnosed with AML were examined. These patients did not suffer from any other systemic disorder. The oral hygiene status, gingival overgrowth (GO) and periodontal status were assessed using traditional clinical indices. RESULTS: Around three-quarters of the patients had either fair or poor oral hygiene. A statistically significant association between dental plaque levels and both GO and periodontal index (P < 0.001) was observed. CONCLUSIONS: Poor oral hygiene is a risk factor for leukaemic GO and for destructive periodontal disease. Both conditions add to the microbial burden these patients are exposed to. In patients showing high levels of oral hygiene, the GO tends to be mild and does not seem to be problematic, especially with respect to mechanical tooth cleaning.