GINGIVAL DISEASES IN

CHILDREN
DR MALEEHA IJAZ
PGR MDS PEDIATRIC DENTISTRY
OUTLINE

• Introduction
• Criteria of healthy gingival tissue.
• Classification of gingival diseases.
• Acute gingival diseases.
INTRODUCTION

• The gingiva is the part of oral

mucous membrane that covers
the alveolar processes and the
cervical portions of the teeth.
CRITERIA OF HEALTHY GINGIVAL TISSUE
GINGIVITIS

• It is the inflammation of the gingiva that doesn’t result in clinical

attachment loss.
 CLASSIFICATION OF GINGIVAL DISEASES
• Eruption gingivitis.
• Dental plaque induced gingivitis.
• Allergy and gingival inflammation.
• Acute gingival disease
1. Herpes simplex virus infection.
2. Recurrent aphthous ulcer.
• Chronic non specific gingivitis.
ERUPTION GINGIVITIS
TREATMENT

• Mild eruption gingivitis requires no treatment other than

improved oral hygiene.

• Painful pericoronitis may be healed by saline

irrigation.

• Pericoronitis accompanied by swelling and lymph node

involvement should be treated with antibiotic therapy
ACUTE GINGIVAL DISEASES

• HSV
• RECURRENT APHTHOUS ULCER
 HERPES SIMPLEX VIRUS INFECTION
• Herpes virus causes one of the most widespread viral infections.

• The primary infection usually occurs in a child younger than 6 yrs of age
who has had no contact with HSV-1 and therefore has no neutralizing
antibodies.

• The primary infection may be manifested by acute sympyoms(acute

herpetic gingivostomatitis) which runs a course of 10-14 days.

• The active symptoms of the disease can occur in children with clean
mouths and healthy oral tissues.

• May be characterized by only one or two mild sores on the oral mucous
membranes, which may be of little concern to the child or might go
unnoticed by the parents.
SYMPTOMS

• Fiery red gingival tissues

• Malaise
• Irritability
• Headache
• Pain associated with the intake of food and liquids of acid
content.
CHARACTERISTICS
• Is the presence of yellow or white fluid filled vesicles.

• In a few days the vesicles rupture and form painful ulcers 1-3mm in diameter.

• Covered with whitish grey membrane and a circumscribed area of inflammation.

• The ulcers may be observed on any area of the mucous membrane, including
buccal mucosa, tongue, lips, hard & soft palate and the tonsillar areas.

• Large ulcerating lesions are usually observed on the palate or gingival tissues or
in the region of mucobuccal fold.
 Cont’
• Primary herpetic infection has been observed on the digits of a
pediatric pt. (digit sucking habit).

• The oral and the lesion on the digit subsides in 2 weeks.

TREATMENT
• The treatments described are useful, they are only palliative.
I. Specific antiviral medication as well as provision for the relief of the
acute symptoms.

II. The application of mild topical anesthetic, such as dyclonine

hydrochloride (0.5%)(Dyclone), before mealtime temporarily relieves
pain.

III. Allows the child to take in soft food.

IV. Vitamin supplementation during the course of the disease.

V. Isolation
DRUGS
• The antiviral medications currently available are acyclovir, famciciolvir,
and valacyclovir. These meds inhibit viral replication in cells infected
with the virus. It should be administered in five daily doses =
1000mg/day for 10 days.

• Mainstay of definitive therapy is regular doses of specific systemic

antiviral medication combined with systemic analgesics(acetaminophen
or ibuprofen).

• Another topical anesthetic , lidocaine(xylocaine), can be prescribed for

the child who can be instructed to hold 1 tsp of the anesthetic in the
mouth for 2-3 minutes and then expectorate the solution.

• Schaaf recommends as an alternative to the anesthetic a mixture of

equal parts of diphenhydramine (Benadryl)elixir and kaopectate. It has
mild analgesic and anti-inflammatory properties , whereas the kaolin –
pectin compound coats the lesions.
 Angle of the lips

Marginal gingiva

ULCERATIVE STAGE OF PHG (a) palatal gingiva

(b)lower lip mucosa
RECURRENT HERPES LABIALIS

• After the initial primary attack during early childhood, the HSV
becomes inactive and resides in sensory nerve ganglia.

• The virus often reappears later as the familiar cold sore or fever
blister, usually on the outside of the lips.

• Approximately 5% recurrences are intraoral.

Recurrent herpes labialis.
A) Early vesicular lesions.
B) Mature vesicular lesions.
C) Appearance of herpes labialis after rupture of
vesicles and crusting of the lesion.
REASON OF RECURRENCE

• Emotional stress.
• Lowered tissue resistance resulting from various types of trauma.
• Excessive exposure to sunlight .
• Lesion on the lip may appear after dental Rx and may be related
to irritation from rubber dam material or even routine procedures.
TREATMENT
• Systemic antiviral medications daily dosages are the same as those for the
primary infection, but the course of treatment is usually 5 days instead of 10.

• FDA in children 12 yrs & older is valacyclovir 2g , initially and 2g 12 hrs later.

• Topical antiviral agent, penciclovir cream may be applied to perioral lesions but
should not be applied to intraoral lesions. Every 2 hrs while awake for 4 days ,
and it is approved for use in children 12 yrs & older.

• Topical 5% acyclovir cream may be prescribed for use five times daily for 4 days
in children 12 yrs of age and older are frequently exposed to HSV-1.
RECURRENT APHTHOUS ULCER
• The peak age is between 10-19 yrs.

• CHARACTERIZED:
• Recurrent ulcerations on the moist mucous membranes of the
mouth, in which both discrete and confluent lesions form rapidly
in certain sites and feature.
• Round to oval crateriform base, raised reddened margins, and
pain.
 CLASSSIFICATION
 MINOR

 MAJOR

 HERPETIFORM
 ETIOLOGY
• The cause of RAU is unknown. But it is possible that the lesions are caused by:

• Local and systemic conditions & GIT disorders.

• Genetic predisposition.

• Immunologic & infectious microbia factors.

• Delayed hypersensitivity to the L form of Streptococcus sanguis.

• autoimmune reaction of the oral epithelium.

• Local factors include trauma, allergy to toothpaste constituents(sodium lauryl

sulfate), and salivary gland dysfunction.
Cont’
• Nutritional deficiencies are around 20% pf the pts with aphthous
ulcers.( iron, vit B12 and Folic acid).

• Stress

• Ship and colleagues also suggested HSV, HHV-6, cytomegalovirus,

EBV and VZV as possible causes of RAS.
TREATMENT OF RAU
• Lesions persist for 4-12 days and heal uneventfully, leaving scars
only rarely and only in cases of unususally large lesion.
• Current treatment is focused on:
• Promoting ulcer healing
• Reducing ulcer duration and pt pain.
• Maintaining the pts’ nutritional intake.
• And preventing or reducing the frequency of recurrences of the
disease.
• A variety of treatments have been recommended for RAU, but a
completely successful therapy hasn’t been found.

• Topical gels, creams, and ointments as anti-inflammatory agents.

• Analgesic medicines and/or systemic immuno-modulating and

immunosuppression agents. E.g topical corticosteroids(0.5%
fluocinonide, 0.025% triamcinolone, 0.5% Clobetasol) is applied to the
area with a mucosal adherent( isobutyl cyanoacrylate, orabase)before
meals and before sleeping may also be helpful or 4 times daily
Cont’

• The topical application of tetracycline to the ulcers is often

helpful in reducing the pain and in shortening the course of the
disease.

• A mouthwash containing suspension of one of the tetracyclines

has been helpful to some , but the mouthwash shouldn’t be
swallowed.

• Chlorhexidine mouthwash has also bee known to alleviate the

symptoms of RAU.
THANK YOU !!!