1. Pediatric Dentistry
“Periodontal disease in children: etiology and pathogenesis. Gingivitis, periodontitis and periodontal syndrome in children: prevalence, clinical manifestations, diagnosis, differential diagnosis, treatment and prevention”
Lecturer: Dr. Katrin Duda

2. The periodontal tissues are:
Gums (also called gingiva). Gums consist of soft, pink tissue, which covers the alveolar bone.
The gum line is where the tooth meets the gum.
Bone (alveolar bone). This is the bone in which the roots of teeth are embedded.
Periodontal membrane or ligament. This connects and attaches the root of the tooth to the bone.

3. What is periodontal disease?
It is chronic inflammatory disease of the gum and tissues that surround and support the teeth. If left untreated, periodontal disease can lead to tooth loss.
This disease divided into two types:
Gingivitis
Periodontitis

4. What Are the Symptoms of Gum Disease?
Gums that bleed during and after tooth brushing
Red, swollen, or tender gums
Persistent bad breath or bad taste in the mouth
Receding gums
Formation of deep pockets between teeth and gums
Loose or shifting teeth
Changes in the way teeth fit together upon biting down, or in the fit of partial dentures.

5. Periodontitis
“inflammation around the tooth" - it is a serious gum infection that damages the soft tissue and bone that supports the tooth. All periodontal diseases, including periodontitis, are infections which affect the periodontium. The periodontium are the tissues around a tooth, tissues that support the tooth. With periodontitis, the alveolar bone around the teeth is slowly and progressively lost. inflammation.

6. 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.

7. What are the risk factors for periodontitis?
Hormonal changes in females 
Diabetes - patients who live with diabetes have a much higher incidence of gum disease than other individuals of the same age
AIDS - people with AIDS have more gum diseases
Cancer - and some cancer treatments can make gum diseases more of a problem
Some drugs - some medications that reduce saliva are linked to gum disease risk.
Genetics - some people are more genetically susceptible to gum diseases

8. Systemic Factors As Etiologic Agents
The possible role of systemic disorders and systemic exposures in initiating or modifying the progression of periodontal disease is a very complex issue. It is however generally agreed that several conditions may give rise to an increase prevalence, incidence or severity of gingivitis and periodontitis

9. Systemic Factors As Etiologic Agents
Microbial plaque is the initiator of periodontal disease but whether it affects a particular subject, what form the disease takes, and how it progresses, are all dependent on the host defenses to this challenge. Systemic factors modify all forms of periodontal disease principally through their effects on the normal immune and inflammatory defenses

10. Systemic Factors as Etiologic Agents
Systemic factors most associated with the etiology and or progression of peritonitis: A. Diabetes Mellitus B. Medications C. Immunosuppressive disorders D. Environmental Conditions or exposures E. Hematological Disorders F. Genetic Disorders.

11. Classification of Periodontitis
1.    Chronic Periodontitis: a) localized b) generalized
2.    Aggressive Periodontitis: a) localized b) generalized
3.    Periodontitis Associated with Systemic Diseases
4.    Necrotizing Periodontal Diseases
5.    Abscesses of the Periodontium
6.    Periodontal Diseases associated with Endodontic Lesions
7.    Developmental or Acquired Deformities and Conditions

12. Characteristics of Chronic Periodontitis
Most prevalent in adults, but can occur in children and adolescents
Amount of destruction is consistent with presence of local factors
Subgingival calculus is a frequent finding
Associated with a variable microbial pattern
Slow to moderate rate of progression but may have periods of rapid progression

13. Chronic Periodontitis

14. Characteristics of Aggressive Periodontitis
 Patients are otherwise clinically healthy
 Rapid attachment loss and bone destruction
 Familial aggregation and variable features
 Severity of destruction inconsistent with amount of microbial deposts
 Elevated proportions of Actinobacillus actinomycetemcomitans and in some patients Porphyromonas gingivalis
 Hyper-responsive macrophage phenotype
 Progress of bone loss may be self arresting

15. 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 localized to a few teeth or it may be generalized.
It is caused by specific bacteria, and is treated by a combination of antibiotic and surgical therapy.

16. 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.

17. Diagnosing periodontitis
Qualified dentist should find it fairly straightforward to diagnose periodontitis. The dentist will ask the patient questions regarding symptoms and carry out an examination of his/her mouth.

18. Dental plaque, calculus and tartar
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.

19. Healthy Gum pink or coral pink color firm, resilient tissues
”orange-peel” texture
shape that follows the contour of the teeth and forms scalloped edge
no areas of redness, swelling or inflammation
no bleeding during daily plaque removal
no discomfort

20. Healthy Gum

22. Gingivitis Gingivitis is inflammation of the gum tissue
The gums are irritated and swollen due to plaque or calculus buildup along the gum line
The gums may be sore, bleed easily and appear puffy, soft and swollen
Bleeding gum is one of the earliest and most common sings of gingivitis
The good news about gingivitis is that it is preventable and reversible through good brushing and flossing techniques/

23. Gingivitis

24. Gingivitis

26. What Causes Gum Disease?
Hormonal changes, such as those occurring during pregnancy, puberty, menopause make gums more sensitive, which makes it easier for gingivitis to develop.
Medications can affect oral health, because some lessen the flow of saliva, which has a protective effect on teeth and gums.
Bad habits such as smoking make it harder for gum tissue to repair itself.
Poor oral hygiene habits such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop.
Family history of dental disease can be a contributing factor for the development of gingivitis.

28. Gum recession

29. Periodontal disease

32. Gingivectomy

35. Thank you for attention