Color Atlas of Oral Diseases in Children and Adolescents. George Laskaris

      Fig. 6.3 Periodontitis

Juvenile Periodontitis

       Definition

      • Juvenile periodontitis is a specific type of early-onset periodontitis, which usually affects adolescents, and is characterized by severe alveolar bone loss.

       Etiology

      • Actinobacillus actinomycetemcomitans and probably other pathogens may be involved.

      • Reduced immune response to endotoxins of bacterial plaque or genetic immune insufficiency have been proposed.

       Occurrence in children

      • Only in adolescents.

      • Familial occurrence.

       Localization

      • Affects only permanent teeth.

      • Localized or generalized.

      • Selectively affects incisors and first molars.

       Clinical features

      • Mild gingival inflammation (Fig. 6.4).

      • Rapid and severe destruction of alveolar bone.

      • Deep periodontal pockets, bleeding, malodorous breath.

      • Absence of local factors (bacterial plaque, calculus).

      • Tooth mobility and migration (Fig. 6.5).

       Radiographic features

      • Severe and rapid bone loss (Fig. 6.6).

       Differential diagnosis

      • Prepubertal periodontitis

      • Adult periodontitis

      • Papillon–Lefèvre syndrome

      • Ehlers–Danlos syndrome, type VIII

      • Crohn’s disease

      • Chediak–Higashi syndrome

      • Ulcerative necrotizing periodontitis in HIV infection

      • Langerhans’ cells histiocytosis

      • Glycogen storage disease Type Ib

      • Cyclic neutropenia and agranulocytosis

      • Juvenile diabetes mellitus (type I)

      • Down’s syndrome

       Treatment

      • Conservative mechanical treatment or surgery.

      • Systemic antibiotics, local antiseptics.

Desquamative Gingivitis

       Definition

      • Desquamative gingivitis is a relatively common clinical manifestation of various mucocutaneous diseases on the gingiva (a non-specific disease entity), with a well-defined clinical pattern.

       Etiology

      • The most common disorders that cause desquamative gingivitis are cicatricial pemphigoid, lichen planus, bullous pemphigoid, pemphigus, linear IgA disease and, rarely, other mucocutaneous diseases.

       Occurrence in children

      • Very rare.

       Localization

      • Buccal anterior gingiva of the maxilla and mandible.

      • Usually localized and rarely generalized.

       Clinical features

      • Red gingiva, edematous with erosions (Figs. 6.7, 6.8).

      • Characteristic desquamation of the epithelium or bleeding bullous formation after rubbing with the spatula.

      • Painful gingiva during mastication and brushing.

      • Rarely, bleeding. The disease has periods of remission and exacerbation.

      • Searching for other signs and symptoms of the underlying disease is important for the diagnosis.

       Laboratory examinations

      • Histopathological examination.

      • Direct immunofluorescence.

      • Indirect immunofluorescence.

       Differential diagnosis