兒童牙科學課件：Periodontal Problems in Children and Adolescents兒童和青少年的牙周問題

1、Periodontal Problems in Children and AdolescentsStructure of the PeriodontiumEpitheliumCementumPeriodontal ligamentAlveolar boneEpitheliumPapillary gingivalMarginal gingivalAttached gingivaAlveolar mucosaPeriodontal MembraneInterdental spacing is commonNo interdental col Papillary gingivalMarginal G

2、ingivalDeep sulcusThicker and rounder free gingivalFlaccid and retractableImmature connective tissue compositionImmature gingival fiber systemIncreased vascularizationAttached gingivalThinner, less keratinized epitheliumLess dense and redderGingival stipple: rareConnective tissue: easy to swellAlveo

3、lar mucosaAbsence of keratinAbundance of elastic fibers and movablePeriodontal MembraneWider and less denseFewer fibers than adultCementum and Periodontal LigamentThinRaritasLittle fiber and abundant blood supplyAlveolar BoneThinner lamina dura and flatter interdental crestsLess calcified, more vasc

4、ular, fewer but thicker trabeculaeAbundant blood and lymph supplyCharacteristic of the Periodontium in Children Less keratinizedFewer fibers and less denseAbundant blood supplyEasy to swell GingivitisGingivitis is an inflammation involving only the gingival tissues next to the tooth. Microscopically

5、, it is characterized by the presence of an inflammatory exudate and edema, some destruction of collagenous gingival fibers, and ulceration and proliferation of the epithelium facing the tooth and attaching the gingiva to it.The characteristicof the Chronic GingivitisLocalized or generalizedInsidiou

6、s and painlessChanges in gingival color ,contour and textureThe epidemiology of gingivitisIncreased with the calculusDecreased after the age of puberty More serious in boys 第三次全國口腔健康流行病學調(diào)查報告顯示： 5個年齡組中小學生牙齦炎患病率為66.9% 12歲組兒童的牙齦出血檢出率為57.7% 牙石檢出率為59.1%對兒童牙周組織的健康狀況應(yīng)予以關(guān)注！Local FactorsAccumulation of plaqu

7、eCalculus increases with age and be more important in older childrenSigns of the disease are more attributed to host response rather than the effects of bacterial enzymes or cytotoxinOthers FactorsTraumatic, eruption, carious, food impaction ,malocclusion ,orthodontic appliance ,mouth breathingImpro

8、per marginal extension of stainless steel crownsThe anatomize characteristics of the primary teethSystemic FactorsThe influence of hormonesMalnutritionChronic illnessMedicationsSimple GingivitisCarry by bacteria live in biofilmInflammation of the gingivalNo loss of attachment or boneFilth Gingivitis

9、Chronic disease cause by poor hygieneEarly gingivitis: reversible ,can be treated with good oral prophylacticModerate gingivitisAdvanced gingivitis: less, can be translate into periodontal diseaseErythema ,bleeding on probing, edema診斷依據(jù)：1. 主訴：牙齦易出血，紅腫2. 臨床表現(xiàn)： 口腔衛(wèi)生情況差，牙面可見 明顯軟垢、牙石 齦緣紅腫，探診易出血治療：1. 局部沖

10、洗、上藥2. 注意口腔衛(wèi)生3. 牙周科齦上潔治Eruptive GingivitisPrimary teeth and the first permanent molarGingival margin receives no protection and vulnerableThe impingement of the foodBacterial plaque collect around May requires no treatment診斷依據(jù)處于牙齒萌出期好發(fā)牙位：第一恒磨牙、恒前牙、乳牙主訴：發(fā)現(xiàn)牙齦小腫物、疼痛臨床表現(xiàn)：正在萌出牙齒牙齦紅腫 第一恒磨牙遠中牙齦覆蓋，齦袋 紅腫、溢膿，

11、如被對頜牙咬傷可能 出現(xiàn)糜爛、潰瘍治療：根據(jù)臨床癥狀的嚴重程度 1. 無明顯自覺癥狀 觀察 2. 癥狀較輕 局部沖洗、上藥，注意口腔衛(wèi)生 3. 腫脹明顯，阻礙牙齒萌出 快機磨出覆蓋的 牙齦組織Eruption cystCyst with blood and tissue fluidDisappear after the eruptionPuberty GingivitisGirl in mensesMay be good or bad oral hygieneCan be turn into periodontitisTreatment : oral hygiene and plaque co

12、ntrol【診 斷】 患兒處于青春期，主要累及前牙唇側(cè)牙齦【治 療】 去除局部刺激因素、改善口腔衛(wèi)生狀況Dilantin Gingival hyperplasiaDrug-induced gingival overgrowthAnticonvulsant phenytoin : DilantinPainless ,fibrous ,firm ,pale pinkOther Drug-induce Gingival HyperplasiaDrug-induced gingival overgrowthCyclosporine control host rejection of transplan

13、ted organs and treat autoimmune diseaseCalcium channel blockers: nifedipine, nitrendipine used in children to control hypertensionLittle tendency to bleedMild: gingival margin hyperplasiaExtreme: interfere the eruptionGenetic susceptibilityPhenytoin gingivitis in a preschool child. The enlarged ging

14、ival tissue covers two thirds of the maxillary primary lateral incisors and canines.Phenytoin gingivitis of the severe generalized type. Surgical removal of the overgrowth of hyperplastic gingival tissue results in temporary improvement of the conditionABPredilection site: labial surface of anterior

15、 teeth buccal surface of posterior teethResolve when medication is discontinuedSurgery but easily to recurWorse because of poor oral hygieneHereditary Gingival fibromatosisSlow,progressive,benign enlargementGenetic and pharmacologicalAutosomal dominant mode: band 2p21Free gingiva and marginal gingiv

16、alPainless ,fibrous ,firm ,pale pinkUnilateral or bilateralOften in lingual surfaceNormal at birthBegin to enlarge: eruption of the primary teethContinue: eruption of the permanent teethCause displacement of the teeth and malocclusionAcute inflammation of gingival papillaInvolving single gingival pa

17、pillaEdema, bleeding, pain With food impaction, dental caries or traumatic factorsconclusionsConditions of gingival color bleeding overgrowth? ulcer?Etiology poor oral hygiene special time: eruption of teeth puberty teeth crowding drug use?Treatment plaque controlorthodontic treatment?Surgical remov

18、al of the overgrowth of hyperplastic gingival tissue resultsPERIODONTITISGingivitisPeriodontal pocketLooseness of teethAlveolar resorptionThe epidemiology of periodontitisIncreased with the calculusIncreased with the ageAbsence of enough statisticEarly-Onset PeriodontitisLocalized Aggressive Periodo

19、ntitisGeneralized Aggressive PeriodontitisEarly-onset PeriodontitisAssociated with systemic diseaseAffect healthy occurRare to studyPrepubertal periodontitis in a 4-year-old girl. Loosening, migration, and spontaneous loss of the primary teethA generalized loss of alveolar bone can be seen in the ra

20、diographs.Eight years after the initial observationthere is evidence of normal gingival tissues.Localized aggressive PeriodontitisAffect the first molars and incisors Rapid and severe loss of alveolar boneWithout evidence of systemic diseaseLocal ,bilaterally symmetrical loss of attachmentMild to mo

21、derate inflammationHeavier than average plaque and calculus depositBe linked to a neutrophil chemootatactic defect or monocyte chemootatactic defect Advance to periodontitis of the permanent dentitionLocalized treatment and antibiotics12-year-old boy with the localized form of periodontitis. Clinica

22、l examination revealed extensive mobility of the anterior teethGeneralized aggressive PeriodontitisGeneralized loss of alveolar boneGo with acute gingivitisBe linked to a neutrophil chemootatactic defect and monocyte chemootatactic defect Bad prognosisLinked to high numbers of Actinobacillus actinom

23、ycetemcomitansBe linked to a neutrophil and monocyte chemootatactic defectTreatment:combination with systemic antibiotic therapy and microbiologic monitoringMetronidazole and amoxicillin are effective in arresting disease progressionLocalized surgical intervention廣泛型侵襲性牙周炎（女，13歲）Acute traumatic Peri

24、odontitisCause by improper orthodontics treatmentsMost in anterior teethStabilization of loosen teeth should be necessary橡皮圈致急性創(chuàng)傷性牙周炎（男，8歲）個別恒中切牙反合 導(dǎo)致下切牙急性牙周破壞（男，7歲） Three-year-old child with Papillon-Lefevre syndromeConstructed complete denturesmodified to allow the eruption of the mandibular incis

25、ors and the first permanent molars.Photographs 15 years after initial diagnosis of Papillon-Lefevre syndromePanoramic radiographic survey revealed normal alveolar bone治療衛(wèi)生宣教，定期檢查，去除刺激因素齦上潔治術(shù)齦下刮治術(shù)內(nèi)壁刮治術(shù)咬頜調(diào)整Mucosal Disease in ChildrenCandidiasis (Thrush)Candida albicansPart of the normal oral floraOccu

26、r on any mucosal surfaceUsually cause no clinical significanceTake place when normal oral flora has been alteredInfants 57 days after birthInfants with systemic diseaseInfants receiving long-term antibiotics,steroids,cytotoxinsTransmitted from mothers vagina or contamination in the nurseryMultiple ,

27、small ,white ,curd like patch lesion form the pseudomembranousAppear to lump together Easily removed and leaves a raw ,bleeding surfacePotassium hydroxide(KOH) preparation of a smear reveal hyphae when observed microscopicallyMild disease: antifungal agentModerate disease: systemic antifungal agent

28、(ketoconazole，酮康唑)Severe disease: systemic antifungal agent (amphotericin，兩性霉素)Physician treatmentHerpetic gingivostomatitisCausative agent: Herpes simplex virus type Primary exposure to the virusMost common in children 皰疹性齦口炎（女，4歲）Primarily herpetic gingivostomatitis: childrenRecurrent herpetic gin

29、givostomatitis: children or adultOften see under 6 years old,mostly 6 months to 3 years oldRecent exposure to an infected personLack of the immunityMalaise, arthralgia, anorexia, fever, chillVesicle on the mucosa of the lips, tongue, gingivaRupture into large ,painful ,ulcerated areasGingiva is edem

30、atous, erythematous and bleeds readilyWhite coating in tongueVirus cultures and antibody titers making the diagnosisThe reveal of multinucleated giant cellsSerum antibody titers obtained during the acute6 weeks later reveal a rise in the antivirus antibody levelsSelf-limiting disease lasting 710 day

31、sTreatment :bed rest, antipyretics, analgesics to control fever and relieve painPhysician treatment :mouthwashMultiple vitamin therapyOral fluid intake or intravenous fluid intakeIsolate the patient to prevent the spreadDont antibiotics unless secondary infection are presentSteroids are contraindica

32、ted治療： 全身抗病毒治療（利巴韋林、抗病毒口服液） 口腔局部可使用漱口水 注意休息、全身支持治療具有自限性，7-10天可自愈需要隔離患者Hand, Foot and Mouth DiseaseCaused by Coxsackie A virus， EV71Children between 110 years oldFever, painful, multiple, small vesiclesSubsequently ulcerateHard palate, tongue, buccal mucosa, soles, fingersTherapy: self-limitingResolv

33、es spontaneously 714 daysMouthrinses ,antipyretics, analgesics23手、足、口HerpangiaCaused by Coxsackie A virusChildren under 4 years oldFever, painful, multiple, small vesiclesSubsequently ulcerateSoft palate, amygdalaeflu-like symptomssmall vesicles on lips, tongue, gingival and buccal mucosaOther part

34、of body: hand, footMainly caused by virusTherapy: self-limiting Resolves spontaneously 714 daysAntivirus therapyMouthrinses and keep good oral hygieneAntibiotics and supportive therapyTraumatic UlcersPterygoid ulcers (Bednars aphthae)Riga-Feda diseaseFactitial ulcersRiga-Feda DiseaseOccurring on the

35、 lingual frenum and ventral tip of the tongue of newborns and infantsCaused by natal and neonatal teethTreatment :removal the irritation source and supportive therapyBednars AphthaeAttempts to clear the mouth of foreign matter at birth Stripping the mucosa covering the pterygoid processesSelf-limiti

36、ng and heal spontaneously Treatment : supportive Traumatic UlcersCaused by residual root and bad habitsLip biting after mandibular block anesthesiaExtraction the residual root Supportive therapyConquer bad habits 根尖周炎形成的創(chuàng)傷性潰瘍（女，4歲） Migratory desquamative on the dorsal and the margins of the tongueEr

37、osion and loss the filiform papillaeWhite keratotic hypertrophic filiform papillae circumscribeWhite and red lesionsLast for yearsBenign and need no treatmentAngular cheilitisA fairly common skin problem at the corner of the mouth at the lip and facial skin junction. Inflammation, burning, redness, and ulceration or cracks characterize the lip skin care problem of angular cheilitisCau