Chapter 27

Gingivitis and periodontitis are inflammatory conditions of the tooth-supporting structures (periodontium). The transition from primary to permanent dentition, and the hormonal changes associated with puberty present unique periodontal conditions in children.1 In adults, these diseases are of a chronic nature, whereas in children they can be aggressive in nature. Thus, early diagnosis and treatment are critical. The nondestructive nature of gingival inflammation of childhood can progress to the more significant periodontal disease seen in the adult population if left untreated.1

Gingivitis and periodontitis are the two major forms of inflammatory diseases affecting the periodontium.2 Broadly speaking, gingivitis refers to reversible inflammation of the gingiva that does not result in clinical attachment loss. In contrast, periodontitis implies inflammation of both the gingiva and the adjacent attachment apparatus, and is characterized by loss of connective tissue attachment and alveolar bone. Each of these diseases may be further classified based upon etiology, clinical presentation, rate of progression, or associated complication factors as follows3,4:

• Dental plaque-induced gingival diseases
• Chronic periodontitis
• Aggressive periodontitis
• Periodontitis as a manifestation of systemic diseases
• Necrotizing periodontal diseases

### Dental Plaque-Induced Gingival Disease

Dental plaque-induced gingival disease can be characterized by redness and edema of the gingival tissue, bleeding upon provocation, changes in contour and consistency, presence of calculus and/or plaque, without radiographic evidence of crestal bone loss (Figure 27–1).5

###### Figure 27–1.

Dental plaque-induced gingival disease in the mixed dentition.

### Chronic Periodontitis

Chronic periodontitis is more prevalent in adults, but can occur in children and adolescents. Chronic periodontitis is characterized by edema, erythema, gingival bleeding upon tissue manipulation, and suppuration with variable degrees of clinical attachment loss. In addition, radiographic evidence of bone loss and increased tooth mobility might be present.6 Chronic periodontitis can be classified based on disease severity and extent of involvement. Disease severity can be categorized into mild (1–2 mm clinical attachment loss), moderate (3–4 mm clinical attachment loss), or severe (≥5 mm clinical attachment loss).3 The disease can be localized (less than 30% of the dentition affected) or generalized (greater than 30% of the dentition affected), and is characterized by a slow to moderate rate of progression that may include periods of rapid destruction.4

### Aggressive Periodontitis

Aggressive periodontitis encompasses the distinct type of periodontitis that affect children, who, in most cases, appear healthy. Aggressive periodontitis can be presented in localized (LAgP) or generalized (GAgP) pattern. The localized version has a circumpubertal onset with familial aggregation, and there is a rapid rate of disease progression around first molars and incisors (Figure 27–2).7 However, atypical pattern of affected teeth are possible.7 Characteristically, the amounts of microbial deposits are inconsistent with the severity of periodontal tissue destruction....

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