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The normal periodontium consists of gingiva, connective tissue, the periodontal ligament, cementum, and the surrounding alveolar bone. Clinicians commonly describe the healthy gingiva as being scalloped, coral pink in color, firm, and knife-edged. The lack of bleeding on probing and the lack of exudates are also taken as clinical signs of health. In children, similar characteristics are observed and recorded (although there are more spaces between primary teeth resulting in a “flatter,” less scalloped appearance). There are several different forms of gingival and periodontal diseases that can be present in children and adolescents that can change the appearance (erythematous), contour (swollen), size (hyperplastic or overgrown), and shape (blunted papillae) of the gingiva. They range from reversible conditions limited to the inflammation of gingival tissues (gingivitis) to those characterized by the destruction of the periodontal connective tissue attachment and alveolar bone (periodontitis).1 If the conditions are left untreated, the deciduous or permanent dentitions can be jeopardized. Fundamental principles concerning the etiology of these diseases and the contributing factors need to be understood in order to identify and manage periodontal disease complications.1


According to the American Academy of Periodontology, periodontal disease in children and adolescents can be classified into five distinct periodontal disease categories (eTables 377.1 and 377.2)2:


  1. 1. Dental plaque-induced gingival diseases

    2. Chronic periodontitis

    3. Aggressive periodontitis

    4. Periodontitis as a manifestation of systemic diseases

    5. Necrotizing periodontal diseases

Table Graphic Jump Location
eTable 377.1. American Academy of Periodontology Classification System for Periodontal Diseases and Conditions: Gingival Diseases22

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