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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
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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:
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1. Dental plaque-induced gingival diseases
2. Chronic periodontitis
3. Aggressive periodontitis
4. Periodontitis as a manifestation of systemic diseases
5. Necrotizing periodontal diseases
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