Plaque induced gingivits and periodontal disease in children

Gingivitis and periodontitis are the 2 major forms of inflammatory diseases affecting the periodontium. Their primary etiology is bacterial plaque, which can initiate destruction of the gingival tissues and periodontal attachment apparatus.

Gingivitisis inflammation of the gingiva that does not result in clinical attachment loss. Periodontitis is inflammation of 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 subclassified based upon etiology, clinical presentation, or associated complicating factors. Gingivitis is a reversible disease. Therapy is aimed primarily at reduction of etiologic factors to reduce or eliminate inflammation, thereby allowing gingival tissues to heal.

Appropriate supportive periodontal maintenance that includes personal and professional care is important in preventing re-initiation of inflammation

According to Dr Bill Geyer, Lutz Dentist therapy for individuals with chronic gingivitis is initially directed at reduction of oral bacteria and associated calcified and noncalcified deposits. Patients with chronic gingivitis, but without significant calculus, alterations in gingival morphology, or systemic diseases that affect oral health, may respond to a therapeutic regimen consisting of improved personal plaque control alone.

The periodontal literature documents the short- and long-term effects following self-treatment of gingivitis by personal plaque control.

However, while it may be possible under controlled conditions to remove most plaque with a variety of mechanical oral hygiene aids, many patients lack the motivation or skill to attain and maintain a plaque-free state for significant periods of time. Clinical trials also indicate that self-administered plaque control programs alone, without periodic professional reinforcement, are inconsistent in providing long-term inhibition of gingivitis.

Many patients with gingivitis have calculus or other associated local factors (eg, defective dental restorations) that interfere with personal oral hygiene and the ability to remove bacterial plaque. An acceptable therapeutic result for these individuals is usually obtained when personal plaque control measures are
performed in conjunction with professional removal of plaque, calculus, and other local contributing factors.

Removal of dental calculus is accomplished by scaling and root planing procedures using hand, sonic, or ultrasonic instruments. The therapeutic objective of scaling and root planing is to remove plaque and calculus to reduce subgingival bacteria below a threshold level capable of initiating clinical inflammation.

Necrotizing ulcerative gingivitis (NUG) is associated with specific bacterial accumulations occurring in individuals with lowered host resistance.NUG usually responds rapidly to the reduction of oral bacteria by a combination of personal plaque control and professional debridement. If lymphadenopathy or fever accompanies oral symptoms, administration of systemic antibiotics may be indicated. The use of chemotherapeutic rinses by the patient may be beneficial during the initial treatment stages. After the acute inflammation of the NUG lesion is resolved, additional intervention may be indicated to prevent disease recurrence or to correct resultant soft tissue deformities.
Necrotizing ulcerative periodontitis (NUP ) manifests as rapid necrosis and destruction of the gingiva and periodontal attachment apparatus. It may initiate gingival bleeding and pain,and it usually represents an extension of necrotizing ulcerative gingivitis in individuals with lowered host resistance. NUP has
been reported among both HIV-positive and negative individuals.

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