Growth and development considerations in the diagnosis of gingivitis and periodontitis in children

Increasing information emphasize the relevance of the prevention, early diagnosis and early treatment of periodontal diseases in children. In order to avoid erroneous diagnosis and unnecessary treatments, the pediatric dentist is required to differentiate between pathologic processes and normal changes that take place in the periodontum with age. The present review outlines structural and functional changes of the periodontal structures, the establishment and maturation of the oral microflora and immune defense reactions to periodontal pathogens in children and adolescents. The age-related tendency to develop gingivitis, that is evident in children and adolescents, may be related to changes in the bacterial composition of the dental plaque, the inflammatory cell response, hormonal changes, morphological differences, tooth eruption and shedding. The hormonal influence on the gingival tissues and the composition of the dental plaque are of particular relevance during puberty. Large ranges for the prevalence of attachment loss, periodontitis or destructive periodontal disease in children and adolescents have been reported. The variance in values may be related to population characteristics, method of examination or diagnostic criteria that may include measurements of attachment loss and distances from the cementoenamel junction to the alveolar bone crest, both of which may be either physiological or pathological. The pediatric dentist should be able to diagnose gingival inflammation, attachment loss or distances from the cementoenamel junction to the alveolar crest which are out of proportion to the child's age and the amount of dental plaque. These may be indicative of a high susceptibility to periodontal diseases or reflect systemic conditions that affect the periodontum.