Gum diseases can occur in children. If group of infections are affecting only the gums, then they are known as gingival diseases and if supporting of tissues (Periodontal ligament, alveolar bone, cementum) of teeth are also involved along with gums, then they are known as periodontal gum diseases. Some people think that gum diseases occur only in children and not in adults but it is not the case. Gingivitis occurs in almost all the kids and adolescents.  Chances of advanced periodontal gum problems are less in children but can occur. Main cause of gum diseases in children is plaque deposits in relation to teeth which can occur because of poor oral hygiene in kid. Bleeding of gums during tooth brushing or flossing, swelling or puffiness of gums, recession of gums and bad breath are the main signs and symptoms of gum diseases in children.  

Normal Periodontium in Children

Various types of gum diseases of children are:

1.   Chronic marginal gingivitis

2.   Localized gum recession

3.   Acute gingival infection including Herpetic gingivostomatitis, Necrotizing ulcerative gingivitis or Trench mouth, Oral thrush or candidiasis

4.   Early onset or aggressive periodontitis

5.   Periodontitis associated with systemic diseases

Chronic Marginal Gingivitis in Children

It is the most common type of gum disease in children and in this condition, change in color of gums and swelling of gums occurs in children. A fiery red discoloration is superimposed on underlying chronic changes.

Chronic Inflammatory Gingivitis in Children

Causes of Chronic marginal Gingivitis in Children

Main causes of chronic marginal gingivitis are food accumulates and plaque deposits around teeth. By poor oral hygiene, chronic marginal gingivitis occurs in children. Various factors which increase the incidence of plaque around teeth are:

  1. Loose baby tooth and partially erupting adult tooth
  2. Malposed teeth
  3. Children who are in habit of mouth breathing  
  4. During teeth eruption, chances of plaque and tartar build up increases

Eruption Gingivitis in Children

Plaque control and debridement is done in case of chronic marginal gingivitis in children. Chronic marginal gingivitis can be reversed in children by regular brushing and flossing. Dental cleaning may also be required to remove the plaque deposits. If not treated, then infection may spread from gums into deeper supporting tissues and cause periodontitis.

Pubertal Gingivitis

Localized Gum Recession in Kids

Gum recession may occur around single tooth or group of teeth and can be because of irritants or malposition of tooth in dental arch. Gum recession in children may be a transitional phase in tooth eruption or may correct on itself. Realigning of teeth may also be required if tooth is in malposition.

Acute Gum Infections in Children

Acute herpetic gingivostomatitis, acute necrotizing ulcerative gingivitis or trench mouth, oral candidiasis can occur in children.  

A.    Acute Herpetic Gingivostomatitis in Children

It is a viral infection of oral mucosa and occurs commonly in infants and children who are younger than 6 years of age. It is caused by herpes simplex virus.

Signs of Acute Herpetic Gingivostomatitis

  1. Gums will appear red, swollen.
  2. Initially vesicles are present, which may rupture to form painful ulcers. Ulcers will appear as red, elevated with halo like margins and a depressed yellowish or grayish white central portion is seen.
  3. Gums will also bleed
  4. It will last for 7-10 days.

Acute Herpetic Gingivostomatitis

Symptoms of Acute Herpetic Gingivostomatitis

  1. Child will experience soreness of whole mouth which will interfere with eating and drinking.
  2. Ulcers are sensitive to touch and sensitivity to spicy food and hot foods is also present.    
  3. Extra oral signs and symptoms
  4. Involvement of lips and face occurs in acute herpetic gingivostomatitis.
  5. Fever, lymph nodes enlargement may also occur.

Treatment of Acute Herpetic Gingivostomatitis

  1. Talbot’s iodine, zinc chloride application can be done in this condition. Antibiotics may also be given for treatment.
  2. Food deposits and accumulates if present can be removed and for pain relief, anesthetic mouth wash can be used.
  3. Patient should take more of fluids and pain meds may also be given to patient.

B.    Acute Necrotizing Ulcerative Gingivitis in Children

Acute necrotizing ulcerative gingivitis is also called trench mouth or Vincent infection and it affects both children and adults. It is sudden in onset and is caused by complex of bacterial organisms. Fusiform bacillus, Bacteroides intermedius and spirochete organisms are known to cause trench mouth.

Signs and Symptoms of Acute Necrotizing Ulcerative Gingivitis

  1. Punched out, crater like depressions are seen on gums between teeth. Gray film or pseudomembrane also occurs on gum surface.
  2. Lateral ulcerations and necrosis or deep ulceration and necrosis occur.
  3. Even on slight stimulation, profuse bleeding occurs.
  4. Constant, radiating, gnawing pain is seen in trench mouth.
  5. Bad breath, metallic taste, more of salivation occurs in condition.

Treatment of Acute Necrotizing Ulcerative Gingivitis

After applying topical anesthesia, pseudomembrane is removed by cotton swab. Superficial deposits are removed and patient is instructed to do rinses with warm water and 3 percent hydrogen peroxide solution every 2 hours.  If patient has fever and lymph nodes enlargement, then antibiotics are given to the patient.
In later visits, dental cleaning is done and plaque control instructions are reinforced.

C.    Oral Candidiasis or Thrush Infection in Kids

It is a fungal infection which can be seen in infants and children who are on antibiotic therapy for quite a long time.

Early Onset Periodontitis or Aggressive Periodontitis in Children

Aggressive periodontitis is a disease of supporting structures of gums and occurs in clinically healthy individuals. Rapid bone loss around one or more than one permanent tooth occurs in this condition.

Aggressive periodontitis is further of 2 types:

  1. Localized aggressive periodontitis and
  2. Generalized aggressive periodontitis

Localized Aggressive Periodontitis

Arc Shaped Bone Loss in Localized Aggressive Periodontitis

Localized aggressive periodontitis is commonly seen between 11-15 years of age and is more common in females as compared to males. It is mostly seen in relation to first molars and or incisors. Deep periodontal pockets are seen with rapid attachment and bone loss in otherwise clinically healthy individual. Mobility and migration of molars and or incisors may also occur.

When more than 14 teeth are involved, then it is known as generalized aggressive periodontitis. It may occur around puberty and generalized involvement of deep periodontal pockets is seen.

Treatment of Aggressive Periodontitis

Prognosis is not good in aggressive periodontitis. If patient comes at earlier stage, then outcome of treatment may be better. Patient is educated about disease and success of treatment. Non-surgical or surgical debridement is done along with antimicrobial therapy. Scaling and root planning (SCRP), curettage, flap surgery with or without bone grafts, root amputation, hemisection, plaque control is done.

Periodontitis Associated With Systemic Diseases in Children

Periodontitis in children may also be associated with systemic diseases like:

  1. Type 1 Diabetes
  2. Down syndrome
  3. Neutropenia
  4. Hypophophatasia
  5. Chadiak- Higashi syndrome etc

Main signs and symptoms in case of gum diseases in children are:

  1. Bleeding gums in child: If bleeding occurs from gums of child while doing tooth brushing or flossing or some other time, then it suggests that there is gum disease present.  
  2. Swelling of gums: Gums will appear puffed up and inflamed. Along with swelling, gums will be red in color.
  3. Recession of gums: Recession of gums leading to root exposure may alert a parent about gum disease in his child.  
  4. Constant bad breath from oral cavity: Bad breath or foul odor from mouth even after brushing and flossing in child suggest gum infection.

Instructions for Parents:

For successful treatment of gum diseases in children, early diagnosis is very important. If above listed signs and symptoms are present in child, then parents should take their kids to dentist. Parents should take their child to dentist for regular visits. Parents should reinforce good oral hygiene measures in their kids.

Prevention of Gum Diseases in Children

To avoid gum diseases, it is important that child maintains good oral hygiene. Parents of child should also inculcate good oral hygiene habits in his child. Various preventive measures by which gum diseases can be avoided in children are:

  1. Child should be taught about good oral health habits early. At 1 year of age, pea sized portion of tooth paste can be given to child so that he can brush his teeth. Child can start dental flossing when gaps between his teeth close.
  2. Schedule regular dental visits for check ups.
  3. Parents should check that their child doesn’t have bleeding or puffy gums or doesn’t have receding gums which are signs of gum diseases.   

Home Remedies for Gum Diseases

  1. If there is swelling of gums present, then to reduce swelling warm saline rinses can be done 2-3 times a day.
  2. Applying aloe vera over effected part may help.   

Main cause of gum disease in children is deposits present around teeth. Parents should serve as good role model for their children and should practice good oral hygiene habits themselves and educate the child about the importance of healthy gums and teeth.

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