Treating Gum Disease in Children

Our dentist believes that my teenage son has periodontal disease. Can children get gum disease? If so, what is the best treatment?

Question:

Most patients diagnosed with gum disease (periodontitis) are adults. However, children and adolescents can also contract periodontitis. If gum disease is noted in a young patient who is otherwise healthy, the condition is called early onset periodontitis (EOP).

There are three forms of EOP:

  1. prepubertal periodontitis;
  2. juvenile periodontitis; and
  3. rapidly progressive periodontitis.

Prepubertal periodontitis can arise between the ages of about 2 to 10-years. Signs of this disease include inflammation of the gum tissue, rapid bone loss, tooth mobility and tooth loss. It may be generalized or localized.

The generalized form is commonly associated with other systemic diseases, ear infections and upper respiratory infections. A defect in the immune system plays a role in the destruction of the tissue. Several types of bacteria have been isolated in patients with this disease. The localized form may be responsive to thorough professional cleaning, meticulous oral hygiene and antibiotic therapy. The generalized form does not typically respond to antibiotic therapy and will continue to progress. This leads to early loss of the primary and permanent teeth. Early extraction of the primary teeth may be recommended to prevent infection of the permanent teeth.

Juvenile periodontitis usually occurs in the preteen to late teen years. This disease presents with little or no plaque and inflammation. Juvenile periodontitis is associated with a defect in the immune system and has a genetic component. This disease may also be localized or generalized.

Typically, the front teeth and the six-year molars are the most frequently affected teeth. Rapid and severe bone loss around these teeth may occur. For patients with the localized form of juvenile periodontitis, deep cleaning and antibiotic therapy with tetracycline and metronidazole may be helpful. Periodontal treatment in combination with antibiotic therapy (metronidazole and amoxicillin) may be somewhat effective for patients with the generalized form.

Rapidly progressive periodontitis usually occurs around ages 25 to 30-years. Again, the immune response appears to have defects leading to rapid tissue destruction around the permanent teeth. Signs of inflammation are minimal. It is possible the generalized form of juvenile periodontitis and rapidly progressive periodontitis may be similar diseases that simply appear at different ages. Patients with this disease may benefit from nonsurgical, surgical and antibiotic treatment.

Hopefully, research in genetics and immune system responses will lead to more information about early onset periodontitis. With this information, treatment for patients affected with these conditions will improve.

Reference:

Wara-aswapati et al. "Periodontitis in the child and adolescent" Journal of Dentistry for Children (1999) 66(3):167-174.

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