Gingivitis in Children and Adolescents

Gingivitis or inflammation of the gingiva, is the commonest oral disease in children and adolescents. It is characterized by the presence of gingival inflammation without detectable bone loss or clinical attachment loss. The causes and risks are as varied in children as in adults and range from local to systemic causes. The most important local predisposing factor in children is poor oral hygiene which stems from children’s dependence on adults for assistance with routine oral hygiene. It also stems from age limitation in perception of the need for regular and efficient tooth brushing. When plaque and food debris accumulate in poor oral hygiene, micro-organisms also accumulate and the process of inflammation starts. This leads to gingivitis, which, if not taken care of can progress to gradual destruction of supporting soft and hard tissues of the teeth. This is evident in the very young and those with disabilities, where manual dexterity is not well developed. Gingivitis in children is also commonly seen during eruption and exfoliation of both primary and permanent teeth and exfoliation of primary teeth. This process, although physiological, if not managed carefully, may contribute to discomfort during tooth brushing, mastication and also cause restlessness in the affected children. During puberty, it may be a response to hormonal changes in the developing adolescent, though more pronounced when there is plaque accumulation. In children with compromised immunity, chronic malnutrition, exanthematous fevers such as malaria, measles or chicken pox, the gingivitis may be acute and necrotic. The systemic effect and local destruction of soft and hard tissues may contribute to increased morbidity and poor aesthetics in affected children. Habitually leaving the mouth open, either spontaneously or due to pathology in the oropharynx, may also contribute to gingivitis. During childhood and adolescence, appliances, either habit breakers or removable and fixed appliances may be required. Most children at this age present with gingivitis. This is a result of non compliance with routine tooth brushing which is further made difficult by orthodontic wires and elastics. One of the pre-conditions for appliance therapy is a commitment to efficient routine tooth brushing because the use of an appliance in the presence of plaque and debris accumulations is deleterious to the periodontal structures. Gingivitis may also be a complication of chronic use of certain medications whose side effects include dryness of the mouth. It predisposes to gingival inflammation which is due to a low output of saliva. This type of gingivitis is frequently encountered in children and