Department of Pediatric Dentistry

Lutheran Medical Center

Date: 07/17/2009

Article title: Periodontal and Soft-Tissue Abnormalities

Author(s): Jayne E. Delaney, DDS, MSD

Journal: Dental Care for the Preschool Child

Volume (number): vol 39 num 4

Month, Year: 1995

Major topic: soft tissue and periodontium

Minor topics:

Type of Article: Informative

Main Purpose: Review pertinent clinical information concerning periodontal problems in children as well as proper treatment. Many common soft tissue abnormalities are also reviewed.

Overview of method of research: Review of Literature

Findings:

Gingival and other soft tissues differ from those of adults. Additionally, they frequently present with myriad soft tissue and periodontal problems. Frequent review of these lesions helps providers better care for children and provide proper referral to medical colleagues, should they need to.

Children are generally more resistant to periodontal disease than adults. Therefore, when children present with periodontal problems, systemic factors should be investigated.

Key points/Summary :

Periodontium

Localized and generalized periodontitis

At least one study says that 6-7% of children approximately age 5 have been shown to have radiographic peridontal bone loss. Treatment is scaling and root planning as well as antibiotics as needed.

Prepubertal Periodontitis

Often associated with systemic diseases. Most successfully treated when localized.

Neutropenias

Neutrophils play a protective role in the periodontium. In their absence, disease and bone loss can occur quickly; ulcers are a common occurrence. Treatment is scrupulous oral hygiene and antibiotic therapy.

Papillon-Leferve Syndrome

Hyperkeratosis on the palms and soles of teeth and premature loss of teeth are common manifestations of this disease. Primary teeth are often lost by age 5. A treatment modality that has shown some promise is the endulate the child, treat heavily with antibiotics and allow later eruption of any unerupted teeth, which can erupt into an oral environment lacking in periodontal bacteria.

Metabolic disorders

Diabetic children may manifest with early periodontal disease due to altered neutrophil chemotaxis

Histiocytosis X

aka Langerhans cell disease. Mostly a radiographic finding of "teeth floating in space" but gingival inflammation is also common.

Hypophosphatasia

Most common oral finding is early loss of teeth, sometimes with primary tooth exfoliation at age 1.5

Soft Tissue

Ankyloglosia

Most children will have some frenum growth with age, but others may need surgical intervention. A speech pathologist should be consulted in any case affecting speech and before any decision for surgery.

Geographic tongue

aka benign migratory glossitis. Asymtomatic and most common in girls.

Fissured tongue

Associated with geographic tongue, also benign.

Retrocuspid Papillae

Present in most children behind the mandibular cuspids. Not anything to worry about.

Gingival Fibromatosis

Can be drug induced, inherited or associated with leukemia. Poor OH exacerbates this problem.

Hemangioma

Benign tumor of mesenchymal origin. Usually painless. Surgical removal is the usual treatment.

Lymphangioma

Benign tumor of lymphatic origin. Usually present at birth. Tongue is the most common site.

Mucocele

Retention of mucous in subepithelial tissues, most common in children and adolescents. Treatment of choice is surgical removal.

Fibroma

One of the most common benign lesions. Treatment is surgical removal with low recurrence.

Parulis

End point of draining sinus tract associated with an abcessed tooth.

Eruption Cyst and Hematoma

see image

Herpesvirus Infection

I think we all know plenty about this

Herpangina

Acute viral infection usually in summer or early fall. Usually has vesicles on tonsillar fauces.

Hand-Foot-and-Mouth Disease

Caused by coxsackie. Ulcerating and crusting vesicles, treatment is palliative only.

Recurrent Apthous Ulceration

Cause is unknown, but suspect food allergies, trauma, stress and hormonal changes. Mouthrinse and topical anesthetics are treatment.

Candidiasis

Treat with topical application of antifungals.

Impetigo

Perioral purulent bacterial infection. Usually due to strep A or Staph aureus; treat with topical or systemic antibiotics.

HIV

Usually children will present with candidiasis. Parotid swelling is also more common in HIV children than adults.

Leukemias

Leukemic gingival enlargement is most common. But mucositis is also common due to chemotherapy associated with leukemia. Poor OH can really worsen the situation.

Traumatic Ulcer

Most common ulcer in children. Often postanesthesia bites.

Assessment of article: Good review, lots of clinical applicability. I wish it had talked about periodontal defects caused by orthodontic problems, like cross bite.

7/17/2009 Peripheral Ossifying Fibroma-a Clinical of 134 Pediatric Cases

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Ray Murphy Date: 7/17/09 Region: St. Joe’s

Article title: Peripheral Ossifying Fibroma-a Clinical of 134 Pediatric Cases
Author(s): Cuisia, E. et al.
Journal: Pediatric Dentistry
Volume #; Number; Page #s): 23:3
Year: 2001
Major topic: Peripheral Ossifying Fibroma(POF)
Minor topic(s): Differential Diagnosis of Soft Tissue Lesions
Type of Article: Clinical Evaluation

Main Purpose: To investigate the clinical features of POF’s in regards to the pediatric population.
Overview of method of research: Detailed clinical and historical information regarding 134 cases of POF’s in children from age 1-19. To evaluate the site occurrence of the POF’s, the maxilla and mandible both divided into three regions, incisor/cuspid, premolar, and molar.
Findings: A peripheral ossifying fibroma is characterized as a gingival nodule, made up of cellular fibroblastic connective tissue, consisting of mineralized products of bone, cementum, or dystrophic calcifications. In the pediatric population, POF’s have a large female predilection.95% of the POF’s were associated with a permanent tooth, or between a primary and permanent tooth. A primary tooth was involved in only 1% of cases(2 cases). The POF presented as a pinkish red, localized, smooth, exophytic lesion with a pedunculated base, ranging from .3cm-3cm in size, with the average being 1.2cm. Ulcers were present in 63% of the lesions. 60% of the lesions were found in the maxilla, with 57% in the incisor region. Etiological factors include local irritation(26%), Orthodontic treatment(7%), Trauma(7%), and unknown/unreported(59%). Only 1% of the cases reported the lesion as being painless. The rest either did not report, or reported no pain(24%). Duration of the lesion varied from two weeks to twenty five months, with two-24months being the norm(79%). Incidence of POF’s peak in the second decade of life, with a decreasing trend in older age groups. Also, there may be a higher incidence of POF’s in the African-American population. Treatment includes excisional biopsy or surgical excision, which should include total excision of the lesion, periosteum, and the affected PDL. Scaling and root planning of adjacent teeth is recommended. Extraction of adjacent teeth is usually not necessary. Of the 134 cases, ten had single recurrences, and one had multiple recurrences. The average time in between lesions was twelve months.

Key points in the article discussion: There were many key points in the article. POF’s have the highest incidence in the second decade of life. A POF in the first decade of life is very uncommon. POF’s are more common in females, and are usually found in the maxillary incisor/cuspid region. Follow up after surgical removal of a POF is highly recommended to monitor for recurrence. The main key point in the article was trying to determine why there is a predilection for POF’s with permanent teeth as opposed to primary teeth. If POF’s are etiologically derived from local irritation and trauma, why are more primary teeth not involved? The constant exfoliation of primary teeth should cause an increased number of POF’s in the pediatric population. The article surmised that there must be other factors must be present that are lacking in the pediatric population. According to this study, the dentist does not need to take radiographs for the differential diagnosis of a POF. This is in contrast to two previous studies. POF’s in children can exhibit large growth rates in short periods of time. Because of this, early diagnosis is important.

Summary of conclusions: A POF is a well defined lesion with various differential diagnosis, including peripheral giant cell granuloma, pyogenic granuloma, fibroma, and peripheral odontogenic fibroma. With regards to the pediatric population, occurrence in children and primary teeth is rare. When present, POF’s are mostly found in female ages 10-20 in the anterior maxilla. While a POF arising from the PDL of a primary tooth, or localized irritation associated with a primary tooth is possible, it is very uncommon. As previously stated, surgical excision or excisional biopsy is the treatment of choice, with close follow up.

Assessment of article: Overall it was a good article. Methods, results, and conclusions were clearly and concisely stated. There could have been more of a focus on figuring out why primary teeth are not affected as much as permanent teeth are. There was numerous differential diagnosis listed, along with the major sites and patient population who are affected by POF’s.