上海第二医科大学教　　案

课程名称　Pediatric dentistry 　　　　　　第 7次课　　2006年 03月 14日

教师姓名 汪 俊 职称 副教授 教研室 口腔儿童教研室 教学时数 2学时

授课题目The periodontal disease in

children教学对象 02级七年制

授课地点 101教室 教学方式 大课授课方式，双语教学

本课的重点、难点及对策：

重点：1 Anatomy of periodontal tissue in children

2 The classification of periodontal disease in children3 The clinical feature and treatment of Primary herpetic

gingivitostomatitis

本次课应用的教材教具参考书：

Teaching material: Pediatric Dentistey Second Edition Richard R.Welbury

OXFORD UNIVERSITY PRESS

Teaching aid：multimedia

主要教学内容及时间分配：1 Periodontal diseases

Periodontal disease comprise a group of infection that affect the periodontal tissue, we say the supporting structures of the teeth. 2 Anatomy of the periodontium in children

2.1 Gingiva 2.1.1 Marginal gingival: For children,marginal gingival tissue around the primary dentition are more highly vascular and contain fewer connective tissue than tissues around the permanent teeth. The epithelia are thinner with a lesser degree of keratinization, giving an appearance of increased redness that may be interpreted as mild inflammation, and it’s easy for marginal gingiva to be affected 2.1.2 Attached gingival: The width of attached gingival is less variable in the primary dentition, so there is less mucogingival problem in the primary dentition2.1.3 Junctional epithelium:There is some normal change that take place in junctional epithelium and we should not treat it as disease. 2.2.Periodontal ligamentPeriodontal ligament space is wider in children and is less fibrous and more vascular2.3 Cementum Thinner2.4 Alveolar bone

Thinner cortical plates(皮质层） Larger marrow spaces（骨髓腔） Greater vascularity Fewer trabeculae

3 A classification of periodontal disease in children 3.1Gingival conditions

Acute gingivitis Chronic gingivitisGingival overgrowth

Factitious（自伤性）gingivitis

Mucogingival problems 3.2 Periodontal conditions

Chronic periodontitisEarly-onset periodontitisPrepubertal（青春期前的） periodontitis associated with systemic disease

4 Acute gingivitis4.1 Primary herpetic gingivostomatitis（原发性疱疹性龈口炎）4.1.1 Definition: An acute infectious disease of the gingiva caused by the herpesvirus 4.1.2 Pathogeny: Herpes simplex viruses (HSVs)Herpes simplex viruses (HSVs)((单纯疱疹病毒）单纯疱疹病毒）

4.1.34.1.3 Transmission: Transmission: HSV-1 is transmitted chiefly by contact with infected saliva,HSV-1 is transmitted chiefly by contact with infected saliva,

Infected saliva from an adult or another child is the mode of infection. whereas HSV-2Infected saliva from an adult or another child is the mode of infection. whereas HSV-2 is transmitted sexually or from a mother's genital tract infection to her newborn.is transmitted sexually or from a mother's genital tract infection to her newborn.

4.1.44.1.4 Prevalence: Prevalence: 4.1.5 4.1.5 Clinical features: Clinical features: 1) 1) AgeAge: 6 months to 3 years : 6 months to 3 years

2)2) Incubation period Incubation period((潜伏期潜伏期):): 1 week 1 week 3) 3) Prodrome:Prodrome:

AA Febrile Febrile（发烧的）（发烧的） illness illness BB Headache, malaise, oral pain, mild dysphagia Headache, malaise, oral pain, mild dysphagia（吞咽困难）（吞咽困难）

CC Cervical lymphadenopathy Cervical lymphadenopathy((淋巴结病）淋巴结病） 4) 4) SymptomSymptom

AA Gingivitis: Gingivitis is the most striking feature,with markedly swollen,Gingivitis: Gingivitis is the most striking feature,with markedly swollen, erythe-matous, friable gumserythe-matous, friable gums

BB Vesicular lesions: Vesicular lesions develop on oral mucosa ,lip and tongue ,Vesicular lesions: Vesicular lesions develop on oral mucosa ,lip and tongue , can occur anywhere in the oral cavity, on the perioral skin, on the pharynxcan occur anywhere in the oral cavity, on the perioral skin, on the pharynx

4.1.6 4.1.6 PrognosisPrognosisOral lesions heal without scarringOral lesions heal without scarring

4.1.7 4.1.7 Course: Course: Acute disease lasts 5-7 days, and the symptoms subside in 2 weeks.Acute disease lasts 5-7 days, and the symptoms subside in 2 weeks. Viral shedding from the saliva may continue for 3 weeks or more. Adults also mayViral shedding from the saliva may continue for 3 weeks or more. Adults also may develop acute gingivostomatitis, but it is less severe and is associated more often withdevelop acute gingivostomatitis, but it is less severe and is associated more often with a posterior pharyngitis.a posterior pharyngitis.4.1.8 4.1.8 Diagnosis: Diagnosis: According to Clinical features,History and ageAccording to Clinical features,History and age4.1.9 4.1.9 Treatment: Treatment: The availability of effective chemotherapy underscores that theThe availability of effective chemotherapy underscores that the prompt recognition of the infection and early initiation of therapy are of utmostprompt recognition of the infection and early initiation of therapy are of utmost importance in the management of the disease. The goals of treatment are to make theimportance in the management of the disease. The goals of treatment are to make the patient comfortable and to prevent secondary infections or worsening systemic illness.patient comfortable and to prevent secondary infections or worsening systemic illness. It includes:It includes:

1) Pharmacotherapy1) Pharmacotherapy((药物疗法药物疗法) :) : A Antiviral treatment :A Antiviral treatment : B Symptomatic treatmentB Symptomatic treatment

2) Supporting treatment: 2) Supporting treatment: A A Bed restBed rest

B B Soft dietSoft dietC C Be kept well hydratedBe kept well hydrated

4.1.10 4.1.10 Warnings to parent:Warnings to parent:A A Children are highly contagious Children are highly contagiousB B No school, day care etc.No school, day care etc.

C C Sterilize eating and drinking utensilsSterilize eating and drinking utensils D D Disease is self-limiting; 10-14 days in duration Disease is self-limiting; 10-14 days in duration

4.2 Acute necrotizing ulcerative gingivitis(ANUG)4.2 Acute necrotizing ulcerative gingivitis(ANUG)4.2.1 4.2.1 Aetiology:Aetiology:Broad anaerobic infectionBroad anaerobic infection

4.2.2 4.2.2 Clinical features:Clinical features:A A Necrosis and ulceration Necrosis and ulceration B B Pre-existing gingivitis Pre-existing gingivitis

C C Distinctive halitosis Distinctive halitosisD D Acute-chronic clinical course: Acute-chronic clinical course:

4.2.3 4.2.3 TreatmentTreatmentA A Intense oral hygiene Intense oral hygiene B B Oxidant: hydrogen peroxideOxidant: hydrogen peroxide

C C Mechanical debridement Mechanical debridement D D Metronidazole Metronidazole

5 Chronic gingivitis5 Chronic gingivitisPrevalence: Prevalence: increases steadily between the ages of 5 and 9 years, peaks at 11increases steadily between the ages of 5 and 9 years, peaks at 11

years and decrease slightly with age to 15 years. years and decrease slightly with age to 15 years. Etiology: Etiology: Closely associated with the amount of plaque, debris and calculusClosely associated with the amount of plaque, debris and calculus

present.present.5.1 Eruptive gingivitis5.1 Eruptive gingivitis

5.2 Filth gingivtis(5.2 Filth gingivtis(不洁性龈炎不洁性龈炎))5.3 Crowding gingivitis (5.3 Crowding gingivitis (牙列拥挤性龈炎牙列拥挤性龈炎))5.4 Puberty gingivitis(5.4 Puberty gingivitis(青春发育期龈炎青春发育期龈炎))5.5 Catarrh gingivitis (5.5 Catarrh gingivitis (卡他性龈炎卡他性龈炎))6 Drug-induced gingival overgrowth6 Drug-induced gingival overgrowth6.1 cause 6.1 cause

1) Phenytoin1) Phenytoin2) Cyclosporin2) Cyclosporin

6.2 Clinical feature:6.2 Clinical feature:1) The clinical changes of drug-induced overgrowth are very similar1) The clinical changes of drug-induced overgrowth are very similar irrespective of the drug involved.irrespective of the drug involved.22) The first signs of changes are seen after 3-4months of drug administration.) The first signs of changes are seen after 3-4months of drug administration.3) Progress: The interdental papilla become nodular before enlarging more3) Progress: The interdental papilla become nodular before enlarging more diffusely to encroach upon the labial tissuediffusely to encroach upon the labial tissue

4) Site:The anterior part is most severely and frequently involved4) Site:The anterior part is most severely and frequently involved5) Sypmtom: with a good standard of oral hygiene, overgrowth gingiva is5) Sypmtom: with a good standard of oral hygiene, overgrowth gingiva is pink,firm and stippled, When there is a pre-exiting gingivitis the enlargedpink,firm and stippled, When there is a pre-exiting gingivitis the enlarged tissues compromise an already poor standard of plaque control.the gingivatissues compromise an already poor standard of plaque control.the gingiva then exhibit the classical signs of gingivitisthen exhibit the classical signs of gingivitis

6.3 Management6.3 Management1)A strict programme of oral hygiene instruction, scaling and polishing must1)A strict programme of oral hygiene instruction, scaling and polishing must

be implemented. be implemented. 2) Severe cases of gingival overgrowth inevitably need to be surgically excised2) Severe cases of gingival overgrowth inevitably need to be surgically excised

and then recontoured to procedure an architecture that allows adequateand then recontoured to procedure an architecture that allows adequate access for cleaningaccess for cleaning

3)A follow-up programe is essential to ensure a high standard of plaque control3)A follow-up programe is essential to ensure a high standard of plaque control

and to detect any recurrence of the overgrowth.and to detect any recurrence of the overgrowth.4)To modify or change the anticonvulsant therapy if phenytion-induced4)To modify or change the anticonvulsant therapy if phenytion-induced

overgrowth is refractory overgrowth is refractory 5)Indefinite oral care if there is no alternative.5)Indefinite oral care if there is no alternative.

7 Factitious gingivitis7 Factitious gingivitis7.1 Minor form7.1 Minor formEtiology: Etiology: Rubbing or picking the gingiva using the fingernail, or from abrasiveRubbing or picking the gingiva using the fingernail, or from abrasive foods foods Management: Management: correct the habit and remove the source of irritationcorrect the habit and remove the source of irritation7.2 Major form7.2 Major form

The injuries are more severe and widespread , can involve the deeperThe injuries are more severe and widespread , can involve the deeper periodontal tissues.periodontal tissues. Other areas of the mouth such as the lips and tongue mayOther areas of the mouth such as the lips and tongue may be involved. Extraoral injuries may be found on the scalp, limbs or face.be involved. Extraoral injuries may be found on the scalp, limbs or face.ManagementManagement

A A Dressing and protection of oral wounds Dressing and protection of oral wounds B B No lying with dentistsNo lying with dentistsC PC Psychological or psychiatric consultationsychological or psychiatric consultation

8 8 Chronic periodontitisChronic periodontitisA number of epidemio-logical studies have investigated the prevalence ofA number of epidemio-logical studies have investigated the prevalence of

chronic periodonditis in children. The prevalence of the study varied due to differentchronic periodonditis in children. The prevalence of the study varied due to different methods of diagnosing and different cut-off value in different studies.methods of diagnosing and different cut-off value in different studies.

PrevalencePrevalenceAt 1-11%, At 1-11%, The chronic periodontitis initiates and progresses during the early teenageThe chronic periodontitis initiates and progresses during the early teenage

yearsyears

9 9 Periodontal complications of orthodontic treatmentPeriodontal complications of orthodontic treatment10 10 Early-onset aggressive periodontal diseaseEarly-onset aggressive periodontal disease Prepubertal periodontitisPrepubertal periodontitis: mainly influences p: mainly influences primary dentitionrimary dentition i immediately aftermmediately after

the teeth have eruptedthe teeth have erupted. It includes . It includes generalizedgeneralized form and localized form: form and localized form:Generalized formGeneralized form

TreatmentTreatmentA A Intense oral hygiene at frequent intervalsIntense oral hygiene at frequent intervals

B B AntibioticAntibiotic C C Extraction of the teethExtraction of the teeth

本

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课

小

结

要

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Summary：1 Anatomy of periodontal tissue in children2 The classification of periodontal disease in children3 Primary herpetic gingivitostomatitis

Pathogeny: Herpes simplex viruses (HSVs)

Clinical feature: prodrome , symptom

Diagnosis and Treatment

4 Necrotizing ulcerative gingivitis

Clinical feature

Management

5 Gingival overgrowth Clinical feature

6 Factitious gingivitis Minor type, Major type

7 Periodontal complications of orthodontic treatment8 Early-onset aggressive periodontal disease

本

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复

习

思

考

题

1 Anatomy of periodontal tissue in children2 The classification of periodontal disease in children3 The clinical feature and treatment of Primary herpetic

gingivitostomatitis

下

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习

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Pediatric Oral Pathology Soft Tissue LesionPediatric Oral Pathology Soft Tissue Lesion