Factors in Planning Space Maintenance

1) Amount of resorption of primary tooth roots

a) More than 1/4 of root remains: space maintenance likely
b) Less than 1/4 of root remains: space maintenance unlikely
2) Amount of bone covering permt tooth
a) No bone remaining btw permt and primary tooth: no space maintenance needed
b) If bone interposed btw primary and permt tooth: space maintenance likely
c) Bone destruction in region of primary molar furcation: should use space maintenance
3) Time elapsed since loss
a) most space closure occurs within first 6 months
b) in molar area, closure occurs by tipping, not by bodily movement
4) Eruption of neighboring teeth
a) active eruption creates increased space loss
-ex. If 2nd primary molar lost during eruption of 1 st permt molar, more space loss results
5) Patient age
-pt age should not be factor in planning space maintenance
-use a rule of 7s@ for primary molars
a) eruption is delayed if primary molar lost before age 7
b) eruption accelerated if primary molar lost after age 7
Part 7: Perio Problems in Children
Child vs Adult Periodontium
1) Greater blood and lymph supply
2) Alveolar crest if flatter
3) Gingival pockets depths larger
4) Attached gingiva not as wide
5) Cementum is thinner and less dense
6) Gingiva is more red

7) Lack of stippling
8) Flabbier tissue
9) Rounded and rolled gingival margins
10) PDL fibers run parallel to teeth (run horizontal in adult)
11) Alveolar bone thinner

Gingivitis
-very common in children and treated w/ improved oral hygiene
-parental participation needed in oral hygiene in children under 8 yrs old due to lack of manual dexterity
-parental supervision may be needed in children over 8 yrs due to lack of interest or understanding of consequences
-common conditions in children can aggravate gingivitis:
a) mouth breathing
c) erupting teeth
b) crowded teeth
d) braces
Puberty Gingivitis
-characterized by enlarged, bulbous interproximal gingival tissue on labial aspects of anterior teeth
-treatment involves improved OH, removing local irritants, and nutrition counseling
Herpes Simplex Infection (HSV-1)
1) Primary herpetic gingivostomatitis
-usually occurs in children under 6 yrs old w/ no previous exposure to HSV
-most infxns are subclinical
2) Acute herpetic gingivostomatitis
-liquid-filled yellow vesicles found intraorally and periorally
-vesicles rupture to form yellow pseudomembrane and erythematous border
-located on tonsils, palate, buccal mucosa, and gingiva
-also have fever, malaise, and lymphadenopathy
-txt: topical anesthetic, diphenydramine, antivirals (acyclovir), and analgesics (ibuprofen)
3) Recurrent herpes simplex (cold sore/fever blister)
-usually found on outside lips
-recurrence associated w/ stress or local trauma
-txt: systemic or topical antiviral, lysine