Gum Disease in Children

What are Pediatric Periodontal Diseases?

Periodontal diseases affect the gums and connective tissues surrounding your teeth. They’re often referred to as gum disease but include several different conditions. Oral bacteria and the resulting destructive response from the immune system cause all of them. 

Gum disease is typically associated with adults but can also affect children and teens. Young people are more likely to have mild gum disease, known as gingivitis, but in rare cases, the disease can be severe.^1,2

Gingivitis is gum inflammation, which is generally reversible. But severe gum disease, known as periodontitis, can cause irreversible damage to the gums and surrounding tissues.

A child’s oral hygiene status, diet, and overall health can all play a role in gum disease. Various treatments are available depending on the severity and type of periodontal disease.

What Causes Gum Disease in Children?

Gum disease is caused by oral bacteria (in both children and adults). The mouth is home to many species of bacteria, but some can damage your teeth and gums.

When these bacteria spread and multiply, they form plaque, a sticky substance that is hard to remove without brushing and flossing. Eventually, plaque can harden into tartar, which is even more difficult to remove.

Plaque and tartar can cause gum inflammation. In severe forms of gum disease, the gums and other tissues can die and fall away. Alveolar bone tissue (the bone that teeth are rooted in) is often lost, and teeth may fall out.

A variety of factors can influence how much these bacteria spread, as well as how vulnerable a child’s gums are. 

Some common causes and risk factors for gum disease in children include:

Poor Oral Hygiene

Oral hygiene is a crucial factor in the development of gum disease. Regular brushing and flossing disrupt plaque, preventing it from continuing to form and spread. Neglecting oral hygiene means allowing plaque to accumulate and form tartar.

Poor Diet

Poor nutrition can contribute to gum disease in two ways. For one, it can provide fuel for oral bacteria. Secondly, it can weaken a child’s immune system. 

A diet high in sugary and processed foods will promote the growth of destructive bacteria and is often low in important nutrients.

In especially severe cases, malnutrition can contribute to necrotizing periodontal diseases (NPD). These are serious forms of the disease that cause rapid gum tissue death.

Crooked Teeth

Children and adolescents with crooked teeth are more likely to develop gum disease. This is primarily because of the effect misaligned teeth have on oral hygiene. Crooked teeth are also harder to brush and floss. 

Genetics

Genetics also play a part in the development of gum disease. A child’s immune system, hormones, and various systemic health conditions can be affected by their genes.

Dry Mouth

Dry mouth is a condition that occurs when the salivary glands do not produce enough saliva to keep the mouth wet. Saliva helps protect the teeth and gums from bacteria. If a child’s mouth is often dry, these bacteria have more of an advantage.

Smoking or Vaping

Smoking or vaping is also a risk factor for gum disease. Smoke and artificial vapor can irritate the gums and contribute to dry mouth. These things make it easier for oral bacteria to harm a child’s or adolescent’s teeth or gums.

Puberty

Changing hormones during puberty can cause increased inflammation and gum sensitivity. This is known as puberty-associated gingivitis.³ Girls and women with gingivitis may notice that symptoms worsen around the start of their periods.⁴

Other Health Conditions

The risk of gum disease is higher if a child has diabetes, an autoimmune disorder, or an infection such as HIV. These conditions make it harder for the immune system to protect the gums from harmful bacteria. Severe gum disease is more likely in children with these conditions.

Preventing Gum Disease in Children and Teens

You can’t eliminate every possible risk factor for gum disease. However, you can reduce your child’s risk for gum disease by:

• Ensuring good oral hygiene — Proper brushing and flossing will remove and disrupt oral bacteria, preventing plaque and tartar from accumulating. 
• Encouraging a balanced diet — A diet rich in whole foods and low in added sugars will support healthy immune function while providing less fuel for oral bacteria. 
• Keeping tobacco products away — Smoking, vaping, and other forms of tobacco can cause dry mouth and irritate the gums, potentially leading to gum disease. 
• Investing in orthodontic treatment — Crooked teeth can make oral hygiene more difficult, so correcting any teeth alignment issues your child has may improve their oral health. 

Treatment for Pediatric Gum Disease

Treatment for periodontal disease can include various nonsurgical and surgical options, depending on the type and severity of the condition. 

Your child may need to see a periodontist (a dentist specializing in gum health). Common treatments include:

Scaling and Root Planing (Deep Cleaning)

Scaling and root planing is a two-part procedure. Scaling removes plaque and calculus above and below the gum line. Then, during root planing, a dentist cleans and smooths the tooth roots to remove any remaining bacteria.

Antibiotics

Dentists can also provide antibiotics to fight the bacteria responsible for gum disease. These may be taken orally or placed directly onto the gums.

Gum Graft 

Gum recession exposes the roots of the teeth, making them less stable and more vulnerable to bacteria. Periodontists use gum graft surgery to cover the exposed roots and protect the teeth from decay and sensitivity.

Bone Graft

Bone grafts are necessary when the bone around a tooth’s root is permanently destroyed. The lost bone is replaced with tissue from another bone in your child’s body. However, a donated bone or synthetic bone might be more suitable.

Flap Surgery

Gum flap surgery removes damaged gum tissue and bacteria living under the gums. The gums are then reattached in a better position. This reduces the gaps or pockets between the teeth and gums, so the procedure is called pocket reduction.

This surgery may go hand-in-hand with gum or bone grafting.

Types of Gum Disease in Children and Adolescents

Gum disease can be divided into several categories based on the nature and severity of the infection:⁵

Gingivitis

Gingivitis is a mild form of periodontal disease. It generally doesn’t affect the connective tissue or alveolar bone. Symptoms include:

• Red, swollen gums
• Gums that bleed easily
• Persistent bad breath

Most cases of gum disease in children and adolescents are cases of gingivitis. Gingivitis can often be reversed with professional teeth cleanings and improved oral hygiene.

Aggressive Periodontitis

Aggressive periodontitis affects more than just the gums. It’s considered aggressive because it progresses rapidly and does not respond well to treatment.

Two important symptoms are:

1. Attachment loss — The connective tissue between the teeth and gums begins to detach, leading the gums to pull away from the teeth.
2. Bone loss — The alveolar bone surrounding the teeth becomes inflamed and is destroyed gradually.

When periodontitis occurs in children, it’s more likely to be aggressive. It may be affected by certain genes. Aggressive periodontitis can also be localized around just a few teeth (usually the molars) or generalized (affecting many teeth).

Chronic Periodontitis

Chronic periodontitis also causes attachment and bone loss, but the disease progresses more slowly. It may be stable for long periods, with severe episodes in between.

This form of periodontitis is more likely to affect adults.

Necrotizing Periodontal Diseases

Necrotizing periodontal diseases (NPDs) include a range of severe and potentially life-threatening conditions. They cause ulcers to form between the teeth and gums and usually involve gum pain that comes on quickly. Children with NPD also often have fevers.

In the most severe cases, NPD can progress to a condition called cancrum oris (noma). This is a form of gangrene that affects the mouth and face. It can be permanently disfiguring and is often fatal.

NPD is rare in both children and adults. It’s most common in children who are severely malnourished and live with poor sanitation.

Summary

Gum disease, or periodontal disease, refers to various conditions. They range from mild gingivitis to severe forms that can result in significant and irreversible damage.

Children and teens are more likely to develop gingivitis, but severe gum disease is possible. Poor oral hygiene, malnutrition, and chronic health conditions like diabetes can all play a role. Hormonal changes during puberty can also cause gingivitis.

All types of gum disease can be treated, with the exact course of treatment depending on the specific condition. You can help prevent gum disease in your child by encouraging good oral hygiene and a balanced diet.