Paediatric Periodontal Disease:

Foundational Articles and Recommendations

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Dental Care of a Child with Down Syndrome. Pediatr Dent 2015; 37(4): 381- 385.

Delaney JE, Keels MA. Pediatric Oral Pathology: Soft-Tissue and Periodontal Conditions. Pediatr Clin North
Am 2000; 47 (5):1125-1147.

Doufexi A, Mina M, Ioannidou E. Gingival Overgrowth in children: Epidemiology, pathogenesis, and

complications. A literature review. J Periodontol 2005; 76:3-10.

Dougherty MA and Slots J. Periodontal Diseases in Young Individuals. Cal Dent Assoc J 1993; 21:55-69.

Henry RJ and Sweeney EA. Langerhan’s Cell Histiocytosis: case reports and literature review. Pediatr Dent.
1996; 18:11-16.

Hu CC and others. A clinical and research protocol for characterizing patients with Hypophosphatasia. Pediatr
Dent 1996; 18: 17-23.

Kalkwarf KL and Gutz DP. Periodontal changes associated with chronic idiopathic neutropenia. Pediatric Dent
1981; 3: 189-195.

Keels MA, Tatakis D, Griffen A and Torchia MM. Periodontal disease in children: Associated systemic
conditions. UpToDate 2019.

Keels MA, Quinonez RB. Pediatric Periodontal Disease Matrix. 2002. (Figure below)

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5: 142-144.

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Clin Periodontol 2004; 31(11):933-938.

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type 2 diabetes. J Periodontal 2012; 83:856-861.

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Background
It is paramount for pediatric dentists to assess their followed with thorough documentation, clinical
patients’ gingival and periodontal health. It is not photographs and dental radiographs, and when
uncommon to diagnose gingivitis in pediatric patients necessary referred to medical providers to evaluate
primarily due to poor oral hygiene. However, there are for systemic causes such as neutrophil qualitative/
children that may present with refractory generalized quantitative defects, leukemias, hypophosphatasia,
severe gingivitis, unexplained tooth mobility and/ Langerhan Cell Histiocytosis X and Papillon-Lefèvre
or alveolar bone loss. These children need to be Syndrome.

IAPD Recommendations
1. Every dental examination include documentation to evaluate for cyclic neutropenia, chronic idiopathic
of the health of the gingiva, periodontium and tooth neutropenia and leukemias.
mobility. Once the permanent dentition is established, Consensus-based statement > Global agreement 88%
dental examinations may include probing to confirm
4. To assist in triaging a child with the presentation
healthy alveolar bone levels. Appropriate dental
of pediatric periodontal disease, the Keels-Quinonez
radiographs are an adjunct to document the health
Pediatric Periodontal Matrix may be used to aid in
of the alveolus; clinical photographs are helpful
identifying the diagnosis.
in documenting and monitoring the periodontal
Consensus-based statement > Global agreement 75%
condition.
Consensus-based statement > Global agreement 94% 5. A child with unexplained premature loss of a
primary incisors prior to age 4 should be evaluated
2. Poor oral hygiene or viral origin should be
for hypophosphatasia.
considered as the etiology for generalized gingivitis.
Consensus-based statement > Global agreement 85%
If the generalized gingivitis with improved oral
hygiene persists beyond two weeks, a non-viral 6. An infant with a natal or neonatal molars should
systemic cause may be considered. be evaluated for Langerhans Cell Histiocytosis X.
Consensus-based statement > Global agreement 88% Consensus-based statement > Global agreement 62%

3. Differential diagnosis of persistent, severe 7. A child with persistent gingival inflammation

gingivitis should include appropriate medical referral beyond two weeks, may require periodontal culturing
to help evaluate anaerobic strains of bacteria that may 8. Monitoring the gingival and periodontal health

be triggering an aggressive immune response, such as of patients with a diagnosis of systemic disease
is a critical marker for compliance, as well as
in Papillon-Lefèvre Syndrome or contributing to the
effectiveness of any medication used to enhance the
inflammation and bone loss as in the neutropenias. immune response.
Consensus-based statement > Global agreement 81% Consensus-based statement > Global agreement 88%

Pediatric Periodontal Disease Matrix

Copyright MA Keels and RB Quinonez, 2003

Healthy Bone Diseased Bone

(no alveolar bone loss) (alveolar bone loss)

Healthy Gingiva Healthy gingiva and no bone loss Healthy gingiva and bone loss
(pink, firm, stippled) Hypophosphatasia**
Inconclusive Pediatric Periodontal Disease (LJP)*
Dentin Dysplasia Type I
Post Avulsion / Extraction

Diseased Gingiva Unhealthy gingiva and no bone loss Unhealthy gingival and bone loss
(erythematous, Gingivitis Neutrophil quantitative defect: (agranulocytosis,
hemorrhagic) Eruption related gingivitis cyclic neutropenia,chronic idiopathic neutropenia)*
Factitial Injury Neutrophil qualitative defect: (Leukocyte adhesion
Mouthbreating Gingivitis deficiency)*
Minimally attached gingival Inconclusive Pediatric Periodontal Disease (LJP)*
Gingival Fibromatosis Langerhan Cell Histiocytosis X***
Herpetic Gingivostomatitis Papillon-Lefèvre Syndrome*
ANUG Diabetes Mellitus*
Thrombocytopenia Down Syndrome*
Leukemia (AML / ALL) Chédiak-Higashi Syndrome*
Aplastic anemia Chronic Granulomatous Disease*
HIV Tuberculosis*
Acrodynia Ehlers-Danlos (Type VIII)*
Vitamin C deficiency Osteomyelitis*
Vitamin K deficiency

* bacteriological culture and sensitivity needed ** tooth biopsy needed *** gingival biopsy needed

How to cite: IAPD Foundational Articles and Consensus Recommendations: Paediatric Periodontal Disease, 2022.
http://www.iapdworld.org/2022_20_paediatric-periodontal-disease.