Gingivitis

The development and rate of progression of gingivitis have been shown to be age-dependent based on factors such as sex hormone changes that affect host-parasite interactions, increased blood vessel permeability, exaggerated responses to microorganisms, and lack of attention to proper oral hygiene (Figure 2). Primary preventive strategies should be initiated to intercept the process of reversible adolescent periodontal diseases; thereby, avoiding the necessity to treat irreversible periodontal diseases in adulthood.
 

Necrotizing Ulcerative Gingivitis

Necrotizing ulcerative gingivitis first appears most frequently during the circumpubertal years. A stress-related component and an altered host-resistance are associated with this condition (Figure 3). Causative bacteria include Borelia vincentii and Prevotella intermedia. Clinically, interproximal gingival necrosis is accompanied by rapid onset of gingival pain. Treatment includes professional debridement of local irritants with prophylaxis and scaling accompanied by meticulous personal home care using a soft-bristled toothbrush. Therapeutic mouthrinses such as 0.2% chlorhexidine gluconate solution can be recommended and in the presence of systemic conditions, e.g. fever and adenopathy, antibiotics such as penicillin or metronidazole can be prescribed. The presence of oral malodor associated with necrotizing ulcerative gingivitis is yet another opportunity for the dental team to promote a comprehensive oral health home care regimen.

Herpes Simplex

Adolescents who have not been exposed to the herpes simplex virus (HSV) can be affected with a primary infection. Teenagers who engage in oral sex may present with soft tissue lesions related to sexually transmitted diseases and HSV-2 lesions in the oral cavity and perioral regions (Figure 4). Questions related to the adolescent patient’s sexual activity are advisable in the presence of HSV lesions. While there is no known cure for HSV, treatment for this condition is palliative. Antiviral medications such as acyclovir along with analgesics such as acetaminophen can be prescribed to alleviate symptoms for the adolescent patient. Recurrent episodes of herpes labialis (RHL) may be treated with pencyclovir cream for perioral lesions (Figure 5).
 

Third Molars

The extraction of impacted third molars is an anticipated event by many adolescents. Third molars usually emerge between the ages of 17 and 25 years. During the process of eruption, the development of pericoronitis is a common, pain-causing sequela. Periodontal therapy in this region should focus on eliminating pathogenic bacteria.

Periodontal disease around asymptomatic third molars may progress even in the absence of symptoms. This should prompt dentists to monitor the eruption of third molars in adolescent patients. Periodontal disease is indicated by probing depths > 4 mm around these teeth. Further anaerobic bacterial infection may spread from the supporting tissues surrounding the third molars to other teeth, particularly the second molars. This may result in the disruption of the periodontal ligament, root resorption, and pocket depth associated with loss of attachment. These factors should alert the dentist to thoroughly evaluate the third molars in adolescent patients to identify and prevent the onset of periodontal disease.10 Despite local lavage and the administration of systemic antibiotics and analgesics, if the periodontal pockets and/or symptoms persist extraction of the third molars may be the most prudent long-term solution.
 

Another consideration is the evaluation of third molars in adolescent female patients who are pregnant. Periodontal pocketing around third molars has been linked to a higher incidence of premature births. Not only should dentists evaluate periodontal pockets surrounding the third molars of their pregnant female adolescent patients, but all women of childbearing age for systemic risks from oral inflammation associated with periodontal pathology.11 In addition, research suggests that women of childbearing age who take oral contraceptives may have a higher incidence of post-third molar extraction dry socket (localized osteitis).12 For further information on women’s oral health, the reader is referred to the MetLife Quality Resource Guide entitled Women’s Oral Health Concerns, 2nd Edition.
 

Impacted third molars may pose an additional concern. For example, the presence of impacted third molars or their extraction make the gonial angle of the mandible more susceptible to fracture in adolescent athletes (Figure 6).