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Pediatric  Dental   Health

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Premature Loss Of Baby Teeth
A number of diseases may contribute to early tooth loss in children. These diseases include: immunological problems associated with the ability to ward off infections; metabolic disorders; diseases of the blood; and the presence of defective cellular enzymes.

Some children have trouble fighting off infections because their body's natural defense systems are impaired.
One such problem is the suppressed movement (defective chemotaxis) of white blood cells. The chemotaxis problem may cause localized prepubertal periodontitis, which is an acute disease of the gums and dental supporting structures in children.
Another type of problem with the body's natural defense system is abnormal adhesion of white cells (leukocytes). Since this prevents white cells from reaching the site of an infection, leukocyte adhesion deficiency may lead to generalized prepubertal periodontitis in young children.

Some children have metabolic disorders, such as poorly controlled diabetes, or hypophosphatasia.
Children with poorly controlled diabetes are at increased risk for periodontal disease due to a number of factors. These factors include: impaired neutrophil function, microvascular abnormalities, and altered collagen metabolism.
Other children may be afflicted with a rare disease called hypophosphatasia. In this genetic disease, 75% of the children experience premature exfoliation (loss) of all primary teeth. This happens because the low levels of serum alkaline phosphatase impairs the health of the suspensory ligaments, which hold the teeth in place.

Two types of blood diseases which can affect children are neutropenia and leukemia.
One of the first lines of defense against bacterial infections are the neutrophil cells. In neutropenia, there is a decrease - or total absence - of these important cells. As a result, children affected by neutropenia have periodontal infections, with early loss of teeth.
In acute leukemia, malignant white blood cells invade the gingival tissue, causing extensive bleeding and loosening of teeth.

The absence of an important enzyme, cathepsin C, is responsible for the premature loss of all teeth in children afflicted with the rare Papillon-Lefèvre disease.
Papillon-Lefèvre syndrome is a disorder characterized by palmoplantar hyperkeratosis and severe early onset periodontitis that results in the premature loss of the baby and adult teeth.
The type of gum disease associated with this syndrome begins very early in life, usually before age 3, and is very severe.

A recent journal article discusses the importance of cathepsin C for periodontal health:
Mutations of the cathepsin C gene are responsible for Papillon-Lefèvre syndrome:
Hart TC, Hart PS, Bowden DW, Michalec MD, Callison SA, Walker SJ, Zhang Y, and Firatli E.
J Med Genet 1999; 36: 881-887.

Can Cleft Lip and Palate Be Prevented?
Cleft lip, with or without cleft palate, affects approximately one in every 1,000 newborn infants. It is a craniofacial, oral, and dental birth defect in which there is an opening in a structure around the mouth and face. The causes of this problem are both environmental and genetic.

Pregnant women may reduce the risk of cleft lip and/or cleft palate in their babies by: