3.2 Oral Examination
Diseases of the Gingiva and Other Soft Tissues
Examine the gingival tissue, noting any inflammation, bleeding, infection, tissue overgrowth, or tissue destruction from self-injurious behavior. (See section 3.4, Anticipatory Guidance, Oral Trauma and Injury.)
Early severe gingivitis or early periodontitis can occur in children who have impaired immunity or connective tissue disorders and/or inadequate oral hygiene.
Gingival overgrowth is a side effect of medications such as phenytoin sodium, calcium channel blockers, and cyclosporine. Look for any signs of superimposed infection.
While inspecting the soft tissues, also check for signs of other infectious diseases such as herpetic gingivostomatitis, herpes labialis, or fungal infections, especially if the child is on regular antibiotic therapy, or if you suspect child abuse or dental neglect. (See section 3.3, Child Abuse and Dental Neglect.)