How should we treat gingival and periodontal diseases and conditions in under-18s with underlying systemic diseases and conditions?

More than 70 genetic, congenital, and acquired systemic conditions that impact upon the periodontal tissues were identified by the systematic review that underpinned the working group’s investigation (Molina et al., 2026). These conditions were categorized into four groups:

1. Genetic and congenital systemic conditions that impact upon periodontal tissues.
2. Acquired systemic conditions that impact upon periodontal tissues.
3. Genetic and congenital conditions that impact upon periodontal disease onset, progression, or response to periodontal therapy.
4. Acquired conditions that impact upon periodontal disease onset, progression, or response to periodontal therapy.

The distinction between these groups is important because the first two categories are, by definition, non-plaque-induced conditions, which map onto the 2018 classification of non-dental-biofilm-induced gingival diseases (Chapple et al., 2018) and systemic disorders that result in the loss of periodontal tissue attachment independently of dental-plaque biofilm (Jepsen et al., 2018). The latter two groups map onto systemic disorders that impact upon periodontal tissue loss by influencing periodontal inflammation—such as Down Syndrome and Ehlers Danlos syndrome (Jepsen et al., 2018; Malfait et al., 2017)—within the 2018 classification system for adults.

The search identified more than 2,760 manuscripts, which varied in terms of evidence quality from cohort and cross-sectional studies to case series and case reports. The quantity of reports per condition also varied widely from one or two for some conditions to 567 papers for Papillon-Lefèvre syndrome.

Key terms were defined before the group developed a “core dataset for periodontal diseases and conditions associated with systemic disorders in children and adolescents”. This serves as a “look-up table” outlining the aetiology, periodontal manifestations, other orofacial manifestations, recommended management, and impact on the onset and progression of each condition and the response to periodontal therapy, where appropriate. These terms were:

• Genetic disorders: conditions that result wholly or partly from mutations within the genome—e.g. cancer develops as a consequence of acquired genetic mutations that are not inherited and thus are not transmitted between generations. Consequently, genetic disorders may be either hereditary or non-hereditary.
• Congenital disorders: those present at birth and which may be hereditary, arising from inherited genetic factors, or non-hereditary, resulting from environmental or maternal influences during foetal development (e.g. enamel defects associated with maternal illness during pregnancy).
• Hereditary disorders: conditions passed down from one generation to the next, which may have a genetic and/or congenital origin.

(For more detail, see Table 7 in the consensus report)

The systematic review identified 11 systemic diseases or conditions that impact upon the onset, progression, or therapeutic response of gingivitis or periodontitis, and more than 70 non-plaque-induced systemic diseases or conditions that present within and impact upon the periodontium.

Importantly, working group 1 excluded both “other” non-plaque-induced gingival lesions in systemically healthy children and adolescents, such as epulides, pigmented and traumatic lesions (there were dealt with by working group 2) and “other” non-plaque-induced periodontal lesions in systemically healthy individuals such as mucogingival deformities (tackled by working group 3).