AGGRESSIVE PERIODONTITIS

SHAISTA ZAFAR

What is PERIODONTITIS

???

AGGRESSIVE PERIODONTITIS

“Comprises of a group of rare,often severe, rapidly progressive forms of periodontitis

often characterized by an early age of clinical manifestation and a distinctive

tendency for cases to aggregate in families.”

Aggressive periodontitis distinguished from chronic periodontitis by:

The age of onsetThe rapid rate of disease progressionThe nature and composition of associated microfloraAlterations in the host responseA familial aggregation of diseased individuals

CLASSIFICATION

EARLY ONSET PERIODONTITI

S

PREPUBERTAL PERIODONTITIS

GENERALIZED LOCALIZED

JUVENILE PERIODONTITIS

GENERALIZED LOCALIZED

RAPIDLY PROGRESSIVE

PERIODONTITIS

PREPUBERTAL PERIODONTITIS

“periodontitis that results in resorption of pdl in young children

during or shortly following the eruption of the primary teeth”

It may also affect permanent dentitionAffected patients are usually diagnosed by age 4Child may has affected leukocytes

-Severe inflammation and bone resorption -involved all primary teeth & leads to early exfoliation-Comparatively rate of tissue destruction is faster

-this condition exhibits defects in both polymorphonuclear & mononuclear leukocytes.

-Minimal clincal signs of gingival inflammation

-Only some of teeth are involved

-Rate of tissue destruction is slower

-Leukocytes defects involve polymorphonucear or mononuclear leukocytes, but not both.

LOCALIZED PREPUBERTAL PERIODONTITIS

GENERALIZED PREPUBERTAL PERIODONTITIS

CLINICAL FEATURES

ETIOLOGY

Associated with frequent abscess formation,upper respiratory tract infection & otitis media.

-Antibiotic treatment-Extraction of affected teeth

Associated with abnormal cementum formation & defective pdl attachment results in decreased resistance of periodontal tissues to microbial infections & allow rapid tissue destruction.

-Local mechanical debridement

-Antibiotic therapy(penicillin or erythromycin –QD 250mg for 3 weeks)

-improved oral hygiene

ASSOCIATED FEATURES

TREATMENT

JUVENILE PERIODONTITIS

“uncommon form of periodontitis seen in children & adolescents”

Characterised by rapid alveolar bone

destruction with minimal signs of

gingival inflammation

CLASSIFICATION

LOCALIZED JUVENILE

PERIODONTITIS

GENERALIZED JUVENILE

PERIODONTITIS

LOCALIZED JUVENILE PERIODONTITIS(LJP)

CHARACTERISED BY:

loss of collagen fibers in pdlReplacement by loose connective

tissueExtensive bone resorptionWidened periodontal ligament

spaceGingiva is not involved

HISTORICAL BACKGROUND

In 1928, Gottlieb termed the disease “Deep cementopathia”

disease of eruption & cementum initiated a foreign body responseHost attempted to exfoliate the toothBone resorptionPocket formation

In 1938 Wannermacher described incisor-first molar involvement and called the disease “parodontitis marginalis progressiva”

Many author considered this to be a degenerative, non-inflammatory disease process & therefore gave it the name “periodontosis”

CLINICAL CHARACTERSTICSAge of onset is around pubertyLocalized involvement of 1st molar/incisorInterproximal attachment loss on atleast two permanent teeth, one of which is a 1st molarInvolves no more than two teeth other than 1st molar & incisorsDistolabial migration of maxillary incisors with concomitant diastema formationIncrease mobility of first molarsSensitivity of denuded root surfaces to thermal & tactile stimuli.Deep,dull,radiating pain during mastication,probably caused by irritation of the supporting structures by mobile teeth & impacted foodPeriodontal abscess may form at this stage & regional lymph node enlargement may occur.

RADIOGRAPHIC FINDINGS

Classic diagnostic sign:Vertical loss of alveolar bone around 1st molars & incisorsBeginning around puberty in an otherwise healthy teenagers“Arc shaped loss of alveolar bone extending from distal surface of 2nd premolar to mesial surface of second molar”

ARC-SHAPED RADIOLUCENCY AT THE 1ST MOLAR REGION IN

LOCALIZED AGGRESSIVE PERIODONTITIS

ETIOLOGYColonization of Actinobacillus actinomycetemcomitansImpaired neutrophils chemotaxis lowers patient’s resistance to bacterial infectionIntense immune responses

TREATMENTPatient education Oral hygiene instructions in plaque control & reinforcementSelective extraction & replacementscaling & root planing of teethSurgical curretement of periodontal pocketSystemic administration of antibiotic (tetracycline—250mg—1 tab—6 hours for 3 weeks)

PREVALENCE & DISTRIBUTION BY AGE & SEX

LJP affects both males and females

Most frequently between puberty & 20 yrs of age

Affects white females more & black males more

GENERALIZED JUVENILE PERIODONTITIS(GJP)

Affects individuals under the age of 30,but older patients may also be affectedInvolves entire dentition, frequently associated with down's syndrome and papillon-lefevre syndrome.Can also occur in individuals with no systemic disease

CHARACTERISED BY:

Generalized interproximal attachment loss affecting atleast 3 permanent teeth other than 1st molars & incisors

CLINICAL CHARACTERSTICS

Small amount of bacterial plaque with affected teethQuantitatively—amount of plaque seems inconsistent with the amount of periodontal desructionQualitatively-A.Actinomycetemcomitants,Bacteroides are detected in plaque

TWO GINGIVAL TISSUE RESPONSES FOUND IN CASE OF GJP

DESTRUCTIVE STAGE:

severe acutely inflammed tissueUlcerativefiery redbleeding may occur spontaneously or on stimulation pressureSuppuration maybe an important featureAttachment & bone are actively lost

OTHER CASES:Gingival tissues may appear pinkFree of inflammationAbsence of some degree of stipplingDeep pockets demonstrated by probing

Systemic manifestations:Weight lossMental depressionMalaise

RADIOGRAPHIC FINDINGS

Severe bone loss associated with minimal number of teeth, to advanced bone loss affecting the majority of teeth in dentition

ETIOLOGYSubgingival plaque from affected siteImpaired neutrophils chemotaxis.Familial involvement.

TREATMENTMedical histories updated & reviewedPatient education Oral hygiene instructions in plaque control & reinforcementPeriodic scaling & curettageAntibiotic therapySurgical pocket elimination(periodontal flap procedure,osseous recontouring,root amputation)Extraction of all teeth & replacement with complete denturesFollow up

PREVALENCE & DISTRIBUTION BY AGE &

SEX

Blacks are at high risk than whites

Males were more likely to have GAP then females

RAPIDLY PROGRESSIVE PERIODONTITIS

“Periodontitis responsible for extensive bone destruction in a short period of time & may begin in puberty and 30-35 years

of age”

CLINICAL CHARACTERSTICS:

ACUTE PHASE

• Highly inflammed gingiva

• Bleeds easily & has mulberry like surface

• Amount of plaque is variable

QUIESCENT PHASE

• Normal gingivaL appearance

• Advanced bone loss• Deep periodontal

pockets

ACTIVE PHASE

• Malaise• Weight loss• Depression

ETIOLOGYImmunocompromised hostDefects in neutrophils & monocytesBacterial flora e.g:Actinobacillus,Capnocytophaga

Diabetes mellitusDown’s syndromeNeutropeniaCrohn’s diseaseAgranulocytosis

SYSTEMIC INVOLVEMENT

TREATMENTScalingOpen or closed curettageAntibiotic therapyOsseous grafts

RISK FACTORSMICROBIOLOGIC FACTORS: A.actinomycetemcomitans,Capnocytophaga sputigenaIMMUNOLOGIC FACTORS: human leukocyte antigens,hyperresponsiveness of monocyteGENETIC FACTORS: familial pattern of alveolar bone,dominant mode of inheritanceENVIROMENTAL FACTORS: amount & duration of smoking

CASE

9 mm probing depth

8 mm probing depth 2 mm probing depth

3mm probing depth11mm probing

depth2mm probing depth

DIAGNOSIS

“LOCALIZED JUVENILE PERIODONTITIS”

FINDINGS:

Clinically, localized juvenile periodontitis (LJP) patients rarely show calculus or plaque formation and often exhibit little or no gingivitis. However, deep probing, attachment loss, radiographic bone loss are found. Deep interproximal vertical bone loss on first molars and incisors are characteristic of LJP. Juvenile periodontits should be identified and treated early with antimicrobial therapy, scaling and root planing, and also surgery according to extent of destruction.1. Generalized: affecting most of the dentition.2. Localized: affecting only first molars and incisors.

REFERENCES

CARRANZA’S CLINICAL PERIODONTOLOGY

ESSENTIALS OF PERIODONTOLOGY IMAGES FROM GOOGLECASE-http://www.drbui.com/

perio.html

F L O B R U S H I S N T S M I L E E E T H A N K Y O U

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