localised aggressive period on tit is
TRANSCRIPT
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LOCALISED AGGRESSIVE
PERIODONTITIS
caution
Group 1
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Aggressive periodontitis
A distinct types of periodontitis that
affect people who, in most cases,
otherwise appear healthy. It tends to
have a familial aggregation and there is
a rapid rate of disease progression.
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Risk factor of LAP
Microbiologic factors
High frequency ofActinobacillus
actinomycetemcomitans is implicated as the
primary pathogen associated with this disease.
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Immunologic factors
Some immune defect are implicated in the progressionof LAP. Functional defects of PMNs can impair eitherthe chemotactic attraction to PMN to the site of
infection their ability to phagocytose and killmicroorganism.
Genetic factors
A familial pattern of alveolar bone loss have implicated
genetic factors n aggressive periodontitis. Geneticpredisposition for LAP suggest that a major gene playsa role in this disease, which is transmitted through anautosomal dominant mode of inheritance.
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Environmental factors
The amount and duration of smoking can
influence the extent of destruction seen in young
adults.
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AAP consensus report 2000-
Primary features
Other than the presence of periodontitis,
patients are otherwise clinically healthy.
Rapid attachment loss and bone destruction.
Familial aggregation.
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AAP consensus report 2000-Secondary
features
Amounts of microbial deposits VS severity ofperiodontal tissue destructioninconsistent
ElevatedActinobacillus actinomycetemcomitans (FarEast populations, Porphyromonas gingivalis may be
elevated as well) Phagocyte abnormalities;
Hyper-responsive macrophage phenotype, includingelevated levels of PGE2 and IL-1b in response to
bacterial endotoxins; Progression of attachment loss and bone loss may be
self-arresting.
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Localized Aggressive Periodontitis
Circumpubertal onset;
Robust serum antibody response to infecting
agents;
Localized first molar/incisor presentation with
interproximal attachment loss on at least two
permanent teeth, one of which is a first molar,
and involving no more than two teeth other
than first molars and incisors.
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Progression of Periodontal Disease
Age
Normal
Aggressive
Chronic
Attachment or
Bone Loss
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Clinical appearance:
extreme bone loss around 1st molars and incisors; loose,drifting teeth; no plaque or inflammation; good OH
severe inflammation, rapid bone loss, and early toothloss
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Aggressive Periodontitis
Radiographicfeatures: advanced
bone loss
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Localized
Aggressive Periodontitis:
Etiology: Aa, largepercentage of
neutrophils with slowchemotacticresponse
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Clinical Management of Aggressive
Periodontitis
-Patient education.
-Oral hygiene instructions and reinforcement.
-Scaling and root planing and control of localfactors.
-A general medical evaluation may determine if
systemic disease is present in children andyoung adults.
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Adjunctive antimicrobial therapy combined withscaling and root plaining with or without surgicaltherapy. Examples of antibiotics:Tetracyclins(avoid in children), metronidazole+
amoxycillin,azithromycin.
-Evaluation and counseling of family members.
*antibiotics may help but it usually slows ratherthan stops disease
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Aggressive Periodontitis
Prognosis: Poor
individuals with prepubertal gingivitisfrequently become edentulous at an earlyage