Aggressive periodontitis
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Transcript of Aggressive periodontitis
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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