Aggressive periodontitis

Department Of PERIODONTICS

Generalized AGGRESSIVE

PERIODONTITIS

Dr Usha.

DEFINITION OF PERIODONTITIS

• Periodontitis is defined as an inflammatory disease of supporting tissues of the teeth caused by specific microorganisms resulting in progressive destruction of the periodontal ligament & alveolar bone with pocket formation , recession , or both .

CLASSIFICATION OF PERIODONTITIS

• Periodontitis can be sub classified into the following three major types :

1-CHRONIC PERIODONTITIS

2-AGGRESSIVE PERIODONTITIS

3-PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASES

Charecteristics common to patients with aggressive periodontitis

• Otherwise clinically healthy patient• Rapid attachment loss & bone destruction• Amount of microbial deposits inconsistent

with disease severity • Familial aggregation of diseased

individuals

AGGRESSIVE PERIODONTITIS

AGGRESSIVE PERIODONTITIS

• Aggressive periodontitis is further classified into –

• 1-LOCALIZED FORM • 2- GENERALIZED FORM

Clinical characteristics :

• It usually affects individuals under the age of 30 yrs , but older may also be affected.

• It is characterised by generalized inter proximal attachment loss affecting atleast three permanent other than first molars space & incisors.

• Destruction appears to occur episodically with periods of advanced destruction, followed by stages of quiescence of variable length.

GENERALIZED AGGRESSIVE PERIODONTITIS

• Radiographs often show bone loss

• Patients have small amounts of bacterial plaque associated with the affected teeth. Quantitatively the amount of plaque seems inconsistent with the amount of periodontal destruction.

• Qualitatively P. gigivalis , A. actinomycetemcomitans & B. forsythus are detected in the plaque .

• Two gingival tissue responses can be found :1. Severe acutely inflamed tissue, often

proliferating , ulcerated & fiery red. Bleeding may occur spontaneously or with slight stimulation. Suppuration may be an important feature.

2. In other cases , gingival tissue may appear pink ,free of inflammation & with some degree of stippling . Deep pockets can be demonstrated by probing.

• Patients may have systemic manifestations such as weight loss, mental depression & general malaise.

• RADIOGRAPHIC FINDINGS

• The radiographic picture can range from severe bone loss associated with the minimal no. of teeth to advanced bone loss affecting the majority of teeth in dentition.

• PREVALENCE & DISTRIBUTION BY AGE & SEX

• RACE- blacks > whites

• SEX- males > females

• • RISK FACTORS FOR AGGRESSIVE

PERIODONTITIS• Microbiologic factors

• A. actinomycetemcomitans ,Capnocytophaga sp.,Eikenella corrodens, Prevotella intermedia & Campylobacter rectus are several specific microorganisms detected in patients with localised agg. Periodontitis.

• A. actinomycetemcomitans- primary pathogen

Evidence given:

1.It is found in high frequency(90%) in lesions of LJP

2.Sites often show elevated levels of this organism.

3.Significantly elevated serum antibody titers 4.Correlation between reduction in the subgingival

load of A. actinomycetemcomitans during treatment & a successful clinical response.5.It produces a number of virulence factors that may

contribute to the disease process. Elevated levels of P.gingivalis F.nucleatum, &

T.denticola were seen in localised or generalised aggressive disease.

IMMUNOLOGIC FACTORS

Immune defects implicated in pathogenesis of aggressive periodontitis :

1.HLA which regulate immune responses, have been evaluated as candidate markers for agg. Periodontitis (HLA-A9 & B15 Antigens)

2.Functional defects of PMNs, monocytes, or both.these defects impair either the chemotactic attraction of PMN to the site of infection or their ability to phagocytose.

3. Hyperresponsiveness of monocytes with respect to their production of PGE-2 in response to LPS.this hyper responsive phenotype could lead to connective tissue or bone loss due to excessive production of these catabolic factors.

4. Autoimmunity has been considered to have a role in generallized aggressive periodontitis – host antibodies to collagen , DNA & IgG.

PERIODONTITIS IN 10 yr BOY WITH AGAMMAGLOBULINEMIA & NEUTROPENIA

• GENETIC FACTORS• Familial pattern of alveolar bone loss have

implicated genetic factors in aggressive periodontitis

• Analysis of families with a genetic predisposition for LAP suggests that a major gene, transmitted through an autosomal dominant mode of inheritence, play a role in this disease.

• Family clustering of the neutrophil abnormalities seen in LAP suggests that immunologic defects may be inherited.

• Ab production (IgG) against periodontal pathogen (A.a.) is under genetic control which may be race dependent.

• ENVIRONMENTAL FACTORS • Amount & duration of smoking are

important variables that influence the extent of destruction seen in young adults.

• Smokers with generalized aggressive periodontitis have more affected teeth & more loss of clinical attachment in non-smokers , which may not be same for LAP.