DEFINITION A bacterial infection characterized by a rapid
irreversible destruction of the periodontal ligament and supporting
bone. It is a specific type of periodontitis. Less Common Than
Chronic Periodontitis.
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COMMON FEATURES of Ag.P: 1. Rapid destruction of periodontal
ligaments and supporting bone. 2. High risk of tooth loss. 3. Poor
response to periodontal therapy. 4. No obvious signs and symptoms
of systemic disease. 5. Other family member with Ag.P ( family
history).
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Ag.P CAN BE DISTINGUSHED FROM C.P: 1. The age of
onset.(systemically healthy individuals less than 30 years of age )
2. The rapid rate of disease progression. 3. the nature and
composition of the associated subgingival microflora 4. Alteration
in the host response. 5. A familial aggregation of diseased
individuals
Localized Ag.P Clinical features: 1. previously known as
Juvenile periodontitis (LJP)\ early-onset periodontitis. 2. Onset
of the disease around the time of puberty ( 20 years old). 3.
Localized attachment loss involving the first molar and incisors
and involving no more than two teeth other than first molars and
incisors ( less than 30%). 4. Female more than male. 5. Black more
than white. 6. Self arresting disease progression.
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Localized Ag.P 8- Progress rapidly ; rate of bone loss is 3-4
times faster than that of chronic periodontitis. Increase mobility
of first molar. 9- The amount of plaque on the affected teeth is
minimal which seems to be inconsistent with amount of periodontal
destruction.
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Radiographic features: Localized Vertical bone loss around the
first molar and incisors ( arc-shape) beginning around puberty in
otherwise healthy teenagers. Destruction starting from the distal
margin of the second premolar and extending to the mesial margin of
the second molar.
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clinically Earliest sign: drifting of teeth in a patient having
a good oral hygiene. The effect teeth becomes mobile followed by
pocket formation. Maxillary incisors migrate in distolingual
direction. Deep dull, radiating pain may occur with mastication (
irritation of the supporting tissue). Periodontal abscess
formation. Sensitive root surface.
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Generalized Ag.P Clinical features: 1. Previously known as
generalized 2. juvenile periodontitis GJP \ rapidly progressive
periodontitis 3. Onset occurs in persons younger than 30 years but
my be older. 4. Generalized interproximal attachment loss ( <
30%) affecting at least three permanent teeth other than first
molars and incisors. 5. Associated with A. a. 6. Patient often have
small amount of bacterial plaque associated with the affected
teeth.
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Clinically : The gingival tissues may be inflamed, ulcerative,
firmly red or may be loss affecting the majority of the teeth.
Bleeding may occur spontaneously or with slight stimulation. Some
patients with GAP may have systemic manifestations, such as weight
loss, mental depression, and general malaise.
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Radiographic appearance: Sever bone loss associated with
minimal of teeth to advanced bone loss affecting the majority of
the teeth.
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Treatment : 1. Early diagnosis aids in successful treatment. 2.
Extraction involved teeth ( depend on severity of tissue loss). 3.
Antibiotics : tetracycline is the drug of choice 1 g/day for 14
days) Or tetracycline + metronidazole Or doxycycline. 4-
periodontal therapy: scaling, root planning, OHI, surgery,
subgingival irrigation, bone graft. Follow up 1-6 months then every
3 months.
