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Department Of PERIODONTICS Generalized AGGRESSIVE PERIODONTITIS Dr Usha.

Aggressive periodontitis

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general features showing periodontal problems most common for young individuals

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Page 1: Aggressive periodontitis

Department Of PERIODONTICS

Generalized AGGRESSIVE

PERIODONTITIS

Dr Usha.

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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 .

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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

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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

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AGGRESSIVE PERIODONTITIS

• Aggressive periodontitis is further classified into –

• 1-LOCALIZED FORM • 2- GENERALIZED FORM

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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

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• 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 .

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• 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.

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• 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.

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• PREVALENCE & DISTRIBUTION BY AGE & SEX

• RACE- blacks > whites

• SEX- males > females

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• • 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.

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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.

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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.

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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.

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PERIODONTITIS IN 10 yr BOY WITH AGAMMAGLOBULINEMIA & NEUTROPENIA

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• 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.

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• 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.

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