Aggressive periodontitis

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general features showing periodontal problems most common for young individuals

general features showing periodontal problems most common for young individuals

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  • 1. Department Of PERIODONTICS Generalized AGGRESSIVE PERIODONTITIS Dr Usha.
  • 2. 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 .
  • 3. 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
  • 4. 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
  • 5. AGGRESSIVE PERIODONTITIS • Aggressive periodontitis is further classified into – • 1-LOCALIZED FORM • 2- GENERALIZED FORM
  • 6. 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
  • 7. • 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 .
  • 8. • 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.
  • 9. • 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.
  • 10. • PREVALENCE & DISTRIBUTION BY AGE & SEX • RACE- blacks > whites • SEX- males > females
  • 11. • • 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.
  • 12. 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.
  • 13. 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.
  • 14. 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.
  • 15. PERIODONTITIS IN 10 yr BOY WITH AGAMMAGLOBULINEMIA & NEUTROPENIA
  • 16. • 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.
  • 17. • 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.