Department Of PERIODONTICS
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 .
• Periodontitis can be sub classified into the
following three major types :
3-PERIODONTITIS AS A MANIFESTATION
OF SYSTEMIC DISEASES
Charecteristics common to patients with
• Otherwise clinically healthy patient
• Rapid attachment loss & bone destruction
• Amount of microbial deposits inconsistent
with disease severity
• Familial aggregation of diseased
• 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 &
• Destruction appears to occur episodically with
periods of advanced destruction, followed by
stages of quiescence of variable length.
• Radiographs often show
• 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.
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
2. In other cases , gingival tissue may appear pink
,free of inflammation & with some degree of
stippling . Deep pockets can be demonstrated
• Patients may have systemic manifestations
such as weight loss, mental depression &
• 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
• PREVALENCE & DISTRIBUTION BY
AGE & SEX
• RACE- blacks > whites
• SEX- males > females
• RISK FACTORS FOR AGGRESSIVE
• Microbiologic factors
• A. actinomycetemcomitans ,Capnocytophaga
sp.,Eikenella corrodens, Prevotella intermedia &
Campylobacter rectus are several specific
microorganisms detected in patients with localised
• A. actinomycetemcomitans- primary pathogen
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
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
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
• 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