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Juvenile Periodontitis

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presentation on management of juvenile periodontitis .

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Juvenile Periodontitis

  1. 1. JUVENILE PERIODONTITIS
  2. 2. What is Periodontitis ?  Periodontitis is  Inflammatory disease of the supporting tissue of the teeth  Caused by specific microorganism  Resulting in progressive destruction of the periodontal legament and alveolar bone with pocket formation , recession or both
  3. 3. Periodontitis Adult periodontitis Early onset periodontitis Prepubertal . Localized . Generalized Juvenile . Localized . Generalized Periodontitis associated with systemic disease . Down’s syndrome . Diabetes type 1 . AIDS and other disease Necrotizing ulcerative periodontitis Refractory periodontitis
  4. 4. Fig : Adult Periodontitis Fig : Localized Juvenile Periodontitis Fig : Generalized Juvenile Periodontitis Fig : Necrotizing Ulcerative Periodontitis
  5. 5. What is Juvenile or Aggressive Periodontitis?  Juvenile or Aggressive periodontitis is  Rapid loss of attachment and bone loss  Occurring in an otherwise clinicially healthy patients with the amount of microbial deposits in consistent with disease severity  Familial aggregation of diseased individual
  6. 6. Aggressive/ Juvenile Periodontitis Localized Generalized Rapidly Progressing
  7. 7. Stages in the development of disease
  8. 8. • Degenaration of principle fibers of PDL • Cessation of cementum formation • Resorption of alveolar bone • Tooth migration without detectable inflammation Stage I • Rapid proliferation of the junctional epithelium along the root • Earliest sings of inflammation appear Stage II • Progressive inflammation and development of deep, infrabony periodontal pocket Stage III
  9. 9. Etiology of juvenile periodontitis Micro organisms  Actinobacillus actinomycetemcomitans  Porphyromonas gingivalis  Eikenella corrodens  Caprocytophaga  Spirocheates  Bacillus  Defective neutrophil or monocyte function  Poor serum antibody response to infecting agent
  10. 10. Localized Juvenile Periodontitis
  11. 11. What is localized juvenile periodontitis ?  Localized juvenile periodontitis is Occuring in otherwise healthy individual under the age of 30 years Destructive periodontitis localized to the 1st permanent molars and incisors not involving more than two other teeth
  12. 12. Clinical features
  13. 13.  Age and sex distribution  Both sexes ( slight female predilection )  Seen mostly between 20 years  Distribution of lesion  1st molar and/or incisors 1st molar and/or incisors + additional teeth ( not more than 2 teeth other than 1st molars and incisors )
  14. 14.  Lack of clinical inflammation despite the presence of deep periodontal pocket  Small amount of plaque, forms a thin film rarely mineralized  Mobility and migration of 1st molars and incisors  Classically distolabial migration of maxillary incisors with diastema
  15. 15.  Root surface sensitivity  Deep dull radiating pain  Periodontal abscess  Enlargement of regional lymphnode
  16. 16. Radiographic findings
  17. 17.  Vertical or angular bone loss around the 1st molars and incisors  The pattern appears to be “Arc shaped” loss of alveolar bone extending from distal surface of 2nd premolar to mesial surface of 2nd molar  Frequently bilaterally symmetrical pattern of bone loss occurs called as “ mirror image pattern” Fig : Radiograph showing localized juvenile periodontitis
  18. 18. Histopathological features
  19. 19.  Ulcerated pocket epithelium  Accumulation of various inflammatory cells in the connective tissue mainly leukocytes, plasma cells and small number of lymphocytes and macrophages  Bacterial invasion of connective tissue  The flora involves A. actinomycetemcomitans , Capnocytophaga sputigena and others
  20. 20. Bacteriology  A. actinomycetemcomitans  short  Facultatively anaerobic  Non motile  Gram negative rod  Caprocytophaga Fig : Showing colony of A.a
  21. 21. Leucotoxin Destroys polymorphonuclear leukocytes and macrophages Endotoxin Activates host cells to secret inflammatory mediators Bacteriocin Inhibit IgG and IgM production Collagenase Degradation of collagen Chemotactic Inhibition factor Inhibit neutrophil chemotaxis Virulence factor associated with A. actinomycetemcomitans
  22. 22. Immunology Functionals defects of polymorphoneuclear leukocytes or monocytes, impairs the chemotactic attraction of these cells to the site of infection
  23. 23. Generalized Juvenile Periodontitis
  24. 24. What is Generalized juvenile periodontitis ?  Generalized juvenile periodontitis is  Generalized interproximal attachment loss  Affecting atleast three permanent teeth other than the 1st molar and incisors
  25. 25. Clinical features
  26. 26. Age and sex distribution Affects between puberty and 35 years No sex discrimination Distritubiton of lesion All or most of the teeth are affected, no specific pattern is observed  There are two phases of lesion
  27. 27. Destructive phase Non destructive phase Tissue appears severely inflammed, ulcerated and fiery red Bleeding with or without stimulation Suppuration Attachment and bone loss Tissue appears pink with some stippling Lack of inflammation Probling will reveal deep pocket Bone attachment levels relatively stable
  28. 28.  Some patients may exhibit Weight loss Mental depression General malaise Systemic condition may predispose patient to generalized juvenile periodontitis, these includes  chornic neutrophil defect Leukocyte adherence deficiency
  29. 29. Radiographic findings
  30. 30.  No define pattern of distribution Range from severe bone loss associated with minimal number of teeth to advanced bone loss affecting the majority of teeth in the dentition Fig : showing radiograph of GJP
  31. 31. Treatment Extraction Standard periodontaltherapy Antibiotic therapy Extraction of involved teeth, specially 1st molar Transplantation of developing 3rd molar into the sockets of previously extracted 1st molar Scaling Root planning Curettage Flap surgery with / without bone grafts Root amputation Hemisection Occlusal adjustment Tetracycline hydrochloride 250mg q.i.d + local mechanical therapy Doxycycline 100mg per day Combination of amoxicilline and metronidazole
  32. 32. Fig : Scaling & Root planning Fig: Curettage Fig : Hemisection Fig : Flap surgery
  33. 33. Periodontal disease accounts for a majority of missing teeth in adults and results in tremendous economic and social burdens both to the individual and the society Periodontal disease is so prevalent that only possible solution to the problem is its prevention by maintaining the good oral hygiene Conclusion
  34. 34. Reference  Essential of Clinical Periodontology And Periodontics ; 4th edition ; Shantipriya Reddy Carranza’s Clinical Periodontology ; 11th edition ; Newman ;Takei ; Klokkevold ; Carranza Cawson’s Essentials of Oral Pathology And Oral Medicine ; 8th edition ; R. A. Cawson ; E. W. Odell

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