This document discusses early onset periodontitis, which comprises rare, severe, and rapidly progressive forms of periodontitis characterized by an early age of onset and familial aggregation. It describes several types including prepubertal, juvenile, and rapidly progressive periodontitis. Localized juvenile periodontitis is highlighted, which clinically presents with deep probing depths, attachment loss, and radiographic bone loss localized to first molars and incisors in otherwise healthy teenagers, despite minimal plaque and gingivitis. Treatment involves nonsurgical and surgical approaches along with antibiotic therapy.

2. SHAISTA ZAFAR

3. What is
PERIODONTITIS
???

4. ―Comprises of a group of rare,often severe,
rapidly progressive forms of periodontitis often
characterized by an early age of clinical
manifestation and a distinctive tendency for
cases to aggregate in families.‖

5. The age of onset
The rapid rate of disease progression
The nature and composition of
associated microflora
Alterations in the host response
A familial aggregation of diseased
individuals

6. EARLY ONSET
PERIODONTITIS
PREPUBERTAL
PERIODONTITIS
GENERALIZED
LOCALIZED
JUVENILE
PERIODONTITIS
GENERALIZED
LOCALIZED
RAPIDLY
PROGRESSIVE
PERIODONTITIS

7. “periodontitis that results in resorption of
pdl in young children during or shortly
following the eruption of the primary
teeth‖
It may also affect permanent dentition
Affected patients are usually diagnosed by age 4
Child may has affected leukocytes

8. -Minimal clincal signs of gingival
inflammation
-Only some of teeth are
involved
-Rate of tissue destruction is
slower
-Leukocytes defects involve
polymorphonucear or
mononuclear leukocytes, but
not both.
LOCALIZED PREPUBERTAL
PERIODONTITIS
GENERALIZED PREPUBERTAL
PERIODONTITIS
CLINICAL FEATURES
ETIOLOGY

9.  Associated with abnormal
cementum formation &
defective pdl attachment
results in decreased
resistance of periodontal
tissues to microbial
infections & allow rapid
tissue destruction.
-Local mechanical
debridement
-Antibiotic therapy(penicillin
or erythromycin –QD 250mg
for 3 weeks)
-improved oral hygiene
ASSOCIATED FEATURES
TREATMENT

10.  “uncommon form of periodontitis seen
in children & adolescents‖
Characterised by rapid
alveolar bone destruction
with minimal signs of
gingival inflammation

11. LOCALIZED
JUVENILE
PERIODONTITIS
GENERALIZED
JUVENILE
PERIODONTITIS

12. CHARACTERISED BY:
loss of collagen fibers in pdl
Replacement by loose connective tissue
Extensive bone resorption
Widened periodontal ligament space
Gingiva is not involved

13. In 1928, Gottlieb termed the disease
―Deep cementopathia‖
disease of eruption & cementum
initiated a foreign body response
Host attempted to exfoliate the
tooth
Bone resorption
Pocket formation

14. In 1938 Wannermacher described incisor-
first molar involvement and called the
disease ―parodontitis marginalis
progressiva‖
Many author considered this to be a
degenerative, non-inflammatory disease
process & therefore gave it the name
―periodontosis‖

15. Age of onset is around puberty
Localized involvement of 1st molar/incisor
Interproximal attachment loss on atleast two
permanent teeth, one of which is a 1st molar
Involves no more than two teeth other than 1st
molar & incisors
Distolabial migration of maxillary incisors with
concomitant diastema formation
Increase mobility of first molars
Sensitivity of denuded root surfaces to thermal &
tactile stimuli.
Deep,dull,radiating pain during mastication,probably
caused by irritation of the supporting structures by
mobile teeth & impacted food
Periodontal abscess may form at this stage &
regional lymph node enlargement may occur.

19. Classic diagnostic sign:
Vertical loss of alveolar bone around 1st
molars & incisors
Beginning around puberty in an otherwise
healthy teenagers
―Arc shaped loss of alveolar bone
extending from distal surface of 2nd
premolar to mesial surface of second
molar‖

21. Colonization of Actinobacillus
actinomycetemcomitans
Impaired neutrophils chemotaxis lowers
patient’s resistance to bacterial infection
Intense immune responses

22. Patient education
Oral hygiene instructions in plaque control
& reinforcement
Selective extraction & replacement
scaling & root planing of teeth
Surgical curretement of periodontal
pocket
Systemic administration of antibiotic
(tetracycline—250mg—1 tab—6 hours for
3 weeks)

23. LJP affects both males and
females
Most frequently between puberty
& 20 yrs of age
Affects white females more &
black males more

24. Affects individuals under the age of
30,but older patients may also be
affected
Involves entire dentition, frequently
associated with down's syndrome and
papillon-lefevre syndrome.
Can also occur in individuals with no
systemic disease

25. CHARACTERISED BY:
Generalized interproximal
attachment loss affecting atleast 3
permanent teeth other than 1st
molars & incisors

26. Small amount of bacterial plaque with
affected teeth
Quantitatively—amount of plaque seems
inconsistent with the amount of
periodontal desruction
Qualitatively-
A.Actinomycetemcomitants,Bacteroides
are detected in plaque

27. DESTRUCTIVE STAGE:
severe acutely inflammed tissue
Ulcerative
fiery red
bleeding may occur spontaneously or on
stimulation pressure
Suppuration maybe an important feature
Attachment & bone are actively lost

28. OTHER CASES:
Gingival tissues may appear pink
Free of inflammation
Absence of some degree of stippling
Deep pockets demonstrated by probing
Systemic manifestations:
Weight loss
Mental depression
Malaise

30. Severe bone loss associated with minimal
number of teeth, to advanced bone loss
affecting the majority of teeth in
dentition

32. Subgingival plaque from affected
site
Impaired neutrophils chemotaxis.
Familial involvement.

33. Medical histories updated & reviewed
Patient education
Oral hygiene instructions in plaque control
& reinforcement
Periodic scaling & curettage
Antibiotic therapy
Surgical pocket elimination(periodontal flap
procedure,osseous recontouring,root
amputation)
Extraction of all teeth & replacement with
complete dentures
Follow up

34. Blacks are at high risk than
whites
Males were more likely to
have GAP then females

35. ―Periodontitis responsible for extensive bone
destruction in a short period of time & may
begin in puberty and 30-35 years of age‖

36. ACUTE
PHASE
• Highly inflammed gingiva
• Bleeds easily & has mulberry like surface
• Amount of plaque is variable
QUIESCENT
PHASE
• Normal gingivaL appearance
• Advanced bone loss
• Deep periodontal pockets
ACTIVE
PHASE
• Malaise
• Weight loss
• Depression

37. Immunocompromised host
Defects in neutrophils & monocytes
Bacterial flora
e.g:Actinobacillus,Capnocytophaga
Diabetes mellitus
Down’s syndrome
Neutropenia
Crohn’s disease
Agranulocytosis
SYSTEMIC INVOLVEMENT

38. Scaling
Open or closed curettage
Antibiotic therapy
Osseous grafts

39. MICROBIOLOGIC FACTORS:
A.actinomycetemcomitans,Capnocytophaga
sputigena
IMMUNOLOGIC FACTORS: human
leukocyte antigens,hyperresponsiveness of
monocyte
GENETIC FACTORS: familial pattern of
alveolar bone,dominant mode of
inheritance
ENVIROMENTAL FACTORS: amount &
duration of smoking

40. 9 mm probing depth 8 mm probing depth 2 mm probing depth
3mm probing depth 11mm probing depth 2mm probing depth

41. ―LOCALIZED JUVENILE
PERIODONTITIS‖

42. Clinically, localized juvenile periodontitis (LJP)
patients rarely show calculus or plaque formation
and often exhibit little or no gingivitis.
However, deep probing, attachment loss,
radiographic bone loss are found. Deep
interproximal vertical bone loss on first molars
and incisors are characteristic of LJP. Juvenile
periodontits should be identified and treated
early with antimicrobial therapy, scaling and
root planing, and also surgery according to
extent of destruction.
1. Generalized: affecting most of the dentition.
2. Localized: affecting only first molars and
incisors.

43.  CARRANZA’S CLINICAL PERIODONTOLOGY
 ESSENTIALS OF PERIODONTOLOGY
 IMAGES FROM GOOGLE
 CASE-http://www.drbui.com/perio.html

44.  F
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S M I L E
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T H A N KY O U
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