localised aggressive period on tit is

8/2/2019 Localised Aggressive Period on Tit Is

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LOCALISED AGGRESSIVE

PERIODONTITIS

caution

Group 1


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Aggressive periodontitis

A distinct types of periodontitis that

affect people who, in most cases,

otherwise appear healthy. It tends to

have a familial aggregation and there is

a rapid rate of disease progression.


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Risk factor of LAP

Microbiologic factors

High frequency ofActinobacillus

actinomycetemcomitans is implicated as the

primary pathogen associated with this disease.


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Immunologic factors

Some immune defect are implicated in the progressionof LAP. Functional defects of PMNs can impair eitherthe chemotactic attraction to PMN to the site of

infection their ability to phagocytose and killmicroorganism.

Genetic factors

A familial pattern of alveolar bone loss have implicated

genetic factors n aggressive periodontitis. Geneticpredisposition for LAP suggest that a major gene playsa role in this disease, which is transmitted through anautosomal dominant mode of inheritance.


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Environmental factors

The amount and duration of smoking can

influence the extent of destruction seen in young

adults.


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AAP consensus report 2000-

Primary features

Other than the presence of periodontitis,

patients are otherwise clinically healthy.

Rapid attachment loss and bone destruction.

Familial aggregation.


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AAP consensus report 2000-Secondary

features

Amounts of microbial deposits VS severity ofperiodontal tissue destructioninconsistent

ElevatedActinobacillus actinomycetemcomitans (FarEast populations, Porphyromonas gingivalis may be

elevated as well) Phagocyte abnormalities;

Hyper-responsive macrophage phenotype, includingelevated levels of PGE2 and IL-1b in response to

bacterial endotoxins; Progression of attachment loss and bone loss may be

self-arresting.


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Localized Aggressive Periodontitis

Circumpubertal onset;

Robust serum antibody response to infecting

agents;

Localized first molar/incisor presentation with

interproximal attachment loss on at least two

permanent teeth, one of which is a first molar,

and involving no more than two teeth other

than first molars and incisors.


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Progression of Periodontal Disease

Age

Normal

Aggressive

Chronic

Attachment or

Bone Loss


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Clinical appearance:

extreme bone loss around 1st molars and incisors; loose,drifting teeth; no plaque or inflammation; good OH

severe inflammation, rapid bone loss, and early toothloss


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Aggressive Periodontitis

Radiographicfeatures: advanced

bone loss


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Localized

Aggressive Periodontitis:

Etiology: Aa, largepercentage of

neutrophils with slowchemotacticresponse


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Clinical Management of Aggressive

Periodontitis

-Patient education.

-Oral hygiene instructions and reinforcement.

-Scaling and root planing and control of localfactors.

-A general medical evaluation may determine if

systemic disease is present in children andyoung adults.


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Adjunctive antimicrobial therapy combined withscaling and root plaining with or without surgicaltherapy. Examples of antibiotics:Tetracyclins(avoid in children), metronidazole+

amoxycillin,azithromycin.

-Evaluation and counseling of family members.

*antibiotics may help but it usually slows ratherthan stops disease


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Aggressive Periodontitis

Prognosis: Poor

individuals with prepubertal gingivitisfrequently become edentulous at an earlyage

localised aggressive period on tit is

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