Aggressive periodontitis
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Transcript of Aggressive periodontitis
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Department Of PERIODONTICS
Generalized AGGRESSIVE
PERIODONTITIS
Dr Usha.
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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 .
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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
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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
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AGGRESSIVE PERIODONTITIS
• Aggressive periodontitis is further classified into –
• 1-LOCALIZED FORM • 2- GENERALIZED FORM
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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
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• 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 .
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• 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.
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• 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.
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• PREVALENCE & DISTRIBUTION BY AGE & SEX
• RACE- blacks > whites
• SEX- males > females
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• • 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.
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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.
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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.
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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.
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PERIODONTITIS IN 10 yr BOY WITH AGAMMAGLOBULINEMIA & NEUTROPENIA
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• 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.
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• 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.
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