DR.HINA ADNAN AGGRESSIVE PERIODONTITIS

DEFINITION A bacterial infection characterized by a rapid irreversible destruction of the periodontal ligament and supporting bone. It is a specific type of periodontitis. Less Common Than Chronic Periodontitis.

COMMON FEATURES of Ag.P: 1. Rapid destruction of periodontal ligaments and supporting bone. 2. High risk of tooth loss. 3. Poor response to periodontal therapy. 4. No obvious signs and symptoms of systemic disease. 5. Other family member with Ag.P ( family history).

Ag.P CAN BE DISTINGUSHED FROM C.P: 1. The age of onset.(systemically healthy individuals less than 30 years of age ) 2. The rapid rate of disease progression. 3. the nature and composition of the associated subgingival microflora 4. Alteration in the host response. 5. A familial aggregation of diseased individuals

CLASSIFICATION Aggressive periodontitis localized Generalized

Localized Ag.P Clinical features: 1. previously known as Juvenile periodontitis (LJP)\ early-onset periodontitis. 2. Onset of the disease around the time of puberty ( 20 years old). 3. Localized attachment loss involving the first molar and incisors and involving no more than two teeth other than first molars and incisors ( less than 30%). 4. Female more than male. 5. Black more than white. 6. Self arresting disease progression.

Localized Ag.P 8- Progress rapidly ; rate of bone loss is 3-4 times faster than that of chronic periodontitis. Increase mobility of first molar. 9- The amount of plaque on the affected teeth is minimal which seems to be inconsistent with amount of periodontal destruction.

Radiographic features: Localized Vertical bone loss around the first molar and incisors ( arc-shape) beginning around puberty in otherwise healthy teenagers. Destruction starting from the distal margin of the second premolar and extending to the mesial margin of the second molar.

clinically Earliest sign: drifting of teeth in a patient having a good oral hygiene. The effect teeth becomes mobile followed by pocket formation. Maxillary incisors migrate in distolingual direction. Deep dull, radiating pain may occur with mastication ( irritation of the supporting tissue). Periodontal abscess formation. Sensitive root surface.

Generalized Ag.P Clinical features: 1. Previously known as generalized 2. juvenile periodontitis GJP \ rapidly progressive periodontitis 3. Onset occurs in persons younger than 30 years but my be older. 4. Generalized interproximal attachment loss ( < 30%) affecting at least three permanent teeth other than first molars and incisors. 5. Associated with A. a. 6. Patient often have small amount of bacterial plaque associated with the affected teeth.

Clinically : The gingival tissues may be inflamed, ulcerative, firmly red or may be loss affecting the majority of the teeth. Bleeding may occur spontaneously or with slight stimulation. Some patients with GAP may have systemic manifestations, such as weight loss, mental depression, and general malaise.

Radiographic appearance: Sever bone loss associated with minimal of teeth to advanced bone loss affecting the majority of the teeth.

Treatment : 1. Early diagnosis aids in successful treatment. 2. Extraction involved teeth ( depend on severity of tissue loss). 3. Antibiotics : tetracycline is the drug of choice 1 g/day for 14 days) Or tetracycline + metronidazole Or doxycycline. 4- periodontal therapy: scaling, root planning, OHI, surgery, subgingival irrigation, bone graft. Follow up 1-6 months then every 3 months.