Aggressive Periodontitis 52223

DD 41 TAK RANUCH NGET RATTANA

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Content Introduction Classification Genetic Diagnosis Treatment Reference

Introduction Periodontitis is the inflammation of the

periodontium which comprise of tissues ing the teeth in the oral cavity. Early onset periodontitis was the previous classification of aggressive periodontitis.

Anatomy of the Periodontium

Classification of Aggressive Periodontitis Localized aggressive periodontitis (LAP) Generalized aggressive periodontitis (GAP)

Changes in junctional epithelium

Proliferates along the root surface (finger – like projections)

Coronal portion detaches form the root

Due to bacterial enzymes and physical forces exerted by them

Apical portion of junctional epithelium migrates

Replaced by pocket epithelium

Localized Aggressive Periodontitis First molar and/ or incisors Low clinical inflammation Poor inflammatory response Mobility and migration of first molar and

incisors most common on the maxillary (Diastema).

Neutrophils

Chemotatic Factor

Macrophage

-Lysosomal enzymes collagenase - PE2

MatrixMetaloProteina se

Localized Aggressive Periodontitis Symptom of LAP Root surface sensitivity Deep dull radiating pain Periodontal abscess formation Regional lymph node enlargement. Patient serum is be found Ig G2. The high risks of LAP is seen mostly between

puberty and 20 year of age. (Female)

Localized Aggressive Periodontitis Aetiology of LAP Plaque (primary): A. actinomycetemcomitans (Aggregatibacter BDJ), P. gingivalis, P. intermidia. Diabetes Trauma occlusion Ig G2 type which is specific to antigens of

A. actinomycetemcomitans.

Generalized Aggressive Periodontitis Previously classified as Generalized Juvenile

periodontitis and Rapid Progressive periodontitits. Characterized by generalized interproximal attachment loss affecting at least 3 permanent teeth. Highly inflammatory response Highly bone and attachment loss

Generalized Aggressive Periodontitis Aetiology of GAP Plaque: A. actinomycetemcomitans, P. gingivalis, Baceroids forsuthus. Invading bacteria: Capnocytophaga sputigena, Mycoplasama sub-species and Spirochetes.

Generalized Aggressive Periodontitis Symptom: Acute inflammation tissues Spontaneous bleeding Deep pocket

GAP affects persons between puberty and 35

year old.

Genetic Factors  Many researchers have suggested that, a major

gene play a role in Aggressive periodontal disease, which is transmitted by the autosomal dominant mode of inheritance.  Approximately 75% of LAP has dyfunctional neutrophils. (Chemotatic )  Complement component C5a  Leukotriene B4  40% deficiency in glycoprotein (GP110) on

neutrophil surface.

Diagnosis Clinical diagnosis X – ray Test of mobility Serological test (A. actinomycetecomitans)

Treatment Remove plaque and calculus Extraction Oral hygiene Scaling (mild) Root planning (moderate) Surgery (severe)

Medication Tetracycline hydrochloride 250mg qid at least

a week Doxycyline Chlorhexidine rinse should be prescribed Such case: Amoxicillin + Metronidazole

Reference www.Scribd.com www.Pubmed.com Essential Clinical Periondontology and

Periodontologic (Shantipriya Reddy 2006) Periodontology 10th edition (2008)