Aggressive Periodontitis

Dr. Reem Abdel-Hafez BDSc,MFDS,DClinDent(perio), FRACDS(perio)

Progression of Periodontal Disease

Aggressive Chronic

Attachment or Bone Loss

Normal

Age

Aggressive Periodontitis

Comprises a group of rare, often severe, rapidly progressive forms of periodontitis characterised by rapid rate of progression and a distinctive tendency for cases to aggregate in families Highly virulent flora or a high level of subject susceptibility to periodontal disease

Previous Classification
Prepubertal Periodontitis (PPP) Localised Juvenile Periodontitis Localised Early-onset Periodontitis Generalised Juvenile Periodontitis & Rapidly Progressive Periodontitis Generalised Early-onset Periodontitis

Now all called Aggressive Periodontitis

Problems with old classification

Systemic diseases predisposing to Prepubertal periodontitis. Overlap between different disease entities. Too much dependance on age.

Thus changed to the simpler more general term of Aggressive Periodontitis

AAP consensus report 2000Primary features

Except for the presence of periodontitis, patients are otherwise clinically healthy. Rapid attachment loss and bone destruction. Familial aggregation.

AAP consensus report 2000Secondary features

Amounts of microbial deposits are inconsistent with the severity of periodontal tissue destruction; Elevated proportions of Actinobacillus actinomycetemcomitans and, in some Far East populations, Porphyromonas gingivalis may be elevated; Phagocyte abnormalities; Hyper-responsive macrophage phenotype, including elevated levels of PGE2 and IL-1b in response to bacterial endotoxins; Progression of attachment loss and bone loss may be self-arresting.

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.

Generalized Aggressive Periodontitis

Usually affecting persons under 30 years of age, but patients may be older; Poor serum antibody response to infecting agents; Pronounced episodic nature of the destruction of attachment and alveolar bone; Generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors.

Host Response

Defective chemotactic response in neutrophils Hyper-inflammatory state resulting in the presence of pro-inflammatory cytokines in the serum. Phagocyte and macrophage abnormalities are minor in the sense that they are usually not associated with infections other than periodontitis.

Prevalence of Aggressive Periodontitis

Saxby (1987):West Midlands of England : Overall prevalence of LJP was 0.1%. 6.8% incidence in Afro-Caribbean, 0.2% Asian, 0.02% Caucasian Saxen (1980):large-scale study of Finnish 16 year olds, prevalence to be 0.1%. Kronaeur et al. (1986), Prevalence of 0.1%. US school children by Loe and Brown (1991): 0.53% have LJP 0.13% had GJP; Blacks having the greatest amount of diseases, followed by Hispanics and finally Caucasians

Clinical Management of Aggressive Periodontitis

-Patient education. -Oral hygiene instructions and reinforcement. -Scaling and root planing and control of local factors. -A general medical evaluation may determine if systemic disease is present in children and young adults.

Adjunctive antimicrobial therapy combined with scaling and root plaining with or without surgical therapy. Examples of antibiotics: Tetracyclins(avoid in children), metronidazole+ amoxycillin,azithromycin. -Evaluation and counseling of family members.

Clinical cases of aggressive periodontitis!

16 year old boy of Vietnamese background

Photos courtesy of Dr B Sethi

THANK YOU

Many thanks to Dr. Ivan Darby