Aggressive periodontitis
Encyclopedia
Aggressive periodontitis describes a type of periodontal disease
and includes two of the seven classifications of periodontitis:
Aggressive periodontitis is much less common than chronic periodontitis
and generally affects younger patients than does the chronic form.
The localized and generalized forms are not merely different in extent; they differ in etiology and pathogenesis.
, primary features that are common to both LAP and GAP are as follows:
The first feature mentioned is to say that patients may not exhibit any disorder that predisposes one to another form of periodontitis.
Moreover, aggressive periodontitis often presents with the following secondary features:
Severity of periodontal tissue destruction is subclassified in the same fashion as is chronic periodontitis
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s.
Several studies suggest that these types of cases respond best to a combination of surgical debridement and antibiotics. Regenerative therapy with bone grafting procedures are often selected in these cases due to the favorable morphology of the bony defects which result from the disease.
Periodontal disease
Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...
and includes two of the seven classifications of periodontitis:
- Localized aggressive periodontitis (LAP)
- Generalized aggressive periodontitis (GAP)
Aggressive periodontitis is much less common than chronic periodontitis
Chronic periodontitis
Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by accumulation of profuse amounts of dental plaque.-Diagnosis:...
and generally affects younger patients than does the chronic form.
The localized and generalized forms are not merely different in extent; they differ in etiology and pathogenesis.
Characteristics
In contrast to chronic periodontitisChronic periodontitis
Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by accumulation of profuse amounts of dental plaque.-Diagnosis:...
, primary features that are common to both LAP and GAP are as follows:
- except for the presence of periodontal diseasePeriodontal diseasePeriodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...
, patients are otherwise healthy - rapid loss of attachmentPeriodontal ligamentThe periodontal fiber or periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits...
and bone destruction - familial aggregation
The first feature mentioned is to say that patients may not exhibit any disorder that predisposes one to another form of periodontitis.
Moreover, aggressive periodontitis often presents with the following secondary features:
- Amounts of microbial depositsDental plaqueDental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...
are inconsistent with the severity of the periodontal tissuePeriodontiumPeriodontium refers to the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms peri-, meaning "around" and -odons, meaning "tooth." Literally taken, it means that which is "around the tooth"...
destruction - elevated proportions of Aggregatibacter actinomycetemcomitansAggregatibacter actinomycetemcomitansAggregatibacter actinomycetemcomitans is an oral commensal found also in severe infections in the oral cavity, mainly the periodontium. A. actinomycetemcomitans, previously Actinobacillus actinomycetemcomitans, is a gram negative facultative non-motile rod. It is also associated with non-oral...
, and in some cases, of Porphyromonas gingivalisPorphyromonas gingivalisPorphyromonas gingivalis belongs to the phylum Bacteroidetes and is a non-motile, gram-negative, rod-shaped, anaerobic pathogenic bacterium. It forms black colonies on blood agar....
as well - phagocytePhagocytePhagocytes are the white blood cells that protect the body by ingesting harmful foreign particles, bacteria, and dead or dying cells. Their name comes from the Greek phagein, "to eat" or "devour", and "-cyte", the suffix in biology denoting "cell", from the Greek kutos, "hollow vessel". They are...
abnormalities - hyperresponsive macrophageMacrophageMacrophages are cells produced by the differentiation of monocytes in tissues. Human macrophages are about in diameter. Monocytes and macrophages are phagocytes. Macrophages function in both non-specific defense as well as help initiate specific defense mechanisms of vertebrate animals...
phenotypePhenotypeA phenotype is an organism's observable characteristics or traits: such as its morphology, development, biochemical or physiological properties, behavior, and products of behavior...
, including elevated levels of prostaglandin E2 (PGE2) and interleukin 1βIL1BInterleukin-1 beta also known as catabolin, is a cytokine protein that in humans is encoded by the IL1B gene. IL-1β precursor is cleaved by caspase 1 . Cytosolic thiol protease cleaves the product to form mature IL-1β.- Function :Interleukin 1 was discovered by Gery in 1972... - progression of pathogenesisPathogenesisThe pathogenesis of a disease is the mechanism by which the disease is caused. The term can also be used to describe the origin and development of the disease and whether it is acute, chronic or recurrent...
may be self limiting
Localized vs. generalized forms of aggressive periodontitis
The 1999 Consensus Report published by the American Academy of Periodontology permitted the subdivision of aggressive periodontal disease into localized and generalized forms based on enough individually specific features, as follows:- Localized aggressive periodontitis
- circumpubertalPubertyPuberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...
onset - robust serum antibodyAntibodyAn antibody, also known as an immunoglobulin, is a large Y-shaped protein used by the immune system to identify and neutralize foreign objects such as bacteria and viruses. The antibody recognizes a unique part of the foreign target, termed an antigen...
response to infective agentPathogenA pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...
s: the dominant serotype antibody is IgG2 - localized first molarMolar (tooth)Molars are the rearmost and most complicated kind of tooth in most mammals. In many mammals they grind food; hence the Latin name mola, "millstone"....
/incisorIncisorIncisors are the first kind of tooth in heterodont mammals. They are located in the premaxilla above and mandible below.-Function:...
presentation
- circumpubertal
- Generalized aggressive periodontitis
- usually affects patients under 30 years of age
- poor serum antibody response to infective agents
- pronounced episodic nature of periodontal destruction
- generalized presentation affecting at least 3 permanent teeth other than first molars and incisors
Severity of periodontal tissue destruction is subclassified in the same fashion as is chronic periodontitis
Chronic periodontitis
Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by accumulation of profuse amounts of dental plaque.-Diagnosis:...
.
Treatment
Treatment generally involves mechanical therapy (non-surgical or surgical debridement) in conjunction with antibioticAntibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s.
Several studies suggest that these types of cases respond best to a combination of surgical debridement and antibiotics. Regenerative therapy with bone grafting procedures are often selected in these cases due to the favorable morphology of the bony defects which result from the disease.