Causes and Treatment of Aggressive Periodontitis

Periodontitis is defined as an inflammatory disease of supporting tissue of the teeth caused by specific microorganisms or group of microorganisms resulting in progressive destruction of periodontal ligament and alveolar bone with periodontal pocket formation, gum recession or both. Chronic periodontitis, aggressive periodontitis, refractory periodontitis, acute necrotizing periodontitis are various types of periodontitis. Aggressive periodontitis is characterized by rapid loss of attachment and bone loss in clinically healthy patient and the amount of microbial deposits are inconsistent with diseases severity and familial aggregation of diseased individuals. Aggressive periodontitis was earlier called as early onset periodontitis or juvenile periodontitis. Aggressive periodontitis are further of 2 types: Localized aggressive periodontitis and generalized aggressive periodontitis.

 Difference between Chronic and Aggressive Periodontitis

Aggressive periodontitis can be universally distinguished from Chronic periodontitis by age of onset, rate of disease progression, nature and composition of associated bacteria (subgingival microflora), alteration in host immune response and familial aggregation of diseased individual. Age of onset of chronic periodontitis is 30-35 years of age whereas aggressive periodontitis mostly occurs between puberty and 20 years of age. Rate of disease progression is faster in aggressive periodontitis as compared to chronic periodontitis. Familial aggregation of diseased individual and alteration in host immune response is seen in aggressive periodontitis. Chronic periodontitis is more common than aggressive periodontitis.   

          

                   Chronic Periodontitis                    Generalized Aggressive Periodontitis

Causes of Aggressive Periodontitis

Super infection of small amount of bacterial deposits with specific, virulent periodontal bacteria can lead to aggressive periodontitis. Main bacteria in Aggressive periodontitis are A.actinomycetemcomitans and Capnocytophaga. Impaired host response is also responsible for aggressive periodontitis.

Types of Aggressive Periodontitis

Aggressive periodontitis is of 2 types:

Localized Aggressive Periodontitis or Localized Juvenile Periodontitis

It is a disease occurring in otherwise healthy individual with destructive periodontitis which is localized to first permanent molars and incisors not involving more than two other teeth.

Clinical features of Localized Aggressive Periodontitis

1.    Age predisposition: Aggressive periodontitis is commonly seen in individuals between puberty and 20 years of age.
Certain studies have shown that aggressive periodontitis is more common in females as compared to males.
2.    Site:  Aggressive periodontitis is mostly seen in relation to first molar and or incisors. In some cases, generalized involvement is seen.

Localized Aggressive Periodontitis

Signs and Symptoms of Localized Aggressive Periodontitis

  1. Rapid attachment loss and bone destruction occurs in otherwise clinically healthy patient. Severe and rapid periodontal destruction occurs in aggressive periodontitis.
  2. A deep periodontal pocket occurs in case of aggressive periodontitis.
  3. Small amount of plaque forms on tooth and rarely mineralizes to become calculus.
  4. Most common initial symptom in case of aggressive periodontitis is mobility and migration of first molars and incisors.
  5. With progression of disease, root surface sensitivity, deep dull radiating pain, periodontal abscess formation and regional lymph node enlargement may also occur.

X-ray findings in Localized Aggressive Periodontitis

Vertical or angular bone loss is seen around first molars and incisors in x-rays in case of aggressive periodontitis. Bone loss will appear as arc shaped loss.
 

Localized Aggressive Periodontitis Bacteria  

Two main bacteria which cause localized aggressive periodontitis are A.actinomycetemcomitans and Capnocytophaga. These bacteria produce various virulence factors such as leukotoxin, Endotoxin, Bacteriocin, Collagenase and Chemotactic inhibition factors.

Generalized Aggressive Periodontitis or Generalized Juvenile Periodontitis

It is destructive periodontitis and affects more than 14 teeth, that is generalized to an arch or an entire dentition.  

Clinical features of Generalized Aggressive Periodontitis

  1. Age predisposition: It mainly affects people between puberty and 35 years.
  2. Site: No specific pattern is observed. All or most of teeth are affected in Generalized Aggressive periodontitis.

Signs and Symptoms of Generalized Aggressive Periodontitis

  1. Gum response may appear as acute inflamed proliferating, ulcerated tissue and spontaneous suppuration and bleeding is seen. In some patients, gums appear pink and little or no swelling occurs on gums with deep pockets on probing.  
  2. Some of the systemic manifestations like weight loss, mental depression and general malaise are also seen.

X-ray findings in Generalized Aggressive Periodontitis

Bone loss occurs involving lesser number of teeth to more number of teeth occurs in aggressive periodontitis.

Generalized Aggressive Periodontitis Bacteria

Bacteria involved in generalized aggressive periodontitis are A.actinomycetemcomitans, Capnocytophaga, Mycoplasma subspecies and Spirochetes.   

Treatment of Aggressive Periodontitis

Prognosis is not that good in case of aggressive periodontitis. Early detection of disease is important in aggressive periodontitis and patient should be educated about the disease and success of treatment. Non-surgical or surgical debridement is done along with antimicrobial therapy. Antibiotics are also given to patient to treat the infection. If patient comes at early stage, then the outcome of treatment is better. Standard periodontal therapy which includes scaling and root planning (SCRP), curettage, flap surgery with or without bone grafts, root amputation, hemisection, plaque control is used.  In case of moderate to advanced attachment loss, tooth extraction may be required. After microbial testing, antibiotics are given to the patient. Augment, Clindamycin, Ciprofloxacin, Metronidazole, Tetracycline are given to the patient after microbial testing.

Periodontal Maintenance

After treatment, patient should maintain good oral hygiene. Patient should brush twice regularly to remove the plaque deposits and should floss daily to remove the deposits which are present interdentally. Mouth wash can also be used by patient to reduce the microflora of oral cavity and patient should get regular dental check up done. 

 

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