Aggressive+Periodontitis

= Case #5 - Aggressive Periodontitis =

Age: 20 Ethnicity: African American No x-rays
 * Medical History**

MBI: 38% BOP: 32% Probing depths: generalized 2-4 mm with localized 5-7mm Recession: Please see perio chart. Attachment level: Please see perio chart. Fremitus: + on 6-10 Mobility: Please see perio chart. Salivary flow: Adequate
 * Assessment Findings**

Aggressive periodontitis is a distinct type of periodontitis that affects people who, in most cases, otherwise appear healthy. It tends to have a genetic connection, and there is a rapid rate of disease progression. The exact etiology of aggressive periodontitis is unknown. Aggressive periodontitis occurs in localized and generalized forms.


 * Localized aggressive periodontitis** usually has a pubertal onset with periodontal damage being localized to permanent first molars and incisors. However, atypical patterns of affected teeth are possible. The disease is frequently associated with the periodontal pathogen //Actinobacillus actinomycetemcomitans// and neutrophil function abnormalities. A robust serum antibody response to infecting agents is frequently detected.


 * Generalized aggressive periodontitis** (GAgP) usually affects people under 30 years of age, but patients may be older. There is generalized interproximal attachment loss affecting at least 3 permanent teeth other than the first molars and incisors. Attachment loss occurs in pronounced episodic periods of destruction. The disease is frequently associated with the periodontal pathogens //Actinobacillus actinomycetemcomitans// and //Porphyromonas gingivalis// and neutrophil function abnormalities. A poor serum antibody response to infecting agents is frequently detected. Patients with GAgP also present neutrophils with suppressed chemotaxis which suggest a linkagebetween LAgP and GAgP. An individual with no GAgP ha an antibody response (IgG) to //A. actinomycetemcomitants. //However, a patient with GAgP has a significant less amount of antibodies to //A. actinomycetemcomitans//, and severe GAgP lacks this antibody. High levels of IgG2 in serum increases periodontal disease, and African Americans have high levels of IgG2, which explains the high prevalence among this population. Some smokers also present high levels of this antibody caused by the carcinogens in the cigarettes, which explains the severe bone defects on the palate of these patients.

1. low amounts of microbial deposits, clinical inflammation, and plaque are inconsistent with the severity of periodontal tissue destruction and 2. the progression of attachment and bone loss may be self-arresting
 * //Clinical Features//**

The rate of bone loss occurs at a rate of about three to four times faster than in chronic periodontitis. Other characteristics include increased mobility, attachment loss, and distolabial migration of the maxillary incisors.

With a combination of professional treatment therapies and aggressive at-home oral hygiene, aggressive periodontitis can be controlled. When left untreated, aggressive periodontitis can lead to tooth loss and further destruction of the alveolar bone.

Free: Generalized pigmented with localized erythematous on lower anteriors; generalized scalloped with localized blunting, bulbous, and rolled; generalized firm with localized edematous, flaccid, and spongy; generalized smooth with localized glossy and shiny. Attached: Generalized pigmented with localized erythematous; generalized firmly bound down to underlying bone with localized edema; and generalized stippled with localized loss of stippling on lower anteriors (shiny).
 * Gingival Description**

RCC calculus code: lt/med ADA: generalized III, localized IV AAP: generalized moderate chronic periodontitis with localized aggressive periodontitis modified by genetic factors.


 * OHI Consideration**

First and foremost, educate the patient about the disease, oral risk factors of the disease, and the importance of the patient’s role in the success of treatment. Educate the family members and recommend that younger siblings be examined and monitored closely.

Review brushing with Bass technique 3X a day Review flossing in a C-shape technique 2X a day Daily fluoride rinse Antibiotic therapy: Metronidazole-amoxicillin

Appt 1: RMH, assessments, FMX, and DDS exam Appt 2: 2nd check in, PI, and OHI (Spend extra time on OHI) Appt 3: Full mouth scale and fluoride tx. Appt 4: 3-month recare
 * Treatment Plan**

Because aggressive periodontitis was detected early, the prognosis is fair. With localized aggressive periodontitis, if detected early, the progression of bone loss can be ceased.
 * Prognosis**

Questions
1. All of the following are contributing factors to aggressive periodontitis EXCEPT: a. Colonization of //A. actinomycetemcomitans// b. Persons with African backgrounds c. Lack of oral hygiene d. Defective neutrophil function

2. Which of the following antibiotics would NOT be used as therapy for aggressive periodontitis? a. Tetracycline b. Cefazolin c. Amoxicillin d. Metronidazole

3. Papillon-Lefevre syndrome (PLS) is often associated with aggressive periodontitis. PLS only affects the permanent dentition. a. The first statement is TRUE; the second statement is FALSE. b. The first statement is FALSE; the second statement is TRUE. c. Both statements are TRUE. d. Both statements are FALSE.

4. The prognosis of a patient with early diagnosis of aggressive periodontitis, proper oral hygiene, and antibiotic therapy is: a. Excellent b. Good c. Fair d. Poor e. Hopeless

5. Dental implants should not be used in patients with aggressive periodontitis. As a rule, only removable prostheses should be used on these patients. a. The first statement is TRUE; the second statement is FALSE. b. The first statement is FALSE; the second statement is TRUE. c. Both statements are TRUE. d. Both statements are FALSE.

6. Aggressive periodontitis was formerly known as: a. late-onset periodontitis b. adult-form periodontitis c. early-onset periodontitis d. surgical periodontitis

7. Which of the following factors DOES NOT distinguish aggressive periodontitis from chronic periodontitis? a. age of onset b. rapid rate of disease progression c. alterations in the host’s immune response d. familial aggression e. none of the above

8. Generalized aggressive periodontitis rarely undergoes spontaneous remission. Localized aggressive periodontitis has been known to arrest spontaneously. a. The first statement is TRUE; the second statement is FALSE. b. The first statement is FALSE; the second statement is TRUE. c. Both statements are TRUE. d. Both statements are FALSE.

9. Compared to patients with localized aggressive periodontitis, patients with generalized aggressive periodontitis have: a. a better prognosis b. a poorer prognosis c. the same prognosis

10. All of the following are factors related to //A. actinomycetemcomitans'// virulence EXCEPT: a. low levels of leukotoxin produced b. production of collagenase c. invasion of host tissue cells d. immunosuppression e. destruction of periodontal tissues

Answer Page