GENERALIZED AGGRESSIVE PERIODONTITIS

The term “juvenile periodontitis” was introduced by Chaput and colleagues in 1967 and by Butler in 1969. In 1971, Baer definedit as “a disease of the periodontium occurring in an otherwise healthy adolescent which is characterized by a rapid loss of alveolar bone about more than one tooth of the permanent dentition.

• Usually affecting persons under 30 years of age (however, may be older).

• Generalized proximal attachment loss affecting at least three teeth other than first molars and incisors.

• Pronounced episodic nature of periodontal destruction. • Poor serum antibody response to infecting agents.

Clinical Characteristics

GAP usually affects individuals under age 30, but older patients also may be affected. In contrast to LAP, evidence suggests that individuals affected with GAP produce a poor antibody response to the pathogens present.

Clinically, GAP is characterized by “gen- eralized interproximal attachment loss affecting at least three per- manent teeth other than first molars and incisors.”The destruction appears to occur episodically, with periods of advanced destruction followed by stages of quiescence of variable length (weeks to months or years). 

P. gingivalis, A. actinomycetemcomitans, and Tannerella forsythia (formerly Bacteroides forsythus) frequently are detected in the plaque that is present.

Two gingival tissue responses can be found in cases of GAP. One is a severe, acutely inflamed tissue, often proliferating, ulcerated, and fiery red. One is a severe, acutely inflamed tissue, often proliferating, ulcerated, and fiery red.

Bleeding may occur spontaneously or with slight stimulation. Suppuration may be an important feature. This tissue response is believed to occur in the destructive stage, in which attachment and bone are actively lost.

Some patients with GAP may have systemic manifestations, such as weight loss, mental depression, and general malaise.

Radiographic Findings

No definite pattern of distribution occurs, The radiographic picture in GAP can range from severe bone loss associated with the minimal number of teeth to advanced bone loss affecting the majority of teeth in the dentition.

Prevalence and Distribution by Age
and Gender

A US national survey of adolescents ages 14 to 17 reported that 0.13% had GAP. In addition, blacks were at much higher risk than whites for all forms of aggressive periodontitis, and male teenagers were more likely to have GAP than female adolescents.

Treatment of aggressive periodontitis 

• Successful treatment of EOP depends on early diagnosis use of antibiotics against the infecting micro organisms and provision of an infection free environment for healing 

• EOP both localized and generalized types includes surgery and use of tetracyclines (Lindhe 1982, Christersson and Zambon 1993) 

T/T of GAP – often less predictable – alternative antibiotics directed to specific pathogenic flora require 

– Multidisplinary approach combines clinical labroartory evaluation with conventional periodontal therapeutic methods for diagnosis and t/t of GAP 

Antibiotic Therapy for Aggressive Periodontitis

Associated MicrofloraAntibiotic of Choice
Gram-positive organismsAmoxicillin–clavulanate potassium (Augmentin)12,72
Gram-negative organismsClindamycin22,23,68,72
Nonoral gram-negative, facultative rodsCiprofloxacin41
Pseudomonads, staphylococci
Black-pigmented bacteria and spirochetesMetronidazole22,65
Prevotella intermedia, Porphyromonas gingivalisTetracycline55
Actinobacillus actinomycetemcomitansMetronidazole-amoxicillin22,65 Metronidazole-ciprofloxacin Tetracycline53
P. gingivalisAzithromycin54

REFERENCE- Caranza textbook of periodontology 11edition and Mc donald 9thed

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