LOCALIZED AGGRESSIVE PERIODONTITIS

The term “juvenile periodontitis” was introduced by Chaput and colleagues in 1967 and by Butler in 1969. In 1971, Baer defined it 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.

According to Hart et al. diagnosis of localized early-onset periodontitis is based on 

• attachment loss of > or equal 4 mm on at least two permanent first molars 

and incisors (one of which must be a first permanent molar) 

Not more than two other permanent teeth, which are not first permanent molars or incisors, should be affected 

• Bone loss around primary teeth can be early finding in LAP

Clinical Characteristics

The lack of clinical inflammation despite the presence of deep periodontal pockets and advanced bone loss .

The amount of plaque on the affected teeth is minimal, which seems inconsistent with the amount of periodontal destruction present.The plaque that is present forms a thin biofilm on the teeth and rarely mineralizes to form calculus.

The rate of bone loss is about three to four times faster than in chronic periodontitis.

 Other clinical features of LAP may include (1) distolabial migration of the maxillary incisors with concomitant diastema formation, (2) increasing mobility of the maxillary and mandibular incisors and first molars, (3) sensitivity of denuded root surfaces to thermal and tactile stimuli, and (4) deep, dull, radiating pain during mastication, probably caused by irritation of the supporting structures by mobile teeth and impacted food.

Radiographic Findings

Vertical loss of alveolar bone around the first molars and incisors, beginning around puberty in otherwise healthy teenagers, is a classic diagnostic sign of LAP. Radiographic findings may include an “arcshaped loss of alveolar bone extending from the distal surface of the second premolar to the mesial surface of the second molar”

Prevalence and Distribution by Age
and Gender

LAP affects both males and females and is seen most frequently in the period between puberty and 20 years of age.

RISK FACTORS FOR AGGRESSIVE PERIODONTITIS

Microbiologic Factors

A. actinomycetemcomitans, Capnocytophagaspp., Eikenella corrodens, Prevotella intermedia, and Campylobacter rectus), A. actinomycetemcomitans has been implicated as the primary pathogen associated with LAP.

Immunologic Factors

Some immune defects have been implicated in the pathogenesis of aggressive periodontitis. The human leukocyte antigens (HLAs), which regulate immune responses, have been evaluated as candidate markers for aggressive periodontitis.

Genetic Factors

Familial pattern of alveolar bone loss and have implicated genetic factors in aggressive periodontitis.

Environmental Factors

The amount and duration of smoking are important variables that can influence the extent of destruction seen in young adults.46 Patients with GAP who smoke have more affected teeth and more loss of clinical attachment than nonsmoking patients with GAP.16 However, smoking may not have the same impact on attachment levels in younger patients with LAP.

Treatment

In ps with LAP,

Aa organisms penetrate into crevicular epithelium T/T with antibiotic alone such as 2 week course of doxycycline reduce Aa organisms 

Surgical removal of infected crevicular epithelium and debridement of root surface during surgery while the patient is on a 14 day course of doxycycline hyclate (1gm per day) (Mandell and Sockaransky 1988, Saxen et al 1990). 

Microdentex manufacturers the DMDx(Microdentex, FORT MYERS, Florida) test, a DNA test kit for establisting the risk of aggressive periodontits and confirms whether the child has responded favorably to the use of antimicrobial therapy Retesting after 4-6 weeks after the completion of antibiotic therapy determines the pts response to t/

• Rams and collagues described keyes technique for treating LAP Scaling and root planning of all teeth , with irrigation to probing depth of saturated inorganic salt solutions and 1% chloramine T.((sodium para-toluene sulfonchloramide) In addition recommended administration of systemic tetracycline (18 per day) for 14 days This dose appropriate for pts 12 yrs of age and older 

Home T/T Daily application of paste of sodium bicarbonate and 3% hydrogen peroxide and inorganic salt irrigation.

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 Donalds 9thedition

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