Aggressive Periodontitis

Question 1

What are four important features of aggressive periodontitis?

Answer 1

• Patient is otherwise HEALTHY clinically
• Characteristic RAPID bone and attachment loss
• INCONSISTENCY with plaque and calculus
• FAMILIAL aggregation

Question 2

What are the two sub-classifications of Aggressive Periodontitis?

Answer 2

Localized Aggressive

Generalized Aggressive

Question 3

LAP most frequently occurs in patients between _____ and _____ years old.

Answer 3

puberty–>20 years old

Question 4

GAP affects patients under the age of _______ but may occur in older patients also.

Answer 4

30

Question 5

In localized aggressive periodontitis, at least ______ _____ must be affected and no more than two teeth other than _____ and _____.

Answer 5

at least one first molar

no more than 2 other teeth besides molars/incisors

Question 6

In GAP, there must be at least _____ permanent teeth other than ______ and ______ that are affected.

Answer 6

at least 3 teeth other than first molars and incisors

Question 7

Which form of aggressive periodontitis (LAP or GAP) is characterized by a robust serum antibody response?

Answer 7

LAP = serum antibody response

Question 8

True or False: GAP has a moderate serum antibody response.

Answer 8

False…POOR serum antibody response

Question 9

Which form of aggressive periodontitis is characterized by intense gingival inflammation and which has relatively less gingival inflammation?

Answer 9

Intense inflammation: GAP (“inflammation causes gaps”)

Less inflammation: LAP

Question 10

True or False: Localized Aggressive Periodontitis is characterized by episodic destruction of attachment and bone.

Answer 10

False, GAP has episodic nature

Question 11

How do you determine rate of bone loss?

Answer 11

Comparison of serial radiographs (aggressive is 3-4 times faster than chronic)

Question 12

True or False: Prevalence of Aggressive Periodontitis in the primary dentition is 0.9% to 4.5%

Answer 12

True

Question 13

True or False: Prevalence of Aggressive Periodontitis in the United States is 5%

Answer 13

False, below 1% in the U.S.

Question 14

True or False: Both types of Aggressive Periodontitis are more prevalent among African Americans (2.6%)

Answer 14

True

Question 15

There is a direct link between ______ ______ microbes and localized aggressive periodontitis.

Answer 15

A.a

Question 16

A.a and, more particularly, the _____ clone or serotype ____ is highly associated with LAP.

Answer 16

JP2 clone  (high in African American populations)
serotype B

Question 17

True or False: A.a is motile.

Answer 17

False

Question 18

True or False: A.a in anaerobic.

Answer 18

False, it’s a facultative anaerobe

Question 19

What are the 4 virulence factors associated with A.a?

Answer 19

1. Leukotoxins
2. LPS
3. Collagenase
4. Immunosuppressive Factors

Question 20

A.a will translocate across the _____ and invade the _____.

Answer 20

junctional epithelium

connective tissue

Question 21

What is the action of leukotoxin?

Answer 21

kills PMNs and macrophages

Question 22

Which two host responses are suppressed by A.a’s immunosuppressive factors?

Answer 22

Lymphocytes

Chemotaxis

Question 23

P.gingivalis is a gram___ microbe that is ______ and _______. P.gingivalis is associated with _____ aggressive periodontitis.

Answer 23

negative
anaerobic
nonmotile
generalized

Question 24

What are the three virulence factors associated with P.gingivalis?

Answer 24

1. Proteinase (gingipains and collagenase)
2. LPS (activates PGs, TNFalpha, and IL-1beta)
3. Inhibition of IL-8 (decreases chemotaxis of PMNs)

=inhibition of host responses

Question 25

True or False: LAP is most likely a genetic polymorphism.

Answer 25

True

Question 26

What is the proposed inheritance mode for LAP?

Answer 26

autosomal dominant

Question 27

There are significantly higher levels of _______ in gingival crevicular fluid in patients with LAP

Answer 27

prostaglandin E2

Question 28

True or False: There are high titers and high avidity of IgA in localized aggressive periodontitis.

Answer 28

False, high titers of IgG2

Question 29

True or False: GAP patients have high levels of antibodies against P.gingivalis.

Answer 29

False, LOW levels of antibodies against P.g

Question 30

LAP is associated with impaired ______ function.

Answer 30

neutrophil

Question 31

Diagnosing AP: If there is high A.a? If there is high P.g?

Answer 31

``` A.a = LAP P.g = GAP ```

Question 32

Diagnosing AP: High crevicular PGE2 levels? High titers of IgG? Low levels of P.g antibody?

Answer 32

high PGE2 = LAP high IgG2 = LAP low P.g Ab = GAP

Question 33

Levels of antibody against A.a are higher in ______ than in blood.

Answer 33

sulcular fluid > peripheral blood

Question 34

What are the two antibiotic cocktails that are prescribed for aggressive periodontitis?

Answer 34

Amoxicillin + Metranidazole (500mg 3x per day) | Ciprofloxacin + Metranidazole

Question 35

Metranidazole is effective against ______ but not _____ when used on its own.

Answer 35

* P.g | (not) A.a