Aggressive Periodontitis

Question 1

What is aggressive periodontitis?

Answer 1

Inflam condition affecting supporting structure of teeth

Question 2

What is needed for a perio party?

Answer 2

Tooth
Bacteria - over 800 species in the mouth
Host response to bacteria

Question 3

What causes the majority of tissue destruction?

Answer 3

80% due to host response

• Genetics
• Stress
• Diet
• Smoking
• Exercise
• Drugs
• Diabetes
• Illness

Question 4

Common features of aggressive periodontitis?

Answer 4

Pts otherwise clinically healthy
Rapid attachment loss and bone destruction
Familial aggregation

2ndry features:

• Microbial deposits not consistent with destruction
• Phagocyte abnormalities
• Hyper-responsive inflam/immune response
• Attachment and bone loss may be self arresting

Question 5

How are genetic polymorphisms risk factors for aggressive periodontitis?

Answer 5

PNM defects = severe PD
LAgP is associated with a PMN defect:
- Chemotaxis
- Phagocytosis
- Bacterial killing
AgP pts have hyper-responsive PMN

Question 6

What is clinical attachment loss?

Answer 6

Recession plus bone loss

Question 7

Aggressive periodontitis features?

Answer 7

Prevalent in adults but may occur in children
Correspond with OH and plaque levels, local predisposing factors, smoking and stress
Host factors determine pathogenesis and progression of the disease
Rate of progression is slow to moderate - periods of rapid tissue destruction may occur
Further periodontal tissue breakdown is likely to occur in diseased sites that are left untreated

Question 8

How to diagnose aggressive periodontitis?

Answer 8

History

• Complaint
• History of complaint
• DH/SH/FH
• Pt motivation for tx

Clinical exam:

• Probing pocket depths
• Plaque index
• Bleeding index
• Recession
• Attachment loss
• Mobility
• Furcation involvement

Additional tests - radiographs, vitality tests

Question 9

Where does the blood come from during probing?

Answer 9

CT

Question 10

Where does bone loss impact in aggressive perio?

Answer 10

Vertical bone loss around 6s and lateral incisors and canines

Question 11

How to give OHI?

Answer 11

Hold and nudge technique with electric toothbrush to remove grainy texture
Brush teeth with mouth shut to allow toothbrush access

Question 12

Why is the diagnosis important?

Answer 12

Medico legal
Early management priority
Tx modality
Early referral

Question 13

What antibiotics are used for aggressive perio disease? When are antibiotics used for perio?

Answer 13

Aggressive disease - amoxicillin 500mg plus metronidazole 400mg TDS 7 days
Azithromycin 500mg once daily 3 days
WITH debridement and homecare
Ideally during 1st cycle of non surgical tx

Question 14

Surgical vs non-surgical tx?

Answer 14

Handinstruments, sonic/ultrasonic scalers both same effectiveness
Ultrasonics faster

Question 15

What factors influence complete calculus removal? - Non-surgical therapy

Answer 15

Extent of disease
Anatomical factors
Skills of the operator
Instruments used

Question 16

Approaches to subgingival infection control? - non-surgical therapy

Answer 16

Quadrant RSD
Single stage full mouth RSD
Same day full mouth RSD

Question 17

Why would non-surgical perio tx fail?

Answer 17

Pt failure

• Poor motivation/cooperation
• Pt circumstances
• Pt med history

Operator failure

• Inappropriate diagnosis
• Inadequate non surgical

Anatomical failure

• Multiple intra-bony defects more than 3mm
• Furcation involvement
• V deep sites
• Difficult anatomy of tooth bone or roots
• Difficult access
• Gingival biotype

Question 18

When is surgical tx suggested?

Answer 18

Aggressive cases need surgery more
Anatomical sites require surgical correction
Aims of surgery depend on clinical situation
- Pocket reduction
- Pocket elimination
- Regeneration

Often require more complex rehab