Agressive Periodontitis 10/22/15

Question 1

What are the 2 major types of Periodontitis?

Answer 1

• Chronic and Agressive

Question 2

What are common features of Aggressive Periodontitis?

Answer 2

• Otherwise health patient
• Characterized by RAPID bone and attachment loss (inconsistent with plaque and Calculus)
• Familial Aggregation (Genetic)

Question 3

What are the 2 sub Classifications of A. Periodontitis?

Answer 3

• GAP (Generalized)

- LAP (Localized)

Question 4

Tell me about LAP…

Answer 4

• Most frequent btw puberty and 20yrs old
• Pattern = Localized CAL in the first molars/incisors (at least 1 molar MUST be affected)
• Distribution = No more than 2 teeth other than 1st molars affected.
• Robust serum antibody response
• Relatively less intense gingival inflammation

Question 5

Tell me about GAP…

Answer 5

• Affects individuals under the age of 30 (also older patients)
• Distribution = at least 3 permeant teeth other than 1st molars and incisors.
• Pronounced episodic nature of destruction of attachment/bone.
• Relatively intense gingival inflammation.

Question 6

What is the Prevalence of A. Periodontitis in Primary dentition?

Answer 6

• Few studies in 5-11 yr-olds

- Prevalence reported between 0.9% and 4.5%

Question 7

What is the prevalence of A.Periodontitis in Permanent dentition?

Answer 7

• estimates = less than 1% for U.S

- around 2.6 for African americans.

Question 8

________ is found to be distributed throughout 89-100% of patients with LAP.

Answer 8

A. Actinomycetemcomitans (A.a)

*So yes, A.a is associated with LAP.

Question 9

What are the characteristics and virulence factors for P. Gingivalis?

Answer 9

• Anaerobic
• Nonmotile
  Virulence factors:
• Proteinases = Gingipains and Collagenases
• LPS: activates cells to produce PG’s IL-1B and TNF-alpha
  Inhibits IL-8 (chemotactic factor) = decreased chemotaxis of PMN’s.

Question 10

What are the Characteristics and Virulence Factors of A.a?

Answer 10

• Facultative Anaerobe
• Non-motile
  Virulence factors:
• Leukotoxins = kills PMN’s
• LPS: activates cells to produce PG’s (IL-B1 and TNF-A)
• Collagenases = degrade collagen
• Immunosuppressive factors
  *Can translocate across the JE and invade CE.

Question 11

What is the Proposed inheritance model for LAP?

Answer 11

Autosomal dominant

Question 12

What is the Host response to LAP?

Answer 12

• Impaired Neutrophil function (know this one!)
• Significantly higher levels of Prostaglandins in E2 and in GCF.
• High titers and High avidity of IgG2 in LAP
• Low levels of Ab against P.g in GAP Patients

Question 13

Is Smoking a risk factor in GAP?

Answer 13

Yes, it increases extent and severity. Also have poorer response to clinical treatment.

Question 14

What questions should you ask when trying to diagnose AP?

Answer 14

Are Crevicular Prostaglandin E2 levels increased? Yes = AP

Are there high titers of IgG2 against A.a? yes = AP

Question 15

What is the Treatment for Periodontitis?

Answer 15

Full Mouth SRP in adjust with systemic antibiotics
Amoxicillin + Metronidazole
or Ciprofloxacin + Metronidazole
*Possible Periodontal surgery