CSA Aggressive PERIO Flashcards
What are features of aggressive perio ?
o Rapid attachment loss & bone destruction occurs
o Familial aggregation occurs
What forms of aggressive perio are there?
localised and generalised
What are secondary features of aggressive perio ?
- Less plaque than amount of periodontal damage reported
- tissue destruction
- Elevated levels of (A. a) & P. Gingivalis
• Phagocyte abnormalities
• Hyper-responsive macrophage phenotype, elevated levels of PGE2 & IL-1 (cytokines)
• attachment & bone loss may be self-arresting
What are specific features of localised aggressive periodontitis ?
- Onset around puberty
- Robust serum antibody response to infecting agent (A. a)
- Localised to 1st molar/incisor presentation
What is interproximal attachment loss like on localised aggressive perio?
on 2 permanent teeth,
1st molar & involving no more than 2 other teeth other than first molars/incisors
What are specific features of generalised aggressive perio ?
- affects <30s, be older
- Poor serum antibody response to infecting agents (A. a & P. Gingivalis)
- episodic nature of destruction of attachment/ alveolar bone
- Generalised interproximal attachment loss affecting 3 teeth other than 1st molars & incisors
What clinical features differentiate aggressive perio to chronic ?
o Age of onset, rate pf progression, pattern of destruction, signs of inflammation, relative amounts of plaque & calculus
What are host responses to aggressive perio ?
- Saliva
- Epithelium
- Inflammatory response (important role of neutrophils I.e. PMNs & macrophages)
- Immune response (humoral & cell mediated)
- Mediators
What is the most common first line of defence to aggressive perio ?
Neutrophils, PMNS
What can happen to PMNS in aggressive perio ?
- decreased PMN chemotaxis (migration) to infecting agents
- impaired phagocytosis & killing
What are PMN abnormalities in localised form ?
o may cluster in families of patients
o can be due to hyper-inflammatory state in presence of cytokines
What is the aggressive perio host response through antibodies ?
- Mainly IgG produced & less IgA
- localised form = high titres & high avidity of A. a
- generalised form decreased ability to high titres of IgG to P. Gingivalis & A. a
What is cell mediated response to aggressive perio ?
• Depressed T-helper to T-suppressor ratio
- altered local immune regulation
What is mediators host response to aggressive perio ?
- Higher levels of PGE2 in GCF than other periodontium of healthy patients
- Monocytes respond very high levels of local release of inflammatory mediators
- Monocytes induce hyper-inflammatory reaction w/ activation of tissue degrading metalloproteinases
What are risk factors for aggressive perio ?
• Smoking for generalised forms
o had more affected teeth & greater levels of attachment loss
o Perhaps antibodies against A. a depressed in smokers
What is microbiology of localised aggressive perio ?
•A. a is key organism;
o studies where A. a isolated in lesions from >90% of patients
o virulence factors from A. a
o Increased immune responses to A. a
o Levels of A. a decreased after successful therapy
what is Aggerogatibacter actinomycetemcomitans:
short faculatively anaerobic, non-motile, gram negative rod w/ 5 serotypes a-e
- Serotype b most commonly found in localised form
What are virulence factors of Aggerogatibacter actinomycetemcomitans:
o Endotoxin (LPS) – Activates host to secrete mediators
o Bacteriocin – inhibits growth of any beneficial species
o Immunosuppressive factors to IgG & IgM
o Collagenases
o Chemotactic inhibition factors – work against neutrophils
What are stages of bacterial pathogenicity ?
1) attachment to host tissue
2) Multiplication
3) evasion of host defences
4) Penetration of tissues
5) Tissue destruction
What are key organisms associated with generalised aggressive perio ?
o Aggerogatibacter actinomycetemcomitans
o Porphyromonas Gingivalis
o Tanerella forsythia (Bacteroides forsythus has also been cited)
o Higher levels of Selenomonas spp. & Treponema lecithinolyticum in preliminary studies
What is aggressive perio. genetics?
- Genetic predisposition determined by single gene of major effect (linkage analysis) inherited as autosomal dominant trait (segregation analysis)
What is JP2 Clone of A.a ?
important aetiological agent in initiation of periodontal attachment loss in children and adolescents
What is simplified BPE?
index teeth: in younger age group
o UR6, UR1, UL6, LR6, LL1, LL6
What is diagnosis of aggressive perio ?
o BPE for initial screening
o appropriate perio indices & monitor (if indices of 4’s)
o radiographs where indicated/justified
