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CSA periodontology > CSA Aggressive PERIO > Flashcards

CSA Aggressive PERIO Flashcards

1
Q

What are features of aggressive perio ?

A

o Rapid attachment loss & bone destruction occurs

o Familial aggregation occurs

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2
Q

What forms of aggressive perio are there?

A

localised and generalised

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3
Q

What are secondary features of aggressive perio ?

A
  • 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
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4
Q

What are specific features of localised aggressive periodontitis ?

A
  • Onset around puberty
  • Robust serum antibody response to infecting agent (A. a)
  • Localised to 1st molar/incisor presentation
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5
Q

What is interproximal attachment loss like on localised aggressive perio?

A

on 2 permanent teeth,

1st molar & involving no more than 2 other teeth other than first molars/incisors

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6
Q

What are specific features of generalised aggressive perio ?

A
  • 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
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7
Q

What clinical features differentiate aggressive perio to chronic ?

A

o Age of onset, rate pf progression, pattern of destruction, signs of inflammation, relative amounts of plaque & calculus

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8
Q

What are host responses to aggressive perio ?

A
  • Saliva
  • Epithelium
  • Inflammatory response (important role of neutrophils I.e. PMNs & macrophages)
  • Immune response (humoral & cell mediated)
  • Mediators
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9
Q

What is the most common first line of defence to aggressive perio ?

A

Neutrophils, PMNS

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10
Q

What can happen to PMNS in aggressive perio ?

A
  • decreased PMN chemotaxis (migration) to infecting agents

- impaired phagocytosis & killing

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11
Q

What are PMN abnormalities in localised form ?

A

o may cluster in families of patients

o can be due to hyper-inflammatory state in presence of cytokines

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12
Q

What is the aggressive perio host response through antibodies ?

A
  • 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
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13
Q

What is cell mediated response to aggressive perio ?

A

• Depressed T-helper to T-suppressor ratio

- altered local immune regulation

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14
Q

What is mediators host response to aggressive perio ?

A
  • 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
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15
Q

What are risk factors for aggressive perio ?

A

• Smoking for generalised forms
o had more affected teeth & greater levels of attachment loss
o Perhaps antibodies against A. a depressed in smokers

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16
Q

What is microbiology of localised aggressive perio ?

A

•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

17
Q

what is Aggerogatibacter actinomycetemcomitans:

A

short faculatively anaerobic, non-motile, gram negative rod w/ 5 serotypes a-e
- Serotype b most commonly found in localised form

18
Q

What are virulence factors of Aggerogatibacter actinomycetemcomitans:

A

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

19
Q

What are stages of bacterial pathogenicity ?

A

1) attachment to host tissue
2) Multiplication
3) evasion of host defences
4) Penetration of tissues
5) Tissue destruction

20
Q

What are key organisms associated with generalised aggressive perio ?

A

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

21
Q

What is aggressive perio. genetics?

A
  • Genetic predisposition determined by single gene of major effect (linkage analysis) inherited as autosomal dominant trait (segregation analysis)
22
Q

What is JP2 Clone of A.a ?

A

important aetiological agent in initiation of periodontal attachment loss in children and adolescents

23
Q

What is simplified BPE?

A

index teeth: in younger age group

o UR6, UR1, UL6, LR6, LL1, LL6

24
Q

What is diagnosis of aggressive perio ?

A

o BPE for initial screening
o appropriate perio indices & monitor (if indices of 4’s)
o radiographs where indicated/justified

25
Q

What is clinical and radiographic features of localised aggressive perio?

A
  • CAL localised to first molar/incisor presentation
  • Interproximal CAL (typically >3mm) on at least 2 permanent teeth, 1 is first molar and involving no more than 2 teeth other than first molars/incisors
26
Q

What is the amount of plaque not consistent with in local aggressive perio?

A

not consistent w/ amount of periodontal destruction present

27
Q

What are pockets like in localised aggressive perio ?

A

o Deep pockets associated with CAL

o : check out BPE 4 i.e. Probing depths > 6mm

28
Q

What are Ging. Inflamma. like in localised aggressive perio ?

A

o May/ May not be evident

o Subgingival calculus, inflammation and progression of attachment loss are present in variable amounts in each patient

29
Q

What is clinical and radiographic features of localised perio?

A 
• Alveolar bone loss
- Angular defects on incisors 
- Arc shaped bone loss on first molars, 
- vertical bone loss first mesially & distally, arc shaped if furcation involved 
• Onset around puberty
30
Q

What are Clinical & radiographic features of generalised aggressive periodontitis:

A

• (CAL)
o generalised interproximal CAL (typically >3mm) affecting at least 3 teeth other than first molars and incisors (may be widespread)
• Alveolar bone loss – generalised & severe
• Plaque, calculus, inflammation, pockets

31
Q

When is onset of gen. aggress. perio ?

A

< 30 years old

32
Q

What are principles of management of aggress. perio ?

A
  • Early diagnosis essential – screening is required
  • establish correct diagnosis  Affects therapy
  • underlying modifying factor or systemic factor that needs managing? (e.g. poorly controlled diabetes)
  • Referral to a specialist considered by GDP
33
Q

What are principles of management of aggressive perio ?

A
  • to Suppress infecting organisms
  • Providing enviro. conducive to long term maintenance
    • Therapy in 3 phases:
    o Initial cause related
    o Corrective
    o Supportive
34
Q

What is corrective therapy like ?

A

adjunctive systemic antibiotics in conjunction w/ non-surgical therapy or periodontal surgery for aggressive periodontitis

35
Q

What is use of systemic antibiotics for aggressive perio like ?

A

• disrupt biofilm on root surfaces (Root Surface Debridement), in conjunction with adjunctive systemic antibiotics

36
Q

What is prognosis of aggressive perio ?

A

• Prognosis improves with:
- Early correct diagnosis, appropriate therapy
- Frequent recall/ monitoring therapy
• Elimination of associated microorganisms is requirement for success
• Extractions may be needed
• Burn out may occur within therapy

37
Q

What are Features of chronic periodontitis that separate it from aggressive:

A

• Most prevalent in adults, & can in teens
• Slow to moderate progression
• Destruction consistent with local factors
• subgingival calculus frequent finding,
- amount of plaque & local factors consistent w/ amount of perio. destruction
• Modifying factors include: local and systemic factors, smoking, stress, poorly controlled diabetes

38
Q

How do we treat chronic perio ?

A

• Treat in usual 3 phases - no systemic antibiotics are used

CSA periodontology (5 decks)

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