33.AGGRESSIVE PERIODONTITIs and it's pathophysiology and classification

Aggressive periodontitis doesn't comsurate with the amount of local factors

1. Aggressive periodontitis generally affects systemically healthy individuals less than 30 years of age, although patients may be older.

2. Aggressive periodontitis may be universally distinguished from chronic periodontitis -by the age of onset,

3. Aggressive periodontitis may be universally distinguished from chronic periodontitis the rapid rate of disease progression,

4. Aggressive periodontitis may be universally distinguished from chronic periodontitis -the nature and composition of the associated subgingival microflora

5. Aggressive periodontitis may be universally distinguished from chronic periodontitis - alterations in the host's immune response

6. Aggressive periodontitis may be universally distinguished from chronic periodontitis - familial aggregation of diseased individuals.

7. Clinical Characteristics: Localized aggressive periodontitis usually has an age of onset around puberty. Clinically, it is characterized as having "localized first molar/incisor presentation with interproximal attachment loss on at least two permanent teeth, one of which is a first molar, and involving no more than two teeth other than first molars and incisors"

8. FEATURES OF LOCALIZED AGGRESSIVE PERIODONTITIS Contains elevated levels of A. actinomycetemcomitans , and in some patients, Porphyromonas gingivalis . Quantity of plaque may be limited Deep periodontal pockets & advanced bone loss Lack of clinical inflammation

9. Other clinical features of localized aggressive periodontitis : - Include distolabial migration of the maxillary incisors with concomitant diastema formation.

10. - Increasing mobility of the maxillary & mandibular incisors and first molars.

11. - Sensitivity of denuded root surfaces to thermal and tactile stimuli.

12. - Deep, dull, radiating pain during mastication

13. - Periodontal abscesses

14. - Regional lymph node enlargement may occur

15. Radiographic Findings: -Vertical loss of alveolar bone around the first molars and incisors - “Arc-shaped loss of alveolar bone extending from the distal surface of the second premolar to the mesial surface of the second molar”.

16. GENERALIZED AGGRESSIVE PERIODONTITIS: Clinical Characteristics: Generalized aggressive periodontitis usually affects individuals under the age of 30, but older patients also may be affected. In contrast to localized aggressive periodontitis , evidence suggests that individuals affected with generalized aggressive periodontitis produce a poor antibody response to the pathogens present.

17. Clinically: Generalized aggressive periodontitis is characterized by " generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors.

18. Immunologic Factors Some immune defects have been implicated in the pathogenesis of aggressive periodontitis Patients with aggressive periodontitis display functional defects of These defects in PMN and Monocytes can impair either the chemotactic attraction of PMN to the site of infection or their ability to phagocytose and kill microorganisms.

19. Environmental Factors The amount and duration of smoking are important variables that can influence the extent of destruction. Patients with generalized aggressive periodontitis who smoke have more affected teeth and more loss of clinical attachment than nonsmoking patients