Juvenile Periodontitis

presentation on management of juvenile periodontitis .

1. JUVENILE PERIODONTITIS

2. What is Periodontitis ? Periodontitis is Inflammatory disease of the supporting tissue of the teeth Caused by specific microorganism Resulting in progressive destruction of the periodontal legament and alveolar bone with pocket formation , recession or both

3. Fig : Adult Periodontitis Fig : Localized Juvenile Periodontitis Fig : Generalized Juvenile Periodontitis Fig : Necrotizing Ulcerative Periodontitis

4. What is Juvenile or Aggressive Periodontitis? Juvenile or Aggressive periodontitis is Rapid loss of attachment and bone loss Occurring in an otherwise clinicially healthy patients with the amount of microbial deposits in consistent with disease severity Familial aggregation of diseased individual

5. Stages in the development of disease

6. Etiology of juvenile periodontitis Micro organisms Actinobacillus actinomycetemcomitans Porphyromonas gingivalis Eikenella corrodens Caprocytophaga Spirocheates Bacillus Defective neutrophil or monocyte function Poor serum antibody response to infecting agent

7. Localized Juvenile Periodontitis

8. What is localized juvenile periodontitis ? Localized juvenile periodontitis is Occuring in otherwise healthy individual under the age of 30 years Destructive periodontitis localized to the 1 st permanent molars and incisors not involving more than two other teeth

9. Clinical features

10. Age and sex distribution Both sexes ( slight female predilection ) Seen mostly between 20 years Distribution of lesion 1 st molar and/or incisors 1 st molar and/or incisors + additional teeth ( not more than 2 teeth other than 1 st molars and incisors )

11. Lack of clinical inflammation despite the presence of deep periodontal pocket Small amount of plaque, forms a thin film rarely mineralized Mobility and migration of 1 st molars and incisors Classically distolabial migration of maxillary incisors with diastema

12. Root surface sensitivity Deep dull radiating pain Periodontal abscess Enlargement of regional lymphnode

13. Radiographic findings

14. Vertical or angular bone loss around the 1 st molars and incisors The pattern appears to be “Arc shaped” loss of alveolar bone extending from distal surface of 2 nd premolar to mesial surface of 2nd molar Frequently bilaterally symmetrical pattern of bone loss occurs called as “ mirror image pattern” Fig : Radiograph showing localized juvenile periodontitis

15. Histopathological features

16. Ulcerated pocket epithelium Accumulation of various inflammatory cells in the connective tissue mainly leukocytes, plasma cells and small number of lymphocytes and macrophages Bacterial invasion of connective tissue The flora involves A. actinomycetemcomitans , Capnocytophaga sputigena and others

17. Bacteriology A. actinomycetemcomitans short Facultatively anaerobic Non motile Gram negative rod Caprocytophaga Fig : Showing colony of A.a

18. Leucotoxin Destroys polymorphonuclear leukocytes and macrophages Endotoxin Activates host cells to secret inflammatory mediators Bacteriocin Inhibit IgG and IgM production Collagenase Degradation of collagen Chemotactic Inhibition factor Inhibit neutrophil chemotaxis Virulence factor associated with A. actinomycetemcomitans

19. Immunology Functionals defects of polymorphoneuclear leukocytes or monocytes , impairs the chemotactic attraction of these cells to the site of infection

20. Generalized Juvenile Periodontitis

21. What is Generalized juvenile periodontitis ? Generalized juvenile periodontitis is Generalized interproximal attachment loss Affecting atleast three permanent teeth other than the 1 st molar and incisors

22. Clinical features

23. Age and sex distribution Affects between puberty and 35 years No sex discrimination Distritubiton of lesion All or most of the teeth are affected, no specific pattern is observed There are two phases of lesion

24. Destructive phase Non destructive phase Tissue appears severely inflammed , ulcerated and fiery red Bleeding with or without stimulation Suppuration Attachment and bone loss Tissue appears pink with some stippling Lack of inflammation Probling will reveal deep pocket Bone attachment levels relatively stable

25. Some patients may exhibit Weight loss Mental depression General malaise Systemic condition may predispose patient to generalized juvenile periodontitis, these includes chornic neutrophil defect Leukocyte adherence deficiency

26. Radiographic findings

27. No define pattern of distribution Range from severe bone loss associated with minimal number of teeth to advanced bone loss affecting the majority of teeth in the dentition Fig : showing radiograph of GJP

28. Extraction of involved teeth, specially 1 st molar Transplantation of developing 3 rd molar into the sockets of previously extracted 1 st molar Scaling Root planning Curettage Flap surgery with / without bone grafts Root amputation Hemisection Occlusal adjustment Tetracycline hydrochloride 250mg q.i.d + local mechanical therapy Doxycycline 100mg per day Combination of amoxicilline and metronidazole

29. Fig : Scaling & Root planning Fig: Curettage Fig : Hemisection Fig : Flap surgery

30. Periodontal disease accounts for a majority of missing teeth in adults and results in tremendous economic and social burdens both to the individual and the society Periodontal disease is so prevalent that only possible solution to the problem is its prevention by maintaining the good oral hygiene Conclusion

31. Reference Essential of Clinical Periodontology And Periodontics ; 4 th edition ; Shantipriya Reddy Carranza’s Clinical Periodontology ; 11 th edition ; Newman ;Takei ; Klokkevold ; Carranza Cawson’s Essentials of Oral Pathology And Oral Medicine ; 8 th edition ; R. A. Cawson ; E. W. Odell