Generalized aggressive periodontitis is a disease condition where
people age less than 30 years or older people may get affected and there
will be interproximal attachment loss which appears to occur
episodically. It tends to have a poor prognosis because the disease typically has
affected more teeth than many other diseases. Besides, it is less likely
to go spontaneously into remission compared with patients with forms of
localized aggressive periodontitis.
Clinical characteristic features:
1. Generalized aggressive periodontitis usually affects individuals under 30 years of age but older patients may also be affected.
2. Generalized interproximal attachment loss affecting at least three permanent teeth other than 1st molars and incisors.
3. The destruction appears to occur episodically with periods of
an advanced destruction followed by stages of quiescence of variable
lengths (weeks to months or years).
4. Individuals have a poor antibody response to the pathogens present.
5. Patients will have small amount of bacterial plaque associated with the affected teeth.
6. Quantitively the amount of plaque seems to be inconsistent with the amount of periodontal destruction.
7. Qualitatively porphyromonal gingivalis, Actinomyces actinomycetem comitans and Tanerella forsythia are frequently detected in the plaque that presents in the marginal, interdental papillae.
8. Two gingival tissue responses can be found in case of generalized aggressive periodontits =>
a)
- One is severe, acutely inflamed tissue, often proliferating, ulcerated, and fiery red.
- Bleeding may occur spontaneous or with slight stimulation.
- Suppuration may be an important feature. This tissue response is believed to be occurring in the destructive stage in which attachment and bone are actively lost.
b)
- Gingival tissues may appear pink, free of inflammation.
- Occasionally with some degrees of stippling can be lost or may be absent.
- Deep pockets may be demonstrated through probing.
This tissue response coincides with periods of quiescence in which bone level remains stationary.
9. Patients may have systemic menifestations such as weight loss, mental depression, and general malaise.
10. Male teenegers are more likely to get affected than female adeloscents.
Management:
1. Diagnosis =>
a) Color of the gingiva:-
- In stationary stage => appear as pink.
- In destructive stage => appear as fiery red.
b) Bleeding on probing :-
- In stationary stage => Eased bleeding.
- In destructive stage => Spontaneous bleeding may occur and may occur with some stimulatory factor.
c) Probing Pocket Depth (PPD) :-
- In stationary stage => Deep pockets can be demonstrated through probing by periodontal probe.
- In destructive stage=> Deep pockets can be demonstrated through probing by periodontal probe.
d) Furcation Involvement :-
Both destructive and stationary stage, furcation involvement is found in multirooted teeth (Molars).
e) Tooth Mobility :-
Tooth loss usually occurs in second molars, canines or premolar teeth.
f) X-ray :-
It can change with severe bone loss associated with the minimal number of teeth. Osseous destruction for about 25-60% occurs during a 9 week period. Despite the extreme loss, other sites in the same patient showed no bony loss.
Treatment
1. Scaling and Root planning :
Scaling => Scaling is a procedure through which plaque, calculus, and stain can be removed from the crown and root surfaces of teeth.
Root Planning =>
This procedure is applied for scaling of the root of the teeth that are made of cementum. It removes the roughened cementum and surface dentin that are impregnated with calculus, micro-organisms, and their toxins.
2. Capsule :
Tetracyclie 250 mg (1 capsule 4 times a day for at least 1 week).
3. Chlorhexidine rinses : This has to be used to prevent plaque accumulation and help in flushing out debris from the oral cavity.
4. Follow up:
Patient will be asked to re-visit in every 3 weeks, 3 months, 6 months, and 1 year with advising him or her to follow or obey the treatment plan and also try to maintain a good oral hygiene. The patient will be adviced to brush twice a day after breakfast at morning, and before going to bed at night. Patient will also be advised to use tooth picks for the removal of foods from the inter dental spaces. Besides, he or she will be asked to use mouth wash with warm saline water to keep the oral cavity plaque free.
However, follow up is usually being addressed for some purposes. They are :
- To check the present status of patient where he or she is recovering well or not.
- Any other pathological condition has evolved or not.
- To detect the pocket depth whether it has reduced or not. If the pocket depth has not been reduced, then patient will be asked to do the periodontal surgery which aim is to eliminate or reduce pocket depth through resecting the pocket wall. It also helps to expose the area for performing the jaw regenerative methods.
1. Generalized aggressive periodontitis usually affects individuals under 30 years of age but older patients may also be affected.
2. Generalized interproximal attachment loss affecting at least three permanent teeth other than 1st molars and incisors.
3. The destruction appears to occur episodically with periods of
an advanced destruction followed by stages of quiescence of variable
lengths (weeks to months or years).4. Individuals have a poor antibody response to the pathogens present.
5. Patients will have small amount of bacterial plaque associated with the affected teeth.
6. Quantitively the amount of plaque seems to be inconsistent with the amount of periodontal destruction.
7. Qualitatively porphyromonal gingivalis, Actinomyces actinomycetem comitans and Tanerella forsythia are frequently detected in the plaque that presents in the marginal, interdental papillae.
8. Two gingival tissue responses can be found in case of generalized aggressive periodontits =>
a)
- One is severe, acutely inflamed tissue, often proliferating, ulcerated, and fiery red.
- Bleeding may occur spontaneous or with slight stimulation.
- Suppuration may be an important feature. This tissue response is believed to be occurring in the destructive stage in which attachment and bone are actively lost.
b)
- Gingival tissues may appear pink, free of inflammation.
- Occasionally with some degrees of stippling can be lost or may be absent.
- Deep pockets may be demonstrated through probing.
This tissue response coincides with periods of quiescence in which bone level remains stationary.
9. Patients may have systemic menifestations such as weight loss, mental depression, and general malaise.
10. Male teenegers are more likely to get affected than female adeloscents.
Management:
1. Diagnosis =>
a) Color of the gingiva:-- In stationary stage => appear as pink.
- In destructive stage => appear as fiery red.
b) Bleeding on probing :-
- In stationary stage => Eased bleeding.
- In destructive stage => Spontaneous bleeding may occur and may occur with some stimulatory factor.
c) Probing Pocket Depth (PPD) :-
- In stationary stage => Deep pockets can be demonstrated through probing by periodontal probe.
- In destructive stage=> Deep pockets can be demonstrated through probing by periodontal probe.
d) Furcation Involvement :-
Both destructive and stationary stage, furcation involvement is found in multirooted teeth (Molars).
e) Tooth Mobility :-
Tooth loss usually occurs in second molars, canines or premolar teeth.f) X-ray :-
It can change with severe bone loss associated with the minimal number of teeth. Osseous destruction for about 25-60% occurs during a 9 week period. Despite the extreme loss, other sites in the same patient showed no bony loss.
Treatment
1. Scaling and Root planning :
Scaling => Scaling is a procedure through which plaque, calculus, and stain can be removed from the crown and root surfaces of teeth.
Root Planning =>
This procedure is applied for scaling of the root of the teeth that are made of cementum. It removes the roughened cementum and surface dentin that are impregnated with calculus, micro-organisms, and their toxins.
2. Capsule :
Tetracyclie 250 mg (1 capsule 4 times a day for at least 1 week).
3. Chlorhexidine rinses : This has to be used to prevent plaque accumulation and help in flushing out debris from the oral cavity.
4. Follow up:
Patient will be asked to re-visit in every 3 weeks, 3 months, 6 months, and 1 year with advising him or her to follow or obey the treatment plan and also try to maintain a good oral hygiene. The patient will be adviced to brush twice a day after breakfast at morning, and before going to bed at night. Patient will also be advised to use tooth picks for the removal of foods from the inter dental spaces. Besides, he or she will be asked to use mouth wash with warm saline water to keep the oral cavity plaque free.
However, follow up is usually being addressed for some purposes. They are :
- To check the present status of patient where he or she is recovering well or not.
- Any other pathological condition has evolved or not.
- To detect the pocket depth whether it has reduced or not. If the pocket depth has not been reduced, then patient will be asked to do the periodontal surgery which aim is to eliminate or reduce pocket depth through resecting the pocket wall. It also helps to expose the area for performing the jaw regenerative methods.
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