Review of a Journal Article on Periodontitis
"Generalized Aggressive Periodontitis and its Treatment Options: Case Reports and Review of the Literature"
Aggressive periodontitis, previously known as early onset periodontitis, is a gingival disease in which there is rapid destruction of the bone and structures supporting the teeth. Aggressive periodontitis can occur as localized (less than 30%) or generalized (more than 30%). The cause of aggressive periodontitis is multifactorial and can include microbiology, genetics, immune system, and environmental/behavioral risk factors. Pathogenic bacteria such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis have been identified as pathogens that aggravate the host response and contribute to the disease.
Clinical Features: Patients may complain of bad breath (halitosis) or pus discharge from the gums. Pain is usually not a factor in aggressive periodontitis. Gingival recession may occur as well as spacing of the teeth, especially in the anterior region. Tooth mobility may be seen at later stages of the infection. Aggressive periodontitis can be seen in an inactive state of disease or an active state. In an inactive state, the patient may be free of symptoms and the gingiva may appear pink and healthy, however probing will reveal deep periodontal pockets and attachment loss. In an active state, the gingiva may show signs of mild to severe inflammation. Bleeding on probing (BOP), spontaneous bleeding, purulent exudation, may all be present as well. Most patients will seek dental care at this stage of the disease as the signs are more obvious to the patient in comparison to the inactive state of the disease. If left untreated, advanced stages of aggressive periodontitis (AgP) may cause severe periodontal destruction including gingival recession, mobility, migration and spontaneous exfoliation.
Radiographic Features: In generalized aggressive periodontitis (GAgP) radiographs typically show generalized mild-severe bone loss depending on the severity of the disease. Bone loss may occur in either a horizontal or vertical direction.
Diagnosis: Early diagnosis is crucial in preventing the progression of bone loss and attachment loss. Diagnosis is made according to the standards set by the American Academy of Periodontology (AAP) periodontal disease classification system as well as a collaboration of the patients’ history, clinical, and radiographic features.
Differential Diagnosis: Aggressive periodontitis differs from chronic periodontitis by the “age of onset, rapid rate of disease progression, the nature and composition of the associated subgingival microflora, alterations in host immune response, and a familial aggregation of the diseased individuals”.
Discussion: Successful treatment of aggressive periodontitis is best achieved with early detection of the disease. Aggressive periodontitis has a familial aggregation, therefore it is also important to perform a periodontal examination on siblings and blood relatives of an individual that is being treated for the disease; this will ensure early detection and treatment. Because AgP is influenced by microbial and environmental risk factors, controlling such risk factors will help to minimize their effect on the disease process. Optimal plaque control by the patient and from the oral health care provider is extremely important since even the smallest amount of plaque can cause an unpleasant host response in an individual that is susceptible to the disease. Smoking is a significant risk factor for aggressive periodontitis as well as contributing to the extent of the disease in comparison to those that do not smoke. Systemic antibiotic therapy has been indicated in patients with aggressive periodontitis because the pathogenic bacteria previously mentioned, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, may be tissue invasive, therefore mechanical therapy will be unsuccessful in removing the bacteria from such sites of disease. Currently, the preferred antibiotic therapy consists of a combination of antibiotics Amoxycillin and Metronidazole in addition to treatment for GAgP, however, single-antibiotic therapy may be recommended as well. In more advanced cases of aggressive periodontitis, surgical therapy may be advised which may include the use of bone grafts, barrier membranes, guided tissue regeneration, biologic modifiers, extracellular matrix proteins or a combination of these. Following successful treatment for an individual with aggressive periodontitis, maintenance therapy must need to take place throughout the life of the individual.
Conclusion: Aggressive periodontitis is not as prevalent as other forms of gingival disease such as chronic periodontitis however the management is much more challenging. Early diagnosis, successful treatment and meticulous patient compliance are the most important factors in the lifelong stabilization of the periodontium.
Personal Reflection: I absolutely loved this article!! Everything that it discussed was completely relevant to what we have been discussing in our classes. I am so happy that I found this article. There were also two case reports that discussed an individuals’ case and the management that was taken to treat their condition which was very interesting and relates to what I may come across while working on patients in the clinic!
Citation:
Roshna, T. T., & Nandakumar, K. K. (2011). Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature.
Case Reports In Medicine, 1-17. doi:10.1155/2012/535321
**Images retrieved from google.com/images**
Aggressive periodontitis, previously known as early onset periodontitis, is a gingival disease in which there is rapid destruction of the bone and structures supporting the teeth. Aggressive periodontitis can occur as localized (less than 30%) or generalized (more than 30%). The cause of aggressive periodontitis is multifactorial and can include microbiology, genetics, immune system, and environmental/behavioral risk factors. Pathogenic bacteria such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis have been identified as pathogens that aggravate the host response and contribute to the disease.
Clinical Features: Patients may complain of bad breath (halitosis) or pus discharge from the gums. Pain is usually not a factor in aggressive periodontitis. Gingival recession may occur as well as spacing of the teeth, especially in the anterior region. Tooth mobility may be seen at later stages of the infection. Aggressive periodontitis can be seen in an inactive state of disease or an active state. In an inactive state, the patient may be free of symptoms and the gingiva may appear pink and healthy, however probing will reveal deep periodontal pockets and attachment loss. In an active state, the gingiva may show signs of mild to severe inflammation. Bleeding on probing (BOP), spontaneous bleeding, purulent exudation, may all be present as well. Most patients will seek dental care at this stage of the disease as the signs are more obvious to the patient in comparison to the inactive state of the disease. If left untreated, advanced stages of aggressive periodontitis (AgP) may cause severe periodontal destruction including gingival recession, mobility, migration and spontaneous exfoliation.
Radiographic Features: In generalized aggressive periodontitis (GAgP) radiographs typically show generalized mild-severe bone loss depending on the severity of the disease. Bone loss may occur in either a horizontal or vertical direction.
Diagnosis: Early diagnosis is crucial in preventing the progression of bone loss and attachment loss. Diagnosis is made according to the standards set by the American Academy of Periodontology (AAP) periodontal disease classification system as well as a collaboration of the patients’ history, clinical, and radiographic features.
Differential Diagnosis: Aggressive periodontitis differs from chronic periodontitis by the “age of onset, rapid rate of disease progression, the nature and composition of the associated subgingival microflora, alterations in host immune response, and a familial aggregation of the diseased individuals”.
Discussion: Successful treatment of aggressive periodontitis is best achieved with early detection of the disease. Aggressive periodontitis has a familial aggregation, therefore it is also important to perform a periodontal examination on siblings and blood relatives of an individual that is being treated for the disease; this will ensure early detection and treatment. Because AgP is influenced by microbial and environmental risk factors, controlling such risk factors will help to minimize their effect on the disease process. Optimal plaque control by the patient and from the oral health care provider is extremely important since even the smallest amount of plaque can cause an unpleasant host response in an individual that is susceptible to the disease. Smoking is a significant risk factor for aggressive periodontitis as well as contributing to the extent of the disease in comparison to those that do not smoke. Systemic antibiotic therapy has been indicated in patients with aggressive periodontitis because the pathogenic bacteria previously mentioned, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, may be tissue invasive, therefore mechanical therapy will be unsuccessful in removing the bacteria from such sites of disease. Currently, the preferred antibiotic therapy consists of a combination of antibiotics Amoxycillin and Metronidazole in addition to treatment for GAgP, however, single-antibiotic therapy may be recommended as well. In more advanced cases of aggressive periodontitis, surgical therapy may be advised which may include the use of bone grafts, barrier membranes, guided tissue regeneration, biologic modifiers, extracellular matrix proteins or a combination of these. Following successful treatment for an individual with aggressive periodontitis, maintenance therapy must need to take place throughout the life of the individual.
Conclusion: Aggressive periodontitis is not as prevalent as other forms of gingival disease such as chronic periodontitis however the management is much more challenging. Early diagnosis, successful treatment and meticulous patient compliance are the most important factors in the lifelong stabilization of the periodontium.
Personal Reflection: I absolutely loved this article!! Everything that it discussed was completely relevant to what we have been discussing in our classes. I am so happy that I found this article. There were also two case reports that discussed an individuals’ case and the management that was taken to treat their condition which was very interesting and relates to what I may come across while working on patients in the clinic!
Citation:
Roshna, T. T., & Nandakumar, K. K. (2011). Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature.
Case Reports In Medicine, 1-17. doi:10.1155/2012/535321
**Images retrieved from google.com/images**