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Management of Rapidly Progressing Periodontitis: an Overview

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Management of Rapidly Progressing Periodontitis: an Overview Review Article Management of Rapidly Progressing Periodontitis: An Overview Sadat SMA1, Chowdhury NM2, Baten RBA3 Abstract causes rapid destruction of periodontal ligament and History of periodontal diseases recognition and alveolar bone which occurs in otherwise systemically treatment is ancient for at least 5000 years. There are healthy individuals generally of a younger age group but 1,8 different presentations of periodontal diseases. Rapidly patients may be older . A familial aggregation of the 9 progression periodontitis or aggressive periodontitis disease is also noted . It includes both localized and causes rapid destruction of the periodontium which leads generalized forms. It was previously known as early onset to early tooth loss. It may be generalized or localized. periodontitis that included three categories of periodontitis Periodontitis may be treated surgically or non-surgically - Pubertal, Juvenile and rapidly progressing but patients with rapidly progressing periodontitis do not periodontitis10,11. Early diagnosis and appropriate respond predictably to conventional therapy due to its treatment is necessary to prevent early tooth loss. multi factorial etiology. Successful management of the disease is difficult if not diagnosed early and treated Classification appropriately. Regenerative therapy, tissue engineering Classification of diseases helps the clinicians to develop a and genetic technologies are the new hope for the structure which can be used to identify diseases in relation treatment of rapidly progressing periodontitis. to etiology, pathogenesis and treatment. The most commonly accepted system of classification of periodontal 1. Corresponding Author: disease has been those of the American Academy of Dr. S. M. Anwar Sadat, BDS, BCS, MCPS, FCPS, MS (OMS) Periodontology (AAP). The recently used definition of Assistant Professor, Department of Oral &Maxillofacial Surgery aggressive periodontitis was introduced at the 1999 Sher-E-Bangla Medical College Dental Unit, Barisal, Bangladesh workshop for the classification of periodontal diseases and e-mail: [email protected] conditions12. In 1989 AAP introduced a classification of periodontal diseases13 based on: 2. Dr. Naim Mahmud Chowdhury, BDS Lecturer, Department of Oral & Maxillofacial Surgery a. Presence or absence of clinically detectable Chattagram International Dental College, Chittagong, Bangladesh inflammation 3. Dr. Redwan Bin Abdul Baten,BDS, BCS b. Extent and pattern of attachment loss Assistant Dental Surgeon Upazilla Health Complex, Nabinagar, Brahmanbaria, Bangladesh c. Patient's age at onset d. Rate of progression Introduction e. Presence or absence of miscellaneous signs and Rapidly progressing periodontitis was first described in symptoms including pain, ulceration and amount of 1923 as diffuse atrophy of the alveolar bone which after observable plaque and calculus. changing a series of terminology finally named as Over time various problems with the application of aggressive periodontitis in 19991-3. It is an inflammatory classification were observed and criticisms arose. The disease affected by a variety of factors as smoking and age classification was revised in 1999 at the workshop for the as well as diabetes mellitus, stress, gender, education level classification of periodontal diseases and conditions14. and immunological diseases such as HIV infection This resulted in the introduction of a gingival disease influences the periodontal diseases4-7. Periodontal diseases category. Adult periodontitis was replaced by chronic range from the relatively benign gingivitis to chronic and periodontitis and early onset periodontitis was replaced by aggressive forms of the diseases. For proper identification aggressive periodontitis. However a Classification should and treatment of periodontal diseases it is classified into several categories. Aggressive periodontitis 32 2016 Volume 28 Number 01 REVIEW ARTICLE not be regarded as a permanent structure. It must be later stages of infection. Gingival recession may be seen adaptable to change and evolved with the development of and patients may complain of food impaction due to loss new knowledge. of contact points between teeth. Advanced stages of the untreated disease with severe periodontal destruction may Epidemiology show extrusion of teeth, mobility and pathologic The disease is generally found to have a racial and sex migration, furcation involvement, generalized gingival predilection with blacks and male teenagers having higher recession and loss of several teeth due to spontaneous risk for the disease compared to whites and females15, 16. exfoliation. Some patients may show systemic The prevalence of severe periodontitis among participants manifestations such as weight loss, mental depression and aged approximately 40-50 years estimated were 21% in general malaise32. Common features of localized and Germany and 16%, 28% and 32% in various populations generalized forms of aggressive periodontitis listed in the 17-19 from the United States . Epidemiological reports show 1999 workshop are33: extensive periodontal damage at some sites in adolescents n except for the presence of periodontitis, patients are and young adults20, 21. There are some data that suggest a otherwise clinically healthy; prevalence ceiling of 11% for aggressive periodontitis among participants under 26 years of age 18. The study of n rapid attachment loss and bone destruction; periodontal conditions among Israeli army personnel in n familial aggregation. ages between 18-30 years and reported a prevalence of localized aggressive periodontitis of 4% and generalized Secondary features that are generally, but not universally, aggressive periodontitis of 2%22. The global prevalence of present are: aggressive periodontitis remains elusive which is n amounts of microbial deposits are inconsistent with the reflective of the unresolved debate about its accurate severity of periodontal tissue destruction definition. n elevated proportions of Actinobacillus Microbiology a c t i n o m y c e t e m c o m i t a n s ( A g g r e g a t i b a c t e r The presence of bacteria around the teeth was recognized actinomycetemcomitans) and, in some populations, by Von Leeuwenhoek in the 17th century23, 24. The Porphyromonas gingivalis may be elevated microbiologic picture of aggressive periodontitis is n phagocyte abnormalities complicated. Because only about 50-60% of subgingival microbiota is in "not yet cultivated" category25. Certain n hyper-responsive macrophage phenotype, including cultivable pathogens listed by the 1996 workshop in elevated levels of PGE2 and IL-1b periodontitis including P. gingivalis, T. forsythia, C. n 26 progression of attachment loss and bone loss may be rectus, Eubacterium sp. P. micra and Treponemasp . self arresting. Prelimenary studies have suggested that individuals with aggressive periodontitis have higher subgingival levels of Further specific features were identified: 27,28 Selenomonas sp. and T. lecithinolyticum . Pathogenic Localized aggressive: bacteria in the dental plaque specially Aggregatibacter n actinomycetemcomitans and Porphyromonas gingivalis circumpubertal onset 29, 30 have role in aggravated host response . The presence n localized first molar / incisor presentation with of various types of periodontal pathogens is the main interproximal attachment loss on at least two permanent reason that aggressive periodontitis does not respond to teeth, one of which is a first molar, and involving no more conventional periodontal therapy (Scaling with root than two teeth other than first molars and incisors planning, Oral hygiene instruction & Surgical n intervention) alone. robust serum antibody response to infecting agents. Clinical Features Generalized aggressive: Rapidly aggressive periodontitis is characterized by its n usually affecting persons under 30 years of age, but severe and fast progressing destructive course in young patients may be older individuals, which often leads to tooth loss early in life n poor serum antibody response to infecting agents followed by the need for prosthetic treatment31. Patient may complain of halitosis and pus discharge from gums. n pronounced episodic nature of the destruction of Mobility of the affected teeth will be seen towards the attachment and alveolar bone 2016 Volume 28 Number 01 33 REVIEW ARTICLE 39 n generalized interproximal attachment loss affecting at site . Absence of gingival inflammation and shallow least three permanent teeth other than first molars and probing depths has a strong negative predictive value for incisors. periodontal stability40, 41. The workshop noted that factors which modify risk, such Treatment as cigarette smoking, stress, drugs or sex hormones, Protocols for treating aggressive periodontitis are largely which affect the course of all types of periodontal diseases. empirical and have been subjected to few well controlled comparative studies42. The response to periodontal Radiographic Features treatment in aggressive periodontitis is much less well Radiographs provide a secondary diagnostic tool and may understood. The bottom line is that the patient with demonstrate the presence of marginal bone loss thus generalized aggressive periodontitis requires careful confirming the attachment loss. Localize aggressive monitoring and close collaboration is necessary between periodontitis typically present radiolucency in the first all the members of a treatment team. molars starting from the distal aspect of second premolars Non-surgical
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