Aggressive Periodontitis

Definition

Aggressive periodontitis is a type of periodontitis where there is rapid loss of bone tissue surrounding the tooth. The teeth are embedded inside the jaws and supported by periodontium, which comprises of gums, bone, and ligaments attaching the tooth root to the bone. In aggressive periodontitis all the support structures are affected leading to migration or mobility of the teeth. Eventually it results in loss of the teeth. Aggressive periodontitis affects healthy young individuals and leads to an early tooth loss. It should not be confused with gingivitis where there is inflammation of the gums.

Symptoms

The disease tends to go unnoticed in the early stages if there is lack of regular dental check-ups. Aggressive periodontitis most commonly affects the incisor teeth and first molars in permanent dentition. Migration of the teeth is one of the first symptoms and the affected tooth loses its firmness. As the disease progresses other symptoms such as tooth root sensitivity, periodontal abscess and lymph node enlargement manifest. The tooth also becomes sensitive to touch, cold drinks or biting.

In cases of aggressive periodontitis the patient may not suffer from obvious tooth pain, but a deep, dull, radiating type of pain is felt at the tooth root region. This pain is caused due to loss of bone structure of the tooth socket. On dental examination the tooth shows periodontal pocket formation which leads to pain and food lodgment. The lack of pain should not be mistaken for a mild dental disorder. Periodontitis can severely comprise dental health.

Causes

The disease almost exclusively affects younger individuals. The age group most commonly afflicted is between puberty to 20 years of age. In some cases the disease can occur up until the age of 35 years. Periodontitis is more frequently seen in females. It affects individuals with good dental health and adequate oral hygiene practices. Periodontitis patients may have little to no dental plaque on examination.

Aggressive periodontitis affects first molars and incisors while generalized teeth involvement is rare. It is more commonly seen in patients who suffer from neutrophil defects. The loss of tooth supporting structure is due to lack of inflammatory response from the body’s defense system.

The disease is said to have a genetic predisposition and some immunological factors are also involved in its development. Smoking significantly increases the intensity of disease .The bone loss in smokers is very rapid, due to which early loss of tooth occurs. However, cigarette smoking is not necessarily a cause of periodontitis.

Treatment

The treatment of aggressive periodontitis is very critical as it has a poor prognosis. The disease has an unpredictable response. If the tooth is beyond saving, it is then extracted. Inthe  treatment of aggressive periodontitis, a standard antibiotic therapy regime is to be followed. Tetracycline hydrochloride is given systemically as well as in local ointment forms.

A dentist may perform periodontal procedures such as scaling, root planning and curettage are performed in early stages of the disease. For more severe cases flap surgeries and uses of bone grafts to fill the lost bone structure is preferred. The patient is advised to use chlorehexidine mouthwashes in all stages of the treatment. In case of any acute exacerbation, antibiotic such as amoxicillin and metronidazole are prescribed.

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