Comparative biology of chronic and aggressive periodontitis: introduction
Description of disease: Chronic periodontitis: Widespread destruction of all periodontal tissue, usually in an older patient, slow progression Aggressive periodontitis: Widespread destruction of all periodontal tissue, usually in a young patient; rapid rate of progression -formerly known as Juvenile Perio
Distinguishing diagnostic factors: Both; Loss of attachment, loss of bone level, inflammatory changes, apical migration of epithelium and inflammatory destruction of connective tissue. Aggressive: rapid and with periods of rest, bone loss 3-4 time faster than chronic, first molars and incisor, minimal plaque Chronic: slow and continuous
Etiology of the disease/condition: Chronic: accumulation of profuse amounts of dental plaque Aggressive: bacteria plaque with highly pathogenic bacteria and impaired host response, neutrophil defects, leukocyte adherence deficiency, PMN defects, impaired chemotaxis and phagocytosis
Pathogens associated with the disease/condition: Both: Porphyromonas gingivalis Tannerella forsythia Treponema Aggressive specific: Aggregatibacter actinomycetemcomitans Actinobacillus actinomycetemcomitans
Classification of the disease/condition: Chronic periodontitis: AAP Class II A and B; Localized or Generalized Aggressive periodontitis: AAP Class III A and B; Localized or Generalized
Prevalence of disease/condition: Aggressive: Estimates below 1%, higher among African Americans Chronic: 80% american with mild, less than 5% with severe
Factors to include in patient education: When dealing with Aggressive periodontitis, it may be difficult to stop to bone and attachment loss, however, the ideal scenario is the slow the deterioration of the periodontium. The long-term prognosis of Chronic periodontitis depends on the desire of the patient to keep up on the periodontal maintenance program set forth by the dental team.
Treatment recommendation or corrective procedures: Early diagnosis Reduce pathogens Eradication of A. a. Sub-gingival scaling Possible diagnosis of antibiotics Continual re-evlauation In addition to these Aggressive may include: Gum flapping may be needed to clean and regain manageable pockets Extraction of teeth
Maintenance recommendations: Chronic: Periodontal maintenance of 3-4 month intervals with continuous re-evaluation of periodontal pockets Aggressive: Periodontal maintenance each month for up to 6 months, then every 3 months, with constant re-evaluation
References: Armitage, G., Cullinan, M., & Seymour, G. (2010). Comparative biology of chronic and aggressive periodontitis: introduction. Periodontology 2000, 537-11. doi:10.1111/j.1600-0757.2010.00359.x
Aggressive periodontitis; Noack, and Huffman http://perio.quintessenz.de/perio0404_s335.pdf