Aggressive periodontitis

1. Aggressive Periodontal
Disease
NUP
Refractory periodontitis
Periodontitis in systemic disease
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2. 1. Necrotizing Ulcerative Periodontitis :

Definition:
an extension of necrotizing ulcerative gingivitis ( NUG ) into periodontal instruction.

Clinical features : signs and symptoms
1. Necrosis and ulceration of interdental papillae ( coronal part )
2. Attachment and bone loss.
3. Bleeding gingiva with painful , bright red margin.
4. Halitosis.
5. Systemic manifestation ( fever , malaise , lymphadenopathy ).
Contributing factors to NUP :
1. > level of stress
2. Heavy smoking
3. Poor nutrition

3. Types of NUP :
1.Aids – associated
2.Non Aids type

1.Non Aids type NUP: clinical features / Etiology :
1. Occur after repeated long – term episode of NUG .
2. Etiologic factors have not been studied but similar in NUG
 Age of Pts :
 Adults
 Children and adolescents ( 2 – 14 -+malnutrition ) = Gangrenous stomatitis =
NOMA
 Signs and Symptoms :
1. Linear gingival erythema ( LGE ).
2. NUG
3. NUP ( with complications )
4. Complications ( soft tissue necrosis, exposure of bone, sequestration of bone
fragment = vestibular area = necrotizing stomatitis .
Progression : extreme bone loss with lesion ( 10 mm of bone every 3 months)

4. Condition that is unresponsive to any treatment provided what ever the thoroughness or
frequency it is not a recurrent disease or incompletely treated case .
Pathway ; Therapy complete remission recurrence ( by formation of plaque ad
calculus )
Etiology :
1. Abnormal host response
2. Unusual pathogenic and virulent micro flora e.g. A actinomycetecomitans
3. Failure to eliminate plaque retentive factors.
Clinical Finding :
No difference in plaque amount and bone + attachment loss in previously treated areas
2. Refractory Periodontitis
American Academy of periodontology define it as :

5. 3. Periodontitis as a manifestation of systemic disease
Many systemic conditions associated with or predisposing to periodontal attachment loss
A. Papillion – Lefevre Syndrome ( autosomal inherited Syndrome )
Signs + symptoms :
1. Hyperkeratotic skin lesion.
2. Severe destruction of the periodontium = bone loss ( before 4 years old )
3. Loss of primary teeth at 5-6 years of age and permanent teeth are lost due
to the destructive lesion.
4. > of osteoclastic activity = thin cementum
5. Similar bacterial flora to one of plaque .
B. Downs Syndrome ( Mongolism , Trisomy 21)
Signs and symptoms :
1. Congenital , chromosomal abnormality disease.
2. 100% of pts >30 years show periodontal disease.
3. Poor oral hygiene , deep periodontal pockets, gingivitis.
4. Acute necrotizing lesion and recession.

6. Factors affecting severity of periodontal destruction
1. poor circulation = < resistant to infection
2.defect in T-cell maturation + polymorph nuclear leukocytes chemotaxis.

C. Neutropenia

Children with neutropenia shows destructive generalized periodontal lesion

D. Chediak – Higashi Syndrome

Rare recurrent bacterial infection including rapidly destructive periodontitis.

E. Hypophosphatasia
1. Rare familial skeletal disease.
2. Rickets, rare cranial bone formation.
3. Premature loss of primary teeth.
4. < serum alkaline phosphatase.
5. In adolescents it resemble localized juvenile periodontitis.
F. Leukocyte adhesion Deficiency ( LAD )
1. Rare
2. Premature loss of primary teeth.
3. Extreme acute inflammation + proliferation of gingival tissue + rapid bone destruction.