Localized Aggressive Periodontitis
Localized aggressive periodontitis is a bacterial infection caused by the pathogens Aggregatibacter actinomycetemcomitans (Aa). The American Academy of Periodontology (AAP) classifies localized aggressive periodontitis as type III A. Localized aggressive periodontitis is less common than chronic periodontitis and was previously called juvenile aggressive periodontitis due to its time of onset being around puberty. According to L.M. Shaddox, H. Huang, T. Lin, W. Hou, P.L. Harrison, I. Aukhil, C.B. Walker, V. Klepac-Ceraj, and B.J. Paster in Microbiological Characterization in Children with Aggressive Periodontitis, "The prevalence of aggressive periodontal disease in children and young adults in the US is around 1 to 2% and is estimated to be up to 3 times more prevalent in Blacks"(L.M. Shaddox, H. Huang, T. Lin, W. Hou, P.L. Harrison, I. Aukhil, C.B. Walker, V. Klepac-Ceraj, and B.J. Paster 2012). Attachment loss is characteristically localized to the first molars and incisors, involving no more than two other teeth. On radiographs, vertical bone loss is viewed around the first molars and incisors. Localized aggressive periodontitis is rapid and usually affects relatively healthy individuals who have a family history of aggressive periodontitis. Often bacterial plaque biofilm is light, although large amounts are known to amplify the disease.
Currently, periodontal probing is the most effective mode of early detection. If probing measurements are difficult to obtain on a child, bitewing radiographs should be screened for the presence of bone loss. If bone loss is seen and local contributing factors (i.e. open contacts, caries, restorations) can be ruled out, periodontitis should be considered.
Localized aggressive periodontitis does not demonstrate clinical signs and responds weakly to periodontal therapy. The disease progression is episodic, alternating between destructive phases and idle phase. The ultimate treatment goal of controlling attachment loss is usually not possible in aggressive periodontitis. Therefore, the goal is modified to slow the progression of the disease.
Treatment of localized aggressive periodontitis is similar to that of chronic periodontitis. The individual should be instructed on proper home care, and since aggressive periodontitis affects children, the parents should be included. Smoking cessation should be considered if appropriate. Tooth surfaces should undergo periodontal instrumentation in addition to the use of antimicrobial agents to help remove bacteria involved with aggressive periodontitis. If the dental hygienist is not able to instrument the entire root surface, the individual should be referred to a periodontis and surgical treatment can be discussed.
Aggressive periodontitis cannot be reversed, but with the help from a well-educated dental team, hopefully further damage can be prevented.
References:
Shaddox, L., Huang, H., Lin, T., Hou, W., Harrison, P., Aukhil, I., & ... Paster, B. (2012). Microbiological characterization in children with aggressive periodontitis. Journal Of Dental Research, 91(10), 927-933
Additional resources from:
Neild-Gehrig, Jill S., & Willmann, Donald E. (2011) Foundations of Periodontics for the Dental Hygienist (3rd ed.). Philadelphia, PA: Lippincott Williams and Wilkins.
*Picture from Google Images
Currently, periodontal probing is the most effective mode of early detection. If probing measurements are difficult to obtain on a child, bitewing radiographs should be screened for the presence of bone loss. If bone loss is seen and local contributing factors (i.e. open contacts, caries, restorations) can be ruled out, periodontitis should be considered.
Localized aggressive periodontitis does not demonstrate clinical signs and responds weakly to periodontal therapy. The disease progression is episodic, alternating between destructive phases and idle phase. The ultimate treatment goal of controlling attachment loss is usually not possible in aggressive periodontitis. Therefore, the goal is modified to slow the progression of the disease.
Treatment of localized aggressive periodontitis is similar to that of chronic periodontitis. The individual should be instructed on proper home care, and since aggressive periodontitis affects children, the parents should be included. Smoking cessation should be considered if appropriate. Tooth surfaces should undergo periodontal instrumentation in addition to the use of antimicrobial agents to help remove bacteria involved with aggressive periodontitis. If the dental hygienist is not able to instrument the entire root surface, the individual should be referred to a periodontis and surgical treatment can be discussed.
Aggressive periodontitis cannot be reversed, but with the help from a well-educated dental team, hopefully further damage can be prevented.
References:
Shaddox, L., Huang, H., Lin, T., Hou, W., Harrison, P., Aukhil, I., & ... Paster, B. (2012). Microbiological characterization in children with aggressive periodontitis. Journal Of Dental Research, 91(10), 927-933
Additional resources from:
Neild-Gehrig, Jill S., & Willmann, Donald E. (2011) Foundations of Periodontics for the Dental Hygienist (3rd ed.). Philadelphia, PA: Lippincott Williams and Wilkins.
*Picture from Google Images