Aggressive Periodontitis and Chronic Periodontitis
Aggressive Periodontitis
Chronic Periodontitis
Description of the disease:
Chronic periodontitis- a bacterial infection resulting in inflammation within the supporting tissues of the teeth, progressive destruction of the periodontal ligament, and loss of supporting alveolar bone.
Aggressive periodontitis- a bacterial infection characterized by a rapid destruction of the periodontal ligament, rapid loss of supporting bone, high risk for tooth loss, and a poor response to periodontal therapy.
Distinguishing diagnostic factors: Both involve irreversible loss of attachment and bone. In chronic periodontitis attachment loss may occur in one area of a tooth's attachment, on several teeth, or the entire dentition. It progresses at a slow to moderate rate. In aggressive periodontitis it involves generalized interproximal attachment loss affecting at least three permanent teeth other than the first molars and incisors. It progresses at a rapid rate.
Etiology of the disease: Determined by the interaction between plaque biofilm and the host immune response.
Pathogens associated with the disease: Both are associated with gram negative bacteria. The main bacteria found in chronic periodontis include Tannerella forsythia (Tf), Porphyromonas gingivalis (Pg), and Aggregatibacter actinomycetemcomitans (Aa). Aggressive periodontitis is associated with Aggregatibacter actinomycetemcomitans (Aa)
Classification of the disease: AAP classification for chronic periodontitis is II A for localized and II B for generalized. AAP classification for aggressive periodontitis is III A for localized and III B for generalized.
Prevalance of the disease: Chronic periodontitis is most commonly seen in adults over the age of 35, but it can occur in children and adolescents. Aggressive periodontitis usually occurs in people under the age of 30, but patients may be older.
Factors to include in patient education: Individualized instruction, reinforcement, and evaluation of the patients self care skills.
Treatment recommendations or corrective procedures: Periodontal therapy to stop the progression and to prevent further attachement loss. Control of attachment loss may not be possible in some cases of aggressive periodontitis. In such cases, the treatment goal is to slow the progression of the disease. Attachment and bone loss in both cases is not reversible.
Maintence recommendations: Good oral hygiene should be implemented and recare appointments should be made every 3 months.
References:
Armitage, G. C., Cullinan, M. P., & Seymour, G. J. (2010). Comparative biology of chronic and aggressive periodontitis: introduction. Periodontology 2000, 53(1), 7-11. doi:10.1111/j.1600-0757.2010.00359.x
Nield-Gehrig, Jill S., Willmann, Donald E., (2011). Foundations of Periodontics for the Dental Hygienist.
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