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Aggressive Periodontitis: Need to Assess the Prevalence and to plan the Management Strategies in Indian Scenario

Vandana A. Pant and R. M. Mathur

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In general, the data support conservative supportive treatment of localized prepubertal periodontitis, which includes mechanical therapy, antibiotic coverage, and maintenance. Juvenile periodontitis also presents in either localized or generalized forms. Generalized juvenile periodontitis (GJP) usually occurs in the late teenage years and affects most teeth.

The disease has been associated with a variable microbial etiology that may include Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Contributing risk factors such as smoking should be considered. Localized juvenile periodontitis (LJP) has an age of onset at or around puberty and is associated with molar and incisor bone and attachment loss. However, atypical patterns of disease have been observed. Association with the periodontal pathogen Actinobacillus actinomycetemcomitans and neutrophil function abnormalities frequently characterizes the localized form. Both GJP and LJP may exhibit abnormalities in host immune cell functions that appear to follow a familial pattern.

The goal of treatment in early-onset periodontitis is to alter or eliminate the microbial etiology and the contributing risk factors, and faster regeneration of the periodontal apparatus. Due to the complexity of this type of periodontal disease with respect to systemic factors, immune defects, and the microbial flora, control of the disease may not be possible in all instances. In such cases, a reasonable treatment objective is to slow the progression of the disease by administering the appropriate antibiotic regimen, and providing repeated microbiological testing and an intensified, supportive periodontal therapy program.

Rapidly progressive periodontitis (RPP) is typically found in patients 20-35 years old. With the exception of the age of onset, the clinical, microbiological, and immunologic diagnostic findings in RPP are similar to those in GJP. In general, treatment methods for early-onset periodontal diseases may be similar to those used for adult periodontitis. These methods should include oral hygiene instruction, and reinforcement and evaluation of the patient’s plaque control; supra- and sub-gingival scaling and root planing to remove microbial plaque and calculus; control of other local factors; occlusal therapy as necessary; periodontal surgery as necessary; and supportive periodontal therapy. In addition, a general medical evaluation may determine if systemic disease is present in children and young adults who exhibit severe periodontitis, particularly if early-onset periodontitis appears to be resistant to therapy. Consultation with the patient’s physician may be indicated to coordinate medical care in conjunction with periodontal therapy.

In the early stages of disease, lesions may be treated with adjunctive antimicrobial therapy combined with scaling and root planing with or without surgical therapy. Microbiological identification and antibiotic sensitivity testing may be considered. The long-term outcome may depend upon the patient’s compliance, and delivery of supportive periodontal therapy at appropriate intervals, as determined by the clinician. If primary teeth are affected, eruption of permanent teeth should be monitored to detect possible attachment loss. A number of systemic factors have been documented as capable of affecting the periodontium and/or treatment of periodontal disease.

Systemic etiologic components may be suspected in patients who exhibit periodontal inflammation or destruction, which appears disproportionate to the local irritants. Periodontal therapy may be modified based on the current medical status of the patients. Periodontal organisms may be the source of infections elsewhere in the body. Therefore, those infections may also affect systemic health. The therapeutic goal is to achieve a degree of periodontal health consistent with the patient’s overall health status. Achieving this goal, however, may be directly affected by the degree of control of the systemic condition. The systemic and psychological status of the patient should be identified, therefore, to reduce medical risks that may compromise or alter the periodontal treatment. Patients with systemic conditions that contribute to progression of periodontal diseases may be successfully treated using established periodontal treatment techniques. However, the systemic/psychologic status of the periodontal patient may alter the nature of therapy rendered and may adversely affect treatment outcomes.

In past few years, we observed that the increasing numbers of cases of aggressive periodontitis are being encountered in our OPD and most of them belong to the same vicinity, almost similar habits, similar socio-economic status, etc. Then, we went for a thorough literature search that, if there is availability of any kind of data on the prevalence, early detection, treatment rational and management strategies for the disease for Indian population. But, to the best of our knowledge, no such kind of database is available for the Indian population on aggressive periodontitis, a severe disease of periodontium with genetic predisposition and coupling association with several systemic disorders.

Therefore, in order to formulate the treatment strategies and management of disease, and further to get the complete interactive static figures of different identified factors associated with the disease, a questionnaire and clinical observation based comprehensive database and data base management system (DBMS) should be developed. DBMS will provide lots of information associated with the treatment rational for individual patient, management strategies for preventive measures, public awareness, association of aggressive periodontitis with factors identified and other systemic diseases, etc. Further, the DBMS developed with the database for aggressive periodontitis will be of immense use for dental practitioners, physicians, local, state and National level health regulating agencies in the country.

Vandana A. Pant and R. M. Mathur
Saraswati Dental College, Lucknow – (U.P) India
[email protected],
[email protected]

*Vandana A. Pant and R. M. Mathur*
Saraswati Dental College, Lucknow - (U.P) India
[email protected],
[email protected]

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