presentation on management of juvenile periodontitis .

1. JUVENILE
PERIODONTITIS

2. What is Periodontitis ?
 Periodontitis is
 Inflammatory disease of the supporting tissue of the teeth
 Caused by specific microorganism
 Resulting in progressive destruction of the periodontal
legament and alveolar bone with pocket formation ,
recession or both

3. Periodontitis
Adult
periodontitis
Early onset
periodontitis
Prepubertal
. Localized
. Generalized
Juvenile
. Localized
. Generalized
Periodontitis
associated with
systemic disease
. Down’s syndrome
. Diabetes type 1
. AIDS and other
disease
Necrotizing
ulcerative
periodontitis
Refractory
periodontitis

4. Fig : Adult Periodontitis Fig : Localized Juvenile
Periodontitis
Fig : Generalized Juvenile
Periodontitis
Fig : Necrotizing Ulcerative
Periodontitis

5. What is Juvenile or Aggressive
Periodontitis?
 Juvenile or Aggressive periodontitis is
 Rapid loss of attachment and bone loss
 Occurring in an otherwise clinicially healthy patients with
the amount of microbial deposits in consistent with disease
severity
 Familial aggregation of diseased individual

6. Aggressive/
Juvenile
Periodontitis
Localized Generalized
Rapidly
Progressing

7. Stages in the
development of disease

8. • Degenaration of principle fibers of PDL
• Cessation of cementum formation
• Resorption of alveolar bone
• Tooth migration without detectable inflammation
Stage I
• Rapid proliferation of the junctional epithelium
along the root
• Earliest sings of inflammation appear
Stage II
• Progressive inflammation and development of
deep, infrabony periodontal pocket
Stage
III

9. Etiology of juvenile periodontitis
Micro organisms
 Actinobacillus actinomycetemcomitans
 Porphyromonas gingivalis
 Eikenella corrodens
 Caprocytophaga
 Spirocheates
 Bacillus
 Defective neutrophil or monocyte function
 Poor serum antibody response to infecting agent

10. Localized Juvenile
Periodontitis

11. What is localized juvenile
periodontitis ?
 Localized juvenile periodontitis is
Occuring in otherwise healthy individual under the
age of 30 years
Destructive periodontitis localized to the 1st
permanent molars and incisors not involving more
than two other teeth

12. Clinical features

13.  Age and sex distribution
 Both sexes ( slight female predilection )
 Seen mostly between 20 years
 Distribution of lesion
 1st molar and/or incisors
1st molar and/or incisors + additional teeth ( not more than 2
teeth other than 1st molars and incisors )

14.  Lack of clinical inflammation despite the presence of deep
periodontal pocket
 Small amount of plaque, forms a thin film rarely
mineralized
 Mobility and migration of 1st molars and incisors
 Classically distolabial migration of maxillary incisors with
diastema

15.  Root surface sensitivity
 Deep dull radiating pain
 Periodontal abscess
 Enlargement of regional lymphnode

16. Radiographic findings

17.  Vertical or angular bone loss around the 1st molars and incisors
 The pattern appears to be “Arc shaped” loss of alveolar bone
extending from distal surface of 2nd premolar to mesial surface of
2nd molar
 Frequently bilaterally symmetrical pattern of bone loss occurs
called as “ mirror image pattern”
Fig : Radiograph showing localized juvenile
periodontitis

18. Histopathological
features

19.  Ulcerated pocket epithelium
 Accumulation of various inflammatory cells in the
connective tissue mainly leukocytes, plasma cells and
small number of lymphocytes and macrophages
 Bacterial invasion of connective tissue
 The flora involves A. actinomycetemcomitans ,
Capnocytophaga sputigena and others

20. Bacteriology
 A. actinomycetemcomitans
 short
 Facultatively anaerobic
 Non motile
 Gram negative rod
 Caprocytophaga
Fig : Showing colony of A.a

21. Leucotoxin Destroys polymorphonuclear
leukocytes and macrophages
Endotoxin Activates host cells to secret
inflammatory mediators
Bacteriocin Inhibit IgG and IgM production
Collagenase Degradation of collagen
Chemotactic
Inhibition factor
Inhibit neutrophil chemotaxis
Virulence factor associated with
A. actinomycetemcomitans

22. Immunology
Functionals defects of polymorphoneuclear leukocytes
or monocytes, impairs the chemotactic attraction of
these cells to the site of infection

23. Generalized Juvenile
Periodontitis

24. What is Generalized juvenile
periodontitis ?
 Generalized juvenile periodontitis is
 Generalized interproximal attachment loss
 Affecting atleast three permanent teeth other than the
1st molar and incisors

25. Clinical
features

26. Age and sex distribution
Affects between puberty and 35 years
No sex discrimination
Distritubiton of lesion
All or most of the teeth are affected, no specific pattern is
observed
 There are two phases of lesion

27. Destructive phase Non destructive phase
Tissue appears severely
inflammed, ulcerated
and fiery red
Bleeding with or
without stimulation
Suppuration
Attachment and bone
loss
Tissue appears pink with some
stippling
Lack of inflammation
Probling will reveal deep pocket
Bone attachment levels relatively
stable

29.  Some patients may exhibit
Weight loss
Mental depression
General malaise
Systemic condition may predispose patient to
generalized juvenile periodontitis, these includes
 chornic neutrophil defect
Leukocyte adherence deficiency

30. Radiographic findings

31.  No define pattern of distribution
Range from severe bone loss associated with
minimal number of teeth to advanced bone loss
affecting the majority of teeth in the dentition
Fig : showing radiograph of GJP

32. Treatment
Extraction Standard
periodontaltherapy
Antibiotic therapy
Extraction of
involved teeth,
specially 1st molar
Transplantation
of developing 3rd
molar into the
sockets of
previously
extracted 1st molar
Scaling
Root planning
Curettage
Flap surgery with /
without bone grafts
Root amputation
Hemisection
Occlusal
adjustment
Tetracycline
hydrochloride 250mg
q.i.d + local
mechanical therapy
Doxycycline 100mg
per day
Combination of
amoxicilline and
metronidazole

33. Fig : Scaling & Root planning
Fig: Curettage
Fig : Hemisection Fig : Flap surgery

34. Periodontal disease accounts for a majority of
missing teeth in adults and results in tremendous
economic and social burdens both to the individual
and the society
Periodontal disease is so prevalent that only
possible solution to the problem is its prevention by
maintaining the good oral hygiene
Conclusion

35. Reference
 Essential of Clinical Periodontology And Periodontics
; 4th edition ; Shantipriya Reddy
Carranza’s Clinical Periodontology ; 11th edition ;
Newman ;Takei ; Klokkevold ; Carranza
Cawson’s Essentials of Oral Pathology And Oral
Medicine ; 8th edition ; R. A. Cawson ; E. W. Odell