Apart from inclusion of systemic anti-microbial therapy and shorter recall intervals..how is treatment of aggressive periodontitis different from treatment of chronic periodontitis??
Dear Ramachandra SS
The treatment of chronic and aggressive periodontitis is the same, in which it differs is that in aggressive periodontitis you have to use systemic or local antibiotics and in chronic periodontitis you do not always use them; since antibiotics should be limited in chronic periodontitis because their misuse and overuse may produce microbial resistance. The last thing I mention is what is currently leading to a good glimpse of photodynamic therapy, since it would avoid the use of antimicrobials, although this requires even more studies and a formal consensus. Then other differences are that in aggressive periodontitis can affect the temporary teeth therefore permanent teeth that are about to erupt must be evaluated and monitored in the long term. As most patients suffering from aggresive periodontitis are children, youth or young adults could also be combined psychological treatment as this disease can reduce self-esteem and confidence to socialize because of its aesthetic (smile). And also as aggressive periodontitis has a strong family association also Should advise, monitor and evaluate the patient's family.
I hope it has served you and answered your question.
Regards
Evaluation of periodontal health of family members is done. Psychological counselling of patients with low self-esteem is very good suggestion.
Thank you Dr Heber
Dear Ramachandra,
we have to admit that we lack an understanding of the differences between aggressive and chronic periodontitis. In most studies there no differences in the immune response profile between aggressive and chronic patients and even when comparing them to healthy controls we find no differences. In complexity terms, it might be simply a "noise" that adds an effect randomly and make the difference (a bacterium intruder for instance). As far as concerning treatment regimes, I recall a study from the 80's by Wennstrom et al. (I graduated from Gothenburg's programm) and I participated in fierce debates where strong evidence suggested there are no difference in treatment response. Basically that what is my experience all these 25 years of perio practice (no differences). There is also no permanent label through the lives of patients. A chronic case can become aggressive, and an aggressive can enter a quiescent phase. Therefore, until we develope a test that periodically could assist our decision making, we rely on our clinical instinct that can be wrong. I see aggressive cases no more demanding than chronic severe cases, What is the meaning of a test? To early apply treatment without delay, to identify clusters of patients with indeed difference in treatment response that we can't see now (personalized dentistry). Other options? Diet counselling (vitamins C and D are important), pro-diabetes identification, help stopping smoking etc.
regards
Thank you for your views Prof..
Yes..i agree, there are lot of grey areas..
https://www.ncbi.nlm.nih.gov/pubmed/20403102
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0757.2010.00359.x/abstract
Thank you very much Prof for you answer..Merchant et al, study is good
Prof. Tatakis added some nice comments. I only want to point out that periodontitis in the primary dentition in so rare (0.06%) and the material of Merchant et al. had no patient that showed affected primary and permanent teeth simultaneously,
regards
Dear Dr,
Treatment is generally same in both the situations. However, patients with aggressive forms of the disease should be on a longer maintenance phase unlike patients having chronic forms of the disease. Similarly, in chronic procedures you may enter into the corrective phase as soon as the disease is treated whereas in aggressive situation this might take a little bit long could be 3 to 6 months. This is what the evidence suggests.
I agree with the colleagues that have previously answered your question that there are no differences in the treatment of agressive and chronic periodontitis. You may consult a good review about this topic in Deas DE, Mealey BL, Response of chronic and aggressive periodontitis to treatment. Periodontol 2000. 2010 Jun;53:154-66. doi: 10.1111/j.1600-0757.2009.00334.x
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