Aggressive periodontitis attacks people at early age of life and causes extensive bone loss which might lead to early loss of dentition, early detection of patients at high risk to be attacked by this type of periodontitis will help them a lot to be involved in a strict professional and personal preventive program thus minimize the periodontal damage to a large extent .I wonder if any one has ideas about any chairside methods for early detection of risk factors and those who are at a high risk for developing this kind of periodontitis?
I believe that the current short answer is no. Generalized periodontitis is caused by some genetic disease, for example Kindler Syndrome & Ehlers-Danlos syndrome type VIII, and especially genetic defects of neutrophil function, such as integrin responsiveness. Usually these diseases are diagnosed because of systemic effects. Localized aggressive periodontitis is primarily caused by infection of the oral cavity by virulent strains of Aggregatibacter actinomycetemcomitans. See attached reference.
Thank you Dr Martine, yes a part of genetic disorders and syndrome you mentioned these are also Chediak-Higiashi syndrome, Down syndrome and Papillon-Lefèvre syndrome, they have also periodontal manifestation at an early age of life which causes early loss of teeth, yes they are rare but i have seen a case of Papillon-Lefèvre syndrome some time ago. In general genetic play role in exposing individuals to both types of aggressive and chronic periodontitis by determining the nature of the oral flora toward more pathogenic bacteria as you mentioned, also patients with aggressive periodontitis are genetically have neutrohpil dysfunction, hence taking a good family history from the young adults to check if there is any member of the family is suffering from periodontal diseases at early age will help to mark those patients whom with yes at a risk of aggressive periodontitis and then to be involved in screening program and periodontal care as being at risk.
Dr. Zardawi - I am pleased to have been of assistance. And yes, there is no alternative to taking a good family history and even also examining siblings and parents to see if some also suffer from aggressive periodontitis and/or a periodontitis-related genetic disease not evident in your patient. Finally, as localized aggressive periodontitis is the most common form of aggressive periodontitis, at least in the US, there is no harm in prescribing metronidazole/amoxicillin along with any surgical therapy. However, bear in mind that amoxicillin is prescribed to remove secondary infections that develop in older patients. Only metronidazole seems specific for Aggregatibacter actinomycetemcomitans (see attached references)
you very welcome Dr. Martin, pleased with your answers, yes also racial factor should be considered as you mentioned as US is a multi national part some races are at a higher risk for developing aggressive periodontitis for example African Amercan are at a higher risk for Loc. Agg. periodontitis to be more specific not all individual are at a similar risk for developing periodontitis some people are at a higher risk regardless to the amount of plaque, and thank you for response.
I do agree with Martin and African Americans are more prone for this and risk may vary from individual to individual.
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