Periodontitis

Generalized Aggressive Periodontitis in Preschoolers: Report of a

case in a 3-1/2 Year Old

The importance of a prompt diagnosis and treatment of periodontitis in children is emphasized by the association between the presence of periodontitis in primary dentition and periodontitis at older ages in the same individual. The 1999 International Workshop for a Classification of Periodontal Diseases and Conditions classified periodontal disease in children as follows: Dental plaque-induced gingival diseases; aggressive periodontitis (previously known as “prepubertal” or “early onset periodontitis”); chronic periodontitis; periodontitis as a manifestation of a systemic disease; and necrotizing periodontal diseases. Aggressive and chronic periodontitis is subdivided into localized or generalized, depending on the size of the area affected. Most of the literature reports of severe periodontal destruction in children are associated with systemic diseases such as hypophosphatasia, cyclic neutropenia, agranulocytosis, histiocytosis X, leukocyte adhesion deficiency, Papillon-Lefèvre syndrome and leukemia.

Although destructive forms of periodontal disease in infants are relatively uncommon, children and adolescents may manifest any form of periodontitis. However, it has been shown that aggressive periodontitis may be more common in children and adolescents, while chronic periodontitis is more frequent in adults. Prevalence estimates range widely in different geographical regions, and demographic and ethnic groups. The estimates of prevalence rates of early onset aggressive periodontitis in the general populations in different continents are: 0.4 – 0.8% in North America, 0.1 – 0.5% in Western Europe, 0.3 – 1% in South America, 0.5 – 5% in Africa and 0.4 – 1% in Asia. In terms of race-ethnic groups, the prevalence varies from 0.1 – 0.2% in Caucasians, 1 – 3% in Africans and African- Americans, 0.5 – 1% in Hispanics and South Americans and 0.4 – 1% in Asians.

Patients with Generalized Aggressive Periodontitis (GAgP) present a history of rapid gingival attachment loss, bone loss, severe periodontal inflammation, and heavy plaque and calculus accumulation. GAgP patient’s exhibit generalized interproximal attachment loss including at least three teeth in addition to first molars and incisors. Although in young subjects the onset of these diseases is often circumpubertal, GAgP may appear at any age and often affects the entire dentition. The etiology of aggressive periodontitis may be broadly divided into two categories: bacterial plaque with highly pathogenic bacteria, and impaired host defense mechanism. As far as pathological micro flora is concerned, the most important bacteria appear to be highly virulent strains of Aggregatibacter actinomycetemcomitans previously known as Actinobacillus actinomycetemcomitans in combination with Porphyromonas gingivalis, Prevotella intermedia and

Treponema denticola, however other bacteria may be present.

Although there seems to be a genetic predisposition for periodontal diseases, it has also been shown that periodontopathic bacteria are transmissible among family members or between children and their caregivers. Regarding the impaired host defense mechanism, neutrophils from patients with GAgP frequently exhibit suppressed chemo taxis or altered phagocytosis. Moreover, alterations in immunologic factors are known to be present in Aggressive Periodontitis. Immunoglobulins, with their important protective disease-limiting effects, appear to be influenced by patients’ genetic background and environmental factors such as bacterial infection. Patients with Aggressive Periodontitis often present impaired immune function, particularly neutrophil dysfunction. In these cases, clinicians should always rule out systemic diseases that can affect host defense mechanisms.

Successful treatment of patients with Aggressive Periodontitis

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