ensures that reinfection is detected early.
Key Points
Primary dentition (prepubertal periodontitis):
- localized/generalized;
- aggressive pathogens;
- intense treatment.
11.11.2 Permanent dentition (juvenile periodontitis)
In the permanent dentition, aggressive periodontitis involves severe periodontal
destruction with an onset around puberty. The localized form occurs in otherwise
healthy individuals, with destruction classically localized and around the first
permanent molars and incisors, and not involving more than two other teeth.
Generalized periodontitis also occurs in otherwise healthy individuals but involves
more than 14 teeth, that is, being generalized to an arch or the entire dentition. Some
reports have monitored children suffering from aggressive periodontitis of the primary
dentition to find that, at around puberty, the disease became generalized to involve the
entire dentition.
Epidemiology
Studies show a prevalence of about 0.1% in developed countries and about 5% in
underdeveloped nations, although some variation may be due to different methods of
screening and different criteria used to define the disease. The disease is clearly more
prevalent in certain ethnic groups. In the United Kingdom an epidemiological study of
7266 schoolchildren in Coventry and Birmingham showed an overall prevalence of
0.02% in Caucasians, 0.2% in Asians, and 0.8% in the AfroCaribbean population.
There was no difference in prevalence between males and females, which does not
concur with the data of many earlier epidemiological studies of the disease which
reported a female to male ratio of 3 : 1.
Clinical and radiographic features
The age of onset is between 11 and 15 years. The clinical features are pocket
formation and loss of attachment associated with the permanent incisors and first
molar teeth. The radiographic pattern of bone loss is quite distinctive. Bilateral
angular bone defects are identified on the mesial and, or distal surfaces of molars (631HFig.
11.12 (a) and (b)). Angular defects are sometimes seen around the incisors, although
the very thin interproximal bone is resorbed more evenly to give a horizontal pattern
of resorption. The bone loss around the molars can be detected on routine bitewing
radiographs. The interpretation of the films must be made with a sound knowledge of
the patient's dental history, however, as localized angular defects are found adjacent
to teeth with overhanging or deficient interproximal restorations, and teeth that have
tilted slightly (632HFig. 11.13). The gingiva can appear healthy when the levels of plaque
are low, but a marginal gingivitis will be present if a good standard of plaque control
is not evident.
The generalized form may also present at puberty. Severe generalized bone loss is the
characteristic feature (633HFig. 11.14). The pattern may be a combination of angular and