Rapidly progressive types of periodontal disease in juveniles and adults in

Have you heard the term rapid progressive periodontitis mentioned by your dentist? Dr Hans Lock explains what you need to know.

Definitions:

Rapid progressive periodontitis: Type of periodontitis (infection of gums and tooth-supporting bone) with abnormal activity during the illness and pronounced lack of relation to age and plaque.
Juvenile periodontitis: Infection of gums and tooth-supporting bone that occurs in early age before adulthood.
Adult Generalized Chronic Periodontitis: Infection of gums and tooth-supporting bone in adulthood with clear relation between age, ongoing infection and accumulation of bacteria (this is the most common type of the periodontal diseases).
Necrositizing Periodontitis: Severe infection and visible necrosis of gums and tooth-supporting bone.

Typical general signs of rapid progressive periodontitis:

Occurance: Often between the age of 20 and 40. Might occur earlier or later.
Generalized periodontal destruction with rapid loss of bone support around involved teeth.
Periodic and cyclic: Ongoing and changing infection-activity especially when left untreated.
Often minimal correlation between the presence of bacteria and the activity of the illness.
Might occur in relation to certain general systemic illnesses.
Often the patient does not respond as expected to treatment. Some patients respond perfectly while other patients do not.
Tendency towards repeated activity at different levels despite optimal treatment including all available options.

Diagnosis:

is based on specific clinical findings, especially:

Minimal relation between the rapid loss of bone support around the teeth and age.
Clinical and radiological pronounced loss of bone support around the involved teet over a relatively short period of time.

Predisposing factors:

Gumdisease with less than optimal oral hygiene.
Smoking tobacco.
Mental stress and depression.
General illnesses: I.e. Diabetes.
Genetic inheritance.

Aim in the treatment of the disease:

is to eliminate or treat the first four of the above mentioned predisposing factors and thereby keeping the activity of the illness at a very low level.

Treatment:

Conventional periodontal treatment (rootscaling and polishing) with short hygiene-phase (2-3 weeks) and the immediate general use of chlorhexidine as a mouth-rinse for 2 weeks.
Local use of chlorhexidin and hydrogen peroxide in infected periodontal pockets after conventional treatment.
Systemic use of antibiotics (Amoxicillin and Metronidazole) in cases with multiple bone-defects and repeated infection despite conventional periodontal treatment and the use of mouthrinse and local administration of chlorhexidine and hydrogen peroxide.
Pronounced indication for periodontal surgery within three month after initial treatment of those inflamed pockets that do not respond to conventional periodontal treatment and the use of antibiotics.
Repeated plaque-controls and maintenance-scaling/-polishing every 2nd or 4th week for several months after initial treatment.
Mouthgard in cases of clenching or grinding.

Further literature:

The American Academy of Periodontology: Parameter on Aggressive Periodontitis. Journal of Periodontology May 2000 (supplement).
Buchmann R, Nunn ME, Van Dyke TE, Lange DE: Aggressive periodontitis: 5-years follow-up of treatment. Journal of Periodontology 2002; 73; p. 675-683.
Gunsolley JC, Zambon JJ, Mellot CA: Periodontal therapy in young adults with severe generalized periodontitis. J of Period 1994; 65; p. 268-273.

Essential advice to the patient:

Stop smoking - your immune system is overworked suppressed and therefore it can not kill bacteria sufficiently itself.
Stop clenching and grinding - it might damage the bone around the teeth.
Stop stressing yourself - it weakens the immune system.
Improve your oral health to an absolute maximum - it is the best way to avoid accumulating bacteria.