Prepeubertal

periodontitis
Definition Distribution & incidence

Classification
Microbiology Progression of ppp
Clinical Features
Radio-graphical Analysis
Histopathology Diagnosis
Management
Prognosis
Summary

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 Definition
A disease of peridontium ,occurring in
otherwise healthy adolescent & children
,characterized by severe rapid destruction
of periodontal tissues accompanied by
premature tooth loss & etiology of which is
not well understood .
 Distribution &
Incidence
Age distribution:- <11 year
Color distribution:- Black men>Black
females> White Females>White males
Distribution of lesion :-
First Molars & Incisors
Molars, Incisors & some additional teeth
(<14 years)
Generalized involvement
Etiology
1) Autosomal recessive form
(Genetic)

2) Infections of oral cavity

3) Benjamin & Baer :- seen

cases among twins, sibling,
first cousins as well as in
parents and their offsprings
Microbiology
 1) Actinobacillus
actinomycetemcomitans
 2) Capnocytophaga Sputigena
 3) Mycoplasma
 4) Spirochetes
 5) Other gram negative cocci,rods &
filaments
 Progression of pre
pubertal periodontitis
- PPP generally begins by the age of 4 years
or even before, immediately after eruption
of deciduous teeth

So it affects
both deciduous as well as permanent teeth
 - Primary teeth are lost by the age of 5 or 6
years
-The permanent teeth than erupt normally
but within a few years destructive periodontal
disease affect all the teeth except third molars
-By
the age of 15 years most of the permanent
teeth are lost
 Classification

Localized
Generalized
Distribution of lesion in the
region of the first molars
and incisors, with least
destruction in the cuspid &
premolar area.
Clinical features
Lack of clinical inflammation
despite the presence of deep
periodontal pockets
Small amount of plaque –rarely
mineralize to become calculus
mobility and migration of 1st molars
& incisors
 In later Stages:- Clinical inflammation seen with
accumulation of plaque and calculus & increase in
size of clinical crown
Denuded roots –sensitive to thermal & tactile
stimuli
Deep dull radiating pain:-
Periodontal abscess
Regional lymph node enlargement
Radiographic
features
Arch shaped bone loss (extending
from distal surface of second
premolar to the mesial surface of
second molar)

Vertical Bone loss over incisors and

1st molars
Clinical
Course
 Rate of bone loss is about 3-4
times faster than in typical
periodontitis cases
 Bone resorption progresses until
teeth are treated , exfoliated or
extracted
Histopatholog
y:-
Histologically ppp shows an absence
of neutrophils in the gingiva, but
numerous lymphoid cells specially
plasma cells are present. Severe
alveolar bone loss may occur in the
absence of neutrophils.
Associated syndromes with ppp
• Papillon lefevre syndrome-
[Also known as hyperkeratosis palmoplantris ]
It is a triad of -
1.Charecterized by hyperkeratotic skin lesions
(palms, soles, neck & elbows) with severe
destruction of periodontium.
2.periodontal lesion consists of early
inflammatory involvement leading to
horizontal bone loss & exfoliation of teeth
3.Calcification of dura.
 Down’s syndrome
Also k/a trisomy 21 or mangolism -A
congenital disease caused by a chromosomal
abnormality .
- Characterized by decrease mental
efficiency & growth retardation.
- Prevalence of
periodontitis is much higher in down’s syndrome
cases than in normal subjects .
- 100%
occurance under 30 years of age
Hypophospatasia
Decrease level of circulatory alkaline phosphate
Severe alveolar bone loss Loss of
deciduous & permanent teeth Fair to poor
prognosis
• Retarted growth & rickets
deformities may be observed
Excreation of
phospoethanolamine in urine
have been reported
Chediak higashi syndrome

-It is a hereditary disease.

-In this condition loss of teeth occurs at
a vary young age due to periodontal
attachment loss, the teeth are lost
before adulthood.
Neutropenia
It is a condition where the number of
circulating neutrophils is reduced. The no.
of polymorphonuclear leukocytes may be
less than 1500 per microlitre. The defect
may be due to inherent or acquired causes.
Infection & certain drugs may cause
neutropenia.
Destructive generalized periodontal lesions
have been described in children.
Diagnosis
Age
Rate of bone loss
Inflammation & subgingival calculus
associated with development & progression of
early onset periodontitis
Bilateral Defects
Little clinical inflammation with little plaque
and calculus
Arch Shaped bone loss
 Management
Preliminary Phase (Emergency Phase)
Etiotropic Phase
Surgical Phase
Restorative Phase
Maintenance Phase
Preliminary
Phase
Extraction of hopeless teeth
&
provisional replacement if
needed
Etiotropic
Phase
Plaque Control
Scaling & Root Planing
Antimicrobial Therapy:- Systemic
Antibiotic therapy (250 mg qid for 1 week)
Tetracyclines esp. Doxicyclin is the drug of
choice
In refractory cases :- Amoxicillin plus
metronidazole regimen
Surgical
phase
Periodontal surgery including placement
of implants
Prior to surgery:-Antibiotics should be
given 1 hr. before
After Surgical intervention:-Anti-
bacterial mouthwash (Chlorhexidine)
recommended to aid healing
Restorative
Phase
Placement of Fixed or
removable prosthesis
Maintenance
Phase
Frequent Visit
Examination & evalution of the
patient current health care (Gingival
Condition)
Scaling & root planing followed by
prophylaxis
Review of oral hygiene instructions
Self Care
Regimen
 Flossing
 Interdental Brushing
 Power assisted Brushing
Prognosis
 Initially, the prognosis used to be
poor ,but the administration of
systemic tetracycline in conjugation
with surgical pocket therapy has
greatly improved the expected result.