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  1. Ramachandra SS
    J Dent Res, 2014 Feb;93(2):212.
    PMID: 24442399 DOI: 10.1177/0022034513515274
    Matched MeSH terms: Aggressive Periodontitis/physiopathology*
  2. Arunachalam R, Rajeev V, Kumaresan R, Kurra SB
    J Contemp Dent Pract, 2019 Aug 01;20(8):952-956.
    PMID: 31797853
    INTRODUCTION: Assessment of host response to inflammation will throw light on the critical role of antioxidants (AOs) and free radicle damage in the etiology of periodontal disease. The purpose of the study was to assess the level of plasma oxidative stress in those having aggressive periodontal disease before and after full-mouth disinfection. Objectives were to find the influence of full-mouth disinfection analyzing the level of thiobarbituric acid reactive substances (TBARSs), thereby quantifying the lipid peroxidation (LPO) and also the activities of reduced glutathione (GSH), glutathione peroxidase (GPX), and catalase (CAT), valuing the AO defense systems in health and disease.

    MATERIALS AND METHODS: The valuation composed of 30 subjects with aggressive periodontal disease and 30 healthy controls. Clinical assessment included following periodontal parameters: plaque index (PI), papillary bleeding index (PBI), probing pocket depth (PPD), and clinical attachment level (CAL). Levels of bone loss were assessed by taking full-mouth periapical radiographs. Initial periodontal therapy comprises of full-mouth disinfection which includes subgingival scaling and root planing within 24 hours combined with adjunctive chlorhexidine chemotherapy for aggressive periodontitis subject's at sites indicated. The parameters (clinical) were evaluated at the baseline and 8 weeks after initial periodontal therapy at six sites of teeth indicated. Plasma samples were taken and evaluated by standard procedures as defined in the literature. All the values were weighed and related.

    RESULTS: Strong positive associations were detected among periodontal parameters and TBARS, enzymatic/nonenzymatic AO levels (p < 0.05), and pre- and postperiodontal management. The plasma levels of patients with aggressive periodontitis had high levels of TBARS and displayed a substantial escalation in the activities of GSH and GPX levels in the plasma matched to the healthy individuals (p < 0.05).

    CONCLUSION: This paper evaluated ROS activity and AO defense before and after treatment to stimulate added periodontal investigation in this part which will give an insight into the therapeutic options with foreseeable results.

    Matched MeSH terms: Aggressive Periodontitis*
  3. Kamil W, Al Bayati L, Hussin AS, Hassan H
    J Med Case Rep, 2015;9:211.
    PMID: 26404671 DOI: 10.1186/s13256-015-0677-6
    Aggressive periodontitis is characterized by a rapid rate of attachment loss and bone resorption. Regenerative therapy offers reconstruction of the periodontium; however, certain advanced cases with a questionable prognosis might remain a challenge. We report a successful intervention outcome of a challenging case in the aesthetic zone of a patient with aggressive periodontitis.
    Matched MeSH terms: Aggressive Periodontitis/drug therapy; Aggressive Periodontitis/surgery*
  4. Yusof ZA
    J. Periodontol., 1990 Dec;61(12):751-4.
    PMID: 2269916
    The objective of this report was to determine the radiographic patterns of alveolar bone loss in early-onset periodontitis (EOP) cases in a selected Malaysian population. The radiographs of 55 cases of EOP patients were examined and the radiographic patterns were classified as follows: Type I: bone destruction on first molars and/or incisors only; Type II: bone destruction on first molars and/or incisors and several additional teeth (less than 14 teeth); Type III: generalized bone destruction (greater than 14 teeth), but with involvement noticeably more extensive on the first molars and/or incisors; Type IV: generalized bone destruction (greater than 14 teeth), but with no more bone loss on the first molars and/or incisors than on other involved teeth. Sex, age, and missing teeth were also recorded. Out of 55 cases, 47 cases, 22 males and 25 females, were classified into the types mentioned above; the remaining 8 cases were excluded due to too many missing teeth. It was found that 7 (14.9%) were Type I; 12 (25.5%) were Type II; 7 (14.9%) were Type III; and 21 (44.7%) were Type IV. There was a predominance of first molar/incisor involvement in Types I, II, and III with the maxillary first molars most frequently involved followed by the mandibular central incisors. Type I occurred in the younger age group and Types II, III, and IV mainly in the older age group. It was concluded that EOP in this patient sample resembled that of western society.
    Matched MeSH terms: Aggressive Periodontitis/classification; Aggressive Periodontitis/radiography*
  5. Wong HC, Ooi Y, Pulikkotil SJ, Naing C
    BMC Oral Health, 2018 10 22;18(1):171.
    PMID: 30348144 DOI: 10.1186/s12903-018-0637-9
    BACKGROUND: Periodontitis is a major oral health problem and it is considered as one of the reasons for tooth loss in developing and developed nations. The objective of the current review was to investigate the association between IL10 polymorphisms - 1082 A > G (rs1800896), -819C > T (rs1800871), - 592 A > C (rs1800872) and the risk of either chronic periodontitis or aggressive periodontitis.

    METHODS: This is a meta- analysis study, following the preferred reporting items for systematic reviews and meta- analyses (PRISMA). Relevant studies were searched in the health related electronic databases. Methodological quality of the included studies were assessed using the Newcastle-Ottawa Scale. For individual studies, odds ratio (OR) and its 95%confidence interval (CI) were calculated to assess the strength of association between IL10 polymorphisms (- 1082 A > G, -819C > T, - 592 A > C) and the risk of periodontitis. For pooling of the estimates across studies included, the summary OR and its 95% CIs were calculated with random-effects model. The pooled estimates were done under four genetic models such as the allelic contrast model, the recessive model, the dominant model and the additive model. Trial sequential analysis (TSA) was done for estimation of the required information size for this meta-analysis study.

    RESULTS: Sixteen studies were identified for this review. The included studies were assessed to be of moderate to good methodological quality. A significant association between polymorphism of IL10-1082 A > G polymorphism and the risk of chronic periodontitis in the non-Asian populations was observed only in the recessive model (OR,1.42; 95% CI:1.11, 1.8,I2: 43%). The significant associations between - 592 A > C polymorphism and the risk of aggressive periodontitis in the non-Asian populations were observed in particular genetic models such as allele contrast (OR, 4.34; 95%CI:1.87,10.07,I2: 65%) and recessive models (OR, 2.1; 95% CI:1.16, 3.82,I2: 0%). The TSA plot revealed that the required information size for evidence of effect was sufficient to draw a conclusion.

    CONCLUSIONS: This meta-analysis suggested that the IL10-1082 A > G polymorphism was associated with chronic periodontitis CP risk in non-Asians. Thus, in order to further establish the associations between IL10 (- 819 C > T, - 592 A > C) in Asian populations, future studies should include larger sample sizes with multi-ethnic groups.

    Matched MeSH terms: Aggressive Periodontitis/ethnology; Aggressive Periodontitis/genetics*
  6. Vohra F, Akram Z, Safii SH, Vaithilingam RD, Ghanem A, Sergis K, et al.
    Photodiagnosis Photodyn Ther, 2016 Mar;13:139-147.
    PMID: 26184762 DOI: 10.1016/j.pdpdt.2015.06.010
    BACKGROUND: The aim was to assess the efficacy of antimicrobial photodynamic therapy (aPDT) in the treatment of aggressive periodontitis (AgP).

    METHODS: The addressed focused question was "Is aPDT effective in the treatment of AgP?" MEDLINE/PubMed, EMBASE, Scopus, ISI Web of knowledge and Google-Scholar databases were searched from 1977 till May 2015 using combinations of the following keywords: antimicrobial; photochemotherapy; photodynamic therapy; photosensitizing agents; AgP; scaling and root-planing (SRP). Reviews, case reports, commentaries, and articles published in languages other than English were excluded.

    RESULTS: Seven studies were included. In 5 studies, aPDT was performed as an adjunct to SRP. Laserwavelengths and duration of irradiation ranged between 660-690 nm and 60-120 s, respectively. Laser power output as reported in 2 studies was 75 mW. One study showed significant improvement in periodontal parameters for subjects receiving aPDT as an adjunct to SRP as compared to treatment with SRP alone at follow up. However, comparable periodontal parameters were reported when aPDT as an adjunct to SRP was compared to SRP alone in the treatment of AgP in one study. One study showed comparable outcomes when aPDT was compared to SRP in the treatment of AgP. In two studies, adjunctive antibiotic administration to SRP showed significantly better outcomes when compared to application of adjunctive use of aPDT to SRP.

    CONCLUSION: aPDT is effective as an adjunct to SRP for the management of AgP, however, further randomized clinical trials with well defined control groups are needed in this regard.

    Matched MeSH terms: Aggressive Periodontitis/epidemiology*; Aggressive Periodontitis/therapy*
  7. Gupta VV, Ramachandra SS
    J Indian Soc Periodontol, 2019 8 2;23(4):371-376.
    PMID: 31367137 DOI: 10.4103/jisp.jisp_654_18
    This report presents a 29-year-old aggressive periodontitis patient from Morocco with a history of orthodontic treatment. Despite all the first molars showing advanced bone loss, the maxillary anterior teeth did not show any periodontal destruction. The scientific literature rarely reports cases of aggressive periodontitis without involving maxillary anterior teeth. The treatment provided includes extraction of hopeless tooth, removal of overhanging restoration, scaling, root debridement, and regenerative periodontal therapy. The discussion highlights the dilemma during diagnosis of the case as either "iatrogenic periodontitis due to orthodontic treatment" or "localized aggressive periodontitis." The age group of 15-35 years is the common age group for patients' seeking orthodontic treatment and the occurrence of aggressive periodontitis. Sound knowledge of periodontitis and identification of early signs of aggressive periodontitis through meticulous periodontal examination may help in earlier identification and minimalistic treatment. Education regarding periodontitis, especially aggressive periodontitis, is essential among orthodontists and general dentists. This case report aims to discuss the dilemma involved during diagnosis of localized aggressive periodontitis.
    Matched MeSH terms: Aggressive Periodontitis
  8. Azizah Ahmad Fauzi, Zaleha Shafiei, Badiah Baharin, Nurulhuda Mohd
    Sains Malaysiana, 2013;42:19-24.
    Bacteriocin or Bacteriocin like inhibitory substances (BLIS) is a protein antibiotic that has a relatively narrow spectrum of killing activity. It could potentially serve as a natural alternative to antibiotics in reducing the development of multi-drug resistant bacteria. Antimicrobial activity of the strains of Lactobacillus sp. isolated from healthy subjects (test strains) against Aggregatibacter actinomycetemcomitans and other periodontal pathogens (indicator strains) isolated from subgingival plaques of aggressive periodontitis patients were determined by using deferred antagonism test and agar-well diffusion method. Strains of Lactobacillus sp., Aggregatibacter actinomycetemcomitans and black pigmented bacteria were selectively isolated from TJA, TSBV and TSBA agars, respectively. Mean diameter zone of inhibition of at least 10 mm was considered as positive results for both methods. Out of 25 strains of Lactobacillus sp. screened, only eight test strains of Lactobacillus sp. showed the specific antimicrobial activity against certain strains of indicator periodontal pathogens during deferred antagonism test. However, out of eight potential strains, only three strains, which were Lactobacillus sp. strain S, Lactobacillus sp. strain V and Lactobacillus sp. strain W consistently showed positive inhibitory activity against black pigmented bacteria by deferred antagonism test and agar-well diffusion method. Therefore, these three strains should be considered as potential BLIS producer strains for further study.
    Matched MeSH terms: Aggressive Periodontitis
  9. Ramachandra SS, Gupta VV, Mehta DS, Gundavarapu KC, Luigi N
    Contemp Clin Dent, 2017 Oct-Dec;8(4):594-603.
    PMID: 29326511 DOI: 10.4103/ccd.ccd_623_17
    Background: Differentiating between chronic periodontitis (CP) and aggressive periodontitis (AgP) is challenging. The aim of this study was to assess the variations in diagnosis between CP versus AgP and the staging of AgP based on the disease-staging index for AgP among periodontists, specialists in oral medicine, and general dental practitioners (GDPs).

    Materials and Methods: Fifteen cases diagnosed as either CP or AgP were included in a "case document" and sent electronically to 75 respondents. Case document included a detailed history with periodontal charting, clinical features, images, and radiographs for all the cases. Diagnosis and staging for the case (if diagnosed as AgP) were requested. A reordered case document (cases in a different sequence) was again sent to respondents after a gap of 1 month.

    Statistical analysis: Descriptive statistics including frequency and percentage were calculated. Pearson's Chi-square test was used to analyze the data collected.

    Results: For the "case document," 10.17% of the responses were different from those of the authors for diagnosis, whereas 4.48% of the responses were different from those of the authors for the staging of AgP. The agreement in the overall responses was in the range of 0.69-0.84, which was considered good. Comparison of the responses for diagnosis showed statistically significant (P = 0.009) difference between specialists in oral medicine and GDPs.

    Conclusions: Variations exist among respondents regarding the diagnosis of CP versus AgP. Staging of AgP based on the listed criteria showed low variations.
    Matched MeSH terms: Aggressive Periodontitis
  10. Rajan G, Baig MR, Nesan J, Subramanian J
    Indian J Dent Res, 2010 Jan-Mar;21(1):125-8.
    PMID: 20427922 DOI: 10.4103/0970-9290.62801
    Treatment of patients with aggressive periodontitis has always been a challenge to the clinician. Both young and old are known to be affected by this progressive destructive condition of the supporting dental structures. Although dental implants have been offered as a viable treatment alternative for such patients, additional procedures (like bone grafting) and delayed protocols have limited their usage. This case report describes the treatment of a young patient with aggressive periodontitis using a graftless implant solution. Zygoma implants in conjunction with conventional implants were used with immediate loading.
    Matched MeSH terms: Aggressive Periodontitis/rehabilitation*
  11. Taiyeb Ali, T.B., Razak, I.A.
    Ann Dent, 2000;7(1):-.
    MyJurnal
    The purpose of the present study was to determine the periodontal profile, toothbrushing habits and oral hygiene status of patients referred to a teaching institution for periodontal treatment, based on patients' treatment records. A total of 207 consecutive patients diagnosed with periodontitis who had been interviewed and clinically examined over a period of approximately one year were included in this study. The assessments of plaque levels, bleeding on probing (BOP) scores, probing pocket depth (PPD) and degree of bone loss from radiographs were made. The average age of this study group was 45 ± 12.8 years old with an age range of 20 to 76 years. The subjects comprised of 40% Malays, 34% Chinese and 26% Indians. The male to female ratio was almost 1.5: 1. These patients presented with high plaque and BOP scores. These findings do not concur with the high frequency of toothbrushing reported (86.5 % of subjects brushing twice or more times per day). This may reflect on the ineffectiveness of brushing as evident from their high plaque scores. Periodontal pockets were detected in 69 % of the teeth in these patients with an average of 17 teeth per patient being involved. Probing pocket depths of >6mm was found on the average in 3 teeth per patient. Alveolar bone loss as assessed from radiographs was detected in 52 % of the teeth in this study group of which 12 teeth per patient on the average exhibited this. Advanced bone loss involving about 2/3 and more of the root length was detected on the average on 1 tooth per patient. Early onset periodontitis accounted for about 5% of the total cases seen. About 21 % of subjects suffered from advanced adult periodontitis. Hence about a-quarter of the patients referred already had marked periodontal destruction.
    Matched MeSH terms: Aggressive Periodontitis
  12. Lim, Fei Yee, Uma Subramaniam, Renukanth Raman, Chua Sim Loo
    Malaysian Dental Journal, 2016;39(1):9-25.
    MyJurnal
    Aim: To assess the prevalence and clinical features of aggressive periodontitis in newly referred patients to the Periodontal Clinic in Seremban.

    Methodology: Sample size calculation was done using Epi Info software with minimum sample estimated at 279. 583 new patients who were referred to this clinic from year 2013 to July 2015 were examined clinically and radiographically. Patients were diagnosed using American Academy of Periodontology workshop 1999 definition.

    Results: Thirty-one (5.3%) patients were identified as having aggressive periodontitis with 28 (90%) of these patients exhibiting generalized form of aggressive periodontitis. Mean age of these patients was 34.9 years. In terms of gender and ethnicity, 21 females and 18 Malays were diagnosed with Aggressive periodontitis. First molars had the highest amount of clinical attachment loss (CAL=5.4mm). The number of missing teeth at the first visit was at median 2 (Interquartile range=4). The number of prognostically hopeless teeth at first visit was at median 1 (Interquartile range=2). Canines were preserved in most of the patients.

    Conclusion: Aggressive periodontitis was found in 5.3% of our samples. It was diagnosed at mean age of 34.9 years old.
    Matched MeSH terms: Aggressive Periodontitis
  13. Goh V, Nihalani D, Yeung KWS, Corbet EF, Leung WK
    J Periodontal Res, 2018 Jun;53(3):324-333.
    PMID: 29105779 DOI: 10.1111/jre.12517
    BACKGROUND AND OBJECTIVE: Risk for deterioration in treated aggressive periodontitis (AgP) individuals remained unclear. This retrospective cohort study investigated 7-26 years of periodontal outcomes and oral health-related quality of life (OHRQoL) of young adults with advanced periodontitis.

    MATERIAL AND METHODS: Eighty-nine previously treated patients with AgP were re-examined. Clinical and radiographic parameters before treatment discontinuation and at re-examination were compared. OHRQoL at re-call was assessed with the short-form Oral Health Impact Profile (OHIP-14S).

    RESULTS: None of the subjects adhered to suggested periodontal therapy and maintenance after discharge. Mean percentage of sites with probing pocket depth (PPD) ≥6 mm at re-examination was 4.5 ± 5.9%. A total of 182 teeth had been lost over time. Tooth loss rate was 0.14/patient/year. From 68 subjects with documented favorable treatment outcomes, higher percentage of sites with PPD ≥6 mm at re-examination and higher radiographic proximal bone loss was associated with current smoking status. Patients with AgP with <20 teeth at re-call had worse OHRQoL than those with ≥20 teeth. Patients with higher full-mouth mean PPD also reported poorer OHRQoL.

    CONCLUSION: Treatment in patients with AgP who smoke and neglect proper supportive care, risk periodontal disease progression. Substantial tooth loss and higher full-mouth mean PPD led to poorer OHRQoL in this cohort.

    Matched MeSH terms: Aggressive Periodontitis/diagnosis; Aggressive Periodontitis/epidemiology; Aggressive Periodontitis/therapy*
  14. Khattri S, Kumbargere Nagraj S, Arora A, Eachempati P, Kusum CK, Bhat KG, et al.
    Cochrane Database Syst Rev, 2020 11 16;11:CD012568.
    PMID: 33197289 DOI: 10.1002/14651858.CD012568.pub2
    BACKGROUND: Systemic antimicrobials can be used as an adjunct to mechanical debridement (scaling and root planing (SRP)) as a non-surgical treatment approach to manage periodontitis. A range of antibiotics with different dosage and combinations are documented in the literature. The review follows the previous classification of periodontitis as all included studies used this classification.

    OBJECTIVES: To assess the effects of systemic antimicrobials as an adjunct to SRP for the non-surgical treatment of patients with periodontitis.

    SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases to 9 March 2020: Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, and Embase. The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials.

    SELECTION CRITERIA: We included randomized controlled trials (RCTs) which involved individuals with clinically diagnosed untreated periodontitis. Trials compared SRP with systemic antibiotics versus SRP alone/placebo, or with other systemic antibiotics.

    DATA COLLECTION AND ANALYSIS: We selected trials, extracted data, and assessed risk of bias in duplicate. We estimated mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE.

    MAIN RESULTS: We included 45 trials conducted worldwide involving 2664 adult participants. 14 studies were at low, 8 at high, and the remaining 23 at unclear overall risk of bias. Seven trials did not contribute data to the analysis. We assessed the certainty of the evidence for the 10 comparisons which reported long-term follow-up (≥ 1 year). None of the studies reported data on antimicrobial resistance and patient-reported quality of life changes. Amoxicillin + metronidazole + SRP versus SRP in chronic/aggressive periodontitis: the evidence for percentage of closed pockets (MD -16.20%, 95% CI -25.87 to -6.53; 1 study, 44 participants); clinical attachment level (CAL) (MD -0.47 mm, 95% CI -0.90 to -0.05; 2 studies, 389 participants); probing pocket depth (PD) (MD -0.30 mm, 95% CI -0.42 to -0.18; 2 studies, 389 participants); and percentage of bleeding on probing (BOP) (MD -8.06%, 95% CI -14.26 to -1.85; 2 studies, 389 participants) was of very low certainty. Only the results for closed pockets and BOP showed a minimally important clinical difference (MICD) favouring amoxicillin + metronidazole + SRP. Metronidazole + SRP versus SRP in chronic/aggressive periodontitis: the evidence for percentage of closed pockets (MD -12.20%, 95% CI -29.23 to 4.83; 1 study, 22 participants); CAL (MD -1.12 mm, 95% CI -2.24 to 0; 3 studies, 71 participants); PD (MD -1.11 mm, 95% CI -2.84 to 0.61; 2 studies, 47 participants); and percentage of BOP (MD -6.90%, 95% CI -22.10 to 8.30; 1 study, 22 participants) was of very low certainty. Only the results for CAL and PD showed an MICD favouring the MTZ + SRP group. Azithromycin + SRP versus SRP for chronic/aggressive periodontitis: we found no evidence of a difference in percentage of closed pockets (MD 2.50%, 95% CI -10.19 to 15.19; 1 study, 40 participants); CAL (MD -0.59 mm, 95% CI -1.27 to 0.08; 2 studies, 110 participants); PD (MD -0.77 mm, 95% CI -2.33 to 0.79; 2 studies, 110 participants); and percentage of BOP (MD -1.28%, 95% CI -4.32 to 1.76; 2 studies, 110 participants) (very low-certainty evidence for all outcomes). Amoxicillin + clavulanate + SRP versus SRP for chronic periodontitis: the evidence from 1 study, 21 participants for CAL (MD 0.10 mm, 95% CI -0.51 to 0.71); PD (MD 0.10 mm, 95% CI -0.17 to 0.37); and BOP (MD 0%, 95% CI -0.09 to 0.09) was of very low certainty and did not show a difference between the groups. Doxycycline + SRP versus SRP in aggressive periodontitis: the evidence from 1 study, 22 participants for CAL (MD -0.80 mm, 95% CI -1.49 to -0.11); and PD (MD -1.00 mm, 95% CI -1.78 to -0.22) was of very low certainty, with the doxycycline + SRP group showing an MICD in PD only. Tetracycline + SRP versus SRP for aggressive periodontitis: we found very low-certainty evidence of a difference in long-term improvement in CAL for the tetracycline group (MD -2.30 mm, 95% CI -2.50 to -2.10; 1 study, 26 participants). Clindamycin + SRP versus SRP in aggressive periodontitis: we found very low-certainty evidence from 1 study, 21 participants of a difference in long-term improvement in CAL (MD -1.70 mm, 95% CI -2.40 to -1.00); and PD (MD -1.80 mm, 95% CI -2.47 to -1.13) favouring clindamycin + SRP. Doxycycline + SRP versus metronidazole + SRP for aggressive periodontitis: there was very low-certainty evidence from 1 study, 27 participants of a difference in long-term CAL (MD 1.10 mm, 95% CI 0.36 to 1.84); and PD (MD 1.00 mm, 95% CI 0.30 to 1.70) favouring metronidazole + SRP. Clindamycin + SRP versus metronidazole + SRP for aggressive periodontitis: the evidence from 1 study, 26 participants for CAL (MD 0.20 mm, 95% CI -0.55 to 0.95); and PD (MD 0.20 mm, 95% CI -0.38 to 0.78) was of very low certainty and did not show a difference between the groups. Clindamycin + SRP versus doxycycline + SRP for aggressive periodontitis: the evidence from 1 study, 23 participants for CAL (MD -0.90 mm, 95% CI -1.62 to -0.18); and PD (MD -0.80 mm, 95% CI -1.58 to -0.02) was of very low certainty and did not show a difference between the groups. Most trials testing amoxicillin, metronidazole, and azithromycin reported adverse events such as nausea, vomiting, diarrhoea, mild gastrointestinal disturbances, and metallic taste. No serious adverse events were reported.

    AUTHORS' CONCLUSIONS: There is very low-certainty evidence (for long-term follow-up) to inform clinicians and patients if adjunctive systemic antimicrobials are of any help for the non-surgical treatment of periodontitis. There is insufficient evidence to decide whether some antibiotics are better than others when used alongside SRP. None of the trials reported serious adverse events but patients should be made aware of the common adverse events related to these drugs. Well-planned RCTs need to be conducted clearly defining the minimally important clinical difference for the outcomes closed pockets, CAL, PD, and BOP.

    Matched MeSH terms: Aggressive Periodontitis/drug therapy*
  15. Mohd-Dom T, Ayob R, Mohd-Nur A, Abdul-Manaf MR, Ishak N, Abdul-Muttalib K, et al.
    BMC Oral Health, 2014 May 20;14:56.
    PMID: 24884465 DOI: 10.1186/1472-6831-14-56
    BACKGROUND: The objective of this paper is to quantify the cost of periodontitis management at public sector specialist periodontal clinic settings and analyse the distribution of cost components.

    METHODS: Five specialist periodontal clinics in the Ministry of Health represented the public sector in providing clinical and cost data for this study. Newly-diagnosed periodontitis patients (N = 165) were recruited and followed up for one year of specialist periodontal care. Direct and indirect costs from the societal viewpoint were included in the cost analysis. They were measured in 2012 Ringgit Malaysia (MYR) and estimated from the societal perspective using activity-based and step-down costing methods, and substantiated by clinical pathways. Cost of dental equipment, consumables and labour (average treatment time) for each procedure was measured using activity-based costing method. Meanwhile, unit cost calculations for clinic administration, utilities and maintenance used step-down approach. Patient expenditures and absence from work were recorded via diary entries. The conversion from MYR to Euro was based on the 2012 rate (1€ = MYR4).

    RESULTS: A total of 2900 procedures were provided, with an average cost of MYR 2820 (€705) per patient for the study year, and MYR 376 (€94) per outpatient visit. Out of this, 90% was contributed by provider cost and 10% by patient cost; 94% for direct cost and 4% for lost productivity. Treatment of aggressive periodontitis was significantly higher than for chronic periodontitis (t-test, P = 0.003). Higher costs were expended as disease severity increased (ANOVA, P = 0.022) and for patients requiring surgeries (ANOVA, P 

    Matched MeSH terms: Aggressive Periodontitis/economics; Aggressive Periodontitis/therapy
  16. Sulugodu Ramachandra S
    Saudi Dent J, 2014 Apr;26(2):47-9.
    PMID: 25408595 DOI: 10.1016/j.sdentj.2013.12.002
    This article is a traditional literature review on caries levels in aggressive periodontitis. Aggressive periodontitis generally affects systemically healthy individuals aged <30 years (older individuals can also be affected) and is characterized by a young age of onset, rapid rate of disease progression, and familial aggregation of cases. Dental caries is caused by the dissolution of enamel by acid-producing bacteria present in the plaque biofilm, especially when the biofilm reaches critical mass due to improper oral hygiene. The association between caries level and aggressive periodontitis has long been debated. Initial research indicated that caries levels were high in patients with aggressive periodontitis, but high-quality studies have consistently shown that caries and aggressive periodontitis are inversely related. A recent in vitro study showed that Streptococcus mutans was killed more readily in the saliva of patients with aggressive periodontitis and Aggregatibacter actinomycetemcomitans positivity than in patients with A. actinomycetemcomitans negativity. Other mechanisms possibly explaining the inverse relationship between caries and aggressive periodontitis in cases of Down's syndrome are also discussed in this literature review. The usefulness of caries level in the diagnosis of aggressive periodontitis in developing countries such as India, where the disease is diagnosed primarily on the basis of clinical and radiographic features and familial history is also discussed.
    Matched MeSH terms: Aggressive Periodontitis
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