Refractory Periodontitis
Question 1. Write short note on refractory periodontitis.
Answer. According to American Academy of Periodontology refractory periodontitis is not a single disease entity. It refers to destructive periodontal diseases in patients who, when longitudinally monitored, demonstrate additional attachment loss at one or more site despite well executed therapeutic measures and patient’s efforts to stop the progression of disease.
Refractory Periodontitis Types
On the basis of causative factors, there are two types of refractory periodontitis
- First type comprises those with refractory sites, i.e. patients with adult periodontitis in whom anatomic conditions favor the proliferation of periodontopathic microorganisms.
- Second type of refractory periodontitis is due to severe PMN defects or other immunologic problems, e.g. aggressive periodontitis associated with Papillon-Lefèvre syndrome.
Etiology
Risk factors responsible for refractory cases:
- Abnormal host response.
- Resistant strain of pathogenic periodontal microflora
- Failure to eliminate plaque retentive factors such as functional involvement, irregular root surface, etc.
- Smoking and systemic disease may result in generalized lesion which may not respond favorably to the treatment. There are three major microbial complex in refractory periodontitis
- B. forsythus, F. nucleatum, C. rectus.
- S. intermedius, P. gingivalis, P. microbes.
- S. intermedius, F. nucleatum.
Read And Learn More: Periodontics Question And Answers
Refractory Periodontitis Clinical Features
- Diversity of clinical condition and treatment under which periodontal therapy fails to arrest the progression of periodontitis
- The refractory case can be identified by presenting new areas of attachment loss or progressive attachment loss in already treated sites.
Refractory Periodontitis Treatment
- Antimicrobial therapy along with mechanical debridement.
- In addition to this, intrasulcular irrigation with 10% povidone-iodine solution and chlorhexidine solution has been used successfully.
Question 2. Write short note on Papillon-Lefevre syndrome.
Answer. Papillon-Leférve syndrome is an autosomal recessive and inherited disorder.
- It is characterized by mutation in cathapsin C gene located on chromosome 11.
- Patients with Papillon–Lefévre syndrome has little or no cathepsin C activity.
- This syndrome was first described by papillon and Lefevre in 1924.
Triad
It is a triad of:
- Calcification of dura
- Hyperkeratosis of palms of hand, soles of foot
- Extensive pre-pubertal destruction of periodontal bone supporting the dentition
Papillon-Lefevre Syndrome Clinical Features
Oral Manifestations
- Gingival swelling and severe halitosis.
- Horizontal PDL bone destruction, PDL pocket
- Loss of primary dentition by the age of 5 years
- Loss of secondary dentition by the age of 20 years.
Skin Manifestations
- Dirty colored skin
- Reddened, scaly, rough palms and soles.
Papillon-Lefevre Syndrome Treatment
No specific treatment.
Dental Management
- Systemic administration of retinoids, when combined with meticulous plaque control, debridement, topical antimicrobials along with systemic antibiotic therapy may give the best chance for preventing the progression of periodontitis.
- Severely involved teeth must be extracted.
- The loss of teeth is almost inevitable, even with a high degree of patient compliance
- A more realistic aim is to maintain alveolar bone height to eventually support removable Implant-retained prosthesis.
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