Aggressive Periodontitis
Ian Dunn
I am delighted to be posting my first PLOG, or Perio Blog, for GDPUK and look forward to penning further PLOGS over the coming months. I hope you find them of some use and will gladly take suggestions on perio related topics that people would like covered.

Our indemnity companies tell us that Perio is one of the main areas for litigation and payouts, leading to a significant upwards trend in our indemnity costs. When we look at the breakdown of the main causes of litigation in perio, DDU figures from 2014 show that 75% of perio cases were centred around failure to diagnose and failure to appropriately treat periodontitis. We are seeing average payouts to patients of around £30K for the failure to diagnose and treat chronic periodontitis and figures upwards of £100K for failing to diagnose and treat aggressive periodontitis. It is the latter that I would like to focus this PLOG on.

Aggressive Periodontitis is the contemporary name for the group of diseases that many of us would have been taught as Early Onset Periodontitis and included Localised Juvenile Periodontitis, Rapidly Progressive Periodontitis and Pre-Pubertal Periodontitis. Many of us will have entered our perio vivas remembering that Localised Juvenile Periodontitis affected central incisors and first molars in patients around the ages of puberty.

Whilst still relatively rare, affecting around 0.1% of the Caucasian population but as high as 2.5-5% of the Asian/Afro-Caribbean population, it can be a devastating disease and we owe it to our patients not to miss it. The diagnosis of aggressive periodontitis should significantly change your management as it may not respond to good plaque control and debridement alone. Right diagnosis, right treatment, wrong diagnosis, wrong treatment……poor outcomes.

The features of Aggressive Periodontitis are:

  • Strong family history
  • Young patients ( tend to be under 35 )
  • Good oral hygiene
  • Rate of progression is disproportionate to the levels of plaque and oral hygiene
  • Otherwise healthy patients
  • Increased prevalence of vertical bone loss.

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