Juvenile Periodontitis
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The early detection and treatment of juvenile, or early-onset, periodontitis is a significant concern for practicing dentists. Prevalence of periodontitis in children and adolescents is considerably lower than in adult populations but its extent is still under study. Epidemiological studies vary widely, from 1.0/1000 to 8.0/1000, but variations seem to be due to differences in diagnostic methods and criteria (1:57; 4:368). As Neely notes, useful screening methods are still a matter of considerable debate (4:367). Distinctive populations also present the disease at higher rates (e.g., geographically distinct groups or periodontitis associated with systemic disease). There are also considerable differences in the definition of the disease and the term juvenile periodontitis sometimes refers simply to the localized form of the disease (2). Despite differences in estimates of prevalence, however, studies have consistently found the disease in young populations for several decades. Methods of diagnosis and treatment of all forms of the disease have evolved considerably and it is now considered "imperative that children receive a periodontal examination as part of their routine dental visits" (1:59). Juvenile periodontosis is defined as a disease of the periodontium occurring in otherwise healthy adolescents (onset as low as 11 and as high as 20 years of age) and characterized by rapid alveolar bone loss in one or more permanent teeth (2:73). The disease has been classi
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ction" (3:268) and usually occurs in young adults, though much earlier onset, around puberty, has been observed (1:58). GJP patients present distinct periodontal inflammation and extensive accumulation of plaque and calculus.
Probable etiologic significance attaches to Actinobacillus actinomycetemcomitans (Aa) which, however, is more prevalent in LJP than in GJP. A second pathogen, Porphyromonas gingivalis has a much higher prevalence in GJP than in LJP (3:268). Levels of Aa at LJP sites can be as much as 100 times greater than the levels found at inactive sites. Another bacteria associated with the disease is Capnocytophaga. Inactive sites also showed elevated levels of Bacteroides intermedius. Subsequent to successful treatment, decreased levels of pathogenic bacteria and significant increases in non-pathogenic bacteria have been observed (2:74).
An Aa endotoxin has been isolated which "has major bone resorbing activity, is able to activate complement and induce lysosomal release from polymorphonuclear leukocytes (PMNs)" (2:74). This is the means by which bacterial toxins achieve access to periodontal tissue. Both elevated levels of Aa antibody and depressed chemotaxis in PMNs are associated with the rapid progress
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Some common words found in the essay are:
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Approximate Word count = 1574
Approximate Pages = 6 (250 words per page)
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