Aggressive Periodontitis (formerly Juvenile Periodontitis)

• Historical Names: Previously referred to as periodontosis, deep cementopathia, diseases of eruption, Gottleib’s diseases, and periodontitis marginalis progressive.
• Risk Factors:
  • High frequency of Actinobacillus actinomycetemcomitans.
  • Immune defects (functional defects of PMNs and monocytes).
  • Autoimmunity and genetic factors.
  • Environmental factors, including smoking.
• Clinical Features:
  • Vertical loss of alveolar bone around the first molars and incisors, typically beginning around puberty.
  • Bone loss patterns often described as "target" or "bull" shaped lesions.

• Papillon-Lefevre Syndrome: Periodontitis, hyperkeratosis, dural calcification.
• Chediak-Higashi Disease: Neutrophil function defect.
• Iron Deficiency Anemia: Moderate bone loss with periodontitis.

High-Yield Numbers

• FBS ≥126 mg/dL (DM diagnosis)
• HbA1C >6.5% (DM diagnosis)
• IGT: 140-199 mg/dL (2-hr GTT)
• Sleep apnea: ≥10 seconds
• Cortisol <3 mg/dL (Addison's)
• ACTH >200 pg/mL (Addison's)
• Nebulizer droplets <2.5 μm

Remember the "Onlys"

• Telmisartan: Only ARB with PPAR-γ activity
• Microalbuminuria: Most reliable diabetic nephropathy marker
• TB: Most common cause of adrenal insufficiency in India
• Melanoma: Most common primary tumor → adrenal mets

Classic Associations

• Type 1 DM: HLA-DR3/DR4, Anti-GAD antibodies
• Aspirin asthma: Nasal polyps
• Emphysema: Weight loss, pneumothorax, ↓DLCO
• Chronic bronchitis: Polycythemia, Reid's index

🔬 Key Features & Forms

• Most infective form: Cavitary lesion
• Primary TB Presentation: Unilateral hilar lymphadenopathy
• Rich focus: Meninges (associated with TB meningitis)
• Cavitation: Absent in HIV-associated or primary TB

💡 Special Manifestations

• Hypersensitivity to Mycobacteria: Phlyctenular conjunctivitis
• Poncet’s disease: Joint pains without active arthritis
• Miliary TB: Mantoux test negative
• Recurrent hemoptysis source: Bronchial artery

💊 Drug Details

• Streptomycin: Not used in TB meningitis
• Bedaquiline: New drug for MDR-TB

Blade Angulation Protocols

Scaling & Root Planing

• Angulation: 45-90 degrees to tooth surface
• Purpose: Effective calculus removal and root surface debridement

Gingival Curettage

• Angulation: >90 degrees
• Technique: Removal of infected soft tissue from pocket wall

Curette Sharpening

• Optimal Angle: 100-110 degrees
• Maintenance: Critical for effective instrumentation

Curette Design

Gracey Curettes

• Offset Angle: 60 degrees
• Specificity: Area-specific design for different tooth surfaces

Universal Curettes

• Angle: 90 degrees
• Application: Suitable for all tooth surfaces

After-Five Curettes

• Modification: Terminal shank extended by 3mm
• Purpose: Access to deep pockets (>5mm)

Probing Systems

CPITN Probe

• Tip Diameter: 0.5mm
• Markings: 3.5, 5.5, 8.5, 11.5mm
• Use: Community periodontal index assessment

Florida Probe

• Tip Diameter: 0.4mm (more precise)
• Technology: Computerized probing system

Implant Probing

• Maximum Force: 25N
• Probe Type: Plastic probes recommended to prevent implant surface damage