Periodontology Diagnosis - Generalized Aggressive Periodontitis

The term “aggressive periodontitis” is used to describe specific types of periodontal disease. It includes the following classifications:

1. Localized aggressive periodontitis (LAP)
2. Generalized aggressive periodontitis (GAP)

Localized aggressive periodontitis or LAP is localized to first molar or incisor interproximal attachment loss. Generalized aggressive periodontitis or GAP is the interproximal attachment loss that affects three or more permanent teeth other than incisors and the first molar.

Generalized Aggressive Periodontitis - Clinical Features

1. GAP is primarily found in individuals who are under 30 years old
   1. The clinical appearance of GAP closely resembles that of chronic periodontitis. The difference, however, is that GAP affects patients who are younger and the disease progresses more quickly.
2. There is a deficient serum response against infecting agents.
   1. There is destruction present which does not align with the amount of local irritants that are present.
3. Generalized inter-proximal attachment loss on at least three permanent teeth. This excludes the first molars or incisors.
   1. The main difference between the localized and generalized form of aggressive periodontitis is in the number of teeth affected. GAP includes attachment loss involves more than 30% of sites on teeth.
4. There is an episodic nature of attachment loss. There are two main tissue responses found in GAP cases:
   1. Tissue may have severe inflammation and often are red in appearance. There may also be spontaneous bleeding.
   2. The other response is known as a period of quiescence. This occurs when gingival tissue may not appear to have inflammation, is pink in appearance and may include some stippling. In addition, there may be deep pockets upon probing.

Radiographic Features

The key diagnostic feature of aggressive periodontist is vertical bone loss around the teeth which includes the first molars and incisors. This typically begins around puberty in what would be otherwise healthy individuals. There may also be an appearance of arc-shaped loss of alveolar bone extending from the distal surface of the second premolar to the mesial surface of the second molar.

In GAP, the generalized bone destruction is present which can range from mild crestal bone resorption to severe alveolar bone destruction. There may also be a combination of vertical and horizontal bone loss.

Screening

Early diagnosis of aggressive periodontitis is vital as the disease can result in rapid and permanent destruction of the periodontal tissues. It is critical for all patients to undergo a routine periodontal examination to screen for any form of periodontal disease during their regular dental exams.

Clinical examination

At the beginning of a clinical exam of the gingival and periodontal tissues, the dental professional will first evaluate the appearance of the gingiva. A healthy periodontium usually appears stippled and pink with a knife edge margin where it touches the tooth. The pigmentation can vary depending on the patient’s race. Following the exam, a gingival probing instrument is used to check the depths. This is normally completed using a basic periodontal probe. Dental professionals should be conscious of “false pocketing” which can occur around erupting or newly erupted teeth. This occurs in the mixed dentition phase and also when there is gingival inflammation. The presence of bleeding upon probing can be an indicator of active disease.

Treatment

Following the initial assessment and diagnosis, an individualized treatment plan is created. Because the overall treatment concepts and goals for aggressive periodontitis do not differ drastically from chronic periodontitis, the treatments are similar.