Periodontology Diagnosis - Localized 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.

Localized Aggressive Periodontitis - Clinical Features

For most patients, LAP starts for most patients when they enter puberty. This is typically when there is interproximal loss of attachment of the first molar and/or the incisors on at least two permanent teeth. One of these teeth is a first molar. There is no involvement of more than two teeth beyond the first molars and incisors, lack of inflammation and evidence of deep periodontal pocket with advanced bone loss. LAP also involves a relatively quick progression of periodontal tissue loss.

With the increased age of the patient, there may be progression of the disease which involves the adjacent teeth and results in the patient developing GAP. The periodontal tissue also exhibits minimal signs of inflammation in a clinical setting and shows a robust response with serum antibodies to pathogens.

The amount of plaque present is usually inconsistent with the severity of the tissue destruction. There is also a high plaque pathogenicity because of the presence of increased levels of bacteria such as Aggregatibacter actinomycetemcomitans (A.a) and Porphyromonas Gingivalis (P.g).

Secondary features of LAP can also be present and include the following;

• Diastema formation with disto-labial migration of the incisors
• Increased mobility of the affected teeth
• Increased sensitivity from the exposed root
• Deep and dull pain which radiates through to the jaw
• Periodontal abscess with possible enlargement in the lymph nodes

Radiographic Features

Radiographically, the periodontal lesion is often present with alveolar bone loss in a vertical pattern. This occurs at the interproximal surface of the permanent first molars and is typically a horizontal bone pattern of bone loss at the interproximal surface of the incisors. This is because the bone is thinner than at the interproximal surface of the molars.

The alveolar bone loss patterns are usually bilateral in nature and are similar on both sides. This is sometimes referred to as a ‘mirror-image’ pattern.

In advanced cases, the alveolar bone loss can sometimes be depicted as a horizontal bone loss pattern radiographically.

Screening

Early diagnosis of aggressive periodontitis is critical. The disease can cause rapid and permanent destruction of the periodontal tissues. It is vital that all patients have a routine periodontal examination in order to screen for any form of periodontal disease during their regular dental checkup.

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.