Prevalence and Risk Factors
- Localized Aggressive Periodontitis (LAP) affects first molars or incisors interproximal attachment loss.
- Generalized Aggressive Periodontitis (GAP) affects at least three permanent teeth other than incisors and first molars.
- LAP prevalence is less than 1% and GAP prevalence is 0.13%.
- LAP affects approximately 0.1% of white Caucasians and 2.6% of black Africans.
- Estimates of disease prevalence range from 1-5% in African populations and groups of African descent.
- Aggressive periodontitis is less common than chronic periodontitis and affects younger patients.
- Approximately 1 in every 1000 patients experience rapid loss of attachment.
- Males are at a higher risk of GAP than females.
- Prevalence of LAP varies considerably between continents.
- Differences in race or ethnicity are major contributing factors to prevalence.
- Aggressive periodontitis is associated with specific bacteria, such as Actinobacillus actinomycetemcomitans.
- Genetic factors play a role in the development of aggressive periodontitis.
- Smoking has been identified as a risk factor for aggressive periodontitis.
- Poor oral hygiene and a weakened immune response can contribute to the development of the disease.
- Aggressive periodontitis can be influenced by systemic conditions, such as diabetes.
Etiology and Pathophysiology
- Approximately 65-75% of bacteria in aggressive periodontitis are Gram-negative bacilli.
- Aggregatibacter actinomycetemcomitans is associated with aggressive periodontitis.
- Porphyromonas gingivalis is a Gram-negative anaerobe associated with the pathogenicity of periodontal disease.
- Capnocytophaga spp are implicated as prime periodontal pathogens.
- Impaired ability of peripheral blood lymphocytes is found in the majority of patients with aggressive periodontitis.
- Aggressive periodontitis is a multifactorial disease involving host factors, microbiology, and genetics.
- Host defenses include saliva, epithelium, inflammatory response, immune response, and chemical mediators.
- Gingival crevicular fluid antibody levels could be potentially useful in the development of a vaccine.
- Genetic factors contribute to the pathogenesis of aggressive periodontitis.
- Smoking is a generalized risk factor for aggressive periodontitis.
Clinical Features and Diagnosis
- Aggressive periodontitis is defined by three primary features: clinically healthy patients, rapid loss of attachment and bone, and familial aggregation.
- Patients with aggressive periodontitis do not have underlying systemic diseases that contribute to the condition.
- The rate of loss of attachment is greater than 2mm per year.
- Aggressive periodontitis runs in the patient's family, indicating a high genetic susceptibility.
- Genetic mutation combined with environmental factors may contribute to the manifestation of aggressive periodontitis.
- Severity of periodontal tissue destruction is disproportionate to the amount of bacteria present.
- Amount of bacteria is often indicated by the level of dental plaque.
- High levels of Aggregatibacter (or Actinobacillus) actinomycetemcomitans and Porphyromonas gingivalis.
- Abnormalities associated with phagocytes.
- Hyper-responsive macrophage phenotype.
- Aggressive periodontitis can be staged into Stage I, II, and III based on severity.
- The staging index was proposed based on clinical and radiological features and risk factors.
- The proposed index was validated with 10 cases of aggressive periodontitis followed for 10 years.
- LAP begins around puberty with interproximal loss of attachment on first molars and/or incisors.
- Lack of inflammation and evidence of deep periodontal pockets with advanced bone loss.
- Relatively fast progression of periodontal tissue loss.
- Diastema formation and disto-labial migration of incisors may be present.
- Radiographically, alveolar bone loss is often seen in a horizontal pattern.
- Mostly affects individuals under 30 years old.
- Clinical appearance resembles chronic periodontitis, but progression is more rapid.
- Poor serum response against infecting agents.
- Generalized inter-proximal attachment loss on 3 or more permanent teeth (excluding first molars or incisors).
- Radiographically, vertical bone loss around teeth, including first molars and incisors, is a key diagnostic feature.
- Early diagnosis is important to prevent rapid permanent destruction of periodontal tissues.
- Routine periodontal examination is essential during dental checkups.
- Clinical examination includes assessing the appearance of the gingiva, probing depths, and bleeding on probing.
- Radiographic assessment helps identify alveolar bone levels and signs of Aggressive Periodontitis.
- Presence of angular or vertical bone loss and furcation lesions may indicate Aggressive Periodontitis.
Treatment and Management
- Treatment plan developed for each individual
- Similar treatment phases as chronic periodontitis
- More aggressive approach due to significant bone loss
- Objective is to retain as many teeth as possible
- Create conducive clinical condition for long-term retention
- Discussion of disease with patient
- Emphasize importance of oral hygiene
- Advise smoking cessation if applicable
- Remove plaque retentive factors
- Non-surgical approach to remove plaque and calculus
- Reassess compliance and tissue response
- Carried out 10-12 weeks following treatment
- Progress to maintenance if disease is stabilized
- Consider cause of failure if disease is not stabilized
- Progress to definitive therapy if cause is correctable
- Further root surface debridement if needed
- Use of locally delivered antimicrobials as adjunct to treatment
- Consider periodontal surgery for localized problems
- Regenerative surgical therapy options available
- Results of surgery may vary
- Periodontal treatment stabilizes the disease
- High risk of disease recurrence
- Attend frequent review appointments
- Ensure no relapse of the disease
- Maintain periodont
Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis as defined by the 1999 classification system:
LAP is localised to first molar or incisor interproximal attachment loss, whereas GAP is the interproximal attachment loss affecting at least three permanent teeth other than incisors and first molar. The prevalence of LAP is less than 1% and that of GAP is 0.13%. Approximately 0.1% of white Caucasians (with 0.1% in northern and in central Europe, 0.5% in southern Europe, and 0.1-0.2% in North America) and 2.6% of black Africans may have LAP. Estimates of the disease prevalence are 1-5% in the African population and in groups of African descent, 2.6% in African-Americans, 0.5-1.0% in Hispanics in North America, 0.3-2.0% in South America, and 0.2-1.0% in Asia. On the other hand, in Asia, the prevalence rate of 1.2% for LAP and 0.6% for GAP in Baghdad and Iran population, and 0.47% in Japanese population.
Therefore, the prevalence of LAP varies considerably between continents, and differences in race or ethnicity seem to be a major contributing factor.
Aggressive periodontitis is much less common than chronic periodontitis and generally affects younger patients than does the chronic form. Around 1 in every 1000 patients experience more rapid loss of attachment. Males seem to be at higher risk of GAP than females
The localized and generalized forms are not merely different in extent; they differ in etiology and pathogenesis.