Prevalence and Risk Factors - Localised Aggressive Periodontitis (LAP) affects first molars or incisors interproximal attachment loss. - Generalised 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 generalised 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. - Generalised 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 stabilised - Consider cause of failure if disease is not stabilised - 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 localised 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