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