Local Aggressive Periodontitis

Aggressive periodontitis is a classification of periodontal disease that can be divided into two sub-categories; these two sub-categories are among the seven types and degrees of periodontitis that were classified in 1999, and they are localized aggressive periodontitis and generalized aggressive periodontitis. Localized aggressive periodontitis is characterized by attachment loss that affects the first molar and may or may not include the incisor. The prevalence of localized aggressive periodontitis is under 1%, though the disease is seen significantly more in black Africans and African-Americans, with other notable variations between continents and between people of different races and ethnicities. Aggressive localized periodontitis generally affects more younger people than chronic periodontitis does, and around 1 in 1000 patients experience rapid loss of tooth attachment.

Localized aggressive periodontitis is characterized by rapid loss of attachment of the periodontium and may be associated with an impaired immune response and highly virulent bacteria. The disease is affected by multiple host factors, genetics, and microbiology. The host factors that affect localized aggressive periodontitis include inflammatory and immune responses, the makeup of saliva and epithelial tissues, and chemical mediators. In some cases, the tissues of the gingiva have an innate functional defect that causes them to respond to certain pathogens abnormally. Studies have demonstrated that there is likely a genetic predisposition to aggressive periodontitis, though periodontal pathogens and possibly environmental factors must be present for the disease to initiate. Studies have also shown that smokers are more likely to have more teeth affected by aggressive periodontitis and have higher levels of attachment loss.

While localized and generalized aggressive periodontitis are different in their etiology and in their development, there are a few common features shared by both types of aggressive periodontitis. First, patients with aggressive periodontitis are clinically healthy, lacking any systemic diseases that would lead to aggressive periodontitis. Second, the rate of bone loss and loss of tooth attachment is rapid. Third, aggressive periodontitis is genetic, meaning it is often seen in multiple family members.

There are other, secondary features that appear frequently but are not always present with diagnoses of aggressive periodontitis. Generally, it is likely that the severity of destruction is disproportionate to the amount of bacteria present in the oral cavity; there may be attachment and bone loss present even when the level of bacterial plaque is relatively low. There are often high levels of certain types of gram-negative microbes present with aggressive periodontitis, and these microbes are found to trigger inflammatory responses in the tissues of the periodontium. There may also be abnormalities with the protective cells known as phagocytes, which are essential to calming inflammation. These abnormalities can lead to persistently inflamed periodontal tissues. People with aggressive periodontitis may also have a highly responsive macrophage phenotype that produces high levels of inflammatory mediators that are associated with tissue destruction and bone loss. In some cases, the progression of attachment loss and bone loss may cease without any therapy and with no known cause.

Localized aggressive periodontitis usually begins at onset of puberty and is indicated by the interproximal loss of the first molar and possibly the incisors, and no other teeth. It is also characterized by a lack of inflammation, a deep periodontal pocket, advanced bone loss, and quickly progressing loss of periodontal tissues. The amount of plaque present is proportionately lower than indicated by the severity of tissue destruction, and levels of some specific bacteria are proportionately higher. Secondary features of localized aggressive periodontitis may include diastema, or a gap between two teeth, because of migration of the affected tooth or teeth; increased mobility and sensitivity of the affected teeth; dull, radiating pain; and the presence of an abscess in the periodontium with corresponding enlargement of the adjacent lymph node. Treatment plans for localized aggressive periodontitis resemble those for chronic periodontitis, though treatment for aggressive periodontitis must also be more aggressive in order to halt further destruction of the periodontium.