Periodontitis is an inflammatory disease of the supporting tissues of teeth caused by specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone. Localized aggressive periodontitis (LAP) generally affects systemically healthy individuals under 30 years of age and is characterized by rapid progression and localized attachment loss on first molars and incisors. Generalized aggressive periodontitis (GAP) also affects individuals under 30 but produces a poor antibody response to pathogens and results in generalized interproximal attachment loss affecting at least 3 teeth. Both LAP and GAP can progress rapidly and result in bone loss despite minimal plaque.

1. Kingshuk Mazumder

2.  Periodontitis is defined as an inflammatory
disease of the supporting tissues of teeth, caused
by specific micro organisms, resulting in
progressive destruction of PDL and alveolar bone,
with increased depth formation, and recession of
teeth.

3.  Generally affects systemically healthy individuals,
less than 30 years of age.
 Universally distinguished from chronic periodontitis,
by:
1. Age of onset,
2. Rapid rate of disease progression,
3. The nature and composition of the associated subgingival
microflora,
4. Alterations in the host’s immune response, and
5. A familial aggregation of diseased individuals.
6. In addition, there is a racial predilection of the disease among
African Americans.

8.  Age of onset is, at around puberty.
 Clinically characterized as having “localized first
molar/incisor presentation, with inter-proximal
attachment loss, on at least two permanent teeth, one of
which is a first molar and involving no more than 2
teeth, other than first molars and incisors.”

9. Clinical manifestation of LAP (Intra oral photograph)

10.  A striking clinical feature of LAP, is the lack of clinical
inflammation, despite the presence of deep periodontal
pockets, and advanced bone loss.
 In most cases, the amount of plaque on the affected teeth is
minimal, which seems inconsistent with the amount of
periodontal destruction exhibited.
 It often contains elevated levels of Aggregatibacter
actinomycetemcomitans, and in some patients,
Porphyromonas gingivalis.

11.  LAP progresses rapidly. Rate of bone loss is 3
to 4 times faster than Chronic Periodontitis.
 Other clinical features of LAP are:
1. Distolabial migration of maxillary incisors, with
concomitant diastema formation.
2. Increasing mobility of the maxillary and mandibular
incisors and first molars.
3. Sensitivity of denuded root surfaces to thermal and
tactile stimulation.
4. Deep dull radiating during mastication, (probably caused
by irritation of the supporting structures by mobile teeth
and food impaction).

14. Vertical loss of alveolar bone around first molars.

15. Vertical loss of alveolar bone

16.  Usually affects individuals under 30
years, but patients may also be affected.
 In contrast to LAP, individuals affected
by GAP produce poor antibody response
to the pathogens present.

17.  “Generalised interproximal attachment loss
affecting at least 3 permanent teeth, other than the
first molars and incisors.”
 The destruction occurs episodically, with periods of
advanced destruction, followed by stages of
quiescence, of variable length.
 As in LAP, patients in GAP often have small
amounts of bacterial plaque associated with the
affected teeth.
 Quantitatively, the amount of plaque seems
inconsistent with the amount of periodontal
destruction.

18.  Qualitatively, P. gingivalis, A. actinomycetemcomitans, and
Tannerella forsythia, are more frequently detected in the
plaque that is present.
 Two types of gingival tissue responses are found in GAP:-
1. One is severely acutely inflamed tissue, often
proliferating, ulcerated and fiery red. Marked by
spontaneous bleeding.
2. In other cases, the gingival tissue may appear
pink, free of inflammation and occasionally with
some degree of stippling (usually stippling is
absent).

20.  However, despite the apparently mild clinical
appearance, deep pockets can be demonstrated
by probing.
 Some patients of GAP may have systemic
manifestations, like: weight loss, mental
depression, and general malaise.
 As seen with LAP, cases of GAP may be arrested
spontaneously or after therapy.

21. Generalised bone loss, affecting majority of the
teeth.

24.  Patients with GAP, who smoke have more affected
teeth and more loss of clinical attachment than non
smoking patients.
 However, smoking may not have the same impact on
young patients suffering from LAP.