Generalized Aggressive Periodontitis
Generalized aggressive periodontitis, one of the seven classifications of periodontitis, is characterized by interproximal attachment loss that affects at least three adult teeth in addition tothe first molars and incisors; the involvement of additional teeth is one of the factors that differentiates it from localized aggressive periodontitis. In both types of aggressive periodontitis, the patient is generally healthy, and the rates of both bone loss and attachment loss are rapid. Both types of aggressive periodontitis are also familial, with genetic factors that predispose patients to the disease. Secondary features, which present in some but not all cases of both localized and generalized aggressive periodontitis, include high levels of specific gram-negative microbes that trigger an inflammatory response in the tissues of the periodontium. In most cases, the relatively low levels of plaque on the teeth are incongruous with the extent of destruction to the tissue, which corresponds both to the composition of the bacteria and to the host’s immune response. Finally, in few patients, aggressive periodontitis may burn out, and loss of bone and attachment may cease without any therapies.
Generalized aggressive periodontitis is seen mostly in people under the age of 30. The disease shares physical manifestations and symptoms with chronic periodontitis and differs primarily in the younger age of those afflicted and the speed with which the disease destroys the tissues of the periodontium. It is less common than localized aggressive periodontitis and is more common in men than in women. The primary distinction between localized and generalized aggressive periodontitis is the number of teeth they affect, as generalized aggressive periodontitis affects more than 30% of the permanent teeth, while localized aggressive periodontitis affects only the first molars and incisors. The amount of destruction present in the oral cavity is not commensurate with the amount of plaque present, indicating an inadequate serum response against infection. Gingival tissue may appear severely inflamed, angry and red with ulceration. The tissue may spontaneously bleed or ooze pus. These visible destructive phases of the disease may appear quite suddenly, and they may be followed by a period of normalcy, with the gingival tissues appearing calmly pink and healthy. However, even in these periods of quiescence, deep periodontal pockets are present upon probing. Bone loss can range from mild to severe and appears vertically between the affected teeth.
While periodontal therapies like root scaling and planing, combined with excellent home care and systemic antibiotics, bleeding on probing and periodontal pocket depths can be reduced. To fully manage generalized aggressive periodontitis, clinicians may perform flap surgery and replace and repair bone defects with bone grafts; when the bone has fully healed, in some cases, patients may undergo orthodontic treatment to restore migrated teeth to their preferred location. In some cases, the disease may be managed through mechanical therapy and systemic antibiotics, often combined with modification of any controllable risk factors. Patients may need to learn better techniques for effectively brushing the teeth without damaging the gingiva, and new, strong home hygiene routines can help control pathogenic bacteria, while regular maintenance visits to the dentist can help keep further destruction at bay.