Localized Aggressive Periodontitis

Localized aggressive periodontitis, one of the seven classifications of periodontitis that were organized in 1999, is characterized by interproximal attachment loss of the first molar and at least one other permanent molar or incisor. There may be few other symptoms of periodontitis present and a somewhat accelerated rate of periodontal tissue loss. As the patient ages, the disease may develop into generalized aggressive periodontitis, which involves teeth adjacent to the first molars and incisors. The amount of plaque present with localized aggressive periodontitis is disproportionately low, and the tissue rarely exhibits any significant signs of clinical inflammation. While there is little plaque present, however, the pathogenicity of the plaque that is present is heightened, due to the presence of increased levels of destructive bacteria.

Localized aggressive periodontitis is a relatively rare disease that first presents at puberty and is significantly more common in African and African-American patients than in patients from other racial groups. Studies of family members, including twins and sibling pairs, strongly suggest that aggressive periodontitis, in both its localized and generalized forms, has a genetic basis. While predisposition to aggressive periodontitis is genetic, exposure to periodontal pathogens is necessary for the disease to initiate; it may also be exacerbated by certain environmental factors, like smoking. If environmental influences are present and can be addressed productively, as with smoking cessation therapies, they are included in treatment, with an overall goal of neutralizing the pathogenicity in the oral cavity as much as may be possible.

While the primary characteristic of localized aggressive periodontitis is this specific localized attachment loss, secondary features may also be present. Secondary features include increased mobility of the affected teeth, which can lead migration of the incisors. This can cause diastema, or a gap between the teeth. The roots of the teeth can become exposed and lead to sensitivity or to a dull, radiating pain. Localized aggressive periodontitis may also lead to enlargement of the lymph node and abscess in the periodontium. When localized aggressive periodontitis is present, bone loss patterns are often U-shaped, with horizontal loss manifesting interproximally, and bone loss patterns are often symmetrical on both sides of the mouth. Because younger people are not often tested for periodontitis, early stages of localized aggressive periodontitis can often go undetected; as with chronic periodontitis, late detection and diagnosis has an adverse effect on treatment. In many cases, however, evidence supports the use of mechanical and antibiotic treatments to lead to favorable treatment outcomes.

While periodontal treatments can help stabilize the disease, the patient’s predisposition remains, necessitating frequent maintenance checkups and a thorough and effective home hygiene routine. When periodontal treatments, like root scaling and planing combined with locally delivered antimicrobials, are ineffective at stabilizing the destruction wrought by localized aggressive periodontitis, surgical procedures may be required. These may include mechanical procedures, like root debridement, or they may include regenerative surgical therapies, like bone grafts or guided tissue regeneration. Because of the rapid rate of acceleration in localized aggressive periodontitis, combined with the young age of the patients, treatment is often aggressive, with the goal of creating a beneficial clinical condition to retain the greatest number of teeth for as long as possible.