Perio Diagnosis - Generalized Aggressive Periodontitis

Generalized Aggressive Periodontitis (GAP) is the interproximal attachment loss affecting three or more permanent teeth other than the incisors and first molar.

Below is a summary of the clinical features associated with generalized aggressive periodontitis:

  • The disease is most commonly seen in patients who are younger than 30 years old
  • In cases of GAP, the disease appears clinically to resemble chronic periodontitis. The main differences include the progression of the disease at a much faster rate and that the disease typically impacts patients who are younger.
  • There is a poor serum response against infecting agents
  • The destruction which is present from the disease is not aligned with the level of local irritants
  • The presence of generalized inter-proximal attachment loss on three or more permanent teeth other than the incisors and first molars
  • The main distinction in the comparison of the localized and generalized forms of aggressive periodontitis is based on the number of teeth impacted. GAP creates an attachment loss which involves over 30% of sites on the teeth. This involves three or more permanent teeth outside of the incisors or first molars.

There is an episodic nature of the attachment loss. In cases of GAP, there are two main tissue responses which include the following:

  1. Tissue may have severe inflammation and often appears to be red. There may also be ulceration present. In some cases, patients also experience spontaneous bleeding. Bleeding typically occurs once the disease has reached the destructive phase. This includes both attachment and bone loss.
  2. The other response is less severe where the gingival tissue may appear without any inflammation, be pink in appearance and have some stippling. In addition to the mild appearance, deep pockets may exist upon probing.

Screening

Early diagnosis is imperative as the disease can cause rapid and permanent destruction of the periodontal tissues. Patients should undergo routine periodontal examinations during their regular dental checkup as this can aid in screening for various forms of periodontal disease.

Family Association

Dentists should also ask patients if they have a family history of periodontal disease. Aggressive periodontitis has been found to have an autosomal dominant inheritance pattern meaning up to 50% of siblings could be impacted if either of their parents have the disease. While it is important for dental to be careful in the interpretation of a family history, it can help in providing critical evidence in the early diagnosis of aggressive periodontitis. Once aggressive periodontitis has been diagnosed, the family members of a patient should also be screened for the disease. Early detection of aggressive periodontitis allows for intervention before extensive periodontal destruction takes place.

Treatment

Once the initial evaluation and diagnosis of aggressive periodontitis are complete, an individualized treatment plan will be created. Treatment plans for aggressive periodontitis are quite similar to the treatment plans for chronic periodontitis and often include the following: cause related therapy, re-examination of the patient’s response to therapy, definitive therapy, and maintenance.

Due to the high levels of possible bone loss and the young age of patients who are diagnosed with aggressive periodontitis, treatment plans are often aggressive in nature. The goals of the treatment plan is preventing additional periodontal destruction and restoring the maximum amount of periodontal attachment. Simply put, the main treatment objective is to retain the maximum number of teeth for as long as possible.