Perio Diagnosis - Localized Aggressive Periodontitis

Localized Aggressive Periodontitis (LAP) is a rare form of inflammatory periodontal disease. A defining quality of the disease is its ability to progress at an extremely fast rate. In addition, it causes severe bone and attachment loss, specifically impacting the first molars and the incisors. Another marking is that the onset of the disease occurs at an early age.

The beginning of localized aggressive periodontitis usually occurs around the age of puberty. The disease occurs when there is an interproximal loss of attachment of the first molar or incisors on at least two permanent teeth. It does not involve more than two teeth other than the first molars and incisors. It also includes a lack of inflammation and evidence of deep periodontal pockets where there is advanced bone loss. There is also a quick rate of progression of the periodontal tissue loss.

As the patient ages, the disease can progress and effect the adjacent teeth which can lead to the patient developing generalized aggressive periodontitis (GAP). Clinically, the periodontal tissue can also exhibit some signs of inflammation and demonstrate a robust response with serum antibodies to pathogens.

The levels of plaque which are present are not consistent with the severity and levels of destroyed tissue. There is, however, a high plaque pathogenicity from the presence of raised levels of some bacteria.

Secondary features of localized aggressive periodontitis may also be present which include:

  • Deep and dull pain which can radiate into the jaw
  • Diastema formation with a disto-labial incisor migration
  • Increased mobility levels on the impacted teeth
  • Periodontal abscess and enlarged lymph nodes
  • Sensitivity due to the exposed root

Radiographic Features

From a radiographic perspective, the periodontal lesion will often occur with an alveolar bone loss in a horizontal pattern. This occurs at the interproximal surface of the permanent first molars. It typically presents itself with a horizontal bone pattern of bone loss at the interproximal surface of the incisors. This occurs because of the thin bone in this area compared to the interproximal surface found on the molars.

In contrast, the alveolar bone loss patterns are typically bilateral and consistent on both sides. It can be referred to as being in the pattern of a mirror-image.

In more advanced cases, it is possible for the alveolar bone loss to be demonstrated as a horizontal bone loss pattern radiographically.

Screening

Because the disease can cause permanent and rapid destruction of the periodontal tissues, an early diagnosis of aggressive periodontitis is critical. It is also imperative for patients to participate in routine periodontal examinations during their dental examination which aids in screening for various forms of periodontal disease.

Clinical Examination

During a clinical examination of the gingival and periodontal tissues, a dental professional will evaluate the physical appearance of the gingiva. In Caucasian patients, a healthy periodontium appears to be stippled and pink with a knife edge margin where it attaches to the tooth. The pigmentation may vary differ for patients based on their ethnicity. The next phase of the examination involves checking the gingival probing depths. This step is typically completed with a basic periodontal probe. During the probing, patients who have aggressive periodontitis commonly have measurable periodontal pocket depths and a loss of attachment. Bleeding on probing is a strong indicator that the disease is present.