Periodontology Diagnosis - Localized Aggressive Periodontitis
Localized Aggressive Periodontitis, also known as LAP, is a rare type of inflammatory periodontal disease. It is defined by its ability to progress at a rapid rate, severe bone and attachment loss, specifically on the first molars and incisors. The disease is also marked by an early age of onset.
Localized aggressive periodontitis typically begins around the time adolescents start puberty. The disease occurs when there is an interproximal loss of attachment of the first molar, and or the incisors on at least two permanent teeth. It does not involve more than two teeth other than the first molars and incisors, includes a lack of inflammation and evidence of deep periodontal pockets with advanced bone loss. In addition, there is a quick rate of progression of periodontal tissue loss.
As the age of the patient increases, the disease may progress and involve the adjacent teeth and lead to the patient developing generalized aggressive periodontitis (GAP). The periodontal tissue can also exhibit some signs of inflammation clinically in addition to demonstrating a robust response with serum antibodies to pathogens.
The amount of plaque which exists is not consistent with the amount and severity of destroyed tissue. However, there is a high plaque pathogenicity from the presence of raised levels of bacteria such as Aggregatibacter actinomycetemcomitans and Porphyromonas Gingivalis.
Some of the following secondary features of localized aggressive periodontitis may also be present:
- Diastema formation with a disto-labial incisor migration
- Increased level of mobility on the impacted teeth
- Sensitivity from the exposed root
- A dull and pain which radiates to the jaw
- Periodontal abscess in addition to an enlargement of the lymph nodes
Radiographic Features
From a radiographic perspective, the periodontal lesion often occurs with alveolar bone loss in a horizontal pattern at the interproximal surface of the permanent first molars. It typically presents with a horizontal bone pattern of bone loss at the interproximal surface of the incisors. This occurs because the bone is thinner in this area compared to the interproximal surface of the molars.
The alveolar bone loss patterns, in contrast, are typically bilateral and similar on each side. It is sometimes referred to as being in the pattern of a mirror-image.
In cases which are more advanced, it is possible for the alveolar bone loss to be depicted as a horizontal bone loss pattern radiographically.
Screening
It is critical to see an early diagnosis of aggressive periodontitis as the disease can cause permanent and rapid destruction of the periodontal tissues. It is important for patients to have a routine periodontal examination during their dental examination to screen for any type of periodontal disease.
Clinical Examination
At the beginning of a clinical examination of the gingival and periodontal tissues, the dental professional evaluates the appearance of the gingiva. In a Caucasian patient, a healthy periodontium appears stippled and pink with a knife edge margin where it attaches to the tooth. The pigmentation can vary based on the ethnicity of the patient. The next phase of the examination includes checking the gingival probing depths. This is typically conducted using a basic periodontal probe. During the probing, patients with aggressive periodontitis will typically have measurable periodontal pocket depths and loss of attachment. If the patient experiences bleeding on probing (BOP), this is a strong indication of the disease.