Periodontology Diagnosis - Generalized Aggressive Periodontitis

Generalized Aggressive Periodontitis, which is also called GAP, is the interproximal attachment loss which affects three or more permanent teeth other than the incisors and first molar.

The clinical features of generalized aggressive periodontitis are summarized below:

  • The disease primarily occurs in individuals who are under 30 years old
  • In cases of GAP, the disease clinically appears as a resemblance of chronic periodontitis. The main differences include that the disease progresses at a much more rapid rate and the individuals who are affected by GAP tend to be younger.
  • There is not a strong serum response against infecting agents
  • The destruction from the disease is present which is not aligned with the level of local irritants which are present
  • The presence of generalized inter-proximal attachment loss on 3 or more permanent teeth, not including the incisors or first molars
  • The main distinction in comparing 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 other than the incisors or first molars.
  • An episodic nature of the attachment loss. In GAP cases, there are two main tissue responses which include:
  • Tissue may have severe inflammation and is often red in its appearance. Ulceration may also occur. Patients may experience spontaneous bleeding. This specific response typically exists when the disease is in the destructive phase, which includes bone and attachment loss.
  • The other response is less severe and the gingival tissue might appear without any inflammation, be pink in its appearance and have some possible stippling. Along with the mild appearance, deep pockets may exist upon probing.

Screening

Early diagnosis for aggressive periodontitis is critical as the disease can result in the quick and permanent destruction of the periodontal tissues. All patients should undergo a routine periodontal examination to aid in screening for any form of periodontal disease during their regular dental checkup.

Strong family association

Dental professionals should also ask the patient if there is a family history of periodontal disease. Aggressive periodontitis has been found to have an autosomal dominant inheritance pattern. This can result in up to 50% of siblings being impacted if either parent has the disease. While dental professionals should be careful in their interpretation of the family history, it can provide critical evidence in an early diagnosis of aggressive periodontitis. If the event that aggressive periodontitis is diagnosed, the patient’s family members should also be screened for the disease. The early detection of aggressive periodontitis allows for intervention prior to extensive periodontal destruction.

Treatment

After the initial evaluation and diagnosis of aggressive periodontitis, an individual treatment plan will be developed. The treatment plan for aggressive periodontitis quite similar to the treatment for chronic periodontitis which often includes the following: cause related therapy, re-examination for the patient’s response to therapy, definitive therapy, and maintenance.

Due to the possible amount of bone loss and the young age of patients with aggressive periodontitis, and aggressive treatment approach is often selected. The goal of the treatment plan is to prevent additional periodontal destruction and restore the maximum amount of periodontal attachment. The main objective of the treatment is to retaining a maximum number of teeth for as long as reasonably possible.