Localized Aggressive Periodontitis
Localized aggressive periodontitis manifests with a rapid progression of periodontal tissue loss that begins around the age of the onset of puberty and affects systemically healthy individuals mostly of African descent. This rare periodontal disease is characterized by the loss of attachment of the gum tissue and significant bone destruction specifically around the first molars and possibly the incisors. It also rarely presents significant plaque or tartar buildup or substantial inflammation around affected teeth. As the patient ages, the disease may progress to generalized aggressive periodontitis. While the amount of bacterial plaque and dental calculus present is disproportionately less than the levels of tissue damage would indicate, the plaque that is present has increased levels of specific forms of bacteria and therefore is highly pathogenetic. Possible secondary features of Localized Aggressive Periodontitis include the formation of diastema, or a gap between the teeth, as the incisors migrate away from each other; mobility of the teeth affected by the disease; tooth sensitivity because of exposure of the roots of the affected teeth; a dull and thorough pain that radiates through the bones of the jaw; and abscess of the periodontium accompanied by enlargement of the adjacent lymph nodes.
When localized aggressive periodontitis is present, radiographic images indicate that alveolar bone defects appear in a specifically U-shaped pattern between the permanent first molars, or between the incisors. These patterns of bone loss most frequently appear bilaterally, appearing similar on both sides; this is referred to as a mirror-image pattern of alveolar bone loss. When advanced, this bone loss may appear horizontal.
Localized aggressive periodontitis is a type of aggressive periodontitis that is included in the seven classifications of periodontal disease defined by the American Academy of Periodontology in 1999; generalized aggressive periodontitis is the other type. Localized aggressive periodontitis is present in approximately .1% of white people in North America and Europe, while it appears in approximately 2.6% of African-Americans and between 1% and 5% of Africans and people of African descent. Localized aggressive periodontitis is also comparatively rare among Asians and Hispanics, indicating that variations in race and ethnicity are a significant contributing factor for the disease. Both types of aggressive periodontitis are considerably less common than chronic periodontitis, and they are also unique in that they affect much younger patients than the chronic form of the disease. In some patients, attachment loss is particularly accelerated.
Aggressive periodontitis is defined, specifically, by three primary features that set it apart from chronic periodontitis and are common in both localized and generalized disease forms. The first notable feature is that patients with aggressive periodontitis are clinically healthy, manifesting no underlying diseases that commonly correlate with periodontitis. Secondly, the rate of both bone loss and attachment loss is rapid. Finally, aggressive periodontitis is genetic, appearing in multiple members of the same family; it is believed that it is due to a genetic mutation in combination with environmental factors. Secondary features that appear in some, but not all, cases of aggressive periodontitis include high levels of specific kinds of microbes and a disproportionately low amount of dental plaque and calculus, and the occasional ability of the disease to halt in its progression with no related therapy.