What are the other Names for this Condition? (Also known as/Synonyms)

• Aggressive Periodontal Disease
• AgP (Aggressive Periodontitis)

What is Aggressive Periodontitis? (Definition/Background Information)

• Periodontitis is a common, but severe form of gum disease that develops due to an infection. It affects the teeth, gums, and surrounding tissues in the mouth, causing the area to swell. The condition causes damage to the gums and tissues, which in turn leads to deterioration of the teeth
• Aggressive Periodontitis (AgP) is an uncommon form of periodontal disease that is particularly seen in children and teenagers, including young adults. It is mostly observed in individuals with healthy immune system, in the absence of any contributory or underlying health conditions
• As the name indicates, Aggressive Periodontitis is an aggressive and rapidly-progressing condition that results in loss of tooth attachment and destruction of bone structure (alveolar bone) supporting teeth. It is characterised by the presence of highly-virulent bacteria. Individuals with AgP may have a family history of the condition
• Two types of Aggressive Periodontitis are described: Localized aggressive periodontitis (LAP) and generalized aggressive periodontitis (GAP). Both types can cause severe dental damage including tooth loss in the absence of early appropriate treatment
• Aggressive Periodontitis develops following a complex interaction of genetic factors, oral microbiology, and a variety of host factors such as body immune response, saliva, etc.
• Early diagnosis and rapid treatment to prevent permanent damage to oral cavity tissues and bones is necessary. The treatment plan may range from oral cleaning, removal of plaque, to medication administration for bacterial infection. Surgery may be necessary in some individuals
• The prognosis of Aggressive Periodontitis is usually difficult to predict. Also, recurrences are observed following initial (successful) treatment, due to the high potency of the condition/bacteria. Hence, periodical and regular dental healthcare checkups are mandatory following therapy

Who gets Aggressive Periodontitis? (Age and Sex Distribution)

• Aggressive Periodontitis is generally seen among the younger population (age below 30 years). The condition typically affects young and old children and young adults
• It can affect both males and females; no gender preference is noted
• All racial and ethnic groups worldwide are at risk for Aggressive Periodontitis

What are the Risk Factors for Aggressive Periodontitis? (Predisposing Factors)

Aggressive Periodontitis is typically seen in children with healthy immunity. Generally, no underlying/associated health conditions are known to be present. However, in general, the risk factors associated with periodontal disease may include:

• Poor oral habits: This facilitates bacterial growth in the mouth thereby increasing the risk for developing gum disease
• A positive family history of periodontal disease
• Early form of gum disease or gingivitis, which is left untreated
• Cigarette smoking and chewing tobacco: Smokers are known to have a higher risk for Aggressive Periodontitis
• Children with diabetes
• Conditions causing hormonal imbalance in the body including puberty and menstruation
• Certain diseases and disorders such as heart diseases and rheumatoid arthritis
• Individuals with cancer
• Use of certain medications including those that are prescribed for heart and neurological conditions
• Nutritional deficiencies
• Genetic susceptibility: Some individuals have a higher risk for gum disease due to their genetic make-up
• HIV infection causing weak immune function makes one more at risk for gingivitis
• Obesity and excessive stress
• Bruxism: A condition in which individuals tend to grind their teeth
• Use of illegal substances/drugs

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Aggressive Periodontitis? (Etiology)

The main cause of periodontitis is infection of the gum, teeth, and surrounding tissue. This leads to plaque buildup on the affected teeth (or tooth).

• When this plaque is left on teeth for extended periods of time, it hardens and bacteria in the mouth start to release toxins that damage the gums
• Over time, as the plaque builds up, pockets form between the teeth and gums that lead to deeper infection of the gums
• Eventually, this infection spreads to the ligaments and bone in the mouth causing degradation of these structures resulting in periodontitis

However, Aggressive Periodontitis (AgP) manifests when one’s genetic make-up is in concurrence with certain environmental factors and the exposure to pathogenic bacteria causing AgP occurs. Based on studies of families and family members, individuals with AgP may have a family history of the condition (usually autosomal dominant inheritance pattern). This is also referred to as familial aggregation.

Following the onset of Aggressive Periodontitis, an abnormal immune response by the body’s white blood cells (WBCs) is noted. WBCs show impaired response and abnormalities in reacting to the disease-causing pathogens.

Disease-causing bacteria associated with AgP include a host of gram-negative bacteria such as:

• Aggregatibacter actinomycetemcomitans 
• Porphyromonas gingivalis 
• Capnocytophaga spp.
• Prevotella intermedia

All the above pathogenic bacteria cause severe and destructive periodontal disease in the affected individuals. Scientific research has defined 3 primary features for Aggressive Periodontitis (including for both the localized type and generalized type):

• Absence of a contributory (underlying) systemic disease or condition to AgP
• Destruction of periodontal structures is rapid (such as attachment loss and loss of bone)
• A positive family history or connection is identified - a higher genetic susceptibility is observed

Certain secondary features have also been noted:

• Extensive gum and tissue destruction is disproportionate to the quantity of dental plaque present (implying lower amounts of bacteria can also cause severe damage)
• Presence of certain bacteria in higher levels, especially A. actinomycetemcomitans and P. gingivalis (in some cases), is noted
• Cells that protect the body, called phagocytes, are impaired and show abnormal behavior
• Abnormally functioning macrophages, which are a type of white blood cell. Macrophages can be hyperactive resulting in increased susceptibility to bone destruction in teeth i.e., presence of hyperactive macrophage phenotypes, resulting in attachment loss and loss of bone

Occasionally, the progression of periodontal tissue destruction stops in the absence of specific treatment. The reason for this phenomenon is not well-understood.

What are the Signs and Symptoms of Aggressive Periodontitis?

The signs and symptoms associated with Aggressive Periodontitis vary based on the type of the condition (whether localized or generalized type) and may include:

• Localized Aggressive Periodontitis is confined to the incisors and first molars; it is found to show minor amounts of plaque formation
• While, generalized Aggressive Periodontitis affects the complete oral cavity region (entire mouth), and show significant buildup of dental plaque and tartar
• Minimal-to-no gum inflammation; while in some swollen, painful gums that appear red are noted
• Abnormal teeth with gaps in between them; having loose teeth
• Severe tissue and bone loss
• Increased tooth sensitivity
• Pus buildup between the teeth and gums
• Mild or dull toothache
• Bleeding during brushing or flossing
• Abnormal taste in the mouth 
• Bad breath

How is Aggressive Periodontitis Diagnosed?

The diagnostic tests for Aggressive Periodontitis (AgP) may involve the following:

• An oral specialist (dentist) will examine the symptoms and perform a physical exam on the mouth. The specialist will look for plaque and tartar buildup
  • Bleeding on probing is a characteristic sign of the condition
  • Individuals with AgP may show significant loss of attachment and deep periodontal pockets
• A thorough analysis of the individual’s family history and medical history. Assessment of family history towards establishing a diagnosis of AgP is important
• X-rays of the jaw, head, and neck area can be taken to detect the extent of bony involvement, which is caused by the inflammation
• An MRI scan or CT scan of the head and neck region can be used to detect the extent of damage to the jaw, head, and neck

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Aggressive Periodontitis?

The possible complications associated with Aggressive Periodontitis include:

• Permanent and irreversible injury to the dental cavity and supporting structures
• Loss of teeth
• Increased susceptibility to other heart and lung related conditions
• Recurrence of the condition

How is Aggressive Periodontitis Treated?

Specific, and often, an aggressive treatment plan for Aggressive Periodontitis (AgP) are developed on a case-by-case basis. The goals for therapy include:

• Formulating a cause-related treatment therapy
• Stopping progression of AgP and maintaining the balance healthy teeth
• Examining one’s treatment response
• Follow-up visits

Therapy may include conservative measures including proper oral hygiene, stopping smoking, professional cleaning and removing plaque, and addressing any factor (such as misaligned tooth or improperly placed prosthetic dental device) that causes retention of plaque.

• Scaling and polishing: Oral cleansing treatment by the dental professional and removal of plaque may be necessary. However, moderate to severe cases may require a dental sealant to level the surface of teeth and avoid further plaque buildup
• Root surface debridement procedure - removal of food debris using abrasion
• Administering systemic antibiotics: Medications, such as amoxicillin and metronidazole, may be recommended to combat any bacterial infection. Doxycycline may be prescribed for those with penicillin allergy
• Use of laser therapy and photodynamic therapy for disinfection and elimination of bacteria
• Periodontal surgery: Typically, for localized destruction and poor response to therapy, invasive procedures may be necessary
  • An open flap debridement procedure or pocket reduction surgery may be performed
  • If necessary, regenerative surgical procedures, such as bone and/or tissue grafting, may be used to correct destruction of periodontal tissue and bone
• After 3-4 months, an evaluation to assess treatment response is essential

Regular visits for dental health checkups and maintaining good oral hygiene, such as brushing and flossing after each meal, are generally recommended.

How can Aggressive Periodontitis be Prevented?

Currently, the best approach to prevent the development of Aggressive Periodontitis (AgP) is to maintain good oral hygiene.

• Screening of family members for periodontal disease is also to be ensured, following a diagnosis of AgP
• Create an awareness of the importance of oral health in children from an early age
• Good oral hygiene can be achieved by brushing the teeth twice daily and by flossing at least once a day. In fact, it is recommended that children brush their teeth after every meal
• Studies indicate that flossing before brushing is beneficial and recommended. Flossing loosens food particles in the teeth, making it easier to remove them with brushing
• Using recommended oral rinses
• Stopping smoking or chewing tobacco and substance abuse
• Parents and caregivers are asked to periodically  check the mouth of children for detecting any early signs of gum disease or other dental health issues
• Controlling diabetes through lifestyle changes
• Have a well-balanced diet with lots of fruits and vegetables, to avoid any nutritional imbalances
• If certain medications place the child at a higher risk for gum disease, check with the physician for alternatives or substitutes
• Use a mouth guard, if the child has a habit of grinding teeth (especially at night)
• Be physically active and exercise regularly to remain healthy and stress-free; meditation and yoga may be beneficial
• Early and prompt treatment of mild gum disease or any dental health conditions can help prevent periodontitis (the advanced stage of gum disease)

Undertake regular visits to a dental health professional for a proper dental check-up and to prevent any tooth-related issues early.

What is the Prognosis of Aggressive Periodontitis? (Outcomes/Resolutions)

The prognosis for Aggressive Periodontitis is difficult to predict and may be assessed only on a case-by-case basis.

• Individuals with relatively milder conditions have better prognosis than those presenting severe symptoms and more aggressive disease
• A high risk for recurrence is noted in those with Aggressive Periodontitis. Thus, following treatment, regular and frequent review visits to the dental healthcare facility is strongly recommended
• Also, following a good oral hygiene regimen after treatment is very important

Additional and relevant useful information for Aggressive Periodontitis:

• In order to prevent periodontitis, gum disease needs to be treated in the early stages

Please visit our Dental Health Center for more physician-approved health information:

https://www.dovemed.com/healthy-living/dental-health/