As the name suggests, aggressive periodontitis is a severe form of periodontitis. Because the damage occurs quickly in this condition, historical, radiographic, and clinical data are important to determine when the disease started. This background check also helps improve aggressive periodontitis treatment approaches.
What Is Aggressive Periodontitis?
Aggressive periodontitis was defined by the 1999 International Workshop for the Classification of Periodontal Diseases. In aggressive periodontitis, gum attachment loss happens much faster than in chronic periodontitis, which is more common.
Some dentists think that significant attachment loss in a young patient indicates rapid disease progression. However, severe attachment loss can also occur in patients with a long history of poor oral hygiene, even if the disease progresses slowly.
Types of Aggressive Periodontitis
Periodontitis can be divided into three main types based on x-rays, lab tests, and clinical features. These types include:
- Localized Aggressive Periodontitis (LAP): This type usually affects teenagers and young adults, causing attachment loss around the permanent molars and incisors. It involves attachment loss between at least two permanent teeth, with one being a first molar. Patients often have a strong antibody response to the bacteria involved, especially Aggregatibacter actinomycetemcomitans.
- Generalized Aggressive Periodontitis (GAP): This type mostly affects people under 30 but can also occur in older adults. It causes attachment loss between at least three permanent teeth, not including the first molars and incisors. GAP is characterized by a weak antibody response to the bacteria and a faster progression of tissue destruction compared to LAP.
Aggressive Periodontitis Treatment Approaches
Patients with aggressive periodontitis used to have poor outcomes. They often required radical treatments. However, recent evidence shows that both surgical and nonsurgical periodontal therapies can be effective.
- Phase I Therapy
Phase I aims to reduce or eliminate the microbial load and factors that cause periodontal disease. This includes:
- Cleaning above and below the gum line to remove calculus
- Treating areas where food gets stuck
- Fixing cavities
Some experts believe that nonsurgical therapy alone might be enough if you catch the disease early. Patients with GAP who received nonsurgical treatment had no disease progression, reduced inflammation, and shallower pockets. They showed many other positive outcomes at three months, six months, and five years post-treatment.
Challenges and Adjunctive Therapies
Managing aggressive periodontitis is challenging due to a lack of standardized treatment protocols. Some patients continue to have periodontal destruction because of persistent pathogens. Therefore, they might need additional local and systemic chemotherapeutic therapy.
An alternative treatment is antimicrobial photodynamic therapy, which uses a photosensitizing agent and low-intensity laser light to kill microbes. This, combined with scaling and root planing, was found to be more effective at reducing pocket depth than scaling and root planing alone after 90 days.
- Phase II Therapy
Phase II of periodontal therapy involves surgical procedures to improve the prognosis of teeth. This includes:
- Respective procedures like gingivectomies and osseous resections
- Regenerative flaps with grafts
These surgeries aim to create an environment that helps the healing of mucosal and gingival tissues. They are often performed on noninflamed tissue and without periodontal pockets. Researchers are considering replacing traditional surgical instruments with lasers, but there is still a long way to go.
Concluding Thoughts
Aggressive periodontitis is the least common and least understood form of periodontal disease. Until more high-quality research identifies the best aggressive periodontitis treatment methods, dentists need to be alert to the clinical signs of it.
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