Penam Periodontics - Evidence based Personalized Periodontics

Aggressive Periodontitis

Aggressive periodontitis describes a type of periodontitis and includes two of the seven classifications of periodontitis;

  1. Localized aggressive periodontitis (LAP)
  2. Generalized aggressive periodontitis (GAP)

Aggressive periodontitis is much less common than chronic periodontitis and is usually first seen when the patients are less than 25-30 years of age. It occurs in approximately 0.5-4% of the population. The localized and generalized forms are definitely different in their tooth distribution and in the type of bacteria associated with their aetiology and pathogenesis.


The primary features that are common to both LAP and GAP are as follows;

  • Rapid loss of attachment of the tissues to the tooth and rapid bone destruction.
  • A familial pattern of occurrence indicating a possible genetic basis. White blood cell phagocytic or response anomalies can be found in a number of subjects.
  • The patients do not appear to have any other health issues.
  • The amounts of plaque are small and calculus usually not present.
  • The bacteria present are usually Aggregatibacter actinomycetemcomitans and/or Porphyromonas gingivalis.

Localized vs. generalized forms of aggressive periodontitis

The features of the conditions differ in the following ways:

  • Localized Aggressive Periodontitis

    • Onset following puberty with slightly higher frequency in females;
    • There is a good serum antibody response to the infective agents;
    • Has a localized first molar/incisor distribution;
    • Some may have very little evidence of gingival inflammation when the disease first occurs but once the antibody reaction occurs there is heightened gingival inflammation, oedematous, bleeding and pocketing.
  • Generalized Aggressive Periodontitis

    • Onset seems to be later and usually starts in late teens early twenties and is very evident by 30 years of age;
    • There is a poor serum antibody response to the infective agents;
    • There is pronounced sporadic episodic periods of periodontal destruction;
    • The bone loss patterns are generalized affecting teeth other than first molars and incisors;
    • More widespread and rapid bony destruction than the localized form;
    • Bleeding and deep pocketing without major gingival inflammation. Frequent periodontal abscesses.

Treatment generally involves non-surgical therapy in conjunction with antibiotics. It has been our practice experience that treatments directed at combined non-surgical/antibiotic use in these situations offers a superior outcome than a surgical approach and usually can resolve the condition without the need to use surgical intervention.

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