Understanding Periodontal Diseases: Types, Features, and Risk Factors

Aggressive Periodontitis: Localized vs. Generalized

This section outlines the key similarities and differences between Localized Aggressive Periodontitis (LAP) and Generalized Aggressive Periodontitis (GAP).

Localized Aggressive Periodontitis (LAP)

• Circumpubertal onset.
• Robust serum antibody response to infecting agents.
• Localized first molar/incisor presentation with interproximal attachment loss on at least two permanent teeth, one of which is a first molar.
• Lack of clinical inflammation.
• Presence of deep periodontal pockets.
• Amount of plaque inconsistent with the amount of periodontal destruction.
• Plaque forms a thin biofilm, rarely mineralizing into calculus.
• Distolabial migration and diastema formation.
• Increasing mobility of first molars.
• Sensitivity of denuded root surfaces to thermal and tactile stimuli.
• Deep, dull, radiating pain during mastication.
• Periodontal abscesses may form.
• Regional lymph node enlargement.

Generalized Aggressive Periodontitis (GAP)

• Usually affects persons under 30, but can occur in older patients.
• Poor serum antibody response to infecting agents.
• Generalized interproximal attachment loss affecting at least three permanent teeth.
• Pronounced episodic nature of destruction.
• Represents the most heterogeneous and severe forms of periodontitis.

Chronic Periodontitis: Patient Profile and Features

Here is an example of a typical patient with Chronic Periodontitis, detailing signs, symptoms, and risk factors.

Clinical Features of Chronic Periodontitis

• Supragingival and subgingival plaque formation.
• Supragingival and subgingival calculus formation.
• Gingival inflammation.
• Pocket formation.
• Attachment loss.
• Loss of alveolar bone.
• Occasional suppuration.
• Moderately to severely enlarged gingiva.
• Bleeding on probing.
• Tooth mobility.

Symptoms of Chronic Periodontitis

• Bleeding gums after brushing or eating.
• Spaces between teeth (diastema formation).
• Loose teeth.
• Often painless (can be a silent disease).
• Hypersensitivity.
• Gingival tenderness or itchiness.

Risk Factors for Chronic Periodontitis

• Prior history of periodontitis.
• Local factors.
• Systemic factors.
• Environmental factors.
• Genetic factors.

Key Concepts in Periodontal Disease

Contained Gingivitis

A stage where T lymphocytes become predominant, leading to a progressively destructive B lymphocytic lesion.

Buttressing Bone Formation

Bone formation that occurs to reinforce bone weakened by resorption. When this occurs within the jaw, it's known as central buttressing. On the external surface, it's called peripheral buttressing, causing bulging (also known as lipping).

Radius of Action (ROA) of Plaque

Bone resorption factors must be present on bone surfaces for their action to occur. Plaque has a radius of action of 1.5-2.5mm, influencing bone destruction within this range.

Vertical Bone Defects

• Vertical defects often increase with age.
• If the distance between two teeth is more than 2.5mm, it can lead to an angular (vertical) bone defect, as plaque's radius of action is limited to 2.5mm.
• Conversely, if the distance is less than 2.5mm, horizontal bone loss is more likely due to the plaque's effective radius of action.