is Generalized Aggressive Periodontitis an Endless Disease When Does it Stop

During the last decades, progressive lines of thinking were proposed by generations of brilliant periodontists who tried to describe the aggressive destruction of periodontal tissues. Periodontitis was basically described 2000 years ago but in 18th century, signs and symptoms of periodontitis were firstly recorded.

History of aggressive periodontitis At the beginning of 19th century, alveolar pyorrhea was a term created and explained by two different schools; the European school has described it as a disease which is not affected by local factors while the American school has described local factors especially salivary calculus as the main cause behind alveolar pyorrhea.

Later by the development of histological, radio graphical and microbiological analysis, three other explanation were raised; school of atrophy and degeneration, school of occlusal trauma and school of infection. The European School has supported the theory of atrophy and degeneration especially in young individuals. Their explanation was mainly based on the histological studies which concluded that alveolar bone loss is the primary crucial point in periodontal disease preceded by gingival ulceration and inflammation. Pocket formation and epithelial proliferation are secondary events. Furthermore, they also reported that inflammation and suppuration are strongly connected to the presence of external irritation and entitled it ''Diffuse atrophy''.

Classification of Aggressive periodontitis In 80s and 90s, numerous classifications with various staging and subtypes had been conducted which were not based upon the true diagnostic background. In 1986, the American academy of periodontology acknowledged the exclusion of rapidly progressive periodontitis and added prepubertal periodontitis as a subclass to juvenile periodontitis. In 1989, the American academy classification was modified. They proposed early onset periodontitis to include both prepubertal, juvenile and rapidly progressive periodontitis and added periodontitis associated with systemic disease as separate entity. In 1989, Topic subdivided the periodontal conditions into acute and chronic. The acute condition included periodontal abscess, pericoronitis while the chronic condition included periodontitis (simplex, complex and generalized forms), localized forms (juvenile, post-juvenile and prepubertal) and symptomatic. The latter classification was lacking essential details concerning the periodontal diseases. In 1994, the European Workshop on Periodontology condensed the previous classes into; early onset, adult and necrotizing periodontitis. In 1997, the Committee of American Academy of Periodontology had set a plan to revise the previously proposed classifications.

Sub-typing of aggressive periodontitis Early onset description of periodontitis was mainly based on the influence of patient's age at the time of reporting the evolution of symptoms added to the short-term period in which uppermost destructive events had happened. In 1989 classification, early onset periodontitis was sub-categorized as pre-pubertal juvenile and rapidly progressive periodontitis. Both sub-categories approved to be either localized or generalized.