Localized Aggressive Periodontitis and Necrotizing Ulcerative Gingivitis

Localized Aggressive Periodontitis (LAP)

Localized aggressive periodontitis, previously known as localized juvenile periodontitis, is characterized by specific microbial profiles and clinical features.

• Microbiota Composition:
  • The microbiota associated with LAP is predominantly composed of:
    • Gram-Negative, Capnophilic, and Anaerobic Rods.
  • Key Organisms:
    • Actinobacillus actinomycetemcomitans: The main organism involved in LAP.
    • Other significant organisms include:
      • Porphyromonas gingivalis
      • Eikenella corrodens
      • Campylobacter rectus
      • Bacteroides capillus
      • Spirochetes (various species).
  • Viral Associations:
    • Herpes viruses, including Epstein-Barr Virus-1 (EBV-1) and Human Cytomegalovirus (HCMV), have also been associated with LAP.

Necrotizing Ulcerative Gingivitis (NUG)

• Microbial Profile:
  • NUG is characterized by high levels of:
    • Prevotella intermedia
    • Spirochetes (various species).
• Clinical Features:
  • NUG presents with necrosis of the gingival tissue, pain, and ulceration, often accompanied by systemic symptoms.

Microbial Shifts in Periodontal Disease

When comparing the microbiota across different states of periodontal health, a distinct microbial shift can be identified as the disease progresses from health to gingivitis to periodontitis:

1. From Gram-Positive to Gram-Negative:

   • Healthy gingival sites are predominantly colonized by gram-positive bacteria, while diseased sites show an increase in gram-negative bacteria.

2. From Cocci to Rods (and Later to Spirochetes):

   • In health, cocci (spherical bacteria) are prevalent. As the disease progresses, there is a shift towards rod-shaped bacteria, and in advanced stages, spirochetes become more prominent.

3. From Non-Motile to Motile Organisms:

   • Healthy sites are often dominated by non-motile bacteria, while motile organisms increase in number as periodontal disease develops.

4. From Facultative Anaerobes to Obligate Anaerobes:

   • In health, facultative anaerobes (which can survive with or without oxygen) are common. In contrast, obligate anaerobes (which thrive in the absence of oxygen) become more prevalent in periodontal disease.

5. From Fermenting to Proteolytic Species:

   • The microbial community shifts from fermentative bacteria, which primarily metabolize carbohydrates, to proteolytic species that break down proteins, contributing to tissue destruction and inflammation.