Patients may complain of halitosis and pus discharge from gums. Mobility of the affected teeth will be seen towards the later stages of the infection. Patients will be otherwise systemically healthy. Severe pain is rarely experienced by the patients except in situations where a periodontal abscess develops or a periodontal-endodontic infection occurs via accessory canals or tooth apex. Some patients may complain of a dull nagging type of pain from gums. Gingival recession may be seen and patients may complain of food impaction due to loss of contact points between teeth.
GAgP patients who smoke and/or maintain a poor oral hygiene demonstrate more severe destruction of periodontium compared to those who do not smoke or maintain a satisfactory oral hygiene
The disease progresses in alternating periods of activity and quiescence [15]. This leads to two types of presentation at the time of examination. In the periods of quiescence, patients are free of symptoms and the gingiva appears pink and healthy even though probing reveals deep periodontal pockets. Lack of visible signs of clinical inflammation despite the presence of deep periodontal pockets and severe attachment loss in an otherwise healthy young individual is the classic sign of aggressive periodontitis presenting at this stage (Figures 1(a)–1(c)). Probing should be done with calibrated periodontal probes at six sites around each tooth.
The periods of inactivity may remain for weeks to months or even years and will be followed by periods of active disease. During this period, there will be active bone destruction and attachment loss. When the patient presents in this stage, the gingiva will show all signs of mild to severe inflammation. Gingiva may be tender, fiery red, edematous, soft, and boggy. Bleeding on probing or even spontaneous bleeding and purulent exudation may be evident. Inflammatory gingival enlargement may also be noticed. The majority of the patients refer to dental consultation at this stage of the disease
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