Generalized acute proliferative gingivitis and rapid alveolar bone destruction are its hallmarks. Treatment regimens are under investigation. Rapidly progressive periodontitis is commonly associated with A. actinomycetemcomitans, Porphyromonas gingivalis , and many gram-negative asaccharolytic rods. It occurs in patients aged 20 to 35 yr. Some cases may be sequelae of undiagnosed localized juvenile periodontitis or prepubertal periodontitis, but others appear de novo.
Most patients have some polymorphonuclear leukocyte dysfunction, often for chemotaxis.
HIV-associated periodontitis is a particularly virulent, rapidly progressing form. Clinically, it resembles acute necrotizing ulcerative gingivitis imposed on rapidly progressive periodontitis. Patients may lose 9 to 12 mm of attachment in as little as 6 mo. Unlike most forms of periodontitis, the HIV-associated form is accompanied by pain, intense erythema, and spontaneous bleeding. Treatment For all forms of periodontitis, the first phase of treatment consists of oral hygiene instruction, thorough scaling and root planing to remove calculus deposits, and reevaluation after 3 mo.