Objective: Aggressive periodontitis is a disease entity that can be classified as Stages III & IV and Grade C chronic periodontitis based on the 2017 classification of the American Association of Periodontology for periodontal diseases. It is a class of chronic periodontal disease that features clinically severe periodontal tissue destruction. The diagnosis of aggressive periodontitis in this environment is delayed because of some influencing factors such as lack of dental awareness, patients’ poor attitude towards this disease entity and their low socio-economic status.  The objective of this case series is to highlight the factors that influence the time of presentation and severity of periodontal tissue destruction of Stages III & IV and Grade C chronic periodontitis (aggressive periodontitis) in this environment.

Cases Description: We present the summary of the history, clinical features and radiological findings of four (4) cases of early and delayed presentation of aggressive periodontitis patients aged 19-27 years and factors that influenced their time of presentation. Severe periodontal tissue destruction was a common feature in these four cases with eventual tooth/teeth loss in delayed presenters. They were all treated using standard periodontal debridement with normal saline and 0.2% chlorhexidine gluconate, scaling, root planing and systemic antibiotics therapy. The patients provided informed consents, ethical approval was obtained from the institutional ethical committee and the study was conducted in accordance with the Helsinki declaration of 1975 as revised in 2000.

Results: The factors that influenced the time of presentation included dental awareness through dental education, missing and mobile teeth, fear of further loss of teeth in the future, replacement of missing teeth, social marginalization, believe in some traditional ‘taboos’ and socio-economic status.

Conclusion: There is a need for aggressive dental education/enlightenment of the people in this environment especially on periodontal disease.

Clinical Significance: Dental awareness through dental education generally influenced time of presentation which prevents severe destruction of the periodontium.