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Generalized aggressive periodontitis is characterized by the loss of attachment and bone that affects multiple teeth rather than just a localized area. Specifically, individuals must exhibit loss of at least three permanent teeth, which typically does not include first molars and incisors, to qualify for this classification. This condition emphasizes a systemic aspect of the periodontal disease where periodontal tissues become severely compromised, leading to significant loss of periodontal support.

In contrast, involvement of only the incisors misrepresents the widespread nature of generalized aggressive periodontitis, which impacts more than just a few teeth. Localized attachment loss pertains to localized aggressive periodontitis, which clearly has a different presentation that does not match the generalized term. An onset before age 11 is also not characteristic of generalized aggressive periodontitis; rather, it can typically occur in older adolescents or young adults, generally presenting after puberty.

Thus, the criteria define that the presence of significant tooth loss across multiple sites, excluding the first molars and incisors, is what distinctly characterizes generalized aggressive periodontitis.