*Periodontology - Fundamentals and Clinical Features*

**Figure 19.**

*Age and gender adjusted alkaline phosphatase (ALP) reference ranges.*


#### **Table 5.**

*Alkaline phosphatase (ALP) level differentiating hypophosphatasia (HPP) from other metabolic disorders [76].*

device without removal; iii) Pain management, such as NSAIDs. High-dose vitamin D, calcium supplements, and bisphosphonates should not be given when HPP is suspected, as they have been shown to exacerbate symptoms of HPP; iv) Dental care to preserve primary dentition. It is often needed to extract primary teeth with high mobility, but on the permanent dentition it is suggested to follow a more conservative therapy and try to keep all teeth as long as possible.

A causal enzyme therapy replacement with asfotase-alfa was approved by FDA in 2015. Asfotase-alfa improves respiratory insufficiency, bone mineralization, and long-term survival, and has a very good safety profile [75, 78].
