Marginal bone loss in the primary dentition of patients with juvenile periodontitis

Adjunctive Application of Systemic Antibiotics in Non-surgical Aggressive Periodontitis Treatment: Clinical and Microbiological Findings

BACKGROUND: Aggressive periodontitis (AgP) is associated with an extensive and rapid destruction of periodontal tissues. Unpredictable treatment outcomes of the disease are consequences of various cross-linked factors. Antimicrobial adjunctive treatment is routinely used as a part of non-surgical periodontal treatment (NSPT) of AgP. AIM: Therefore, the aim of this study was to compare the effects of active periodontal treatment (APT) combined with systemic antibiotics with mechanical debridement alone, in patients with generalized AgP (GAgP). METHODS: Two groups, consisting of 10 participants each, were randomly formed. Both groups were clinically and microbiologically tested and monitored for 3 months. Test group received APT with antimicrobial supplementation (amoxicillin and metronidazole [AMX-MET]). Patients from the control group were treated by APT only. Clinical and microbiological parameters were recorded at baseline and 3 months following the NSPT. Clinical measurements involved probing depth, clinical attachment level, bleeding on probing, and plaque index. Samples of subgingival crevicular fluid were analyzed by qualitative polymerase chain reaction. RESULTS: Significant improvement of all clinical parameters was observed 3 months following the NSPT (p < 0.05), but significant difference between groups was not found (p > 0.05). Periodontal pathogens’ detection between baseline and 3 months follow-up was also not statistically significant in both examined groups (p > 0.05). CONCLUSION: Similarity of results obtained in both treatment groups underlined the key role of APT in the treatment of AgP. The AMX-MET supplementation did not improve clinical and microbiological outcomes, when compared to APT alone. Longer follow-up period, with larger sample, could provide a more comprehensive insight into this issue.

Alveolar bone level at deciduous molars in Flemish children: A retrospective, radiographic study

AIM

The aim of this retrospective radiographic study in Flemish children was to examine the bone level and bone loss around deciduous molars and factors influencing this.

MATERIALS AND METHODS

Two thousand eight hundred ninety six digital intra-oral radiographs of children younger than 18 years old were screened for eligibility. The distance from the cementoenamel junction to the alveolar bone crest was measured, and tooth surfaces were screened for local risk factors that are presumably related to changes in the bone level. A distance >2 mm was defined as bone loss based on previous literature. All measurements were performed by two examiners.

RESULTS

One thousand four hundred ninety one radiographs of 796 patients (mean age 6.46 ± 2.38 years) were included. The distance between the cementoenamel junction and the alveolar bone crest ranged from 0.07 to 2.88 mm, and the mean distance was 0.93 ± 0.37 mm. This distance was positively correlated with age (p < .001). In 3.5% of patients, bone loss was diagnosed. Caries, fillings and pulp pathology were associated with bone loss and higher cementoenamel junction-alveolar bone crest distances (p < .05).

CONCLUSION

This study found a low prevalence of alveolar bone loss in the primary dentition. Both the bone level and bone loss were strongly correlated with local factors.

Radiographic Description of the Distribution of Aggressive Periodontitis in Primary Teeth

OBJECTIVE

To describe the prevalence by site and tooth of aggressive periodontists (AP) in primary teeth of children with AP, that will facilitate the early diagnosis of AP.

STUDY DESIGN

Radiographic evidence of AP by tooth and site of primary teeth of 29 children with AP was analyzed by gender, ethnicity, type of dentition (primary or mixed), alveolar bone site and type of tooth.

RESULTS

The range and mean ± standard error of number of sites and teeth per patient with AP were 4 to 28, 13.1±1.2 and 4 to 12, 8.3±0.5 respectively. The differences in prevalence of AP by gender, ethnicity, dentition and homologous sites at both sides of the mouth were not statistically significant (Chi square). AP was mostly diagnosed at the distal area of the maxillary canine, the proximal areas of the first maxillary primary molars, and the distal area of the mandibular first primary molar. The most affected teeth with AP were the first primary molars followed by the maxillary cuspid, and the second molars.

CONCLUSIONS

Examination of children's primary teeth should include abnormal mobility, when found it should be followed by radiographic evaluation for the presence of AP, taking in consideration the present findings.

Radiographic morphology of intrabony defects in the first molars of patients with localized aggressive periodontitis: Comparison with health and chronic periodontitis

BACKGROUND AND OBJECTIVE

The aim of this study was to describe the radiographic features of the first molars of patients with localized aggressive periodontitis (LAgP) and of their associated intrabony defects and to compare them with a control sample of chronic periodontitis cases and healthy subjects.

METHODS

Data from a total of 93 patients were included in this analysis. First, dental panoramic tomograms of 34 patients with LAgP (131 first molars) and 30 periodontally healthy patients (110 first molars) were compared. Then, periapical radiographs of the first molars of the same patients with LAgP and of 29 patients with chronic periodontitis affected by intrabony defects were analysed.

RESULTS

Shorter root trunks were associated with the presence of intrabony defects in patients with LAgP (P = .002 at multilevel logistic regression), also when LAgP molars were compared with healthy subjects (P = .036). Although no difference in defect depth and angle was noted between LAgP and chronic periodontitis intrabony defects, LAgP intrabony defects appeared to be more frequently symmetrical and arch-shaped than in chronic periodontitis (P = .008), with positive predictive value and negative predictive value of for 'wide arch' defect of 87.3% (95% CI = 77.2%-93.3%) and 32.3% (95% CI = 27.7%-37.2%) respectively.

CONCLUSION

First molars of patients with LAgP affected by intrabony defects may have some distinct radiographic anatomical characteristics to those of healthy subjects. The shape of intrabony defects seems to differ between LAgP and chronic periodontitis cases. Further studies need to confirm these features and investigate if they are related to the initiation and progression of periodontitis.

Localised aggressive periodontitis in a 3-year-old-boy

BACKGROUND

Localised aggressive periodontitis (LAgP), characterised by rapid attachment and bone loss, which may occur in children and adolescents, without clinical evidence of systemic disease.

CASE REPORT

Three-year-old boy was referred with excessive mobility of 83 and exfoliation of 73. Clinical examination revealed acceptable oral hygiene. Blood tests were performed to evaluate PMNs activity and the parents were advised to apply 0.2% chlorhexidine twice a day. One month later 83 was still excessively mobile. Blood tests were normal.

TREATMENT

A full mouth scaling and curettage were performed under general anaesthesia. Since 83 had been spontaneously exfoliated one day earlier, a biopsy was taken from its socket. The biopsy examination revealed granulation tissue with actinomyces colonies. A course of amoxicillin 250 mg three times a day for 7 days was prescribed. Cultures from periodontal pockets of the child's family members were found negative to Aggregatibacter actinomycetem comitans (Aa).

FOLLOW-UP

Examination 3 months later, no tooth mobility was observed and the cultures from the periodontal pockets were negative to Aa. Thereafter, the child was periodically reviewed every 3 months for 26 months with no signs of periodontal disease.

CONCLUSION

Amoxicillin combined with curettage around the involved teeth may be effective in LAgP treatment.

Clinical Characteristics of Localized Aggressive Periodontitis in Primary Dentition

OBJECTIVES

Due to the low prevalence of localized aggressive periodontitis (LAP), clinical characteristics of LAP in primary dentition are derived from a few case reports/series in the literature. The goal of this study was to determine common clinical characteristics such as bone and root resorption patterns, in a series of cases with LAP in primary dentition. We hypothesize these cases present aggressive periodontal bone destruction starting mostly around first primary molars and atypical root resorption patterns.

STUDY DESIGN

We have evaluated 33 LAP cases in primary dentition for pattern of bone destruction, root resorption and early exfoliation.

RESULTS

Cases evaluated were aged 5-12 (mean=8.7 years). Thirty cases presented more severe bone loss on first than second molars, with relatively fast progression to second molars, altered pattern of root resorption, mostly external (n=16) and early exfoliation of primary teeth due to periodontal bone loss, rather than physiologic root resorption (n=11).

CONCLUSIONS

This study showed common clinical characteristics found in LAP in primary molars, including possible initiation on first primary molars and abnormal root resorption patterns. These characteristics are important to be early identified and treated in order to prevent possible progression into the permanent dentition.

Localized aggressive periodontitis treatment response in primary and permanent dentitions

BACKGROUND

The comparative treatment response of children and young adults with localized aggressive periodontitis treatment (LAgP) affecting primary and permanent dentition is unknown. The objective of this study is to evaluate the influence of non-surgical periodontal therapy with adjunctive systemic antibiotics on the clinical outcome of children and young adults with primary versus permanent dentition affected by LAgP.

METHODS

A cohort of 97 African American participants aged 5 to 21 years (30 males and 67 females; 22 primary and 75 permanent dentitions affected) diagnosed with LAgP were included. Patients presented with no significant medical history. All patients underwent periodontal therapy, which consisted of full-mouth mechanical debridement at baseline and the 3-, 6-, and 12-month appointments. Additionally, all patients were prescribed a 1-week regimen of systemic antibiotics at the initial appointment. Clinical parameters were analyzed, including probing depth, clinical attachment level (CAL), bleeding on probing, and percentage of visible plaque.

RESULTS

Overall, periodontal therapy was found to be effective in improving the clinical outcomes of both primary and permanent dentitions. Although baseline CALs were similar between the groups, the reduction in mean CAL at 3, 6, and 12 months and reduction in percentage plaque at 3 months were significantly greater in primary dentition compared with permanent dentition.

CONCLUSIONS

Non-surgical therapy with systemic antibiotics is effective for LAgP in both primary and permanent dentitions. A greater reduction in CAL in LAgP of primary dentition may suggest that younger children may carry a greater propensity for positive treatment outcomes and healing potential compared with children/young adults with permanent dentition.

Rare case of generalised aggressive periodontitis in the primary dentition

BACKGROUND

Generalised aggressive periodontitis (AP) in the prepubescent age is an exceptionally rare disease in the primary dentition of otherwise healthy children. Characteristics of AP are gingival inflammation, deep periodontal pockets, bone loss, tooth mobility and even tooth loss. The most common way of treating this disease is the extraction of all the involved primary teeth.

CASE REPORT

A 4-year-old girl presented with signs of severe gingival inflammation. Clinical examination revealed deep pockets, increased tooth mobility and bone loss. Microbiological testing revealed the presence of a typical periopathogenic flora consisting of Aggregatibacter actinomycetemcomitans and the typical members of the red complex (Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola). The patient underwent tooth extraction of all primary teeth except the primary canines, followed by thorough root debridement and treatment with systemic antibiotics (amoxicillin plus metronidazole).

FOLLOW-UP

Regular clinical and microbiological examinations over 4 years showed no signs of recurrence of a periodontitis, even in the erupted permanent teeth.

CONCLUSION

Early diagnosis and consequent early treatment of aggressive periodontitis can stop the disease and therefore avoid the development of a periodontal disease in the permanent dentition. A close collaboration between specialists of different disciplines is required for a favourable outcome.

Prevalence of Periodontal Bone Loss in Brazilian Adolescents through Interproximal Radiography

Purpose. The aim of this study was to verify the prevalence of alveolar bone loss in Brazilian adolescents through the interproximal X-rays analysis. Methods. Bilateral and standardized interproximal (bitewing) X-rays were performed in 15-year-old adolescents (n = 326), and the processing of films and measurements of alveolar bone levels were accomplished by a single examiner. A distance between the cementoenamel junction (CEJ) and the alveolar bone crest more than 2 mm was considered as periodontal bone loss. Results. The results showed percentage of bone loss of 10.4% with predominance of horizontal defects (8.9%) over the vertical types (1.5%). It was verified higher individual distribution of one lesion (67.6%) than two (26.5%) or three lesions (5.6%), and higher occurrence was detected in men (14.95) than in women (8.21). Conclusion. It can be concluded that the interproximal radiography was an efficient method for the detection of alveolar bone loss, revealing low prevalence in adolescents and predominance of horizontal bone defects.

Prevalence of alveolar bone loss in healthy children treated at private pediatric dentistry clinics

Objectives

The purpose of this study was to evaluate the prevalence of alveolar bone loss (BL) in healthy children treated at private pediatric dentistry clinics in Brasília, Brazil.

Material and Methods

The research included 7,436 sites present in 885 radiographs from 450 children. The BL prevalence was estimated by measuring the distance from the cementoenamel junction (CEJ) to alveolar bone crest (ABC). Data were divided in groups: (I) No BL: distance from CEJ to ABC is ≤2 mm; (II) questionable BL (QBL): distance from CEJ to ABC is >2 and <3 mm; (III) definite BL (DBL): distance from CEJ to ABC ≥3 mm. Data were treated by the chi-square nonparametric test and Fisher's exact test (p<0.05).

Results

Among males, 89.31% were classified in group I, 9.82% were classified in group II and 0.85% in group III. Among females, 93.05%, 6.48% and 0.46% patients were classified in Group I, II and III, respectively. The differences between genders were not statistically significant (Chi-square test, p = 0.375). Group composition according to patients’ age showed that 91.11% of individuals were classified as group I, 8.22% in group II and 0.67% in group III. The differences among the age ranges were not statistically significant (Chi-square test, p = 0.418). The mesial and distal sites showed a higher prevalence of BL in the jaw, QBL (89.80%) and DBL (79.40%), and no significant difference was observed in the distribution of QBL (Fisher’s exact test p = 0.311) and DBL (Fisher’s exact test p = 0.672) in the dental arches. The distal sites exhibited higher prevalence of both QBL (77.56%) and DBL (58.82%).

Conclusions

The periodontal status of children should never be underestimated because BL occurs even in healthy populations, although in a lower frequency.

Presence of Aggregatibacter actinomycetemcomitans in young individuals: a 16-year clinical and microbiological follow-up study

AIM

To look for clinical signs of periodontal disease in young adults who exhibited radiographic bone loss and detectable numbers of Aggregatibacter actinomycetemcomitans in their primary dentition.

MATERIAL AND METHODS

Periodontal status and radiographic bone loss were examined in each of the subjects 16 years after the baseline observations. Techniques for anaerobic and selective culture, and checkerboard, were used to detect periodontitis-associated bacterial species. The isolated A. actinomycetemcomitans strains were characterized by polymerase chain reaction.

RESULTS

Signs of localized attachment loss were found in three out of the 13 examined subjects. A. actinomycetemcomitans was recovered from six of these subjects and two of these samples were from sites with deepened probing depths and attachment loss. Among the isolated A. actinomycetemcomitans strains, serotypes a-c and e, but not d or f, were found. None of the isolated strains belonged to the highly leucotoxic JP2 clone, and one strain lacked genes for the cytolethal distending toxin.

CONCLUSIONS

This study indicates that the presence of A. actinomycetemcomitans and early bone loss in the primary dentition does not necessarily predispose the individual to periodontal attachment loss in the permanent dentition.

Acute generalized exanthematous pustulosis following a spider bite: Report of 3 cases

Acute generalized exanthematous pustulosis (AGEP) is a rare severe cutaneous adverse reaction caused mostly by drugs. Three of 22 AGEP cases (13.6%), recruited by us as part of two prospective multinational studies, occurred 24 to 48 hours after a spider bite. We suggest that a spider bite is a possible trigger for AGEP.

Langerhans' Cell Histiocytosis in a 5-Year-Old Girl: Evidence of Periodontal Pathogens

BACKGROUND

Langerhans' cell histiocytosis (LCH) is a rare disorder characterized by Langerhans' cell proliferation in various organs or tissues. When periodontal tissue is involved, clinical manifestations can vary from gingival recession and pocket formation to severe alveolar bone loss. This case report describes periodontal pathogens found in the pockets of involved primary teeth.

METHODS

A 5-year-old girl with LCH presented with loose teeth. Intraoral examination and radiographs revealed deep pockets and severe bone loss around all primary molars. Bacterial samples were obtained from saliva and subgingival plaque and analyzed for the presence of five periodontopathic bacteria using a polymerase chain reaction (PCR) method. Due to severe periodontal destruction, all primary molars were extracted, and a gingival biopsy was taken from tooth T to confirm the diagnosis of LCH.

RESULTS

The biopsy specimen revealed the histologic features of LCH. The patient was diagnosed as having periodontitis as a manifestation of LCH. PCR results of subgingival plaque from LCH-affected molars indicated the presence of Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia. However, Actinobacillus actinomycetemcomitans was absent from these teeth. No tested bacteria were found in the non-affected anterior teeth.

CONCLUSIONS

The bacteria commonly associated with periodontal disease were detected in subgingival plaque samples from this LCH patient. More microbiological data are required to understand the role of these bacteria in LCH-associated periodontal destruction.

Radiographic study of the prevalence of periodontal bone loss in Australian school-aged children attending the Royal Dental Hospital of Melbourne

OBJECTIVES

To investigate the prevalence of alveolar bone loss around the first permanent molars, and first and second deciduous molars in Australian school-aged children attending the Royal Dental Hospital of Melbourne.

METHOD

Nine hundred and ninety-five records were examined for useable bitewing radiographs. From these, radiographs of 542 Australian school children aged 5-12 years were used. The cervical-enamel junction (CEJ) to the alveolar bone crest (ABC) distance was measured using the transparent ruler on the magnifier. Each inter-dental site that was readable was scored as one for the following categories: not available (NA); no bone loss (NBL)- the CEJ-ABC was < or =2 mm; questionable bone loss (QBL): the distance from the CEJ-ABC was >2 and <3 mm; and definite bone loss (DBL): the distance from the CEJ to ABC was > or =3 mm.

RESULTS

Seventy-one children (13.0%) were found to have 83 DBL sites, as determined by bone levels >3.0 mm from the CEJ. Seventy children had QBL lesions only, 50 children had DBL only and 21 children had both. The overall prevalence of bone loss was 26%. Second deciduous molars were found to be the most affected teeth with almost 75% lesions being distal. These teeth comprised 50% of the DBL lesions. Children of Asian-Far Eastern origin had a higher percentage of sites with bone loss compared with children of Caucasian origin, being 29.5% and 19.7%, respectively, but lower than that of children of Middle-Eastern origin (35.2%). When the data were analysed with relation to age, there was no relationship between age and prevalence of bone loss.

CONCLUSION

In the population studied, there was an overall prevalence of periodontal bone loss of 26% and DBL of 13% in an Australian school-aged group. Calculus was detected infrequently and, where present, was associated with bone loss.

Position paper: periodontal diseases of children and adolescents

Children and adolescents are subject to several periodontal diseases. Although there is a much lower prevalence of destructive periodontal diseases in children than in adults, children can develop severe forms of periodontitis. In some cases, this destructive disease is a manifestation of a known underlying systemic disease. In other young patients, the underlying cause for increased susceptibility and early onset of disease is unknown. These diseases are often familial, suggesting a genetic predisposition for aggressive disease. Current modalities for managing periodontal diseases of children and adolescents may include antibiotic therapy in combination with non-surgical and/or surgical therapy. Since early diagnosis ensures the greatest chance for successful treatment, it is important that children receive a periodontal examination as part of their routine dental visits.

Detection of a highly toxic clone of Actinobacillus actinomycetemcomitans (JP2) in a Moroccan immigrant family with multiple cases of localized aggressive periodontitis

The JP2 clone of Actinobacillus actinomycetemcomitans, a high-leukotoxin-producing strain, characterized by a 530-basepair (bp) deletion in the promoter region of the leukotoxin gene operon and mainly found among individuals with African origin, is associated with localized aggressive periodontitis. The objective of the study was to examine the occurrence of periodontal disease in a Moroccan immigrant family living in Denmark in which the oldest son (14 year) was referred and treated for localized aggressive periodontitis. Further, the potential occurrence of the JP2 clone of A. actinomycetemcomitans in the family was examined. Here we present the clinical, radiographic, and microbiological findings from the family. Clinical and radiographic examination of the other family members revealed that 3 of 5 younger siblings had localized aggressive periodontitis, one had gingivitis and the mother had chronic periodontitis. Despite scaling followed by intensive maintenance therapy several family members, including the sibling with gingivitis, had further attachment loss at the 1-year examination. The JP2 clone of A. actinomycetemcomitans was isolated from subgingival plaque samples from 4 children with periodontitis. In contrast, it was not detected in plaque from the oldest boy, who had been treated for localized aggressive periodontitis by surgery combined with antibiotic therapy. The 4 children with periodontitis and colonized with the JP2 clone were treated by scaling and antibiotic administration. One month later the JP2 clone could still be detected in plaque samples. In conclusion, it is confirmed that members of immigrant families with African origin are potential carriers of the JP2 clone and that those families often have multiple family members with localized aggressive periodontitis. It is proposed that those families are given periodontal examination frequently to benefit from early diagnosis and treatment of the disease.

Periodontal diseases in the child and adolescent

BACKGROUND

Periodontal diseases are among the most frequent diseases affecting children and adolescents. These include gingivitis, localized or generalized aggressive periodontitis (a.k.a., early onset periodontitis which includes generalized or localized prepubertal periodontitis and juvenile periodontitis) and periodontal diseases associated with systemic disorders. The best approach to managing periodontal diseases is prevention, followed by early detection and treatment.

METHODS

This paper reviews the current literature concerning the most common periodontal diseases affecting children: chronic gingivitis (or dental plaque-induced gingival diseases) and early onset periodontitis (or aggressive periodontitis), including prepubertal and juvenile periodontitis. In addition, systemic diseases that affect the periodontium and oral lesions commonly found in young children are addressed. The prevalence, diagnostic characteristics, microbiology, host-related factors, and therapeutic management of each of these disease entities are thoroughly discussed.

Periodontal pathogen detection in gingiva/tooth and tongue flora samples from 18- to 48-month-old children and periodontal status of their mothers

Few studies have detected periodontal pathogens in young children, and when detected the prevalence has been relatively low. In this epidemiological study, we determined the prevalence of periodontal pathogen colonization in young children and examined the relationship between periodontitis in mothers and detection of periodontal pathogens in their children aged 18-48 months. Children were selected and enrolled randomly into the study; tongue and gingival/tooth plaque samples were harvested and analyzed by DNA probe checkerboard assay for Porphyromonas gingivalis and Bacteroides forsythus. Clinical measurements included a gingival bleeding score in the children and a periodontal screening and recording (PSR) score in the mothers. Mothers having one or more periodontal sites with probing depths > 5.5 mm were classified as having periodontitis. In this population, 71% (66/93) of the 18- to 48-month-old children were infected with at least one periodontal pathogen. Detection rates for children were 68.8% for P. gingivalis and 29.0% for B. forsythus. About 13.8% (11/80) of children had gingival bleeding in response to a toothpick inserted interproximally. Children in whom B. forsythus was detected were about 6 times more likely to have gingival bleeding than other children. There was no relationship between bleeding and detection of P. gingivalis. 17.0% (16/94) of the mothers had periodontitis. When all mother-child pairs were considered, the periodontal status of the mother was found not to be a determinant for detection of periodontal pathogens in the floral samples from the children. However, the odds ratio that a daughter of a mother with periodontitis would be colonized was 5.2 for B. forsythus. A much higher proportion of children in this population were colonized by P. gingivalis and/or B. forsythus than has been previously reported for other populations. A modest level of association between manifestations of periodontitis in mothers and detection of B. forsythus in their daughters was observed.

Early-onset periodontitis

In 1993, the 1st European Workshop on Periodontology explicitly recognized that there was insufficient knowledge to differentiate truly different forms of periodontal disease from differences in the presentation/severity of the same disease. In spite of recent progress in our understanding of periodontal diseases, the issue is far from having been resolved. Classification of periodontal diseases, therefore, remains based upon the definition of specific clinical syndromes. Early-onset periodontitis (EOP) is one such syndrome and comprises a group of pathological conditions leading to loss of periodontal tissues early in life. The notion that classifies periodontitis syndromes as "early-onset" or "adult" is primarily epidemiological in nature and is based on the observation that periodontitis is rather infrequent in children and young adults. Nevertheless, considerable epidemiological evidence indicates that periodontitis does affect children and young adults to a level of severity that may lead to premature exfoliation of primary and/or permanent teeth. Clinical presentation of periodontitis early in the life of an individual is thought to indicate that the etiologic agents have been able to cause considerable tissue damage over a relatively short period of time. It also implies either infection with highly virulent bacteria and/or a highly susceptible subject. The purpose of this review is to discuss the criteria generally utilized to classify EOP, provide the rationale to designate EOP as a distinct disease entity, and to review the evidence justifying a subclassification into particular subgroups of EOP.

Oral colonization by anaerobic bacteria during childhood: role in health and disease

Anaerobes constitute a significant part of bacterial communities in human mouths. Their ability to colonize and survive in the environment, where remarkable changes occur during early childhood, is fundamental for oral homeostasis. However, relatively little is known of the time of colonization and succession of anaerobic species in the oral cavity. This article presents an up-to-date review on the development of the oral anaerobic microflora in respect to age, and in addition, considers some aspects of the role of oral anaerobes in health and disease.

Untreated periodontal disease in Indonesian adolescents. Clinical and microbiological baseline data

At present, several risk factors for the initiation and progression of periodontitis have been identified. In order to investigate the rôle of various potential clinical and microbiological risk factors and indicators, a longitudinal study was initiated in a young population deprived from regular dental care. The present communication describes the baseline cross-sectional data obtained in 1987 in terms of the clinical periodontal condition and prevalence of periodontal bacteria in the oral cavity. All inhabitants in the age range 15-25 years of a village with approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were examined clinically and microbiologically. In total, 255 adolescents, comprising 130 males and 125 females participated in the study. Samples for bacteriological examination were taken from the gingiva, the dorsum of the tongue, and the saliva. Plaque index, bleeding upon probing, pocket depth, and attachment loss (AL) were scored on the approximal surfaces from the vestibular aspect of all teeth as well as the mid-vestibular and mid-lingual aspects of the Ramfjord teeth. Calculus was scored only on the 4 surfaces of the Ramfjord teeth. Following the clinical measurements, the deepest bleeding pocket with no clinical loss of attachment was sampled for microbiological examination. In addition, in 37 subjects a deep bleeding (> or = 4 mm) with at least 4 mm of attachment loss was sampled. Moderate periodontitis (max. AL 3-4 mm) was found in 26% of the population, advanced periodontitis (max. AL > or = 5 mm) in 8%, whereas 66% of the population showed no or minor periodontitis (max. AL 0-2 mm). Actinobacillus actinomycetemcomitans was found in 57% of the population, Porphyromonas gingivalis in 87%, Prevotella intermedia and motile rods in all cases and spirochetes in 89%. P. gingivalis (66%), A. actinomycetemcomitans (37%) and spirochetes (63%) were, of all the sampled sites of the oral cavity, most frequently detected in pockets without attachment loss. Motile rods were most prevalent on the tongue and in the saliva (92% and 89%, respectively). A high prevalence of the investigated periodontal bacteria was detected both in the pockets without and with attachment loss. No significant association between the clinical periodontal parameters and the prevalence of the microorganisms was observed at a patient level. At a site level, both P. gingivalis and spirochetes were more prevalent in sites with attachment loss. The actual rôle of these putative periodontal pathogens may be elucidated more extensively, when longitudinal data on the present population become available.

Possible autosomal-dominant inheritance of prepubertal periodontitis in an extended kindred

This study presents the clinical findings and the distribution of prepubertal periodontitis in an extended family with high prevalence of this entity. The expression of surface markers and adhesion molecules on peripheral lymphocytes were also studied. Approximately 50% of the children in this family suffered from prepubertal periodontitis. All the affected children were otherwise healthy. 2 identical twins were similarly, but not identically, affected. Detailed laboratory tests and analysis of lymphocyte surface marker expression, including CD18, were all within the normal levels. Both localized and generalized forms of prepubertal periodontitis were found. The high prevalence of prepubertal periodontitis in the 2 branches of this family, and the fact that identical twins were similarly affected, suggest a strong genetic predisposition for prepubertal periodontitis. The family pedigree is consistent with an autosomal-dominant mode of transmission. The coexistence of localized and generalized forms of the disease in sibs suggests the same genetic etiology for both entities with variability in disease expression. This variability in disease expression is further supported by the fact that 2 identical twins were not identically affected.

Children, adolescents and periodontal diseases

OBJECTIVES

This manuscript attempts to critically review current literature regarding the natural history, aetiology and pathogenesis of the common periodontal diseases to affect children and adolescents. The logic behind the emergence of a new classification in the early 1990s is explained and potential problems with the interpretation of such systems outlined.

DATA SOURCES

The manuscript focuses upon recent developments, reported in the international periodontal literature, aimed at unraveling the molecular basis for this group of diseases. The concept of one disease type progressing with time to another disease within the same individual is discussed, and early data presented that indicate the possibility of microbial transmission from deciduous to permanent dentition's within a subject.

CONCLUSIONS

It is concluded that differing classification systems for adolescent and childhood periodontal diseases may lead to confusion within the dental profession, unless the clinical and molecular basis for such diseases is fully understood. Further advances in basic research using molecular biology tools should assist in our understanding of the aetiopathology at a molecular level and hopefully lead to the development of new treatment strategies.

Periodontal diseases: epidemiology

1. The interpretation of epidemiological data of periodontal disease is difficult, due to inconsistencies in the methodology used. It is not possible, therefore, to accurately assess if the prevalence of the periodontal diseases shows a world-wide decline. As long as the disease is assessed through accumulated clinical attachment loss, retention of the natural dentition in older ages entails increased prevalence in these cohorts. Contemporary epidemiological studies should ideally employ full-mouth examination of the periodontal tissues. Partial recording estimates are generally biased, especially when the prevalence of the disease is low. 2. Early-onset periodontitis is infrequent in all populations. Adult periodontitis is rather prevalent; however, advanced disease affects limited subfractions of the population (probably less than 10 to 15%). Although prevalence figures vary with race and geographic region, in most cases, the progression pattern of the disease seems compatible with the retention of a functional dentition throughout life. 3. Of a plethora of behavioral and environmental risk markers identified by multi-variate analysis, smoking and presence of certain subgingival microorganisms have been proven to be true risk factors. The same holds true for diabetes mellitus, a systemic condition that confers a risk for periodontal disease which is independent of the effect of other significant factors. 4. In certain cases, periodontal infections appear to have a systemic impact on the host. Most recent data indicate that periodontal disease may confer risk for coronary heart disease and pre-term low birth weight.

Periodontal and systemic findings in children with marginal bone loss in the primary dentition

In a previous population-based study of 3896 7-9-year-old children living in Sweden, it was found that 32 children (0.8%) exhibited radiographic, periodontal bone loss at > or = 2 proximal surfaces of their deciduous teeth. In the present study, 26 of the 32 children were subjected to additional oral and systemic health examination. 20 other children without any radiographic evidence of bone loss in their primary dentition served as referents. None of the cases or the referents were detected to have any systemic disease. The frequency of bleeding and suppuration on probing, radiographic proximal calculus and probing attachment loss was higher among the cases than the referents. Actinobacillus actinomycetemcomitants was found subgingivally in 14 of the cases but in none of the referents. 11 of 22 cases analysed for presence of serum antibodies against A. actinomycetemcomitans leukotoxin were sero-positive compared to none of 7 referents available for analysis. Evaluation of the data from each child revealed wide variations in clinical parameters among the children in the case group. In this group, there were children with deep probing depths, probing attachment loss, suppuration on probing, proximal calculus and presence of subgingival A. actinomycetemcomitans, indicating current periodontitis. However, in the case group there were also children without positive signs of inflammatory disease, similar to the children in the reference group. In fact, the findings suggest that less than half of the number of individuals with > or = 2 proximal sites with bone loss had current periodontitis.

Marginal bone loss in the primary dentition. A survey of 7-9-year-old children in Sweden

The present study was designed to determine the prevalence of bone loss in the primary dentition of children. Radiographs from children aged 7-9 were collected from 25 out of a total of 26 Public Dental Clinics in the County of Orebro, Sweden. These radiographs, representing 36.0%, 50.3% and 48.7% of all 7-, 8- and 9-year-old children (n = 8666) living in the districts of the participating clinics, constituted a primary sample. In addition, the 9-year-olds were subjected to a more comprehensive sampling procedure to obtain a more complete sample (sample of 9-year-olds), resulting in a group of 2017 children (71.9%). The radiographs were evaluated with respect to presence of marginal bone loss (CEJ-MBL: distance between the cemento-enamel junction and the marginal bone level > 2 mm), proximal calculus and number of decayed and filled proximal surfaces (dfsp) in the posterior areas of the primary dentition. In the primary sample, the prevalence of bone loss for > or = 1 proximal surfaces of the primary dentition in the 7-, 8- and 9-year-old children was 2.0%, 3.1% and 4.5%, respectively. The corresponding figures for proximal calculus were 2.5%, 3.1% and 4.2%. Mean number of dfsp amounted to 2.3, 2.5 and 3.0. The prevalences of bone loss and proximal calculus as well as the mean number of dfsp in the sample of 9-year-olds corresponded to the findings for the 9-year-old children in the primary sample.(ABSTRACT TRUNCATED AT 250 WORDS)