A comparative clinical evaluation of diet intake and effect of various nutritions on aggressive periodontitis patients

AIM

The aim of this study is to investigate the effect various dietary nutrients in aggressive periodontitis patients.

MATERIALS AND METHODS

A total of 85 patients were selected and divided into two groups, 45 patients are with aggressive periodontitis and 40 patients are healthy. Periodontal parameters such as oral hygiene index, Russels periodontal index and radiograph were taken. The food consumption survey was conducted in all the households of subjects both in control and experimental group. The individual of food intake of the subjects was assessed by the oral questionnaire (24 hours recall) method. The quantity of raw foods used for various preparations and volumes of cooked quantities of such preparations in terms of standardized cups were noted. Body measurements were taken on all the subjects, standing height using a height measuring rod and weight in standard weighing machine.

RESULTS

Aggressive periodontitis is seen in young individual and mostly in females; majority of the patients of both groups belongs to low socioeconomic group. Body mass index which is a refection of nutritional status of an individual indicated that chronically energy defcient subjects in experimental group appeared to be higher. The average food and nutrient intake in control group was slightly better than that of experimental group.

CONCLUSION

The diet survey indicated marginal and negligible defciencies in aggressive periodontitis patients compared to controls, and this coupled with chronically energy defciency as indicated by body mass index, calls for a detailed study of this aspect of aggressive periodontitis. The present study indicates that nutritional infuences point to a needle of suspicion toward the etiology of aggressive periodontitis.

Apoptotic activity of gingival crevicular fluid from localized aggressive periodontitis

INTRODUCTION

The aim of this study was to examine a potential link between apoptotic biomarkers in gingival crevicular fluid (GCF) and periodontal destruction in four cases of localized aggressive periodontitis (LAP), diagnostically enhanced by cone beam computed tomography.

CASE SERIES

This study examined the GCF in four patients diagnosed with LAP (formerly localized juvenile periodontitis) at a routine periodontal examination. The LAP diseased sites had attachment loss ranging from 5-12 mm. Atotal of 62 samples of GCF were collected from diseased sites and from contralateral, matched healthy sites with minimal or no attachment loss. All samples were assayed for apoptotic markers, including Fas/FasL, DNAfragmentation, and nitric oxide. The GCF samples were analyzed utilizing enzyme-linked immunosorbent assays for DNA fragments and nitric oxide levels, whereas Western blotting was used for Fas/FasL analyses. Our results showed a significant increase in the apoptotic markers Fas/FasL and DNA fragmentation when comparing GCF from diseased versus non-diseased sites in patients with LAP.

CONCLUSION

To our knowledge, this is the first report of apoptotic biomarkers associated with patients diagnosed with LAP. Finding significantly increased levels of these markers in localized areas may help us understand the pathophysiology associated with this specific form of periodontitis, and, furthermore, may provide a basis for a quantifiably prognostic test when attempting to treat this disease.

The role of pathophysiological explanations in clinical case representations of dental students and experts

INTRODUCTION

Teaching of biomedical knowledge lays the foundations for the understanding and treatment of diseases. However, the representation of pathophysiological explanations in the management of clinical cases differs for various levels of medical expertise and different theories have been proposed to explain this phenomenon. The present study investigated for the first time how biomedical knowledge is used in clinical reasoning in dental medicine.

MATERIALS AND METHODS

In an experimental study 20 experts in the field of Periodontology and 61 students of different levels of training produced written pathophysiological explanations after having studied three different clinical cases. By comparing the written protocols to a visualised expert-made 'canonical' explanation the concepts used in the pathophysiological explanation were counted and classified as well as the links between concepts.

RESULTS

The statistical analysis by MANOVA showed significant differences between third- and fourth-year students, students of intermediate expertise level (fifth-year) and experts for various parameters qualifying concepts or links of the written pathophysiological explanations. The participants of intermediate expertise level produced a high rate of concepts and links; however, characteristic findings for knowledge encapsulation in the different levels of expertise were not evident. The analysis showed that the design of the clinical cases and of the canonical explanations significantly influenced the outcomes.

CONCLUSION

The present study demonstrated the pathophysiological representations of clinical cases in dental students and experts to be different from other medical disciplines. It could be assumed that this observation is based on different contents for teaching of practical skills and diagnostic procedures in dental compared with medical education.

[Analysis of short chain fatty acids in gingival crevicular fluid of patients with aggressive periodontitis]

OBJECTIVE

To investigate 7 short chain fatty acids (SCFA) concentrations in gingival crevicular fluid (GCF) of aggressive periodontitis (AgP) and to analyze the relationship between levels of SCFA and AgP clinical parameters.

METHODS

GCF was collected from 152 sites of 38 AgP patients and 56 sites of 14 healthy subjects. Formic acid, succinic acid, acetic acid, lactic acid, propionic acid, butyric acid and isovalerianic acid were detected by high performance capillary electrophoresis.

RESULTS

The concentrations of succinic acid, acetic acid, lactic acid, propionic acid, butyric acid and isovalerianic acid in GCF were significantly higher in AgP patients than in healthy group, while formic acid was lower in GCF of AgP group compared with healthy group. Correlation analysis showed that formic acid was negatively correlated with bleeding index (BI), probing depth (PD) and attachment loss (AL), while BI was positively correlated with succinic acid, acetic acid, lactic acid, propionic acid and butyric acid; PD and AL were positively correlated with succinic acid, acetic acid, propionic acid, butyric acid and isovalerianic acid.

CONCLUSIONS

The elevation of succinic acid, acetic acid, propionic acid, butyric acid and isovalerianic acid concentrations in GCF may be related with AgP destruction condition, while formic acid concentration was reduced.

Implant therapy in aggressive periodontitis patients: a systematic review and clinical implications

Implant therapy in partially edentulous patients has proven to be a predictable procedure with a high implant survival rate. The success rate in patients with a history of aggressive periodontitis, however, is still unclear. A Medline/PubMed search was conducted to identify and summarize articles published in English and reported on the survival of implants in aggressive, rapidly progressive, or juvenile periodontitis patients. Our search revealed only 9 articles, 4 of which were case reports. Although available evidence is weak, it suggests good short-term survival of implants placed in periodontally well-maintained aggressive periodontitis patients. Bone loss around implants in aggressive periodontitis patients, however, appears to occur more frequently than it does in chronic periodontitis patients or periodontally healthy individuals. A summary and critical analysis of the aforementioned articles is presented.

Risk of aggressive periodontitis in adolescent carriers of the JP2 clone of Aggregatibacter (Actinobacillus) actinomycetemcomitans in Morocco: a prospective longitudinal cohort study

BACKGROUND

Periodontitis is a loss of supporting connective tissue and alveolar bone around teeth, and if it occurs in an aggressive form it can lead to tooth loss before the age of 20 years. Although the cause of periodontitis in general remains elusive, a particular clone (JP2) of the gram-negative rod Aggregatibacter (Actinobacillus) actinomycetemcomitans is considered a possible aetiological agent of the aggressive form in adolescents living in or originating from north and west Africa, where the disease is highly prevalent. We did a population-based longitudinal study of adolescents to assess the role of the JP2 clone in the initiation of aggressive periodontitis.

METHODS

A total of 700 adolescents from public schools in Rabat, Morocco, were enrolled in the study. We used PCR to detect A actinomycetemcomitans in plaque samples (taken from molar and incisor sites) and to differentiate between the JP2 clone and other non-JP2 genotypes of the bacterium. 18 individuals were found to already have periodontitis and were excluded. The 682 periodontally healthy adolescents (mean age 12.5 years; SD 1.0) were classified according to their A actinomycetemcomitans carrier status at baseline. After 2 years, 428 (62.8%) individuals returned for re-examination, which included recording of periodontal attachment loss measured from the cemento-enamel junction to the bottom of the periodontal pockets of all teeth present.

FINDINGS

Individuals who carried the JP2 clone of A actinomycetemcomitans alone (relative risk 18.0; 95% CI 7.8-41.2, p<0.0001) or together with non-JP2 clones of A actinomycetemcomitans (12.4; 5.2-29.9, p<0.0001) had a significantly increased risk of periodontal attachment loss. A much less pronounced disease risk was found in those carrying non-JP2 clones only (3.0; 1.3-7.1, p=0.012).

INTERPRETATION

The JP2 clone of A actinomycetemcomitans is likely to be an important aetiological agent in initiation of periodontal attachment loss in children and adolescents. Co-occurrence of non-JP2 clones of A actinomycetemcomitans reduces the risk of development of periodontitis, suggesting competition for the ecological niche between the JP2 and non-JP2 clones of this species.

Influences of systemic diseases on periodontitis in children and adolescents

Systemic diseases affecting the host response as primary immunodeficiencies or secondary defects caused by lack of nutrients or changes in the local tissues are very often accompanied by early-onset prepubertal periodontitis. Local treatment in combination with systemic antibiotics may in milder forms improve the situation, but in many cases the success is questionable and premature loss of teeth occurs. Since the genetic basis of many of the diseases has been identified, future developments permit the correction of at least some of these defects by gene therapy.

[The mechanical action of Dirol chewing gum on the periodontal tissues and masticatory muscles]

Regional hemodynamics, bioelectric activity of masticatory muscles, and compactness of mandibular bone were studied by the rheographic method for measuring periodontal bloodflow, by electromyography, and echo-osteometry in 52 volunteers after 4-week regular chewing of Dirol chewing gum. Congestive hyperemia develops in periodontal tissues; functional activity of masticatory muscles and compactness of mandibular bone are normal.

Relationship between conversion of localized juvenile periodontitis-susceptible children from health to disease and Actinobacillus actinomycetemcomitans leukotoxin promoter structure

The periodontal pathogen Actinobacillus actinomycetemcomitans produces a leukotoxin that is considered a primary virulence factor in localized juvenile periodontitis (LJP). Select strains of the bacterium contain a 530-bp deletion in the promoter region of the leukotoxin gene operon which results in enhanced transcription of the leukotoxin. DNA hybridization and polymerase chain reaction (PCR) were used to examine genetic variants of A. actinomycetemcomitans in 24 LJP-susceptible children from 21 families having a history of the disease and 34 control children from non-LJP families. A significant association was found between the detection of variants that had a deletion in the leukotoxin promoter region, indicative of a high level expression leukotoxin genotype, and conversion from a healthy periodontal status to disease. Subjects harboring A. actinomycetemcomitans of this genotype were more likely to convert to LJP than those subjects who had variants containing the full length leukotoxin promoter region (odds ratio = 22.5; 95% C.I., 2.84 < 206.66) [corrected]. These findings support the concept that highly virulent strains or clonal types of periodontal pathogens play a major role in the initiation of periodontal disease in susceptible hosts.

Gingival inflammation and subgingival calculus as determinants of disease progression in early-onset periodontitis

This study was undertaken to test the hypothesis that gingival inflammation and dental calculus are important determinants of the development and progression of early-onset periodontitis. The study sample included 156 individuals who were 13-20 years old at baseline and who were examined 2x during 6 years to assess the attachment loss, gingival state and the presence of dental calculus. 33 (21%), 62 (40%), and 61 (39%) individuals were classified as having localized, generalized, or incidental EOP, respectively. The results showed an increase in the % of teeth with overt gingivitis and subgingival calculus, and also an increase in the % of teeth showing attachment loss during the 6-year period in all classification groups. Of teeth with 0-2 mm attachment loss at the beginning of the study and which developed > or = 3 mm attachment loss during the following 6 years, there were 2x as many teeth with overt gingival inflammation, and 4x more teeth with subgingival calculus at baseline than teeth without. Gingivitis and subgingival calculus when present at both examinations resulted in a stronger association with the development of new lesions than presence of these variables at baseline. Teeth with gingivitis at baseline had a significantly higher mean attachment loss during 6 years than teeth without gingivitis (p<0.0001), and teeth with subgingival calculus at baseline had a significantly higher mean attachment loss than teeth without subgingival calculus (p<0.0001). The presence of gingivitis and subgingival calculus at baseline and 6 years later was associated with the occurrence of even higher disease progression during this period. The association between gingival inflammation and subgingival calculus and the development and progression of attachment loss during the study period in the generalized and the localized EOP groups was significantly higher than the association in the incidental EOP group. In an appreciable % of the sites in all 3 groups, however, the presence of the 2 factors was not associated with attachment loss during 6 years. The results suggest a significant association between gingival inflammation and subgingival calculus and the development and progression of early-onset periodontitis.

Relationship of serotype, leukotoxin gene type and lysogeny in Actinobacillus actinomycetemcomitans to periodontal disease status

Actinobacillus actinomycetemcomitans has been associated with different forms of periodontitis, particularly with localized juvenile periodontitis (LJP). The bacterium possesses several virulence factors which have been shown to interact with the host immune system. Among these factors, leukotoxin, surface antigens (serotype) and bacteriophages have been suggested directly or indirectly to influence the course of infection. However, few studies have been able to show associations between these factors and periodontal disease, alone or in combination. Thus, the purpose of the present study was to investigate possible correlations between periodontal disease status and selected virulence factors (serotype, presence of bacteriophages, and the presence of a 530 bp deletion in the promoter region of the leukotoxin gene). 36 subjects took part in the study. Serotype c was the most frequently found serotype among periodontally affected subjects, although serotypes a and b were also present. 27 out of 36 strains harbored bacteriophages, and there was strong evidence that some of the bacteriophages were different from the previously characterized phi Aa phage. A. actinomycetemcomitans containing the F-fragment phage were more frequently associated with periodontal disease. Five strains, all serotype b, 3 from LJP patients and 2 from healthy subjects, showed a 530-bp deletion in the promoter region of the leukotoxin gene.

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.

Early-onset periodontitis: progression of attachment loss during 6 years

We studied the pattern of progression of early-onset periodontitis and the change in the extent and severity of the periodontal condition in adolescents who were followed for 6 years. In a national survey of the oral health of U.S. children, 14,013 adolescents were examined clinically in 1986/1987 to assess the periodontal attachment loss of teeth. Individuals with early-onset periodontitis within this population were identified and classified into localized juvenile periodontitis (LJP), generalized juvenile periodontitis (GJP), and incidental attachment loss (IAL) groups. Ninety-one subjects, 13 to 20 years old at baseline, were examined 6 years later. They included 51 males and 40 females; and 72 Blacks, 6 Hispanics, and 13 Whites. They were clinically re-examined and then reclassified according to their periodontal status at follow-up. The severity and extent of these diseases continued to increase during the study period. In teeth that were affected at baseline, the lesions had progressed to include deeper portions of the periodontium, and more of the teeth unaffected at baseline exhibited periodontal attachment loss at follow-up, thus changing the disease characteristics and the basis for the clinical classification. Of the individuals classified with LJP at baseline, 62% continued to have LJP 6 years later and 35% developed GJP. Of those classified with GJP initially, all but two (82%) continued to have GJP at follow-up. Among the IAL group, 28% of subjects developed LJP or GJP, and 30% were reclassified in the no attachment loss group. Molars and incisors were the teeth most often affected in all three groups. The mean change in attachment loss over 6 years in the LJP, GJP, and IAL groups was 0.45, 1.12, and 0.13 mm, respectively. The present findings demonstrate the limitations of the currently used morphological criteria in the classification of early-onset periodontitis. The findings also suggest that the difference between LJP and GJP is in the number and type of teeth involved, and that the two classifications progress similarly, with some cases of LJP developing into GJP.

Sequential manifestation of different forms of early-onset periodontitis. A case report

Pathogenic bacteria constitute the primary extrinsic agent in the etiology of early onset periodontitis. However, the risk of developing periodontal disease is not equal for all individuals, suggesting host factors are involved in determining an individual's disease susceptibility. In this report, a case of an otherwise healthy female, who exhibited prepubertal periodontitis (PPP) at age 10, juvenile periodontitis (JP) at age 13, and rapidly progressive periodontitis (RPP) at age 29 years, is presented. Microbial, immunological, and genetic features of the case are presented. PPP, JP, and RPP are considered distinct disease entities, albeit with similar pathology and pathogenesis, yet all were manifest sequentially in the same individual. This report presents the idea that certain individuals are predisposed to early-onset periodontal diseases and the early identification of risk factors is important in the management of these individuals.

Postoperative bleeding tendency as a risk factor in Actinobacillus actinomycetemcomitans-associated periodontitis

Frequent bleeding on probing (BOP) has been considered a risk factor for recurrence of periodontitis. In the present study, 29 patients with Actinobacillus actinomycetemcomitans-associated periodontitis were enrolled in a carefully performed recall system. At 6 sites per tooth, periodontal probing depth (PPD), gingival index (GI), plaque index (PlI) and BOP was assessed 6 weeks, 6 months, 1 and 2 years after comprehensive therapy. Professional toothcleaning and subgingival scaling at sites with PPD > or = 5 mm and BOP was carried out every 2nd or 3rd month. Subgingival samples from 2 sites, a pooled subgingival sample, cheek mucosa, saliva and tongue samples were selectively cultivated for A. actinomycetemcomitans after 2 years. Following active therapy, 8% sites had a PPD of > or = 4 mm, whereas 21% sites bled on probing. After 2 years, respective figures were 12 and 27%. During maintenance, frequent BOP (> or = 3 times at 4 visits) had a predictive value of 0.133 to indicate an increase in PPD of > or = 2 mm and a negative predictive value of 0.947. The predictive value of no bleeding to indicate a stable site was 0.972, the negative predictive value 0.078. There was evidence for heterogeneity of associations between increase in PPD of > or = 2 mm and > or = 3 times BOP among patients (chi 2(28) = 41.45, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Defective chemotaxis and calcium response in localized juvenile periodontitis neutrophils

Localized juvenile periodontitis (ljp) is an early onset form of periodontal disease characterized by unique localization to first molars and incisors and a high prevalence of neutrophil abnormalities, particularly chemotaxis. The intracellular transduction mechanisms that follow receptor-ligand coupling on the neutrophil surface and lead to chemotaxis are not clearly established. Chemotaxis and phagocytosis are modulated by a variety of receptors and involve several activation pathways; the role of intracellular calcium as a presumptive second messenger and mediator of these events is well established. The putative effector mechanisms for the chemotactic receptor of neutrophils also include the possible activation of a phospholipase, protein kinase C, methyltransferase, or adenylate cyclase. In normal neutrophils, a phosphoinositide pathway initiated by phospholipase C, which results in the activation of protein kinase C via diacylglycerol and the generation of IP3, has been implicated. In order to better understand the stages of neutrophil transduction, fluorescent probes were used to monitor neutrophil calcium changes. Chlorotetracycline (CTC) was used as an indirect probe of intracellular membrane-bound pool of calcium stores, and Quin-2 was used to monitor cytosolic free calcium levels of FMLP stimulated normal and LJP neutrophils. The results indicate that the early phase of the calcium response affiliated with the release of intracellularly sequestered calcium appears intact in LJP neutrophils, as the CTC fluorescence changes were similar to control values. The second phase of the calcium response, associated with membrane channel activation and an influx of extracellular calcium, appeared compromised in the neutrophils of the LJP population.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased rate of salivary epidermal growth factor secretion in patients with juvenile periodontitis

We compared salivary epidermal growth factor (EGF) concentrations in patients with juvenile periodontitis (JP) and periodontally healthy controls. In initial screening of 45 JP patients and a group of healthy controls, significantly higher salivary EGF concentrations were measured in the JP patients. Subsequently, 17 JP patients who had high EGF concentrations in some of their salivary samples were chosen, and a group of age- and sex-matched controls was selected. We then examined their EGF concentrations and EGF secretion rates under standardized conditions in stimulated and unstimulated saliva and studied the expression of EGF receptor (EGF-R) in their gingival tissues. The results showed that the mean EGF concentration (pmol/ml) was slightly higher in JP patients than in controls. However, the difference was statistically significant only in stimulated saliva and when calculated per milligram salivary protein. When EGF release was measured as the rate of EGF secretion (pg/min), significantly higher values were observed in JP patients than in controls both in unstimulated and stimulated saliva. Immunofluorescence microscopy (IF) of gingival samples from JP patients and their controls revealed no quantitative or qualitative differences in the expression of EGF-R. Our results demonstrate the complex nature of salivary EGF release. The elevated rate of salivary EGF secretion in JP patients may be associated with the pathogenetic mechanisms of juvenile periodontitis.

Longitudinal monitoring for disease progression of localized juvenile periodontitis

The present study was performed to investigate the factors associated with disease progression in localized juvenile periodontitis (LJP) patients by longitudinal monitoring of microbiological changes. Following a 9-month period, 9 LJP patients were divided into 2 groups based upon attachment loss, progressing and non-progressing. Both groups received scaling, root planing, and modified Widman flaps. Clinical and microbiological data were obtained at baseline, following the observation period, and at 6 and 12 months post-treatment. At 6 and 12 months post-treatment significantly more cocci were persistent in the non-progressing group than in the progressing group. Actinobacillus actinomycetemcomitans was also more frequently isolated in the progressing group than in the non-progressing group initially and following the 9-month observation period. Also after treatment, A. actinomycetemcomitans recolonized earlier in the progressing group than in the non-progressing group. These studies suggest that A. actinomycetemcomitans may play a role in disease progression in LJP; however, they do not eliminate the possibility that other organisms may also play a role, since A. actinomycetemcomitans was not detected in all of the patients in whom disease progressed.

Longitudinal monitoring of humoral antibody in subjects with destructive periodontal diseases

Fifty-one subjects (16-61 years old) with evidence of prior destructive periodontal disease were monitored clinically and immunologically at bi-monthly intervals for up to 5 yr. Periodontal disease activity, determined as new attachment loss, was detected in 33 of these subjects. Only 4 of 51 subjects failed to show an elevated serum antibody level to any of the 18 subgingival species tested. The antibody level threshold established for periodontally healthy subjects was exceeded most often in diseased subjects with serum antibody to Actinobacillus sp., P. gingivalis, E. corrodens, C. concisus, F. nucleatum and P. intermedia in that order. In general, most serum antibody levels to subgingival species remained relatively consistent for periods as long as 5 yr. However, major increases and decreases in antibody could be detected to at most one or two species in individual subjects. In addition, prolonged, steady increases and decreases in antibody to specific species could be detected in certain subjects. These findings suggest that major changes occurring in serum antibody may reflect fluctuations in the nature of the infection. Differences were observed in the antibody level to specific species when subjects were divided into subsets on the basis of clinical criteria. These included high levels of antibody to A. actinomycetemcomitans Y4 in LJP and RPP subjects and to A. actinomycetemcomitans 29523 in LJP and GJP subjects.

[The adhesion of Actinobacillus actinomycetemcomitans to oral epithelial cells]

Adherence is a major pathogenicity factor for many bacteria. The aim of this study was to measure the adherence potential of Actinobacillus actinomycetemcomitans (A.a.) for buccal epithelial cells (BEC). In the second part of the study, the inhibitory potential of saliva on adherence between A.a. and BEC was tested. Saliva specimens were obtained from three groups of subjects: a group of normal subjects (NS), a group of subject with localized juvenile periodontitis (LJPS) and a group of subjects with adult periodontitis (APS). Clinical strains of A.a. showed a major adherence potential for BEC (25.5 A.a./BEC). In contrast, reference strains of bacteria appeared to possess a much lower potential for adherence (12.6 A.a./BEC). Saliva samples taken from from the LJPS and APS group had a high inhibitory adherence potential, since in each of these groups a reduction of 60.9% and 66.7% respectively, was observed in the number of bacteria adhering to BEC.

Flow cytometric evaluation of phagocytosis by peripheral blood polymorphonuclear leucocytes in human periodontal diseases

The complement-dependent phagocytic functions of polymorphonuclear leucocytes (PMNL) in peripheral blood from 15 patients with localized juvenile periodontitis (LJP), 13 with generalized juvenile periodontitis (GJP) and 52 with adult periodontitis (AP), and from 30 normal subjects as controls were measured by flow cytometry. Heparinized blood was collected and incubated with fluorescent microspheres, and erythrocytes were removed. By means of single-cell analysis the percentage of phagocytosing cells (% phagocytosis) and the mean number of microspheres phagocytosed by one PMNL (degree of phagocytosis; d-phagocytosis) were measured. Some but not all patients with LJP (53%) and GJP (46%) showed consistently low % phagocytosis and d-phagocytosis. On the other hand, only 6% of AP patients and no healthy subjects showed a reduction of PMNL phagocytosis. Phagocytosis was unchanged after initial periodontal treatment in all subjects, suggesting the depression of PMNL phagocytosis may not be a transient phenomenon associated with periodontal status. Furthermore, PMNLs from the LJP patients that showed depressed phagocytic function exhibited depressed phagocytic responses with either autologous or normal plasma, while control PMNLs with either normal or the patients' plasma showed normal responses. These results suggested that the depressed phagocytic responses in LJP patients could be due to cell-associated defect(s) on the PMNL.

Phenotypic assessment of early onset periodontitis in sibships

Early onset periodontitis is a group of familial diseases that are not yet clearly defined by etiologic mechanisms, although some risk factors have been recognized. The disorders include a localized form of juvenile periodontitis (JP), and a more generalized form (GP). In a family study, 39 sibships (116 individuals, aged 13-48) were evaluated for clinical indices, neutrophil chemotaxis, and serum antibodies to A. actinomycetemcomitans (Aa). Of 77 siblings, 41 were healthy at examination. In 14 sibships, all affected persons had JP; 14 other sibships had all affected individuals with GP; and 11 had at least one sib with each form. For probands with decreased chemotaxis, 71% of affected sibs and 36% of clinically healthy sibs had decreased chemotaxis. For Aa seropositive probands, 83% of affected siblings and 65% of currently healthy sibs were also seropositive. The associations of disease with these risk factors were stronger in JP-only sibships. Some affected sibs had neither risk factor, while many currently healthy sibs had 1 or both. While these 2 factors demonstrate population association with disease, neither fits the pattern expected within families to clearly suggest a causal mechanism. The assessment of within and among family variability remains the best approach for recognition of possible causal mechanisms and sources of heterogeneity.

[Normobaric pulsed hypoxic stimulation in the combined therapy of periodontitis in adolescents]

Hypoxic stimulation was added to local therapy of periodontitis in 26 adolescents with the initial manifestations of this condition. Analysis of the results has shown that hypoxic stimulation enhanced the body adaptive and compensatory potentialities, was conductive to recovery of the disordered oxygen metabolism and normalization of the regional hemodynamics and periodontal microcirculation.

Destructive forms of periodontal disease in adolescents. A 3-year longitudinal study

We studied the periodontal disease progression and the relationship between some forms of destructive periodontitis in a group of Brazilian adolescents with high prevalence of periodontal destruction, and evaluated the adequacy of reducing data by limiting the measurement of disease to first molars and by aggregating and pooling site-scores into subject-level scores. Over a period of 3 years 222 adolescents were examined annually by bite-wing radiographs. Individuals displaying arc-shaped bone lesions adjacent to greater than or equal to 2 first molars were diagnosed as juvenile periodontitis (JP) patients, while those with greater than or equal to 1 first molars showing vertical lesions were regarded as periodontal risk subjects. Teenagers with greater than or equal to 2 first molars exhibiting longitudinal bone loss were defined as high-risk patients. At the ages of 13 and 16 years, 3 (1.3%) and 4 (1.8%) subjects had JP, while 12 (5.4%) and 28 (12.6%) were regarded as periodontal risks; 8 (3.6%) subjects were assigned to the high-risk group; 4 (1.8%) 13-year olds had greater than or equal to 1 first molars missing; hence, no loss of posterior teeth occurred over a period of 3 years. Analyzing the data at the site-level revealed progressive loss and little fluctuation in the alveolar bone height in the high-risk group, and a more pronounced bone loss at the mesial than at the distal surfaces. Simpler data sets were constructed by aggregating some of the site-scores or by pooling these into subject-level scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Defective polymorphonuclear leukocyte formyl peptide receptor(s) in juvenile periodontitis

Juvenile periodontitis (JP) is a disease characterized by severe gingival infections. PMN from some JP patients exhibit abnormal chemotactic responsiveness when challenged with the synthetic formyl peptide, FMLP. While investigating PMN function in JP, we found a patient in whom abnormal PMN chemotactic responses to FMLP were associated with a defective population of PMN formyl peptide receptor(s) (FPR). JP PMN failed to respond chemotactically when challenged with FMLP, but exhibited normal chemotactic responses upon exposure to purified human C5a. Furthermore, JP PMN were capable of degranulating and generating superoxide anion radicals as well as normal PMN upon exposure to FMLP. Binding studies demonstrated that JP PMN had a diminution in the number of high-affinity FPR. Studies in which FPR was radiolabeled by chemical cross-linking demonstrated that JP PMN FPR exhibited the same molecular weight and N-linked glycosylation as normal PMN FPR. JP PMN FPR, however, was more resistant to papain cleavage than normal PMN FPR. Autoradiograms obtained from 2D-PAGE of normal and JP PMN FPR demonstrated decreased amounts of FPR isoforms in JP PMN.

Repair potential in localized juvenile periodontitis. A case in point

An aggressive form of localized juvenile periodontitis (LJP) in a 12-year old West African female is reported. The case was treated with scaling, root planing, debridement, and tetracycline therapy, which resulted in complete resolution of the disease, including elimination of periodontal inflammation, regeneration of lost periodontal structures, and spontaneous repositioning of teeth that had pathologically migrated. A hopelessly involved mandibular right first molar was successfully replaced by an incompletely developed maxillary third molar tooth bud whose roots and pulp structure continued to develop after autotransplantation. It is suggested, that LJP can be successfully treated without periodontal surgery and that the potential for repair in LJP cases is apparently greater than what one can anticipate in adult forms of periodontitis.

[The clinical and etiological study on juvenile periodontal disease]

Seven juvenile periodontally diseased patients were evaluated for clinical, microbiologic and local or systemic host factors. Three patients showed the localized from of periodontitis clinically and radiographically and by deep periodontal pockets associated with the molars and incisors. Four were in the generalized froms, in which in most cases all teeth were affected. The results in both diseased froms on the predominant cultivable subgingival microflora, the composition of which was not different from that in adult periodontitis, consisted of significantly increased proportions of Gram-negative anaerobic rods, Bacteroides sp. and B. gingivalis, Haemophilus sp. and H. actinomycetemcomitans were detected in 1/3 of the localized and 2/4 of the generalized periodontitis. They were of no value in distinguishing activity that enhanced disease in the generalized from. Elevated serum IgG responses were noted with B. gingivalis. No markedly functional abnormalities of neutrophils from peripheral blood have been demonstrated, however it might function with systemic factors, like an insulin-dependent diabetes. Morphologic characteristics of the oral and periodontal tissue in localized periodontitis were that the pattern of destruction was confined to specific teeth groups characterized by extensive the bucco-lingual width ratio of the dental crown to alveolar bone width. These observations indicate that the generalized form of juvenile periodontitis lesions were associated not only with the presence of subgingival bacteria, but also with conditions such as local morphologic and systemic or constitutional factors, individual variation in relation to destructive and protective aspects of the defense mechanisms.

[The involvement of the cerebral cortex, hypothalamus, pituitary and adrenal cortex in the development of periodontosis]

The authors emphasized in parodontosis patients functional alterations of hypothalamic centres with phagocytosis-stimulatory, vasomotor and neurotrophic functions and disturbances of the functional relationship between the hypothalamus (H), the ascendent reticular formation (RF) and the cerebral cortex (CC). Stimulatory therapy of this areas, especially by direct stimulation of the H improves the hypothalamic functions, the relationship between H and the RF and all the clinical status of parodontosis patients. In rabbits with experimental parodontosis have been found functional and histological alterations in cerebral cortex, and especially in hypothalamus, together with lesions in the hypothalamo-posthypophyso-neurosecretoric system, in the anterior pituitary (P) cells (for ACTH, TSH and FSH) as well as in zona fasciculares of the adrenal cortex (AC). This data, together with findings of other authors, prove that parodontosis is a diencephalopathy involving a whole system: CC-H-P-AC.

[Photoplethysmographic indices of hemodynamics in periodontal diseases]

In 120 patients the periodontal photoplethysmography was performed. Statistical analysis of the frequency-amplitude characteristics of the photoplethysmographic signal was useful for differential diagnosis of various forms and stages in periodontal diseases and for evaluation of the treatment efficiency.

[Pathophysiological analysis of rapidly progressive periodontitis]

Pathophysiological features were studied on 7 patients with rapidly progressive periodontitis but without any evidence of systemic disease, to analyse the clinical pathogenesis. The patients consisted of 5 females, 2 males, between the ages of 32 and 42 years. All patients had severe and rapid alveolar bone destruction on the basis of radiographic measurement. Abnormal serum levels of IgG and IgM were detected in some patients. Higher IgG level was found in 4 patients and higher IgM level was found in 2 patients. The proportion of lymphocyte subsets was calculated in mononuclear cells from peripheral blood of patients. Higher OKT4/OKT8 ratio was found in all patients. The percentage of OKT4 positive cells in 2 patients was higher than that in normal subjects while the percentage of OKT8 positive cells in 4 patients was lower than that in the healthy controls. Microorganisms from periodontal pockets were examined in 5 patients. Bacteriodes was isolated in all 5 patients and Haemophilus actinomycetemcomitans in 2 patients.

Neutrophil chemotactic behaviour in patients with early-onset forms of periodontitis (I). Leading front analysis in Boyden chambers

Despite some reports to the contrary, it is generally assumed that early-onset forms of periodontal disease (including both juvenile and rapidly progressive periodontitis) are associated with a defect in neutrophil (PMN) chemotactic behaviour. Using the Boyden chamber technique and N-formyl-methionyl-leucylphenylalanine (FMLP) to assess locomotion by the leading front method, we have failed to show any evidence for such depressed PMN locomotion. Indeed, when PMN chemotaxis and chemokinesis are considered in response to a range of chemoattractant doses our results indicate significant enhancement of all but random locomotion. When taken together with other studies, our results suggest that PMNs from patients with early-onset periodontitis may show abnormal locomotory behaviour which can either be enhanced or reduced in nature. The extent to which these results reflect in vitro methodology in uncertain and, furthermore, their in vivo significance is unclear.

Neutrophil chemotactic behaviour in patients with early-onset forms of periodontitis (II). Assessment using the under agarose technique

The locomotory behaviour of peripheral blood neutrophils (PMNs) from patients with juvenile (JP) and rapidly progressive (RPP) forms of early-onset periodontal disease was studied using the under agarose technique and n-formyl-methionyl-leucyl-phenylalanine (FMLP) as the chemotractant. PMNs from experimental patients showed normal random, chemotactic and chemokinetic locomotory behaviour when compared with control subjects. Further investigation of single-cell movements using time-lapse video analysis also failed to show any significant differences in locomotory behaviour between the PMNs of experimental and control individuals. We conclude that differences in technique may account for much of the variation which exists in the literature with respect to PMN locomotion in periodontal disease. In the final analysis, it is difficult to dispute direct observation of moving cells, and using this approach, we have been unable to confirm the presence of any PMN locomotory defect in our series of patients with early-onset periodontal disease.

Altered free cytosolic calcium changes and neutrophil chemotaxis in patients with juvenile periodontitis

Nearly 70-75% of patients with localized juvenile periodontitis (JP) have abnormal polymorphonuclear leukocytic (PMN) chemotaxis. The objective of this study was to determine whether the lower chemotactic response in PMNs from JP patients is associated with a defect in intracellular signal transduction, as measured by stimulus-induced changes in free cytosolic calcium (Ca2+) mobilization. We report that peptide chemoattractants such as N-formyl-methionyl-leucyl-phenylalanine (fMLP) and the complement fragment C5a in direct comparative studies induced lower amounts of initial Ca2+ mobilization in PMNs from JP patients than healthy controls, as monitored by intracellular fura-2 fluorescence. The initial resting levels of free cytosolic Ca2+ in PMNs from JP patients and normal individuals were found to be similar. fMLP and C5a both mobilized Ca2+ in PMNs in a dose-dependent manner. Treatment of PMNs from 0.16 to 20 nM fMLP and 0.2 to 20 nM C5a resulted in elevated levels of free cytosolic Ca2+. However, above 20 nM fMLP and 5 nM C5a concentrations the extent of total Ca2+ mobilization did not differ significantly. Although fMLP and C5a caused Ca2+ mobilization in PMN cells from JP and healthy control subjects, fMLP stimulation induced higher levels of free cytosolic Ca2+ mobilization in PMN cells from healthy control subjects (141.29 +/- 25.55 nM/2 x 10(6) PMNs), than PMNs from JP patients (62.33 +/- 23.76 nM/2 x 10(6) PMNs). Similarly C5a induced higher levels of Ca2+ mobilization in PMNs from healthy control individuals (130.43 +/- 18.26 nM Ca2+/2 x 10(6) PMNs)O, when compared to JP patients (49.92 +/- 14.92 nM Ca2+/2 x 10(6) PMNs).(ABSTRACT TRUNCATED AT 250 WORDS)

Chemotactic response of neutrophil polymorphonuclear leukocytes in juvenile periodontitis measured by the Leading Front method

Previous studies have implied that chemotaxis defects of neutrophil polymorphonuclear leukocytes (PMNs) can be found in approximately 75% of patients with juvenile periodontitis (JP). In the present study, the Leading Front (LF) method was used to study whether the chemotactic response of PMNs from JP-patients differed from that of adult periodontitis (AP) patients and periodontally healthy control individuals (C). Sixteen JP-patients, 21 AP-patients, and 13 C-individuals were studied. PMNs from each individual, and from a daily reference person were tested against three chemoattractants (N-f-Met-Leu-Phe (FMLP), casein (CA), bacterial chemotactic factor (BCF] and a neutral buffer (Gey's solution (GEY]. Regardless of the test solution a greater difference among individuals could be observed in the JP-group than in the other groups. Apart from this, there were no differences among the groups as regards CA, BCF, and GEY. However, with FMLP, the PMNs of the JP-group had a significantly greater migration distance as compared to the other groups. This finding can probably be ascribed to the fact that the LF method detects other aspects of the PMN response than do the methods used for earlier studies of JP. The finding, in this study, of an enhanced PMN response in JP as regards FMLP may be a reflection of the presence of a non-uniform PMN population whose composition in JP differs from that of the other groups.

Peripheral PMN cell activity in relation to treatment of juvenile periodontitis

Ten patients with untreated juvenile periodontitis (JP) showing an increased generation rate of free oxygen radicals from their peripheral polymorphonuclear neutrophils (PMN) as measured by luminol enhanced chemiluminescence (CL) were rechecked after treatment. The PMN cells from eight patients still reacted with higher CL after stimulation with Staph. aureus opsonized with autologous serum when related to pair-matched controls. The increased CL was not caused by adsorption of serum factors from untreated JP patients when assayed with healthy PMN cells. The increased CL found in peripheral PMN cells from patients with JP thus depends very little on the disease activity.

Neutrophil function in patients with localized juvenile periodontitis and with rapidly progressive periodontitis

PMN chemotactic function and oxydative metabolism were investigated in 13 patients with rapidly progressive periodontitis (RPP) and 9 patients with localized juvenile periodontitis (LJP) using a chemotaxis assay (CHA), luminol chemiluminescence (CL) and nitroblue-tetrazolium (NBT) tests. In the LJP patients there was a significantly lower CHA than in the RPP patients (less than 40%). Three out of the 13 RPP patients displayed a cell-dependent increase of CHA and in 3, the reduced CHA measured was serum-associated whilst among the 9 LJP patients, a cell-dependent defect of CHA was present in 5 patients, a serum-associated defect in one patient and a combined cell- and serum-associated defect was found in another patient. The average values of CL in the RPP patients were significantly lower (1309.3 +/- 814.2) than those measured in the LJP group (2208 +/- 826.9). In contrast, the mean NBT test values indicated a lower phagocytic function in the LJP patients than in the RPP ones suggesting also the presence of a serum-dependent factor in RPP and that of a combined cell- and serum-response in LJP. According to these results, the neutrophil dysfunction in RPP, as indicated by both the chemotaxis and the oxydative metabolism nature, was frequently associated with a serum factor.

Clinical immunologic and microbiologic features of active disease sites in juvenile periodontitis

Eight juvenile periodontitis (JP) patients with progressing disease were evaluated for clinical, immunologic, and microbiologic features. Clinically, bleeding on probing, pocket depth, and attachment level were unrelated to progressing disease. Only Actinobacillus actinomycetemcomitans was related to a marked increase in attachment loss when examined on both a site and patient basis. Eikenella corrodens was significantly elevated in progressing sites with A. actinomycetemcomitans as opposed to non-progressing sites harboring A. actinomycetemcomitans. Eikenella corrodens may function synergistically with A. actinomycetemcomitans to enhance disease in JP patients. Darkfield microscopy was of no value in distinguishing disease activity. All patients screened had elevated serum IgG levels to the same serotype of A. actinomycetemcomitans as that isolated from the subgingival flora. Other elevated serum IgG responses were noted to various organisms including F. nucleatum. B. intermedius, B. gracilus, B. gingivalis and E. corrodens.

The decreased antibacterial activity of oral polymorphonuclear leukocytes coincides with the occurrence of virus-carrying oral lymphocytes and epithelial cells

Patients suffering from periodontitis or periodontosis were selected for the study. Further subdivision of these groups was based on the presence or absence of herpes and/or adenoviruses in their oral lymphocytes and epithelial cells. The phagocytic and bactericidal activities of oral leukocytes isolated from the same individuals were compared with virus carriage. In the periodontitis group, 60.5%, and in the periodontosis group 61.5% of patients carried viruses, while this was established only in 21.1% of control cases. On the other hand, emigration and sulcular gathering of the less viable polymorphonuclear leukocytes was elevated but their phagocytotic activity was decreased among periodontitis patients. Bactericidal capacity was significantly lowered among those subjects who carried viruses in their cells, as compared with virus-free persons, especially in the periodontitis group. The functions of the polymorphonuclear leukocytes accumulated in the sulcus gingivalis may be modified by mediators released from the virus-carrying cells. These mediators could achieve a greater concentration locally, and the damaged leukocytes would not be able to eliminate the microbes continuously so that the accumulation of bacterial products, among them endotoxins, could lead to periodontal inflammation.

Association of an abnormality of neutrophil chemotaxis in human periodontal disease with a cell surface protein

Localized juvenile periodontitis (LJP) is characterized by severe, early-onset, molar and incisor bone loss; neutrophil chemotaxis disorders; and a high prevalence of Actinobacillus actinomycetemcomitans infection. LJP is further characterized by significant familial aggregation of the disease. Recent work in our laboratory has demonstrated the selective depletion of a surface glycoprotein of 110,000 Mr (GP110) from LJP neutrophils by using surface labeling with [14C]formaldehyde and autofluorography. The function of GP110 is unknown; however, it does not appear to be a chemotactic factor receptor. Rather, it is bound by a monoclonal antibody (NCD-1) that recognizes a neutrophil differentiation antigen and which itself alters neutrophil chemotactic and secreting functions. To quantify GP110 on LJP and normal neutrophils, fluorescein-labeled NCD-1 was bound to neutrophils and the amount of fluorescence was evaluated by using cytofluorography. Our results indicate that there is a quantifiable reduction (40%) of GP110 on the surface of LJP and GJP neutrophils, compared with controls. Other patients with neutrophil defects express normal quantities of GP110, suggesting disease specificity. Our data suggest that GP110 may be a useful disease marker for LJP and may provide a useful probe for the study of neutrophil chemotactic function and dysfunction.

Calcium concentrations in dental plaque of patients with juvenile and adult periodontitis

Calcium concentrations in plaque of patients with juvenile (JP) and adult (AP) periodontitis were compared. These calcium concentrations in JP patients were significantly (P less than 0.01) lower than in AP patients. Because JP patients are not intense calculus-formers, the finding that they have low calcium concentrations in plaque agrees with the authors' previous suggestion that calculus formation is a marker of high calcium concentrations in plaque. JP patients have good caries resistance in general, as was the case in this study. The finding that they have low calcium concentrations in plaque conflicts with the view that caries-resistant dentitions are usually associated with high concentrations of calcium in plaque.

Depressed leukotriene B4 chemotactic response of neutrophils from localized juvenile periodontitis patients

Previous studies have demonstrated that certain local juvenile periodontitis (LJP) patients possess neutrophils with an intrinsic chemotactic defect to the peptide chemoattractants f-met-leu-phe (FMLP) and C5a. In this investigation, the in vitro response of neutrophils to the chemotactic agent leukotriene B4 (LTB4) was examined. Those LJP patients who possessed defective chemotactic responses to FMLP and endotoxin activated serum (EAS) also had impaired chemotaxis to LTB4. Exogenous LTB4 failed to augment the impaired response to FMLP. Evidence for a global membrane defect in LJP neutrophils resulting in hyporesponsiveness to chemically diverse chemotactic agents is presented.

Neutrophil function in localized juvenile periodontitis. Phagocytosis, superoxide production and specific granule release

Patients with localized juvenile periodontitis (LJP) exhibit defective neutrophil functions to a variety of environmental and host stimuli. It is not clear, however, how many of the measurable functions are defective and whether individual patients exhibit single or multiple dysfunctions. The purpose of this study was to evaluate chemotaxis, phagocytosis, specific granule release and superoxide production in a group of 23 previously unreported LJP patients. Our results indicate that all 23 of these LJP patients exhibited chemotaxis depression to N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP) and endotoxin-activated serum (EAS). Smaller groups from the 23 chemotactically defective LJP group were used to test other function due to inability to obtain sufficient quantities of blood. Fourteen of 14 LJP patients tested exhibited defective phagocytosis. Ten LJP patients were evaluated for specific granule release, and 14 LJP patients were evaluated for superoxide production. Both granule release and superoxide production were found to be normal in chemotactically defective LJP patients. Since both defective and normal responses noted in the same neutrophil populations are mediated by the same receptor, it is hypothesized that the cellular defect lies in a post receptor pathway.

Periodontal destruction in Down's syndrome and in juvenile periodontitis. How close a similarity?

Advanced destruction of the periodontium, with similarities in alveolar distribution, age range, and diminished host responses of varying severity, may be seen in Down's syndrome and in juvenile periodontitis. This review compares and contrasts periodontal destruction and immunologic mechanisms in the two conditions. Both are characterized by raised serum immunoglobulins, selective cell-mediated immunodeficiencies, and defective neutrophil polymorphonuclear leukocyte chemotaxis. There is a possibility of defective monocyte chemotaxis in both conditions, although this is less clear in juvenile periodontitis. By contrast, antigen-induced DNA synthesis is enhanced in Down's syndrome, but reduced in juvenile periodontitis.

Healing following surgical and non-surgical treatment of juvenile periodontitis. A 5-year longitudinal study

The patient sample used in the present study comprised 16 young individuals who were referred for treatment of advanced periodontal disease. Based upon the age of the patients and the location of the diseased sites, the patients were divided into 2 groups; a juvenile periodontitis group (JP) and a post-juvenile periodontitis group (post-JP). The patients in the JP group had periodontal lesions only at first molars and incisors. All 16 subjects were in excellent general health and none had been treated with antibiotics during a period of at least 12 months prior to the 1st examination. At a baseline examination and 6, 24 and 60 months after active therapy, the diseased sites were examined regarding plaque, gingivitis, probing pocket depths, probing attachment level, recession of the gingival margin and marginal alveolar bone level. Following a case presentation and instruction in proper oral hygiene measures, the 16 subjects were subjected to periodontal treatment, utilizing a split mouth design. By random selection, the diseased sites in one side of the jaws were treated by scaling and root planing in conjunction with a "modified Widman flap" procedure, while in the contralateral jaw quadrants treatment was restricted to scaling and root planing. During the 1st 6 months following active therapy, the patients were subjected to professional tooth cleaning once every 4 weeks. Subsequently, the interval between the recall appointment was 3 months. 2 years after treatment, this maintenance care program was terminated. A final examination was performed 5 years after therapy. None of the patients involved in the trial received antibiotic treatment during the 5 years of observation. The findings of the present study revealed that the response of the periodontal tissues to therapy, both in the JP and the post-JP group of patients, was almost identical to that found for similar types of treatment in patients with adult periodontitis. The re-examinations performed after 6, 24 and 60 months following active therapy of JP and post-JP lesions revealed that excision of the granulation tissue in conjunction with flap elevation did not enhance the degree of probing pocket depth reduction, probing attachment gain and bone fill that occurred following meticulous root surface instrumentation.

Juvenile periodontitis

Juvenile periodontitis occurs in children and young adults and can be classified into: periodontitis which occurs in otherwise healthy individuals, and periodontitis which occurs in juveniles with systemic disease. The periodontitis which occurs in otherwise healthy individuals consists of two major forms: juvenile periodontitis, also called periodontosis or localized juvenile periodontitis (LJP), and generalized juvenile periodontitis which includes early onset adult periodontitis, recurrent necrotizing ulcerative periodontitis and the true generalized form of juvenile periodontitis. Periodontitis in systemically diseased individuals can be divided into three subgroups: juvenile periodontitis associated with primary neutrophil disorders, juvenile periodontal disease in which neutrophils are secondarily abnormal, and juvenile periodontitis associated with other diseases. Juvenile periodontitis is perhaps the best understood form of periodontal disease. A major infecting organism, Actinobacillus actinomycetemcomitans, is strongly associated with the disease, and may be an exogenous pathogen since it is not found in healthy individuals or in healthy sites in LJP patients. It is virulent with marked leukaggressive properties and it induces a marked antibody response in infected patients. Eradication of Actinobacillus actinomycetemcomitans requires attention to the fact that it invades the tissue and hence systemic antimicrobials or surgical excision of the tissues is necessary for eradication. Marked suppression of the organism from subgingival sites is associated with healing. Host responses in LJP have also been well described and most immune functions studied appear to be normal. The notable exception is neutrophil chemotaxis which is depressed. Associated with depressed neutrophil chemotaxis is a reduction of neutrophil receptors for several chemotactic factors including C5a, the fifth component of complement.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of data from clinical studies of localized juvenile periodontitis

Data from 27 subjects with localized juvenile periodontitis were used to compute estimates of the intraclass correlation coefficient for initial periodontal pocket depth measurements and total subgingival Actinobacillus actinomycetemcomitans counts, and for changes from pre- to post-treatment in periodontal pocket depth, probing attachment level and Actinobacillus actinomycetemcomitans counts. The estimates for the clinical parameters were considerably higher than those found in a similar study of adult periodontitis. On the average, the estimates for the intraclass correlation coefficients for Actinobacillus actinomycetemcomitans counts did not differ markedly from the corresponding estimates for the clinical parameters. Although the results of this study indicate that the major component of variability in parameters commonly used in studies of periodontal disease can be attributed to site-specific factors, sites within subjects cannot be considered statistically independent. For the analysis of data arising from studies of periodontal disease, it is recommended that statistical techniques, like the nested mixed effects analysis of variance model be employed, which account for this dependence. These techniques will allow meaningful biological questions concerning site-specific phenomenon to be answered. However, changes in clinical and microbiological parameters, when therapeutic measures are employed on localized juvenile periodontitis patients, are often dramatic enough to allow informal data presentation.

Dynamics of infection by leukotoxic strains of Actinobacillus actinomycetemcomitans in juvenile periodontitis

Juvenile periodontitis is associated with a high incidence of infection by Actinobacillus actinomycetemcomitans (Aa). The data presented indicate that the ability of Aa to destroy human PMNs is altered during the course of infection. Leukotoxic strains of Aa are characteristically found in isolates obtained from younger patients (6-12 years of age) but not in older subjects (13-25 years old). This suggests that the leukotoxin may be more important during early as opposed to more advanced phases of juvenile periodontitis.