The periodontal status of renal transplant patients on immunosuppressant drug therapy was compared with that of an age matched normal group over a period of 2 to 4 1/2 years. Gingival Index, Plaque Index, and Periodontal Destruction Index were used as measures of comparison. Over this period of time the Gingival Index of the immunosuppressed patients increased significantly when compared to the normals. There was a significant increase in the mean Plaque Index for both groups during the study period. The increase was greater in the immunosuppressed group. However, the difference in the Plaque Index for the two groups was not significant. There was little change in the Periodontal Destruction Index in both groups over time. The results of this study indicate that there is little difference in the rate of periodontal destruction between patients taking immunosuppressant drugs and normal patients. These findings, taken in conjunction with other recent reports, would seem to indicate that T cells play a minor role in the etiology of periodontal disease.

Refractory cases of periodontitis were assayed for chemotaxis of polymorphonuclear neutrophilic leukocytes using an in vivo assay. 9 refractory patients and 9 normal patients were studied. When cell counts were plotted against time, normal patients showed a single peak at 25-30 min after casein (chemo-attractant) challenge, whereas refractory patients showed 2 and 3 peaks of PMN's at varying time intervals. 5 of the refractory patients showed this pattern in tests of normal sulci as well as deep periodontal pockets. 4 of the refractory cases showed a double peak in tests of deep periodontal pockets. This suggests that some refractory cases have an intrinsic chemotactic defect of polymorphonuclear neutrophils while in others the defect may be a secondary phenomenon. It appears that patients with refractory periodontitis have the characteristic cell response that was reported for LJP.

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THE FEASIBILITY OF USING A simplified laboratory procedure to select an appropriate antibiotic for treatment of refractory periodontitis was investigated. Six different antibiotics were added to commercially available CDC-agar plates. Plaque samples from periodontal pockets were inoculated onto the plates. The percentage kill was determined by comparing colony counts on the antibiotic-containing medium with those on the control plates. The three most effective antibiotics were ranked by visual inspection as well as by colony count. It was determined that visual inspection may be used to determine an effective antibiotic.