Clinical and Microbiological Evaluation of Therapy for Juvenile Periodontitis

Abstract

Eight patients (mean age 15.6 yrs) with severe molar-incisor bone loss and pocket formation characteristic of juvenile periodontitis were entered into a clinical protocol of three sequential stages: scaling and root planing (S/RP); S/RP concurrent with systemic tetracycline therapy (1 gm/day for 28 days); periodontal surgery concurrent with systemic tetracycline therapy. Clinical and microbiological examinations were scheduled at baseline, at 1 to 2 months after Stage I, at 1 to 2 months after completion of tetracycline therapy in Stages II and III, and during recall. A decision to progress to the next stage or to place the patient on a 3-month recall was based solely on clinical findings (suppuration, bleeding upon probing and pocket depth) at the deepest site in each patient. Paperpoint subgingival plaque samples from representative affected sites were analyzed for percentage of total cultivable microflora composed of black-pigmented Bacteroides species (BPB), surface translocating bacteria (STB) and Actinobacillus actinomycetemcomitans (Aa). At baseline, all sites bled to probing, seven of eight sites showed suppuration, and deepest pocket depths averaged 8.0 mm. STB were detected in one and BPB in four sites, respectively, and all sites demonstrated Aa, which constituted approximately 40% of the total cultivable flora. S/RP alone had essentially no effect on either clinical or microbiological findings, and all patients progressed to Stage II. Five went on to Stage III. S/RP with tetracycline was clinically and microbiologically more effective at sites in which Aa was predominant. Surgery was required in all sites containing high levels of both BPB and Aa. These results suggest that microbiological diagnosis may be useful in selecting and monitoring treatment for juvenile periodontitis.

Improved, Low-Cost Selective Culture Medium for Actinobacillus actinomycetemcomitans

“…A. actinomycetemcomitans has been isolated from adult periodontitis lesions, but less frequently and in lower numbers than from lesions in juvenile periodontitis subjects (21,26). Treatment failures have been associated with the failure to reduce the amount of the microorganism in treated sites (14,17). Furthermore, data on the transmission of A. actinomycetemcomitans from host to host (5,6,32) and new evidence of its role as an infectious agent involved in disease development at extraoral sites (35) are providing one of the strongest associations between this oral pathogen and periodontal and systemic diseases.…”

A Judicious Treatment Approach for the Management of Localized Aggressive Periodontitis: A Case Report

“…Several studies in the 80's and early 90's have demonstrated that treatment revolving solely around mechanical debridement either in the form of "closed" debridement or access flap technique did not produce satisfactory results leading to progressive attachment loss [7][8][9][10][11]. This was later attributed to the fact that pathogens associated with LAP such as Aggregatibacter actinomycetemcomitans (A.A) can penetrate tissues and therefore never completely eliminated by mechanical therapy alone [12].…”

Improving Scaling And Root Planing Over The Past 40 Years: A Meta-Analysis

“…However, the heterogeneity of the included studies was remarkable. Some publications dealt only with the deepest site in every patient, while others calculated with full mouth PD [54,77]. In that way "mean pocket reduction" could simply be the wrong parameter to base such a statement on.…”