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PubMed1985

Comparative bacteriology of juvenile periodontitis.

Statistical comparisons of the floras associated with juvenile periodontitis, severe periodontitis, and moderate periodontitis indicated that differences in the bacterial compositions of affected sites in these populations were not statistically significant. The subgingival flora of affected juvenile periodontitis sites was statistically significantly different from the adjacent supragingival flora and from the subgingival floras of people with healthy gingiva and of children with developing (experimental) gingivitis. However, the subgingival flora of affected juvenile periodontitis sites was not significantly different from the flora of sites with gingival index scores of 1 or 2 in adults with developing (experimental) gingivitis. Of 357 bacterial taxa among over 18,000 isolates, 54 non-treponemal species, 2 treponemal species, and mycoplasma were most associated with diseased periodontal sulci. These species comprised an increasing proportion of the flora during developing gingivitis and constituted over half of the cultivable flora of diseased sites.

Actinobacillus↗
PubMed1996

Highly toxic clone of Actinobacillus actinomycetemcomitans in geographically widespread cases of juvenile periodontitis in adolescents of African origin.

The bacterium Actinobacillus actinomycetemcomitans has been implicated in the pathogenesis of juvenile periodontitis as the etiologic agent on the basis of several lines of circumstantial evidence. A matter of extensive debate is whether A. actinomycetemcomitans is an exogenous contagious pathogen or an opportunistic pathogen that resides in the normal oral microflora. Here we show evidence of a single clone of A. actinomycetemcomitans isolated from multiple patients with juvenile periodontitis in members of families of African origin living in geographically widespread areas. The clone is characterized by a 530-bp deletion in the leukotoxin gene operon, resulting in a significantly increased production of leukotoxin.

Adolescent↗
PubMed1985

The presence of bacteria within the oral epithelium in periodontal disease. I. A scanning and transmission electron microscopic study.

The presence of bacteria within the gingival oral epithelium and adjacent connective tissue in cases of periodontitis and localized juvenile periodontitis have been described using scanning and transmission electron microscopy. The following bacterial morphotypes were identified: cocci, short rods, filaments and few spirochetes in periodontitis and mainly coccobacillary-shaped bacteria in localized juvenile periodontitis. Also Mycoplasma-like structures were identified in the localized juvenile periodontitis cases. Tunnel-like formations at different depths of the oral epithelium contained higher numbers of bacteria than those seen on the adjacent oral surface. Identification of specific bacteria in the oral epithelium may have important pathogenic and therapeutic implications.

Aggressive Periodontitis↗
PubMed1993

A 2-year study of adjunctive minocycline-HCl in Actinobacillus actinomycetemcomitans-associated periodontitis.

To study the effects of a step-wise treatment regimen on Actinobacillus actinomycetemcomitans-(Aa) associated periodontitis, 4 clusters among 33 patients harboring the organism were followed during successive periods of systemic minocycline plus mechanical debridement and minocycline plus modified Widman flap treatment. Localized periodontitis was found in 2 clusters, one with 7 localized juvenile periodontitis patients and a 24-year old male with localized destruction and extremely low plaque levels (LJP), and the other consisting of 10 patients with plaque and gingivitis and a wider age range (16 to 54 years, LP). Generalized severe and moderate periodontitis was found in 2 clusters which were further discriminated by severe gingivitis and high levels of supragingival plaque (9 patients, GSP), and mild inflammation and low plaque levels (6 patients, GMP). Mean percentages of Aa, as determined by selective cultivation of microbiota from at least 2 periodontal pockets of 6 mm or more were 63, 16, 33, and 7.8% in the clusters (P < 0.01). Six months after active treatment, Aa was present in 6/9 patients and 50% of sites in GSP, and 3/6 patients and 46% of sites in GMP patients. In contrast, the organism was virtually eliminated by scaling and flap procedures in the localized periodontitis clusters, and did not reappear after 6 months (P < 0.05). Combined antibiotic, mechanical, and surgical therapy resulted in a persistence of 20% of sites with residual probing depth of > or = 4 mm in GMP patients after active therapy. At this point, 3 of the GMP patients and 1 GSP patient left the study. Multiple regression analysis showed a significant influence of log-transformed numbers in Aa in cheek and saliva samples at the end of the study, and cluster on the percent residual number of sites with periodontal probing depth of > or = 7 mm (P < 0.001). The present results suggest that the applied therapy would be appropriate in localized forms of Aa periodontitis, but inappropriate in more severe and generalized forms to predictably eliminate Aa. Controlled long-term studies with larger groups of patients will be needed to establish the difference in treatment response suggested by these studies.

Adolescent↗
PubMed1994

Genetic and heritable risk factors in periodontal disease.

The purpose of this paper is to review current knowledge of genetic risk factors for the periodontal diseases and to present updated and additional data from the Minnesota Twin Periodontal Study. Family studies suggest that susceptibility to the early onset forms of disease, particularly prepubertal and juvenile periodontitis, is, at least in part, influenced by host genotype. Inherited phagocytic cell deficiencies appear to confer risk for prepubertal periodontitis. The prevalence and distribution of juvenile periodontitis in affected families are most consistent with an autosomal recessive mode of inheritance. However, considerable etiologic as well as genetic heterogeneity within these clinically-defined diseases is evident. Whether or not genetic factors influence the more common adult chronic periodontitis is less clear. Although results from family studies suggest that environmental factors appear to be the major determinants of variance in adult periodontitis, data from our twin studies indicate that both genetic and environmental factors influence disease. Furthermore, comparisons between reared-together and reared-apart adult monozygous twins indicate that early family environment has no appreciable influence on probing depth and attachment loss measures in adults.

Adult↗
PubMed2002

Do interleukin-1 polymorphisms predict the development of periodontitis or the success of dental implants?

Factors which increase the risk of severe adult periodontitis (AP) may also contribute to the success of dental implants. To determine which cytokines may be relevant, levels of interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta), interleukin-1 receptor antagonist (IL-1ra), interleukin-6 (IL-6) and interferon-gamma (IFN-gamma) mRNA were quantitated in gingival tissue from periodontitis patients and healthy controls. Periodontitis significantly increased levels of IL-1alpha, IL-1beta, IL-6 and IFN-gamma mRNA relative to healthy tissues. IL-1 was selected for further study, as it has inflammatory and bone resorbing properties. We examined IL-1A(-889) and IL-1B(+3953) alleles in Caucasian patients with AP and early-onset periodontitis (EOP), patients with dental implants and healthy individuals. The IL-1B(+3953) polymorphism was associated with AP. This was evident from an increased homozygosity for allele 2 in patients with AP and a decreased heterozygosity in advanced AP patients. IL-1A(-889) and a composite genotype [IL-1A(-889)2 plus IL-1B(+3953)2] showed no association with the incidence of periodontitis, disease onset or disease severity. IL-1A(-889), IL-1B(+3953) and the composite genotype also showed no association with failure of dental implants.

Adult↗
PubMed1998

Laboratory and clinical comparison of preservation media and transport conditions for survival of Actinobacillus actinomycetemcomitans.

The capacity of clinical isolates and type strains of Actinobacillus actinomycetemcomitans to survive in a new transport medium (AaTM), phosphate-buffered saline (PBS) and Ringer's solution (RS) was evaluated. The effects of exposure to air, transportation time and temperature on viability were also studied. In addition, the culture of A. actinomycetemcomitans from subgingival plaque of patients with different forms of periodontitis was quantified. The results following storage in AaTM, PBS and RS showed that A. actinomycetemcomitans survived better in AaTM than in PBS or RS when transportation times exceeded 20-22 h, and that survival was enhanced by storage at below 12 degrees C. Serotype b strains of A. actinomycetemcomitans were able to survive better than either serotype a or c. In the clinical study the optimal transportation conditions for subgingival plaque containing A. actinomycetemcomitans were AaTM at a temperature of 8 degrees C for 24 h under anaerobic conditions. These conditions resulted in a high survival and isolation rate for A. actinomycetemcomitans without inhibition of the other periodontopathic bacteria isolated from deep periodontal pockets. These findings have practical implications for future multicentre clinical trials in which the transportation of oral specimens over relatively long distances and at different ambient temperatures during various periods of the year are required.

Actinobacillus Infections↗
PubMed1992

New considerations in the prevalence of periodontal disease.

International surveys demonstrate that the prevalence of pocketing of 6 mm or more is between 5% and 20% for much of the world's population. A recently completed national survey of employed adults found the prevalence of gingival bleeding was 44%, the prevalence of pocketing of 4 mm or more was 14%, and the prevalence of attachment loss of 3 mm or more was 44%. Risk indicators for a higher prevalence of periodontal disease include increasing age, poor education, lack of professional dental care, previous periodontal destruction, tobacco use, and diabetes. African-Americans show a higher prevalence of juvenile periodontitis and adult periodontitis than whites. The female-to-male ratio in juvenile periodontitis may be close to 1:1. Another report during the review period suggests that periodontal disease in adults may have a strong genetic component. A doctoral dissertation demonstrated that the sensitivities of methods used in a national survey to detect pocketing and attachment loss range from 0.24 to 0.87 in a high-prevalence population.

Adolescent↗
PubMed1995

Papillon-Lefèvre syndrome associated early onset periodontitis: a review and case study.

A case of Papillon-Lefèvre syndrome that has been managed successfully for six years is reported. Papillon-Lefèvre syndrome is a rare form of early onset periodontitis that occurs at a rate of 1-3 per million. Diagnostic features include palmar-plantar hyperkeratosis and rapid periodontal destruction. Although the etiology of this syndrome is unknown, current theories on the nature of the underlying defect fall into three main categories: anatomical, bacterial and host response. Historically, Papillon-Lefèvre syndrome was thought to lead to the inevitable loss of both the primary and permanent dentitions. However, a recently proposed treatment involving antibiotic coverage, extraction of the primary dentition and a period of edentulism has been shown to be effective in maintaining the permanent dentition. Since treatment may begin prior to the eruption of the permanent dentition, early recognition of Papillon-Lefèvre syndrome is critical. Any young patient who exhibits palmar hyperkeratosis should be examined carefully for periodontal breakdown. Since the number of cases available for study is limited, referral of such individuals to University dental clinics may allow for a more specific analysis of immune or bacterial factors that may lead to a better understanding of this disease.

Aggregatibacter actinomycetemcomitans↗
PubMed1993

The influence of race and gender on periodontal microflora.

Previous studies have demonstrated that demographic characteristics of subject populations influence both the incidence of periodontal diseases and various aspects of host responses to periodontal bacteria. In this study we analyzed the components of the subgingival microflora from individuals with adult periodontitis, early onset periodontitis, gingivitis, and periodontal health as a function of gender and race (black and white). Clinical categories were analyzed individually so that there were no differences in the clinical characteristics of the sampled sites. No significant differences were noted in the subgingival microflora between males and females. When either the first two bacterial samples from each subject or all bacterial samples taken from each subject were included in the analysis, it was found that Porphyromonas gingivalis was more significantly associated with black subjects in the adult periodontitis group. When all samples were considered in the analysis, it was found that Peptostreptococcus anaerobius was associated with black subjects in the adult periodontitis group, while Fusobacterium nucleatum was associated with white subjects in both the adult periodontitis and early onset periodontitis groups. Thus a limited number of important bacterial components of the subgingival microflora are influenced by the race and diagnosis of the subject group.

Adolescent↗
PubMed1996

Chymotrypsin-like enzyme secretion is stimulated in cultured epithelial cells during proliferation and in response to Actinobacillus actinomycetemcomitans.

A chymotrypsin-like enzyme was partially purified from culture medium of epithelial cells of human skin, human gingiva and porcine periodontal ligament by aprotinin-affinity chromatography. The enzyme levels from all three cell types were low in quiescent cultures but increased markedly when the cells were allowed to proliferate. The biphasic elution profile of the enzyme from the affinity column closely matched that of alpha-chymotrypsin and the protein comigrated with it on polyacrylamide gels at 27,000 ML. Synthetic substrate tests of purified fractions showed strong chymotrypsin-like but no trypsin-like or elastase-like activity. Inhibition of protease activity and pH optimum in the range of 7.5-8.0 were consistent with chymotrypsin-like enzymes. Secreted activity was found to be significantly increased by phorbol myristate acetate treatment in a time-course that differed from that of elastase-like activity. Keratinocyte growth factor and epidermal growth factor but not transforming growth factor-beta increased the chymotrypsin-like activity in a concentration-dependent manner. The enzyme secretion by epithelial cells was strongly elevated by exposure to 5 of 6 Actinobacillus actinomycetemcomitans strains isolated from plaque samples of juvenile periodontitis patients. These results indicate that chymotrypsin-like enzymes are secreted by proliferative phenotypes of normal epithelial cells. This enzyme may, therefore, play a role in epithelial physiology and in cell response to certain pathogenic bacteria.

Aggregatibacter actinomycetemcomitans↗
PubMed1991

Endodontic therapy as an adjunct for treatment of juvenile periodontitis: case report.

The four first permanent molars in a 16-year-old girl with juvenile periodontitis were treated by selective grinding, tooth eruption, conventional periodontic treatment and endodontic therapy. The endodontic treatment was carried out as an elective procedure under ideal conditions, thereby pre-emptying the emergency treatment which would have been necessary following occlusal reduction. The two-year follow-up examination showed successful resolution of the original condition.

Adolescent↗
PubMed2001

Interleukin-4 polymorphisms in early onset periodontitis.

BACKGROUND, AIMS: Periodontitis is the result of a complex interplay between oral bacteria and the host response, often modulated by behavioral factors. Early-onset periodontitis (EOP) is defined by the age of onset, the distribution of lesions and specific microbial pathogens. METHOD: Studies in twins suggested a genetic contribution to the pathogenesis of periodontitis. EOP heritable factors may be related to immune mechanisms which could enhance the pathogenic potential of plaque bacteria in susceptible individuals. Among others, Interleukin 4 (IL-4) is a potent cytokine in the immune response and is a potent down regulator of macrophage function. In the present study, we report a specific genotype of the IL-4 gene, which was detected by specific primers and PCR analysis. RESULTS: In the EOP-group 27.8% were IL-4 promotor- and intron polymorphism positive (PP+ and IP+). None of the age-matched healthy controls or patients with adult periodontitis (n=25) carried the markers. Moreover, serum IL-4 levels of PP+ and IP+ patients were below the detection limit and significantly different (p<0.01) from the IL-4 concentrations of healthy controls and PP- and IP- patients.

Adult↗
PubMed2005

Role of helper T cells in the humoral immune responses against 53-kDa outer membrane protein from Porphyromonas gingivalis.

Outer membrane protein with a 53-kDa molecular weight (Ag53) isolated from Porphyromonas gingivalis evokes strong humoral immune responses in many periodontitis patients. To examine the effects of cytokines produced by Ag53-specific Th cells on the IgG production against Ag53, we established Ag53-specific Th-cell lines from patients with early onset periodontitis and from healthy volunteers. We then developed a mixed lymphocyte culture system between Ag53-specific Th cells and auto- or allo-derived T-cell-depleted leukocytes produced from the subjects whose HLA class II haplotypes were completely matched. Interferon-gamma production was observed in all Th cell lines from patients and healthy subjects. As for Th2 type cytokines, interleukin (IL)-4, IL-5, IL-6 and IL-10 production varied greatly in Th cells regardless of the periodontal condition of the donor. Only Th cell lines with a high Th2/Th1 ratio induced Ag53-specific IgG production when cocultured with T-cell-depleted leukocytes. Thus, the difference in Th2/Th1 balance may regulate the Ag53-specific IgG production.

Aggressive Periodontitis↗
PubMed1985

Transmission and colonization of Actinobacillus actinomycetemcomitans in localized juvenile periodontitis patients.

Actinobacillus actinomycetemcomitans is a Gram-negative oral microorganism, which has been implicated in the etiology of localized juvenile periodontitis and in severe medical infections such as bacterial endocarditis. This study evaluated the ability of periodontal probes to transmit A actinomycetemcomitans from juvenile periodontitis lesions to healthy gingival sulci in the same patient. Localized juvenile periodontitis patients exhibiting first molar and incisor alveolar bone loss and with large numbers of A actinomycetemcomitans in deep periodontal pockets were included in this study. A periodontal probe was inserted into periodontal pockets of 6 mm or greater depth. The probe was then placed into a healthy gingival sulcus of 3 mm or less, in the same subject. Fifty-five transfers by probing were made and A actinomycetemcomitans in both the donor and recipient sites was assessed by a selective culture technique. The results indicate that periodontal probes can become contaminated with A actinomycetemcomitans from juvenile periodontitis lesions during routine dental examinations and can transfer this microorganism from infected to previously uninfected sites. However, A actinomycetemcomitans inoculated into the healthy gingival sulci did not permanently colonize these sites since the organisms were eliminated within 3 weeks.

Actinobacillus↗
PubMed1990

[Periodontitis juvenilis--a new view on the aetiology and treatment].

The development of views on the terminology and aetiology, and a new approach to the treatment of juvenile parodontitis are described. The verification of these views has contributed to the explanation of the role of the bacterial factor (Actinomyces actinomycetecomitans) in the development of parodontal changes. This made possible outlining of an optimal therapeutic programmes.

Actinobacillus↗
PubMed2003

Improved PCR for detection of the highly leukotoxic JP2 clone of Actinobacillus actinomycetemcomitans in subgingival plaque samples.

The JP2 clone of Actinobacillus actinomycetemcomitans is associated with early-onset periodontitis in certain ethnic populations of African origin. Here, we describe and evaluate a set of primers for PCR to assay for the presence of A. actinomycetemcomitans and to discriminate between JP2-like strains and other genotypes in subgingival plaque samples.

Actinobacillus Infections↗
PubMed1997

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.

Adolescent↗