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PubMed1993

Suppression of subgingival Actinobacillus actinomycetemcomitans in localized juvenile periodontitis by systemic tetracycline.

The current study assessed the clinical and microbiological effects of systemic antimicrobial therapy alone in Actinobacillus actinomycetemcomitans-infected adolescents with periodontal disease. The study involved 6 localized juvenile periodontitis patients 13-18 years of age, who harbored high numbers of A. actinomycetemcomitans in subgingival plaque samples. The periodontal lesions were microbiologically monitored by selective culture, and clinically assessed for probing pocket depth and periodontal attachment level 3 months prior to baseline, and at 3, 6, 12, and 24 months posttreatment. Tetracycline-HCl (250 mg/QID) was prescribed until 1 week after subgingival A. actinomycetemcomitans was no longer detectable or for a maximum of 8 weeks. During 3 months prior to treatment, pocket depth was unchanged, and was then significantly reduced from an average of 7.1 mm to 5.1 mm 12 months after treatment (p = 0.02). The mean change in clinical attachment level was a gain of 1.4 mm between baseline and 12 months (p = 0.02). 3 of the 6 patients were still infected with A. actinomycetemcomitans after 8 weeks of antibiotic therapy and 4 subjects were infected at 12 months. Numbers of A. actinomycetemcomitans were still suppressed in most lesions. There was a strong association between mean numbers of A. actinomycetemcomitans in periodontal pockets and mean change in probing attachment level at any given time point. For 22 available comparisons, derived from all time points, there was a strong association (r = 0.68) between subgingival A. actinomycetemcomitans and change in probing attachment level.(ABSTRACT TRUNCATED AT 250 WORDS)

Actinobacillus Infections↗
PubMed1984

Clinical, microbiological and immunological studies of a family with a high prevalence of early-onset periodontitis.

Extensive clinical, laboratory and microbiological studies were performed on members of a family with an unusually high prevalence of early-onset severe periodontitis. Clinical observations included intraoral photographs and assessment of inflammation, plaque, probing depths and bone loss. Pocket bacteria were sampled, cultivated and identified. Immunological studies included assessment in vitro of neutrophil (PMN) and monocyte (MN) chemotaxis, assessment of PMN phagocytosis and other functions using the iodination assay, measurement of serum opsonic and chemoattractant activities and determination of levels of serum antibodies specific to various putative periodontal pathogens. The proband, a 19-year-old white woman, had rapidly progressive periodontitis (RP). Of her six siblings available for study, all had juvenile periodontitis (JP), and both parents had been edentulous since early adulthood. Early edentulism and recurrent infections, especially otitis media, were prevalent in the forebearers, especially on the maternal side. Two married sisters of the proband had young male children with recurrent infections. Abnormalities in leukocyte chemotaxis were found in the proband, in two of her siblings and in both parents. The pocket flora was predominantly Gram-negative, anaerobic rods with a high prevalence of Bacteroides species, and serum antibodies specific to Bacteroides species were detected in the sera of five of the seven patients studied. Actinobacillus actinomycetemcomitans was not found in any of the pockets studied, nor were antibodies specific to any of the three known serotypes of this bacterium detected in the serum of any of the patients. There was a relatively good correlation between the bacterial species isolated from the periodontal pockets and the antibodies found in the serum. PMN iodination and serum opsonic activity were normal in all of the patients. Thus not all JP patients have detectable Actinobacillus species in their periodontal pockets, nor do all have antibody detectable with the techniques we used specific to these bacteria in their serum. In contrast, JP patients may have Bacteroides species in their periodontal pockets and antibody specific to Bacteroides species in their serum. Although abnormal leukocyte chemotaxis is generally common in RP and JP patients, in this family the correlation between this defect and the presence of these diseases was poor.

Adolescent↗
PubMed1990

[Function of polynuclear neutrophils in patients with juvenile periodontitis and rapidly progressing periodontitis].

It is generally assumed that early onset forms of periodontal disease (including Juvenile and Rapidly Progressive Periodontitis) are associated with a defect in neutrophil behaviour. We have investigated neutrophil functions in patients with Juvenile (J.P.) and Rapidly Progressive Periodontitis (R.P.P.). In the group of J.P. patients the directed mobility (FMLP and zymosan activated plasma) is significantly decreased. The superoxide generation in response to FMLP decreases while the PMA response is normal. In the group of R.P.P. patients no significant abnormality has been reported.

Aggressive Periodontitis↗
PubMed1995

Susceptibility of Actinobacillus actinomycetemcomitans strains to norfloxacin.

The minimal inhibitory concentration of norfloxacin to Actinobacillus actinomycetemcomitans strains isolated from patients with localized juvenile periodontitis was determined by using an agar dilution method. All the tested strains, including the three reference strains, were susceptible at concentrations lower than the breakpoint used, with 90% of the strains susceptible to 0.125 micrograms/ml.

Aggregatibacter actinomycetemcomitans↗
PubMed1994

Ex vivo studies of polymorphonuclear neutrophils from patients with early-onset-periodontitis (II). Chemiluminescence response analysis.

Previous studies have indicated that oxygen-free radicals may cause damage to the periodontal tissues. This study compared the luminol-dependent chemiluminescence response (after stimulation with either opsonized zymosan or phorbol myristate acetate (PMA) of peripheral blood polymorphonuclear leukocytes (PMN) isolated from human subjects with a healthy periodontium (n = 7), gingivitis (n = 8), adult periodontitis (n = 8), or early-onset periodontitis (n = 17). These results were also compared with those obtained in a larger reference group which consists of 50 subjects without infection or inflammation, selected on the basis of laboratory investigations. An enhanced response was defined as being 2 standard deviations above the reference group mean; a reduced response was defined as being 2 standard deviations below this mean. Although PMN from patients with either gingivitis or periodontitis were often functionally activated (when compared to the PMN from the reference group), no significant differences could be found between the 4 groups, with regard to the chemiluminescence response means obtained in a basal state or after stimulation.

Adult↗
PubMed1998

Increased adhesion of peripheral blood neutrophils from patients with localized juvenile periodontitis.

Adhesion of peripheral blood neutrophils from 5 patients with localized juvenile periodontitis (LJP) and age- and gender-matched healthy controls was measured using a semi-automated 96-well microtiter plate assay method. Both unstimulated and formyl-methionyl-leucyl-phenylalanine (FMLP, 10-1000 nM)-stimulated neutrophils from LJP patients showed in general higher adhesion than did their controls. After 15-60 min incubation with 100 and 1000 nM FMLP the numbers of adherent cells were significantly (p < 0.05), 2.1-2.6-fold higher in LJP patients than in controls. Neutrophils from these LJP patients showed also enhanced respiratory burst activity in response to unopsonized zymosan stimulation. To test whether a decrease in intracellular diacylglycerol (DAG) kinase activity could account for the increased neutrophil adhesion of LJP patients normal neutrophils were treated with R59949 (10 microM), a DAG-kinase inhibitor. Both unstimulated and FMLP-stimulated normal neutrophils showed significantly (p < 0.05) enhanced adhesion after R59949-treatment. Taken together, our data indicate that neutrophils from the 5 LJP patients investigated here exhibit 2 parallel hyperactivities, namely increased adhesion and enhanced production of reactive oxygen species. Furthermore, our present and previous (Hurttia et al., J Periodont Res 1997; 32: 401-407) results suggest that the observed neutrophil functional abnormalities in some LJP patients may be associated with decreased cellular DAG-kinase activity. It is proposed that the hyperadherent and -active neutrophils may promote the development of LJP by causing tissue damage in the periodontium.

Adolescent↗
PubMed1993

Microbiological and clinical monitoring of non-localized juvenile periodontitis in young adults: a report of 11 cases.

It has been shown that patients with localized juvenile periodontitis (LJP) often harbor Actinobacillus actinomycetemcomitans in the subgingival area. However, little is known of the oral microflora in non-LJP juvenile periodontitis patients with less extensive disease. The purpose of this study was to describe the microflora and clinical parameters of young adults with minor to moderate periodontitis during treatment for a period of 1 year. Eleven patients 15 to 16 years of age were studied. All of them had 4 to 8 mm loss of attachment at minimally one site, but the typical clinical description of localized juvenile periodontitis was an exclusion criterion in this study. Microbiological examination of the deepest periodontal pocket and of the tongue revealed that 6 patients harbored Actinobacillus actinomycetemcomitans and 5 harbored Porphyromonas gingivalis. Almost all subjects showed relatively high proportions of Prevotella intermedia, Campylobacter rectus, motile organisms, and spirochetes. On the basis of clinical and microbiological parameters the 11 patients could be assigned to 1 of 2 groups. Six cases had moderate periodontal breakdown with loss of attachment at 7 to 44 sites. All harbored A. actinomycetemcomitans and 5 of them P. gingivalis. These 6 cases responded relatively well to initial treatment despite the continued presence of A. actinomycetemcomitans. The other group consisted of 5 cases with relatively minor periodontal breakdown; i.e, 1 or 2 sites with 4 to 6 mm loss of attachment. Neither A. actinomycetemcomitans nor P. gingivalis was detected in the deepest pocket of these patients. All 5 responded well to initial treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

The prevalence of localized juvenile periodontitis in Saudi subjects.

The purpose of this study was to determine the prevalence and sex ratio of localized juvenile periodontitis (LJP) cases in a selected Saudi population, to compare these values with different societies, and to correlate the sex ratio with the presence of Actinobacillus actinomycetemcomitans in the afflicted sites. In a retrospective study over a 3-year period 23 cases of LJP were diagnosed from a group of 5,480 subjects with different forms of periodontal disease. The overall prevalence was 0.42%. The female to male ratio was 1.88:1. The difference in the sex ratio was statistically significant (X = 5.490, P < .05). No statistically significant difference in the sex ratio association regarding the sites afflicted by Actinobacillus actinomycetemcomitans was found.

Adolescent↗
PubMed1990

[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.

Adolescent↗
PubMed1989

[The use of antibiotics in periodontics. A review of the literature].

Since periodontal diseases are mainly of bacterial origin, the use of antibiotics could seem justified for their treatment. Numerous studies, however, have shown that these drugs are not a first choice treatment for acute and chronic periodontitis. Chemotherapy can represent a valuable adjunct to routine mechanical debridement, particularly for adult recurrent periodontitis, juvenile periodontitis and rapidly progressive periodontitis. Furthermore, prophylactic chemotherapy should be provided for patients at risk with systemic diseases, notably when congenital or acquired valvular heart defects are present. For the treatment of adult recurrent periodontitis, the most appropriate systematic drugs are, presently, tetracyclines or imidazoles. Juvenile periodontitis can be treated with the help of tetracyclines and rapidly progressive periodontitis with imidazoles. As for high risk patients, the use of various penicillins is mandatory. A decision to use antibiotics must be made only after due consideration of their potential disadvantages. One should also remember that the possible positive or negative effects of antibiotics upon the host defence mechanisms are for the moment unknown.

Adult↗
PubMed1994

Ex vivo studies of polymorphonuclear neutrophils from patients with early-onset forms of periodontitis. (I). Chemotactic assessment using the under agarose method.

The polymorphonuclear neutrophil (PMN) appears to be an important cell in the protection of the host from pathogenic periodontal microorganisms and, despite some reports to the contrary, it is generally assumed that early-onset forms of periodontal disease (including both juvenile and rapidly progressing periodontitis) are associated with a defect in PMN chemotactic behaviour. The purpose of the present study was to examine the peripheral PMN chemotactic behaviour, using the under agarose method, in 4 groups, namely healthy periodontium group (n = 7), gingivitis group (n = 8), early-onset periodontitis group (n = 17) and adult periodontitis group (n = 8). PMN from early-onset periodontitis patients showed normal random and chemotactic locomotory behaviour when compared with those of PMN from subjects of the other groups. No statistically significant difference could be found among the 4 studied groups, with regard to spontaneous and oriented migration.

Adult↗
PubMed1989

Prevalence of periodontal breakdown in adolescents and presence of Actinobacillus actinomycetemcomitans in subjects with attachment loss.

The present investigation was carried out to study the prevalence and clinical appearance of destructive periodontal disease in a school population of 15- to 16-year old adolescents in Amsterdam. In addition the prevalence of Actinobacillus actinomycetemcomitans was studied in those subjects showing attachment loss. Attachment loss was diagnosed in 230 of the 4565 subjects participating which is about 5% of the population studied. Within this population males were more frequently affected than females (P = 0.008). Extensive periodontal destruction was found in 16 subjects (0.3%). In this group a female/male ratio was found of 1.3:1. As a result of the epidemiological survey, 105 subjects with attachment loss volunteered for further investigation. The results showed that presence of plaque, redness and swelling of the gingiva, and bleeding on probing were general phenomena. In addition, the bleeding/plaque ratio, as determined for each subject at sites without attachment loss, increased with the severity of periodontal disease as expressed by the number of sites with attachment loss (P = 0.0038) as well as by the amount of destruction at these sites (P = 0.002). A. actinomycetemcomitans could be identified in 18 of the 105 subjects with attachment loss. Analysis showed that A. actinomycetemcomitans was more frequently isolated in subjects with moderate to severe periodontal breakdown than in subjects with mild breakdown (P less than 0.02). When estimating the percentage of juvenile periodontitis patients on the basis of the classically accepted criteria, it seems likely that between 0.1% to 0.2% of the population in Amsterdam is suffering from this disease entity.

Actinobacillus↗
PubMed1995

Bacterial-stimulated cytokine production of peripheral mononuclear cells from patients of various periodontitis categories.

Periodontitis is a general term for disease categories, including juvenile periodontitis (JP), rapidly progressive periodontitis (RPP), and adult periodontitis (AP), which may or may not share a common etiology and pathogenesis. These disease categories are characterized by differences in progression of tissue destruction and differences in age group susceptibility, but not, to our knowledge, by differences in cytokine responses of inflammatory cells. The present study examined blood cell counts and interindividual variation in the ability of PBMC of patients in three different categories of periodontitis to produce cytokines after stimulation with different oral bacterial species in vitro. The AP group had a significantly lower production of IL-1ra when stimulated with Porphyromonas gingivalis (P.g.) and Actinobacillus actinomycetemcomitans (A.a.) (P < 0.05). Streptococcus sanguis (S.s.), which is associated with normal periodontal conditions, induced extremely high levels of IL-1 alpha and TNF alpha production in all groups. The RPP group had a significantly higher number of monocytes (MC) than the AP group (P < 0.05). Additionally, JP patients had a significantly higher concentration of polymorphonuclear granulocytes compared to juvenile controls (P < 0.05). In conclusion, IL-1 alpha, TNF alpha, or IL-6 production by peripheral blood MC after in vitro stimulation with oral bacterial type stains may not distinguish different categories of periodontitis. The results support the hypothesis that the cytokine IL-1ra is produced in different concentrations in the two groups: RPP and AP. Furthermore, elevated MC concentration in the RPP group compared to the AP group may be an important pathogenic feature in RPP.

Adolescent↗
PubMed1997

Neutrophil chemotaxis and serum factor modulation in Brazilian periodontitis patients.

The polymorphonuclear neutrophil (PMN) chemotaxis index and modulation of serum factors in 15 Brazilian periodontal patients (five localized juvenile and ten adult periodontitis) and ten healthy subjects were examined. Adult periodontitis patients showed a normal chemotaxis index, Localized juvenile periodontitis LJP patients showed diminished chemotaxis and serum cell-directed inhibitor activity. The results suggest that PMN abnormalities could not be caused by only the neutrophils themselves, but also by modulation of serum factors acting on this LJP disease.

Adolescent↗
PubMed1984

Autosomal recessive inheritance of juvenile periodontitis: test of a hypothesis.

The heredity of juvenile periodontitis was studied in a series of 30 families. None of the 60 parents showed any sign of this disease. Of the 52 siblings, nine in seven families were affected. The calculated genetic ratio concurred with the hypothesis of autosomal recessive inheritance based on the results of an earlier study of 31 families (Saxén 1980).

Adolescent↗
PubMed1995

Tetracyclines in the management of periodontal diseases. A review.

Periodontal diseases essentially comprise a group of oral infections whose primary aetiological factor is dental plaque. Removal of the cause (and its effects) is the primary aim of both non-surgical and surgical treatment regimens, although the infective nature of the diseases has led to the widespread use of antimicrobials as an adjunct to mechanical debridement. The tetracyclines are primarily bacteriostatic agents that are effective against many Gram-negative species including putative periodontopathogens such as Actinobacillus actinomycetemcomitans (A.a.). The proven efficacy of this group of drugs in the management of periodontal diseases may be related not only to their antibacterial actions, but to a number of additional properties that have been recently identified. These include collagenase inhibition, anti-inflammatory actions, inhibition of bone resorption and their ability to promote the attachment of fibroblasts to root surfaces. Consequently, tetracyclines have also been used as an adjunct to bone grafting in periodontal defects, and as agents for 'conditioning' root surfaces to enhance the regeneration of periodontal tissues. When tetracyclines are taken orally, consideration must be given both to the potential unwanted effects and to interactions with other drugs that are taken concurrently. Such problems are minimised however, when the drugs are incorporated into controlled, slow-release formulations which are currently being researched and marketed for intra-oral use.

Aggressive Periodontitis↗
PubMed1995

Clinical and laboratory studies on a patient with early onset periodontitis and her family members. A case report.

Extensive clinical, microbiological, hematological, and immunological studies were performed on a patient with early onset periodontitis (EOP) and two other members of the family. The proband, a 27-year-old female, had early onset periodontitis and a high level of serum rheumatoid factors (RF) with no diagnosable medical disease. Her mother had lost all her teeth at the age of 50 because of advanced periodontitis, while her elder sister was unaffected by periodontitis. Neither the proband's periodontally-affected mother nor her unaffected sister exhibited a detectable level of RF. In this study, we examined: 1) serum immunoglobulin G (IgG) antibody titers against putative periodontal pathogenic bacteria; 2) peripheral neutrophil functions; 3) phenotypic analyses of peripheral lymphocyte subpopulations; and 4) peripheral lymphocyte functions (T cell proliferative activity, ability of cytokine [interleukin (IL)-2, tumor necrosis factor-alpha, interferon-gamma, IL-6 and IL-8] and IgG and IgM productivity). High antibody titers to Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Campylobacter rectus were detected in the sera of the proband, as were high serum antibody titers to P. gingivalis in the mother and to C. rectus in the unaffected sister compared to the non-periodontitis affected subjects. The proband also showed enhanced neutrophil chemotaxis; a high percentage of pan-B cells; and high productivity of IL-6, IgG, and IgM compared to individuals who were not periodontally affected. The mother showed slightly low helper/induced T cells (Th/i) suppressor/cytotoxic T cells (Ts/c) ratios due to the elevated count of Ts/c, and high IFN-gamma productivity compared to control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

A review of localized juvenile periodontitis (LJP): II. Clinical trials and treatment guidelines.

Localized juvenile periodontitis (LJP) causes severe alveolar bone loss and early tooth loss in adolescents and young adults. If it is not appropriately treated as an infection in association with Actinobacillus actinomycetemcomitans, treatment failure is likely. This review of clinical trials of treatment of LJP uses those trials to construct guidelines for LJP treatment.

Actinobacillus Infections↗