tetracycline and Aggressive-Periodontitis

Patients with aggressive periodontitis can be both rewarding and frustrating to treat in clinical practice. Interindividual variation in response to therapy can be widespread, and we do not clearly understand the reasons for this variable response. It is possible that new research into the resolution of inflammation may reveal basic differences between patients with chronic periodontitis and those with aggressive disease. In addition, future research involving modulation of host inflammatory responses may clarify the reasons for the differences in clinical outcomes between patients. We think it likely that this research could result in further alterations to the classification of periodontal diseases, as with more knowledge of the mechanisms of disease it is possible that patients currently classified as having aggressive periodontitis may be found not to represent a single diagnostic entity. Better understanding of the true nature of patients currently identified as having aggressive periodontitis may therefore lead to more effective treatment approaches.

Topics: Aggressive Periodontitis; Anti-Infective Agents, Local; Chronic Periodontitis; Debridement; Dental Scaling; Guided Tissue Regeneration, Periodontal; Humans; Tetracycline; Treatment Outcome

The purpose of this review is to provide the clinician with some practical rationale for the selection and use of antibiotics in the treatment of destructive periodontal diseases. We have attempted to integrate approximately 20 years of periodontal literature describing antibiotic therapy with personal experience and 21st century ideas. This article addresses antibiotic use during treatment of aggressive periodontitis with emphasis on juvenile disease and adult refractory diseases. The literature review revealed few large, controlled studies that compared efficacy of adjunctive antibiotic use to mechanical therapy alone. Even fewer studies evaluated the efficacy of one antibiotic relative to another. However, based on the evidence available, certain conclusions were drawn. Adjunctive use of an antibiotic along with mechanical debridement is recommended for the treatment of Actinobacillus actinomycetemcomitans-associated periodontitis as an acceptable therapeutic regimen. Due to the emergence of tetracycline-resistant A. actinomycetemcomitans, the combination of metronidazole and amoxicillin may be preferable. In aggressive refractory periodontitis, compelling evidence exists that the use of an appropriate adjunctive antibiotic frequently gives a more favorable clinical response than mechanical therapy alone. Unfortunately, the selection of antibiotic is not as clear and is probably case-dependent. Positive responses have been reported with amoxicillin/clavulanic acid, clindamycin, metronidazole, and the combination therapy metronidazole plus amoxicillin. The introduction of local delivery antibiotics specifically for the treatment of periodontitis offers a novel concept for the treatment of localized disease. The latter, in particular, may prove useful in the treatment of recurrent disease activity or where only a few individual sites are involved.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Amoxicillin; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Child; Clavulanic Acid; Dental Scaling; Drug Delivery Systems; Drug Therapy, Combination; Gram-Negative Anaerobic Bacteria; Humans; Metronidazole; Periodontitis; Tetracycline

This article discusses the use of tetracyclines in the clinical management of periodontal infections. A review of the drugs pharmacology, pharmacokinetics, and potential adverse effects shows that they are relatively safe if used in appropriate dosages and under controlled conditions. Current data suggest that the routine use of tetracyclines in conjunction with the treatment of periodontitis is unnecessary. However, their distinctive characteristics can be utilized in different delivery systems as an adjunctive aid to conventional treatment of juvenile and refractory forms of periodontitis.

Topics: Adult; Aggressive Periodontitis; Anti-Bacterial Agents; Drug Delivery Systems; Humans; Periodontal Diseases; Periodontitis; Tetracycline; Tetracycline Resistance

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.

Topics: Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Child, Preschool; Denture, Complete; Humans; Male; Papillon-Lefevre Disease; Tetracycline; Tooth Extraction; Tooth Loss

Juvenile periodontitis (JP) and its treatment has become a critical concern to the practicing dentist. Actinobacillus actinomycetemcomitans has been diagnosed as the prime etiological agent associated with this disease. Decreased chemotaxis and phagocytosis of polymorphonuclear leukocytes have also been described in these patients. The precise treatment regimen must be individualized for each patient. In addition to aggressive antibiotic therapy, root planing, curettage or a surgical approach, with mandatory follow-up care, should be considered. This review discusses the etiology and pathogenesis of JP and recommends treatment regimens, according to patient diagnosis.

Topics: Adolescent; Aggressive Periodontitis; Bone Transplantation; Child; Humans; Metronidazole; Penicillins; Surgical Flaps; Tetracycline

This case involves a 14-year-old female patient affected with localized juvenile periodontitis. Treatment consisted of periodontal flap surgery in conjunction with tetracycline therapy. A successful result was obtained and maintained. The case depicts the fact that in many instances localized juvenile periodontitis can be treated with confidence and a high degree of predictability. It should also be noted that, like all treatment modalities, the treatment of this disease as discussed in this case is not the panacea and will undergo considerable changes in the future; however, in light of current knowledge, this combined treatment approach appears to be effective in LJP patients.

Topics: Adolescent; Aggressive Periodontitis; Female; Humans; Periodontal Diseases; Surgical Flaps; Tetracycline

Topics: Actinobacillus; Adolescent; Aggressive Periodontitis; Humans; Neutrophils; Tetracycline

Topics: Aggressive Periodontitis; Anti-Bacterial Agents; Chlorhexidine; Gingivitis; Gingivitis, Necrotizing Ulcerative; Humans; Periodontal Diseases; Periodontitis; Periodontium; Tetracycline

In a comparative evaluation of the effectiveness of two treatment modalities for juvenile periodontitis, 12 patients aged between 15 years and 23 years were recruited into a six months longitudinal study. The split mouth design was used such that one side (upper and lower quadrants) received conservative treatment. Each side was randomly assigned one of the two treatment modalities. Standardized probing attachment level (PAL) measurement and degree of mobility of the teeth were taken at recruitment (baseline), one, three and six months postoperation. Tetracycline capsules 250mg, 6 hourly, was administered for 2 weeks at baseline and at 3 months follow-up. Initial thorough scaling and polishing of the whole mouth was done for all the patients. At follow-up, there were marked improvements seen with both treatment modalities. The mean probing depth for surgical treatment (3.57mm +/- 0.78) was significantly lower than that of conservative treatment (4.11mm +/- 0.74) P < 0.05 at 3 months. Also, this significant difference continued up to 6 months (2.70mm +/- 0.57, 3.55mm +/- 0.65; P < 0.05 ). For the degree of mobility, significant difference was only evident at 6 months of follow-up (0.48 +/- 0.29, 0.98 +/- 0.523; P < 0.05 ) for surgical treatment and conservative treatment respectively. It was therefore concluded that surgical debridement with systemic administration of tetracycline is more effective than the conservative technique in the treatment of juvenile periodontitis, although both gave improvement.

Topics: Adolescent; Adult; Age Factors; Aggressive Periodontitis; Analysis of Variance; Anti-Bacterial Agents; Debridement; Female; Humans; Longitudinal Studies; Male; Periodontal Attachment Loss; Periodontal Index; Random Allocation; Tetracycline; Tooth Mobility

Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP.. After initial therapy and full-mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups. Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD > or =5 mm (SRP + TCF group).. In both treatment groups, PD decreased significantly from BL to week 54 (6.2+/-1.5 mm to 4.7+/-1.4 mm for SRP + TCF and 6.5+/-1.4 mm to 4.2+/-0.6 mm for SRP + AUG). However, there was no statistically significant difference between the 2 groups in pocket reduction. Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0+/-1.8 mm to 11.3+/-1.8 mm for SRP + TCF and 12.3+/-1.5 mm to 11.2+/-1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, both groups showed significant PD reduction and CAL gain (P <0.001) compared to BL. The frequency and percentage of bleeding sites decreased significantly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG).. These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9-month observation period.

Topics: Administration, Oral; Administration, Topical; Adult; Aggressive Periodontitis; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Dental Scaling; Drug Therapy, Combination; Humans; Periodontal Index; Periodontitis; Statistics, Nonparametric; Tetracycline

The aim of the study was to evaluate the adjunctive effect of systemic tetracycline (250 mg qds for 14 days) in sequential root planing and surgical phases of treatment in a randomised, double-blind controlled trial. 38 patients who were under 26 years of age, in good general health and with localised (15 test/15 control) or generalised (4 test/4 control) early onset periodontitis completed the non-surgical phase. Data were analysed by ANOVA using baseline covariates and transformations where appropriate. Improvements in probing depth, probing attachment level and bleeding on probing were significantly better in the group treated with adjunctive tetracycline, at 3 months post-treatment. 26 patients (13 test/13 control) subsequently completed the surgical phase (modified Widman flap surgery with adjunctive tetracycline or placebo as before) and were re-examined at 6 months and 12 months. In the test group, 58% of the originally affected teeth required surgery compared to 75% in the control group. Surgery produced further reductions in mean probing depths but no further gains in probing attachment. There were no further statistically significant differences between test and control groups for any of the clinical measures, although the tetracycline group appeared to maintain an advantage. In conclusion, systemically administered tetracycline is a useful adjunct in the management of early onset periodontitis, particularly in non-surgical treatment.

Topics: Administration, Oral; Adolescent; Adult; Aggressive Periodontitis; Analysis of Variance; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Child; Double-Blind Method; Female; Humans; Male; Root Planing; Subgingival Curettage; Tetracycline

Twenty-six (26) patients, 18 female and 7 male, aged 16 to 25 years (mean age 19.03 +/- 2.2 years) previously diagnosed as suffering from localized juvenile periodontitis were randomly assigned to one of the following treatment groups: 9 patients acted as controls; 8 received subgingival chlorexidine gel; and 9 had subgingival tetracycline paste application. All treatment modalities resulted in a pronounced improvement in PI, GI, and GI-S by 12 weeks (P < 0.001). The mean probing depths also decreased, but there were no significant differences found between the three groups. However, when the interproximal sites of the 3 groups were examined separately from the buccal and lingual sites, it was found that there was a significant (P < 0.05) difference between the probing depths, with the control group showing the greatest reduction of 2.58 mm and the chlorhexidine group showing the least reduction of 1.37 mm. It was concluded that a single application of topical subgingival tetracycline did not result in any short-term improvement over that achieved by standard non-surgical therapy in the clinical parameters of these localized juvenile periodontitis patients.

Topics: Administration, Topical; Adolescent; Adult; Aggressive Periodontitis; Chlorhexidine; Female; Humans; Male; Periodontal Index; Single-Blind Method; Tetracycline; Treatment Outcome

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)

Topics: Actinobacillus Infections; Adolescent; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Chi-Square Distribution; Colony Count, Microbial; Female; Humans; Male; Periodontal Index; Periodontal Pocket; Tetracycline

Systemic metronidazole and tetracycline were compared as adjunctive agents in the treatment of localized juvenile periodontitis (LJP). 27 patients with Actinobacillus actinomycetemcomitans-positive (Aa) LJP were treated with scaling and rootplaning, control of oral hygiene and periodontal surgery if indicated. The patients were randomly divided into 3 equal groups: the 1st group had metronidazole 200 mg x 3 x 10 days, the 2nd tetracycline 250 mg x 4 x 12 days, the 3rd group received no medication and served as a control. 6 patients had periodontal surgery. 4 sites with the most advanced bone loss as determined on radiographs were selected in each subject for test sites. Gingival index, gingival bleeding after probing (GB), probing depth (PD), suppuration, and radiographic bone loss were registered, and subgingival Aa was selectively cultured. GB and PD > or = 4 mm were registered in the whole dentition as well. All parameters were monitored at baseline and at 6 and 18 months after treatment. By the end of the study, Aa was suppressed to below detection level at all test sites only in the metronidazole group, at 17/26 sites (4 patients) in the tetracycline group and at 19/26 sites (6 patients) in the control group. Clinically, all groups showed improvement. In conclusion, metronidazole was more effective than tetracycline in the suppression of Aa and the suppression of Aa appeared to produce better clinical results.

Topics: Adolescent; Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Alveolar Bone Loss; Dental Plaque; Female; Gingival Hemorrhage; Humans; Male; Metronidazole; Periodontal Index; Periodontal Pocket; Radiography; Tetracycline

Ten patients with bilateral, posterior osseous defects associated with localized juvenile periodontitis (LJP) completed the study. Following the initial therapy, osseous defects were surgically debrided and grafted with a 4:1 volume ratio combination of either Synthograft/tetracycline (b-TCP/TTC), Periograf/tetracycline (HA/TTC) or freeze-dried bone allograft/tetracycline (FDBA/TTC). Graft materials were selected randomly for each half mouth following defect debridement, with a different material used on the opposite side for that patient. Immediately following each surgery, patients were placed on doxycycline 100 mg/day for 10 days. Direct re-entry evaluation of 51 osseous defects demonstrated no significant differences among the graft materials regarding hard tissue or soft tissue changes, except for greater percent defect fill for HA/TTC compared to b-TCP/TTC. Significant decreases in defect depth and pocket depth were achieved with each graft material. No adverse reactions to the use of any of the graft materials in combination with local and systemic tetracycline were found. The results indicate all three graft materials used in conjunction with TTC are acceptable and beneficial for the treatment and repair of osseous defects associated with localized juvenile periodontitis.

Topics: Adolescent; Adult; Aggressive Periodontitis; Alveolar Process; Alveoloplasty; Biocompatible Materials; Bone Transplantation; Calcium Phosphates; Ceramics; Durapatite; Female; Gingiva; Humans; Hydroxyapatites; Male; Periodontal Diseases; Periodontal Pocket; Prostheses and Implants; Surgical Flaps; Tetracycline

Sixteen patients diagnosed as having juvenile periodontitis were randomly placed into one of two treatment groups. Group I received local and systemic tetracycline (TTC), while Group II received no antibiotics. Osseous defects were grafted with allogeneic freeze-dried bone (FDBA) mixed with TTC powder (Group Ia) or FDBA alone (Group IIa). Contralateral defects were debrided only in both Groups (Ib and IIb). Direct reentry evaluation of 104 measurement sites demonstrated significantly greater bone fill (mean = 2.8 mm) and resolution of osseous defects (mean = 72.7%) in the TTC/FDBA-treated group (Ia) as compared to the TTC plus debridement only (Ib) or no TTC-treated groups (IIa and IIb). The results of this study indicate that of the modes of treatment investigated, the combination of local and systemic tetracycline coupled with freeze-dried bone allografts was the treatment of choice for defects associated with juvenile periodontitis.

Topics: Adolescent; Adult; Aggressive Periodontitis; Alveolar Process; Bone Transplantation; Debridement; Drug Implants; Female; Freeze Drying; Humans; Male; Periodontal Diseases; Random Allocation; Tetracycline

Individuals with Down syndrome (DS) are susceptible to severe periodontal disease, due to immune alterations related to functional defects of polymorphonuclear leukocytes and monocytes. The adjunctive use of locally delivered antimicrobials has been proven to be beneficial, especially in areas where mechanical therapy might fail. This article describes the management of a patient with DS who had aggressive periodontitis. The treatment used a local drug delivery system with tetracycline fibers as an adjunct to scaling and root planing.

Topics: Adult; Aggressive Periodontitis; Alveolar Bone Loss; Anti-Bacterial Agents; Collagen; Combined Modality Therapy; Dental Plaque Index; Dental Scaling; Down Syndrome; Drug Carriers; Drug Delivery Systems; Female; Follow-Up Studies; Furcation Defects; Humans; Periodontal Attachment Loss; Periodontal Index; Periodontal Pocket; Root Planing; Tetracycline; Tooth Mobility

Root resorption is reported as a microscopic finding in trials attempting to regenerate the periodontium using tetracycline or citric acid root conditioning. This report deals with a case of progressive cervical root resorption in a female patient who had been successfully treated by tetracycline root conditioning. The article emphasizes the possibility of this adverse effect, and discusses a possible mechanism inducing this phenomenon.

Topics: Adult; Aggressive Periodontitis; Alveolar Bone Loss; Anti-Bacterial Agents; Decalcification Technique; Female; Humans; Periodontal Attachment Loss; Root Resorption; Tetracycline

A 17-year-old male patient with localized juvenile periodontitis was treated by subgingival instrumentation with full thickness flap on the lower molars, combined with a 3-week course of systemic tetracycline, and a programme of supervised oral hygiene. The treatment was rapidly followed by dramatic clinical and microbiological improvement. However, despite good oral hygiene, gingival inflammation recurred at regular intervals. It was necessary to maintain the clinical results by periodic subgingival instrumentation with an ultrasonic scaler. Healing of alveolar bone was monitored in the lower 1st molar regions over 3 years by using superimposable radiographs. Quantitative analysis of bone density performed with a high-resolution digitalisation technique showed a considerable improvement 1 year after therapy. However, continuous remodelling, probably related to variations in inflammation, occurred during the 3 postoperative years.

Topics: Adolescent; Aggressive Periodontitis; Alveolar Process; Anti-Bacterial Agents; Bone Density; Bone Remodeling; Combined Modality Therapy; Follow-Up Studies; Gingivitis; Humans; Male; Oral Hygiene; Radiographic Image Enhancement; Recurrence; Subgingival Curettage; Surgical Flaps; Tetracycline; Ultrasonic Therapy

Mammalian interstitial collagenases (E.C.3.4.24.7) are considered as key initiators of collagen degradation in periodontal diseases. However, the cellular sources of collagenases present in gingival crevicular fluid have not been completely clarified. Resident fibroblasts and epithelial cells as well as infiltrating neutrophils and monocyte/macrophages are potential sources of the enzymes. We have recently found significant differences in tetracycline inhibition between human neutrophil and fibroblast interstitial collagenases. To address the cellular source of collagenase present in gingival crevicular fluid in 2 distinct periodontal diseases, we studied the tetracycline inhibition of collagenase in gingival crevicular fluid of patients with localized juvenile periodontitis and adult periodontitis. Gingival crevicular fluid samples were collected from deep (greater than 5 mm) periodontal pockets and assayed for collagenase in the presence of 0-1000 microM doxycycline as well as a chemically modified tetracycline devoid of antimicrobial activity (4-de-dimethylaminotetracycline). The drug concentration required to inhibit 50% of collagenase activity (IC50) in localized juvenile periodontitis gingival crevicular fluid was 280 microM for doxycycline and 470 microM for 4-de-dimethylaminotetracycline. Significantly lower values, 10-20 microM, were obtained for collagenase in gingival crevicular fluid of patients with adult periodontitis. We propose that systemic tetracycline levels are efficient inhibitors of collagenase in gingival crevicular fluid in affected sites of patients with adult periodontitis but not of patients with localized juvenile periodontitis and that the fibroblast type interstitial collagenase is the predominant collagenase type in gingival crevicular fluid in affected sites of patients with localized juvenile periodontitis and the neutrophil collagenase in adult periodontitis gingival crevicular fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aggressive Periodontitis; Child; Fibroblasts; Gingival Crevicular Fluid; Humans; Matrix Metalloproteinase 1; Microbial Collagenase; Neutrophils; Periodontitis; Tetracycline

Topics: Aggressive Periodontitis; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Middle Aged; Periodontal Pocket; Tetracycline

Our previous studies have demonstrated that early-identified lesions of localized juvenile periodontitis (LJP) can be treated by the use of systemically administered tetracycline alone (1 gm/day for 6 weeks). This therapy results in arrest of disease progression, decreased pocket depths, gains in clinical attachment, and significant repair of alveolar defects. This paper reports on the long-term clinical and radiographic improvement in 4 subjects followed for 1 to 4 years after the completion of tetracycline therapy. Four patients (mean age 14 years) were examined 1 to 4 years following the completion of a single 6 week course of tetracycline. Mean pocket depth was reduced from the initial level of 7.1 mm to 3.6 mm. Mean attachment loss was reduced from 3.8 mm to 0.9 mm and angular bone defects had filled by an average of 72%. Pocket depths and attachment loss continued to decrease during the entire study period, while alveolar bone repair continued to increase. The findings support those of our previous investigation and confirm that: 1) early identified lesions of LJP can be effectively treated with 6 weeks of tetracycline therapy alone; 2) decreases in pocket depth, gains in clinical attachment, and repair of alveolar defects remain stable up to 4 years following antibiotic therapy; 3) clinical and radiographic improvement continues over time and may lead to complete resolution of some lesions; and 4) the reparative/regenerative potential of the periodontium in early onset disease in young individuals may exceed that observed in chronic adult periodontitis.

Topics: Adolescent; Aggressive Periodontitis; Alveolar Bone Loss; Alveolar Process; Dental Prophylaxis; Epithelial Attachment; Follow-Up Studies; Humans; Male; Periodontal Pocket; Tetracycline; Time Factors; Wound Healing

Topics: Adolescent; Aggressive Periodontitis; Denture Design; Female; Humans; Malocclusion; Orthodontic Appliances, Removable; Orthodontics, Corrective; Tetracycline

Topics: Actinobacillus; Adult; Aggressive Periodontitis; Bacteroides; Humans; Male; Tetracycline

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.

Topics: Aggressive Periodontitis; Child; Dental Scaling; Female; Gingivitis; Humans; Molar, Third; Periodontal Pocket; Tetracycline; Tooth Germ; Tooth Loss; Wound Healing

The bacterium Actinobacillus actinomycetemcomitans is found in large numbers in subgingival plaque and gingival tissues of patients with LJP and PLS. This bacterium too has been found to cause infective bacterial endocarditis in patients at risk. Antibiotic prophylaxis is necessary for at risk patients with LJP and PLS because significant bacteraemia is produced during extensive periodontal instrumentation, extractions and surgery which are required in managing these cases. The current antibiotic regimens recommended by the American Heart Association/Council on Dental Therapeutics are not effective against this bacterium. A two-stage prophylactic approach is advocated, first with tetracycline for two weeks to eliminate the Actinobacillus actinomycetemcomitans, followed by the regimens recommended by the American Heart Association on the day of the dental procedure itself. Tetracycline should not be used concurrently or as a substitute for the recommended regimens by the American Heart Association/Council on Dental Therapeutics.

Topics: Actinobacillus Infections; Aggressive Periodontitis; Endocarditis, Bacterial; Humans; Keratoderma, Palmoplantar; Papillon-Lefevre Disease; Periodontal Diseases; Tetracycline

Tetracycline therapy, when used in conjunction with surgery or root planing, has been shown to be effective in controlling the progression of juvenile periodontitis. However, the ability of tetracycline alone to control the disease has not been assessed. The present study evaluated the effects of tetracycline therapy, with supragingival plaque control, on clinical attachment levels and radiographic bone height in patients with clinical and radiographic evidence of juvenile periodontitis. The four patients (mean age 15.2 +/- 0.3 yrs) each demonstrated loss of attachment of greater than or equal to 2 mm at one or more probing sites and had accompanying radiographic evidence of early localized bone loss. Following an initial clinical evaluation consisting of pocket depths, attachment levels and standardized radiographs, the patients received systemic tetracycline therapy (1 gm/day for three to six weeks) and oral hygiene instruction. At the completion of antibiotic therapy, patients received a supragingival professional prophylaxis every two weeks for three months, whereupon the initial evaluation was repeated. On comparing the initial and three-month clinical and radiographic data, there were significant decreases in clinical and radiographic measurements. For a total of 85 affected probing sites around 26 teeth, 79% decreased in pocket depth by greater than or equal to 2 mm (with no sites increasing in pocket depth) and 69% gained clinical attachment (with only one site losing attachment of 1 mm). Radiographic measurements revealed an increase in both the height and area of coronal alveolar bone. The findings indicated that six weeks of systemic tetracycline therapy combined with supragingival plaque control was effective in the initial control of early juvenile periodontitis.

Topics: Adolescent; Aggressive Periodontitis; Alveolar Process; Bone Resorption; Dental Prophylaxis; Humans; Periodontal Diseases; Periodontal Pocket; Radiography; Tetracycline

Three treatment regimens including local tetracycline delivery, systemic doxycycline and surgery plus systemic doxycycline were investigated in a localized juvenile periodontitis (LJP) population. Of the investigated treatments only surgery plus systemic doxycycline for 14 days was effective in eliminating or suppressing Actinobacillus actinomycetemcomitans, an organism strongly associated with LJP lesions. While surgery plus antibiotics was the superior treatment, it appears that the possibility of reinfection or incomplete elimination of the organism exists. Careful long-term follow-up, including clinical and microbiological monitoring, is highly recommended in this periodontal population.

Topics: Actinobacillus; Administration, Topical; Adolescent; Aggressive Periodontitis; Doxycycline; Female; Humans; Male; Periodontal Diseases; Periodontal Pocket; Staining and Labeling; Surgical Flaps; Tetracycline

The correction of malocclusions in juvenile periodontitis (JP) patients completing periodontal therapy is a problem of increasing clinical concern to orthodontists, since many teeth with severe alveolar bone loss in these patients can now be successfully treated without extraction. In this report, fixed edgewise orthodontic therapy was carried out after the completion of periodontal therapy on four JP patients. The orthodontic therapy included extensive intrusion of teeth severely affected by JP. Phase-contrast microscopic analysis of subgingival plaque from orthodontically treated teeth was used to monitor longitudinally the effects of fixed orthodontic bands on the subgingival flora and also to monitor the efficacy of topical and systemic antimicrobial therapy aimed at suppression of suspected periodontopathic bacteria. Orthodontic movement was completed on most periodontally compromised teeth without significant evidence of additional deterioration in periodontal status. However, within the first 6 months of orthodontic band placement, all patients had significant increases in the number of spirochetes and motile rods in their subgingival flora. Three of the patients also developed high levels of crevicular polymorphonuclear leukocytes around orthodontically treated teeth, indicating significant subgingival inflammation. Intensive antimicrobial measures, including topical inorganic salt applications and systemic tetracycline, were helpful in limiting clinical inflammation and subgingival colonization by periodontopathogens during orthodontic therapy. The results demonstrate that successful orthodontic repositioning can be carried out in treated JP patients. In addition, bacteriologic monitoring and chemotherapeutic suppression of periodontal pathogens may be valuable in the prevention of further destructive periodontal disease activity in periodontitis patients undergoing orthodontic therapy.

Topics: Adolescent; Adult; Aggressive Periodontitis; Bacteria; Bicarbonates; Dental Plaque; Female; Humans; Hydrogen Peroxide; Male; Malocclusion; Microscopy, Phase-Contrast; Neutrophils; Orthodontic Appliances; Periodontal Diseases; Sodium; Sodium Bicarbonate; Spirochaetales; Tetracycline; Tooth Movement Techniques

Topics: Adolescent; Adult; Aggressive Periodontitis; Bacteria; Bicarbonates; Child; Female; Humans; Hydrogen Peroxide; Male; Periodontal Diseases; Sodium; Sodium Bicarbonate; Sodium Chloride; Tetracycline

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.

Topics: Actinobacillus; Adolescent; Adult; Aggressive Periodontitis; Alveoloplasty; Bacteria; Bacteroides; Child; Combined Modality Therapy; Dental Scaling; Female; Gingival Hemorrhage; Humans; Male; Periodontal Diseases; Suppuration; Tetracycline; Tooth Root

The present investigation was performed to study the effect on localized juvenile periodontitis (LJP) of a treatment program which included tetracycline administration, surgical elimination of inflamed tissues, scaling and root planing, and careful plaque control during healing. Treatment of LJP lesions was carried out on 16 individuals aged 14 to 18 years (JP group). Lesions in first molars and incisors in a group of patients with adult periodontal disease (AP) were treated in an identical manner and served as controls. The presence of angular bony defects adjacent to first molars and incisors was first documented in all patients. Thereafter, a clinical examination was carried out, including assessments of oral hygiene status, gingival conditions, probing depths and attachment levels. The patients were subjected to a treatment program involving administration of tetracycline (250 mg 4 times per day for 2 weeks), removal of granulation tissue after flap elevation, and root curettage. After surgery, the patients were instructed to rinse the mouth with 0.2% chlorhexidine for 2 min twice a day during the first 2 postsurgical weeks. Professional tooth cleaning was carried out once every 3 months during a 5-year period. At 6, 12, 24 and 60 months after surgical treatment, the patients were re-examined regarding oral hygiene, gingival conditions, probing depths and attachment levels. Treatment of LJP lesions resulted in resolution of gingival inflammation, gain of clinical attachment, and refill of bone in angular bony defects. The healing of the lesions of this patient sample was similar to healing observed in patients with AP.

Topics: Adolescent; Adult; Aggressive Periodontitis; Dental Plaque; Dental Prophylaxis; Dental Scaling; Evaluation Studies as Topic; Follow-Up Studies; Humans; Middle Aged; Oral Hygiene; Periodontal Diseases; Periodontal Index; Tetracycline; Tooth Root

Four patients, ages 14-17, who demonstrated characteristics of juvenile periodontitis, underwent antibiotic and surgical therapy to control microbial etiologic factors. No occlusal equilibration or bone grafting techniques were employed. Subsequent to treatment, all four patients demonstrated decreased pocket depths and mobility on teeth associated with vertical osseous defects. Osseous repair was evident on postoperative radiographs. Reentry procedures, on one patient, confirmed that osseous repair had occurred in 2- to 3-wall, 3-wall, hemi-circumferential and furcal defects. If infection and inflammation are controlled, it appears that the potential for osseous repair in juvenile periodontitis patients is greater than has been thought.

Topics: Adolescent; Aggressive Periodontitis; Combined Modality Therapy; Humans; Male; Oral Hygiene; Patient Compliance; Periodontal Diseases; Surgical Flaps; Tetracycline

Since recent studies have implicated Actinobacillus actinomycetemcomitans in the etiology of localized juvenile periodontitis, this investigation determined the effectiveness of subgingival debridement, topical Betadine Solution, and systemic tetracycline in suppressing subgingival A. actinomycetemcomitans and other microorganisms. A total of 20 deep periodontal pockets and 10 normal periodontal sites of 6 localized juvenile periodontitis patients was included in the study. Each patient was treated in 3 stages over a period of 22 weeks, and the result of treatment was monitored for an additional 38 weeks. The first stage of treatment included plaque control, as well as thorough scaling and root planing, composed of at least 6 h of debridement. No concomitant periodontal surgery was performed. In the second stage, Betadine saturated cotton gauze was inserted into the periodontal pockets for 10 min. Stage 3 involved systemic tetracycline therapy (1 g/day) for 14 days. The subgingival microflora was determined at frequent intervals by selective culturing of A. actinomycetemcomitans and Capnocytophaga and by direct microscopic examination. The clinical effect was assessed by measuring changes in probing periodontal attachment level, probing periodontal pocket depth, radiographic alveolar bone mass, and other relevant clinical parameters. Scaling and root planing reduced the total subgingival bacterial counts and the proportions of certain Gram-negative bacteria, but no periodontal pocket became free of A. actinomycetemcomitans. Betadine application had little or no effect on the subgingival microflora. In contrast, tetracycline administered via the systemic route suppressed A. actinomycetemcomitans, Capnocytophaga, and spirochetes to low or undetectable levels in all test periodontal pockets. A. actinomycetemcomitans reappeared in 9 of the deep periodontal pockets after the administration of tetracycline. Most of these 9 pockets became free of detectable A. actinomycetemcomitans during the second week of tetracycline administration, whereas pockets which yielded no A. actinomycetemcomitans after tetracycline therapy became free of the organisms during the first week of tetracycline treatment. This data suggests that systemic tetracycline therapy of localized juvenile periodontitis should, as a practical rule, be continued for 3 weeks. Periodontal destruction continued in 4 deep pockets which all showed high posttetracycline A. actinomycetemcomitans counts. Al

Topics: Actinobacillus; Adolescent; Aggressive Periodontitis; Bacteria; Female; Humans; Iodine; Male; Periodontal Diseases; Povidone-Iodine; Subgingival Curettage; Tetracycline