Prepubertal periodontitis: a recently defined clinical entity.

A classification for advanced alveolar bone loss in children and adolescents is presented for the purpose of clarifying the oftentimes confusing terminology that presently exists. Page’s definiton of prepubertal periodontitis is advocated, and a representative case is presented. The classic definition of periodontosis is "a disease of the periodontium occurring in an otherwise healthy adolescent, which is characterized by a rapid loss of alveolar bone about more than 1 tooth of the permanent dentition. The amount of destruction manifested is not commensurate with the amount of local irritants present. ’’1 The rate of destruction is 34 times the rate of progression of adult periodontitis. One form affects the first permanent molars and incisors, and a more generalized form may affect most of the permanent dentition. Most of the dental community now refers to periodontosis as juvenile periodontitis (JP). Page2 recently has established specific diagnostic criteria to distinguish true periodontosis (juvenile periodontitis), as defined by Baer1, from periodontosis of the primary dentition in young children, which he terms prepubertal periodontitis (PP). According to Page, PP occurs in localized and generalized forms. The onset of PP is during or immediately after eruption of the primary teeth. The prevalence is unknown, but probably rare, and there is a possibility of a genetic basis for some types of the disease. PP may be followed by severe periodontitis of the permanent teeth or by a normal permanent dentition. In the localized form of PP, some but usually not all of the primary teeth are affected. The onset of the disease occurs around--or even before--the age of 4 years. The gingival tissue manifests only minor inflammation, if any, and microbial plaque is minimal. Alveolar bone destruction proceeds more rapidly than in adult periodontitis or chronic periodontitis in teenagers. Otitis media is not a frequent finding, and usually there is no history of frequent infections. Functional defects are present in either neutrophils or monocytes, but not both. The disease is amenable to treatment by curettage, antibiotic therapy, and improved toothbrushing. The hallmarks of generalized PP include a fiery red, acute inflammation pervading the marginal and attached gingiva around all the teeth, gingival proliferation, cleft formation, and recession. Onset is at the time of or soon after tooth eruption. Alveolar bone destruction sometimes is accompanied by destruction of the tooth roots and proceeds at an alarming rate. The primary teeth may be lost by age 2-3 years. The affected children suffer from otitis media and recurrent, sometimes life-threatening, infections. This form of the disease seems to be refractory to antibiotic therapy. Both neutrophils and monocytes are profoundly abnormal in this form of the disease, and the peripheral blood white cell count is elevated markedly. Traditional definitions of periodontosis or juvenile periodontitis exclude involvement of the primary dentition. A few cases of significant alveolar bone loss affecting the primary dentition of apparently healthy children have been reported in the dental literature under such designations as juvenile periodontitis 3, juvenile periodontosis 4, Pleasants’ disease s, periodontosis of the primary dentition 6, and advanced alveolar bone loss in the primary dentition.: Boraz8 recently reported a case as PP, but used the term interchangeably with JP. The relationship between JP and PP is not understood at the present time. Spektor9 reported on a very large family (13 living children) whose mother had rapidly progressive periodontitis. Five of the children had JP and 2 had PP, indicating a very close PEDIATRIC DENTISTRY: September 1986/Vol. 8 No. 3 235 FIG 1. Representative area showing slightly edematous nature of the gingival tissues. relationship between these diseases and possibly a common underlying mechanism. JP was not always preceded by PP, although 1 sister with PP did go on to manifest JP at age 15. In her case the alveolar bone around the primary molars had been destroyed, but it regenerated as the permanent premolars erupted. The idea that JP has its onset during the circumpubertal period is supported by the fact that 7 of the postpubertal family members had periodontitis, while only 2 of 6 prepubertal children manifested the disease.