Advanced periodontitis in the primary dentition: case report.

Juvenile periodontitis (periodontosis) is observed early puberty with the initial manifestation of rapid bone loss around permanent first molars and incisors. Periodontitis in the primary dentition is rare. The relationship between periodontitis in the primary dentition and the manifestation in the permanent dentition is not known. This report describes a case of advanced periodontitis in the primary dentition and its treatment. Juvenile periodontitis (periodontosis) first was described by Gottlieb ~ in 1920 as a noninflammatory degenerative disease of the supporting tissues with diffuse atrophy of the alveolar bone. In 1942 Orban and Weinmann2 renamed the condition periodontosis. A recently proposed definition of periodontosis is a disease of the periodontium occurring in an otherwise apparently healthy adolescent characterized by a rapid loss of alveolar bone around more than one tooth. 3 More recently, this form of periodontitis has become known as juvenile periodontitis (JP) and is no longer considered a degenerative disease but a bacterial-related inflammatory disease. 4 Periodontitis in the primary dentition was considered rare if it occurred at all. Page et al. reported 4 different forms of periodontitis: prepubertal, juvenile, rapidly progressive, and adult; however, no clinical case was reported in the primary dentition, s Several authors have reported idiopathic bone loss in the primary dentition. 6-~ Since the etiology of the disease is unknown and the reported cases are so few, the treatment of periodontitis in the primary dentition is not well documented. Recently, Cogen et al. reported 5 cases of advanced alveolar bone resorption in the primary dentition of healthy black children; they concluded that rapidly destructive periodontitis could affect the primary as well as the permanent dentition. ~2 Periodontitis in the permanent dentition is characterized by healthy-appearing gingiva in the early stages of the disease. The diagnosis usually is made radiographically on the basis of large vertical osseous defects initially confined to the regions of the first molars and incisors. ~3 In the primary dentition, however, there may be inflamed and swollen gingiva and accumulations of gross subgingival plaque and calculus. 1° A radiographic examination reveals advanced alveolar bone loss around the interproximal areas of the primary molars. In advanced cases, the bifurcation and periapical areas also may be involved. While the etiology of jP is still unknown, there is a report indicating a familial tendency. 14 Recent studies also have implicated specific microorganisms, immunological deficiencies, and polymorphonuclear leukocyte dysfunction. Newman and Socransky 15 initially reported an association between JP and certain capnophilic gram-negative, fusiform, and surfacetranslocating microorganisms. These microorganisms later were classified as the new genus Capnocytophaga.16 In addition to Capnocytophaga, a gram-negative, anaerobic rod also was found to be associated with JP. This microorganism recently has been identiffed as Haemophilus actinomycetemcomitans (Ha) (formerly Actinobacillus). ~7 In contrast to Capnocytophaga, which may be cultured from individuals without periodontal disease, Ha appears to be associated primarily with rapidly progressing alveolar bone loss in young individuals. Of particular interest regarding the pathogenic potential of Ha strains is that the leukotoxin isolated from these strains conceivably could affect the normal function of polymorphonuclear leukocytes in individPEDIATRIC DENTISTRY: December 1985/Vol. 7 No. 4 255 uals with JP. Other studies have shown that in patients with JP there is a significant decrease in the function of polymorphonuclear leukocytes. Possibly the development of JP requires both neutrophil dysfunction and a specific bacterial flora. Apart from the laboratory findings, Down's syndrome, Papillon-Lefevre syndrome, cyclic neutropenia, agranulocytosis, and Chediak-Higashi syndrome also have been associated with bone loss."