Clinical and Microbiological Evaluation of Therapy for Juvenile Periodontitis

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Abstract
Eight patients (mean age 15.6 yr) with severe molar-incisor bone loss and pocket formation characteristic of juvenile periodonitis 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 microbiologic examinations were scheduled at baseline, at 1-2 mo. after Stage 1, at 1-2 mo. 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 mo. 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, 7 of 8 sites showed suppuration and deepest pocket depths averaged 8.0 mm. STB were detected in 1 and BPB in 4 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. Microbiological diagnosis may evidently be useful in selecting and monitoring treatment for juvenile periodontitis.