Juvenile periodontitis – pattern of progression and relationship to clinical periodontal parameters

Abstract – The present investigation was carried out 1) to identify subjects with juvenile periodontitis (JP) in a group of schoolchildren from a community with a high prevalence of periodontal diseases and with no access to preventive dental care, and 2) to study the clinical features of the disease and the progression pattern during a period of 1 yr, and the relationship of JP to clinical periodontal parameters. The periodontal condition of a group of 502 Iraqi schoolchildren (260 girls and 242 boys) was assessed radiographically and clinically at baseline. Children showing 3 mm arc-shaped angular radiographic bone loss at the proximal surfaces of two or more first molars and who showed clinical attachment loss at the same sites were regarded as JP patients. A second group of children with no signs of JP were randomly chosen from the study material. One year later, the JP and the non-JP groups were re-examined radiographically and clinically to assess plaque, gingivitis and presence of calculus. The results showed that nine children (1.8%) had JP. The ratio of girls to boys was 3.5:1, and of localized to generalized forms 2:1. Mesial surfaces of first molars were more often affected than distal surfaces. Clinical assessments showed a more profound loss than was depicted radiographically. All JP patients exhibited evidence of periodontal disease progression during the following year. There were no differences between JP and non-JP children with respect to gingival inflammation, dental plaque, or calculus deposits on teeth. It was concluded that the present findings are consistent with the view that plaque and plaque-retaining factors may predispose to the high rate of periodontal support loss usually seen in JP patients.     

Prevalence of juvenile periodontitis in Chile

The aim of this survey was to study the prevalence of juvenile periodontitis in schoolchildren aged 15-19 years in Santiago, Chile. A random sample of 2500 schoolchildren (1318 male, 1182 female) that represented the full range of different socio-economic strata and ethnic groups seen in the population of Santiago, was used. Initially, the children were screened clinically at school by assessment of probing depths around the incisors and first molars with a WHO 621 pattern probe. Children with 2 or more teeth with 5.5 mm or deeper pockets were invited for a radiographic examination comprising bitewing radiographs of molars, and periapical radiographs of incisors. Any subject with 2 mm or more alveolar bone loss was invited for a full clinical and radiographic examination. After screening, 27 subjects had a tentative diagnosis of juvenile periodontitis. 4 of these refused radiographic examination and only accepted a thorough clinical examination. 23 subjects presented themselves for the radiographic and complete clinical examination. Of the 27 subjects selected for detailed examination, 8 subjects (7 female, and 1 male) were diagnosed as having juvenile periodontitis. There was an overall prevalence of juvenile periodontitis of 0.32% with 95% confidence, which gives a range of +/- 0.10%. When prevalence was assessed by socio-economic status, juvenile periodontitis was found more commonly in low socio-economic group. The results of the current study suggest that in Chile, there might be a relationship between socio-economic status and prevalence of juvenile periodontitis, and that this disease is more frequent in women.     

No female preponderance in juvenile periodontitis after correction for ascertainment bias.

Juvenile periodontitis (JP) is generally recognized to exist in 2 clinical forms: localized and generalized. Historically, females have been reported to be affected by both forms of JP at rates of 2 to 10 times greater than males. However, evidence suggests that females are more likely than males to seek dental care. If this is true, females will be diagnosed with JP more often than males even if juvenile periodontitis is equally prevalent among males and females in the general population. Thus, previous reports of a female predominance for JP may simply reflect this selection bias. The purpose of this study was to test our hypothesis that juvenile periodontitis occurs with equal frequency in males and females after correcting for selection bias. Twenty-four juvenile periodontitis probands were ascertained from the VCU/MCV dental clinics. The families of these individuals were examined to determine the relative prevalence of JP among male and female relatives of these probands. Our results indicate that while females are 3 times more likely than males to be initially ascertained as juvenile periodontitis probands, among relatives of probands the proportion of affected males and females is equal.     

Destructive forms of periodontal disease in adolescents. A 3-year longitudinal study

We studied the periodontal disease progression and the relationship between some forms of destructive periodontitis in a group of Brazilian adolescents with high prevalence of periodontal destruction, and evaluated the adequacy of reducing data by limiting the measurement of disease to first molars and by aggregating and pooling site-scores into subject-level scores. Over a period of 3 years 222 adolescents were examined annually by bite-wing radiographs. Individuals displaying arc-shaped bone lesions adjacent to greater than or equal to 2 first molars were diagnosed as juvenile periodontitis (JP) patients, while those with greater than or equal to 1 first molars showing vertical lesions were regarded as periodontal risk subjects. Teenagers with greater than or equal to 2 first molars exhibiting longitudinal bone loss were defined as high-risk patients. At the ages of 13 and 16 years, 3 (1.3%) and 4 (1.8%) subjects had JP, while 12 (5.4%) and 28 (12.6%) were regarded as periodontal risks; 8 (3.6%) subjects were assigned to the high-risk group; 4 (1.8%) 13-year olds had greater than or equal to 1 first molars missing; hence, no loss of posterior teeth occurred over a period of 3 years. Analyzing the data at the site-level revealed progressive loss and little fluctuation in the alveolar bone height in the high-risk group, and a more pronounced bone loss at the mesial than at the distal surfaces. Simpler data sets were constructed by aggregating some of the site-scores or by pooling these into subject-level scores.(ABSTRACT TRUNCATED AT 250 WORDS)     

Space conditions and prevalence of anterior spacing and crowding among nine-year-old schoolchildren

OBJECTIVE: To give detailed insight into the space conditions and prevalence of spacing and crowding in schoolchildren at nine years of age. The reliability and validity of screening methods was also assessed. DESIGN: Epidemiological survey. SETTING: South-western part of Germany (Rhein-Neckar-Kreis); elementary schools in a region with a low orthodontic care rate. SAMPLE AND METHODS: 494 nine-year-old German schoolchildren (237 males, 257 females, median age 9 years) were examined orthodontically in cooperation with the local community dentistry service. A special measurement ruler was developed to enhance validity and reliability of space measurements on location in the schools. RESULTS AND CONCLUSIONS: Concerning space conditions in the incisor segments: in the maxilla the variety encountered comprised both space excess and moderate to severe crowding. This was considerably larger in the maxilla than in the mandible. Severe crowding (> 5 mm) was found more often in the maxilla than in the mandible and affected around 2-3% of the maxillary dentitions. Also severe contact point displacements (IOTN Grade 4) were mainly restricted to the maxilla (prevalence approximately 3%). In the canine-premolar segments, the arch segments in males were in general around 0.5 mm larger than among the females, also within each dental stage. In general, the maxilla was more often affected by posterior crowding than the mandible. Anterior crowding seemed to be more prevalent than posterior crowding. With respect to the screening methods used in the present study, reliable and valid measurements were also found to be possible in schools. This may open up further opportunities for orthodontic screening by community dentistry services or similar organizations.     

上海市黄浦区9548名中学生青少年牙周炎的调查

目的：调查了解上海市黄浦区11－19岁中学生青少年牙周炎的患病率，以便早期发现、明确诊断和及时治疗。方法：2000年1月－2001年4月，对9548名学生（男性4739人，女性4809人）进行软垢指数，牙石指数、龈沟出血指数、社区牙周指数检查。结果：牙周炎患病率为0．76％，男：女＝1：1．03（P＞0．05）。随着年龄的增长，牙龈出血及牙行的检出率逐渐上升，牙周炎的患病率也逐渐增高。结论：上海市黄浦区9548名中学生青少年牙周炎患病率为0．76％，由于牙周病新分类的出现，这些病例需进行重新评价，还必须加强口腔卫生的宣教及防治工作。     

Radiographic and clinical examination of periodontal status of first molars in 15–16-year-old Danish schoolchildren

Abstract – The prevalence of alveolar bone loss was investigated in 2813, 15- and 16-year-old Danish schoolchildren using bitewing radiographs. The interproximal spaces of the mesial and distal aspects of the first molar tech were examined. Inly defects with depths of more than 2 mm were considered periodontal bone loss. Radiographic evidence of bone resorption was found in 48 children. When evaluated clinically, 42 out of the 48 children with radiographic sings of bone loss demonstrated clinical loss of attachment. Only four children (0.1%) had the characteristic radiographic features of juvenile periodontitis. Loss of attachment of more than 2 mm was oberved in these children.     

In vitro evaluation of ICDAS and radiographic examination of occlusal surfaces and their association with treatment decisions

This in vitro study evaluated the performance of visual (International Caries Detection and Assessment System [ICDAS]) and radiographic (bitewing [BW]) examinations for occlusal caries detection and their associations with treatment decision (TD). Permanent teeth (n=104) with occlusal surfaces varying from sound to cavitated were selected. Sites were identified from 10× occlusal surface photographs. Standardized bitewing (BW) radiographs were taken. Four dentists with at least five years of experience scored all teeth twice (one-week interval) for ICDAS (0–6), BW (0=sound, 1=caries restricted to enamel, 2=caries in outer third dentin, 3=caries in inner third dentin), and TD (0=no treatment, 1=sealant, 2=microabrasion and sealant, 3=round bur sealant, 4a=resin, 4b=amalgam). Histological validation was performed by observation under a light microscope, with lesions classified on a five-point scale. Intraexaminer and interexaminer repeatability were assessed using two-way tables and intraclass correlation coefficients (ICCs). Comparisons between percentage correct, specificity, sensitivity, and area under the receiver-operating characteristic (ROC) curve were performed using bootstrap analyses. ICCs for intraexaminer and interexaminer repeatability indicated good repeatability for each examiner, ranging from 0.78 to 0.88, and among examiners, ranging from 0.74 to 0.81. Correlation between ICDAS and TD was 0.85 and between BW and TD was 0.78. Correlation between the methods and histological scores was moderate (0.63 for ICDAS and 0.61 for BW). The area under the ROC curve was significantly greater for ICDAS than for BW (p<0.0001). ICDAS had significantly lower specificity than BW did (p=0.0269, 79% vs 94%); however, sensitivity was much higher for ICDAS than for BW (p<0.0001, 83% vs 44%). Data from this investigation suggested that the visual examination (ICDAS) showed better performance than radiographic examination for occlusal caries detection. The ICDAS was strongly associated with TD. Although the correlation between the ICDAS and BW was lower, it is still valuable in the clinical decision-making process.     

Prevalence of chronic periodontitis in 13–15–year-old children

The bitewing radiographs of 1,731 English and Danish schoolchildren aged 13--15 years were examined to assess the prevalence of chronic periodontitis. Only one child (0.06%) was found to be affected in comparison with the high prevalence of 51.5% reported by Hull et al. (1975). Minute qualitative changes in the radiographic appearance of the alveolar crest, or changes in the visual representation of the width of the periodontal ligament space are not reliable or valid criteria for assessing chronic periodontitis. Horizontal bone loss observed on radiographs, which can be accurately measured using the cemento-enamel junction as a reference point, is a useful diagnostic criterion for the measurement of chronic periodontitis.     

Prevalence of juvenile periodontitis in schoolchildren in Lagos, Nigeria

The aim of this survey was to study the prevalence of juvenile periodontitis in schoolchildren aged 12-19 yr in Lagos, Nigeria. 1001 children, 565 boys and 436 girls, took part in the study. Initially all the children were screened clinically at school according to the recommendations of CPITN. A mirror and WHO 621 pattern probe were used for this examination. Any child with two or more sextants or teeth with CPITN code 3 or one sextant code 4 was taken for a radiographic and full clinical examination. Only 19 children, 12 boys and seven girls, fulfilled these requirements. Of these 19 children, five boys and three girls showed radiographic evidence of bone loss as well as increased probing depths, and were diagnosed as having juvenile periodontitis. The other children showed no evidence of bone loss radiographically, despite maximum probing depths of 4-5 mm. The results indicate a prevalence of juvenile periodontitis of 0.8% in this Negro population.     

Human herpesviruses and Porphyromonas gingivalis are associated with juvenile periodontitis

BACKGROUND: Although herpesviruses have been associated with adult periodontitis, their relationship with juvenile periodontitis (JP) has not been established. This case-control study examined possible associations between JP and pathogenic bacteria, the human cytomegalovirus (HCMV), and the Epstein-Barr type 1 virus (EBV-1). METHODS: Subjects were participants in a larger survey of schoolchildren in North-Central Jamaica. Subgingival plaque samples from 15 subjects with JP, 20 with incipient periodontitis (IP), and 65 randomly-selected healthy controls were assayed for Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans using a 16S rRNA polymerase chain reaction (PCR) identification method, and for HCMV and EBV-1 using nested PCR identification. RESULTS: Strong bivariate associations were found between JP and P. gingivalis (odds ratio [OR] = 12.7; 95% CI = 2.6, 61.4), HCMV (OR = 10.0; 95% CI = 2.7, 36.3), and A. actinomycetemcomitans (OR = 8.0; 95% CI = 2.3, 27.5), but not EBV-1. In multivariate analyses, P. gingivalis remained a significant explanatory variable (OR = 7.8; 95% CI = 1.5, 40.9); however, the associations were marginal for HCMV (OR = 4.6; 95% CI = 0.9, 22.7), and non-significant for A. actinomycetemcomitans (OR = 2.0; 95% CI = 0.4, 9.7). The associations with JP and the extent of attachment loss were even stronger when both P. gingivalis and HCMV were detected together. P. gingivalis (OR = 3.9; 95% CI = 1.3, 12.0) and EBV-1 (OR = 3.3; 95% CI = 1.0, 10.3) were the only significant explanatory variables in the multivariate analysis of IP. CONCLUSIONS: P. gingivalis is the strongest and most stable indicator of periodontitis in Jamaican adolescents. Co-infection with P. gingivalis and HCMV appears to be particularly deleterious to periodontal health.     

Longitudinal study and analysis of clinical supervision of maxillary canine eruption

In 505 Swedish schoolchildren, the need to supervise the eruption of the maxillary canines was assessed by digital palpation and related to occlusal development and somatic maturity. The aim was to judge the extent to which clinical methods should be supplemented with radiographic methods. The 505 children, aged 8-12 yr, were clinically investigated and the eruption was followed over a 3-yr period. The age of the child was found not to be a valid criterion for radiographic investigation of the canine position. The investigation showed that 29% of 10-yr-old children had non-palpable canines bilaterally. In 11-yr-old children, the corresponding figure was 5%. A palpable buccal bulge in the primary canine apical area was found to signify a favorable eruption position. The prevalence of non-palpable or unerupted canines was 3% in the age group 11-15 yr. Indications for radiographic examination of canine position were present in altogether 7% of the children over 10 yr of age according to the clinical diagnostic criteria used.     

Proximal caries in juvenile periodontitis patients

BACKGROUND: Caries is recognized as the prevalent proximal dental disease in adolescents, while proximal bone loss is minimal to non-existent in this population. Adolescents demonstrating an inverse disease pattern, i.e., minimal caries and active periodontitis, could provide powerful clues with regard to both diseases. However, data are inconsistent. This study was designed to clarify this relationship by comparing proximal caries prevalence in a juvenile periodontitis (JP) group to a matched non-periodontally diseased control group. METHODS: Two groups (cases [JPs] and control patients [CPs]) were matched for age, sex, and race and evaluated for decayed, missing, filled teeth and surfaces (DMFS) by radiographic analysis. Statistical analysis was performed by ANOVA and Student t test. The study consisted of four phases. Phase I was based on data from a previous study that failed to include race in the analysis. Thus, the original 23 JP patients (mostly African-Americans from New York City) were rematched for race as well as sex and age with CPs from Newark, NJ. The effect of water fluoridation (found in NYC) was evaluated in Phase II by matching the 23 original CPs (mostly Caucasian from NYC) with 23 CPs from NJ. Since differences were seen, we rematched our original JPs from NYC with a new set of race-matched CPs from NYC (Phase III). Finally, 13 JP patients from the University of Medicine and Dentistry of New Jersey (UMDNJ) were matched with CPs from NJ (Phase IV). RESULTS: Phase I and III indicated that JP patients had significantly less proximal caries than their matched CPs (P < or =0.05). Phase II confirmed the role of fluoride in caries reduction. Phase IV (NJ sample) supported our previous data and suggested that JP patients had less proximal caries than CPs (P < or =0.05). CONCLUSIONS: JP patients had significantly less proximal caries than their matched CPs when groups were balanced and radiographic evaluations were performed. In-depth studies of JP patients could provide important clues about both caries and periodontal disease etiology and pathogenesis.     

Early-onset periodontitis in Morocco is associated with the highly leukotoxic clone of Actinobacillus actinomycetemcomitans

A particular clone (JP2) of Actinobacillus actinomycetemcomitans with increased leukotoxin production has been isolated from individuals with early-onset periodontitis (EOP). The aim of this study was to determine the frequency of carriers of this clone and its association with EOP in Moroccan schoolchildren. Of 217 plaque samples, 131 (60.4%) were culture-positive for A. actinomycetemcomitans. A total of 19 of these isolates had a 530-bp deletion in the leukotoxin promoter region characteristic of the JP2 clone. A strong association between the presence of A. actinomycetemcomitans with the 530-bp deletion and EOP was found (adjusted OR = 29.4; 95% Cl = 8.3 - 104.4; p < 0.0005), while no association could be demonstrated between the presence of A. actinomycetemcomitans without the deletion and EOP (adjusted OR = 1.3; 95% CI = 0.5 -2.9; p = 0.750). The study demonstrates that the endemic presence, in a human population, of the highly leukotoxic JP2 clone may result in an unusually high prevalence of EOP.     

The prevalence and sex ratio of juvenile periodontitis in a young racially mixed population

The need to accurately determine the prevalence of a disease is important especially in establishing treatment needs for particular population groups. Reported prevalences for juvenile periodontitis (JP) have varied from less than 0.1% to 17%. The use of overall prevalence values to determine treatment needs in populations which include various ethnic groups is not reliable since there is evidence that the prevalence in different groups is unequal. The purpose of this study was to determine the prevalence and sex ratio of JP in a large group of military recruits and to compare these values between the different racial populations. Thirty-eight cases of JP were diagnosed from a group of 5,013 young male and female recruits of varying ethnic origin. The overall prevalence was 0.76% and the female:male ratio 1.1:1.0. These findings raise questions as to the continued quotation of a female:male ratio of 3:1, and provide additional evidence for an overall ratio closer to 1:1. In addition, prevalences of JP varied considerably between racial groups. Blacks had a much higher JP prevalence (2.1%) than caucasians (0.09%). Black males had a higher prevalence (3.81%) than black females (1.99%). For black recruits the F:M ratio was 0.52:1. For caucasian recruits the F:M trend is opposite (4.3:1), although the number of cases diagnosed in the caucasian group was too low to compute a true ratio. The data support studies which show that in the blacks, the disease is less prevalent in females than in males. Caution must be exercised in interpreting results in any study in which the sample population is not categorized.     

Radiographic evaluation of juvenile periodontitis (periodontosis)

Of 49,380 male naval recruits who were screened for juvenile periodontitis (JP), 270 were clinically diagnosed as having the disease. Full-mouth radiographs identified 182 of these 270 patients as having JP with extensive bone loss on permanent first molars and/or incisors. These 182 patients, 137 (75.3%) of whom were black, were further classified into Type I: bone loss involving first molars and/or incisors and up to two additional teeth; Type II: involvement of first molars/incisors and several additional teeth; and Type III: generalized involvement (more than 14 teeth) but with bone loss notably more extensive on the first molars and/or incisors. Of the 182 patients, 129 (70.9%) were Type I; 43 (23.6%) were Type II, and 10 (5.5%) were Type III. The molars were involved more frequently than the incisors; more than one molar was always involved, with or without incisor involvement. Most cases had minimal or no radiographic caries, and 46% had demonstrable calculus. Of the remaining 88 cases from the 270 with the initial diagnosis of JP, 63 demonstrated severe bone loss on more than 14 teeth, with many of the teeth being involved to the same degree. These cases were termed rapidly progressive periodontitis. Six of the 88 cases had bone loss on only one tooth surface of the dentition. These cases were termed acute localized destruction of alveolar bone. The status of the other 19 cases could not be determined.     

The plasma cell at the advancing front of the lesion in chronic periodontitis

This study analyses the ultrastructure of the plasma cell population of periodontitis-affected soft tissue close to the advancing front of interdental lesions. Biopsies from 20 patients and 3 control volunteers were examined: 5 with treated adult periodontitis (AP), 5 with untreated AP, 5 with treated juvenile or post-juvenile periodontitis (JP) and 5 with untreated JP. Plasma cell (PC) counts increased significantly (p less than 0.05) with lesion severity. They were absent from epithelium and sparse in the clinically healthy control specimens. Degenerate PC tended to be more numerous within JP tissue but differences were not significant (p greater than 0.05) when compared to AP. Intact plasma cells were never seen within JP superficial connective tissue. Russell bodies were small and few in number. The presence of degenerated plasma cells indicated normal formation and release of immunoglobulins within the tissues of AP and JP. Increased counts of degenerate PC and tissue destruction in JP suggested a correlation, possibly attributable to anti-collagen antibody secretion.     

Variation in prevalence of radiographic alveolar bone loss in subgroups of 14-year-old schoolchildren in Oslo

The aim of the present study was to assess the prevalence of radiographic alveolar bone loss, as related to selected background variables in 2767 14-year old schoolchildren. Bone loss was recorded when the distance from the cemento-enamel junction to the alveolar crest exceeded 2 mm. The radiographs were magnified approximately 10 times. 3% of the subjects and 18.5% of the sites were excluded because of indistinct radiographic reference points. Radiographic bone loss was found in 4.5% of the subjects. Horizontal lesions were more prevalent than vertical defects. Most subjects with bone loss had 1 (75%) or 2 (22%) lesions. No subject was diagnosed with juvenile periodontitis kind of lesion. The prevalence of bone loss depended on the variables sex, orthodontic treatment and ethnic background.     

Caries prevalence ratios in a Tanzanian child population

The use of risk ratios, odds ratios and prevalence ratios is limited within dental epidemiological research. These measures of association have been applied to relate the risk indicators' geographical location and sex to the caries prevalence in the maxilla, the mandible and the total dentition of 7-11-yr-old Tanzanian schoolchildren examined in 1986. The risk indicators were studied by means of odds ratio, using logistic regression. There were no associations found between the risk indicators studied and caries prevalence in the maxilla and the total dentition: a significant association was found only in the mandible. This resulted in girls having a greater (PR = 1.4) chance of developing caries than boys, and children living in naturally fluoridated (greater than or equal to 0.5 ppm) rural areas having a lower (PR = 0.5) chance of developing caries than those living in urban and rural areas.     

Destructive periodontal disease in healthy children.

This study determined the prevalence of destructive periodontal disease affecting the deciduous dentition among otherwise healthy subjects, who were diagnosed with juvenile periodontitis (JP) in their permanent dentitions. There were 4,757 subjects in this retrospective, cross-sectional study. Diagnosis of JP was based on age (< or = 15 years), negative medical history, and radiographic evidence of arc-shaped alveolar bone loss. The study population was one-third white and two-thirds black and the male/female ratio was 1:1, reflecting the general patient population. The prevalence among whites was 0.3%, with a female/male ratio 4:1; whereas among blacks the prevalence was 1.5%, with a female/male ratio approximately 1:1. Among the black JP subjects with radiographs of the mixed dentition, 85.7% presented evidence of bone loss, and of those with radiographs of the deciduous dentition, 71.4% had discernible alveolar bone loss. This study suggests that JP is much more prevalent in blacks and that it does indeed occur in the prepubertal years affecting the deciduous as well as the permanent dentitions in otherwise healthy children. These data imply the importance of including a periodontal evaluation in the examination of children, using the periodontal probe and radiographs sufficient to adequately view the alveolar bone.