Presence of Aggregatibacter actinomycetemcomitans in young individuals: a 16-year clinical and microbiological follow-up study

Aim: To look for clinical signs of periodontal disease in young adults who exhibited radiographic bone loss and detectable numbers of Aggregatibacter actinomycetemcomitans in their primary dentition.
Material and methods: Periodontal status and radiographic bone loss were examined in each of the subjects 16 years after the baseline observations. Techniques for anaerobic and selective culture, and checkerboard, were used to detect periodontitis-associated bacterial species. The isolated A. actinomycetemcomitans strains were characterized by polymerase chain reaction.
Results: Signs of localized attachment loss were found in three out of the 13 examined subjects. A. actinomycetemcomitans was recovered from six of these subjects and two of these samples were from sites with deepened probing depths and attachment loss. Among the isolated A. actinomycetemcomitans strains, serotypes a–c and e, but not d or f, were found. None of the isolated strains belonged to the highly leucotoxic JP2 clone, and one strain lacked genes for the cytolethal distending toxin.
Conclusions: This study indicates that the presence of A. actinomycetemcomitans and early bone loss in the primary dentition does not necessarily predispose the individual to periodontal attachment loss in the permanent dentition.     

Marginal bone loss in the primary dentition of patients with juvenile periodontitis

Abstract 118 patients with juvenile periodontitis (JP), diagnosed when the patients were 13–19 years old, were studied retrospectively with respect to radio-graphic marginal bone loss in the primary dentition, experienced when the patients were 5–12 years old. 168 other 13–19 year old patients without any signs of bone Joss in the permanent teeth were used as a reference group. The JP patients were classified into 2 groups according to the number of sites with bone loss in the permanent dentition: JP group I having 1 site with bone loss (n=45) and JP group II having 2 sites with bone loss (n=73). It was found that 35 patients (52%) of JP group II displayed 1 or more sites with bone loss in the primary dentition during the age of 5–12 years. The corresponding numbers for JP group I and the reference group were 9 (20%) and 8 (5%) respectively. These findings indicate that juvenile periodontitis, at least in some individuals, may have its onset already in the primary dentition.     

Metronidazole in the treatment of localized juvenile periodontitis

Abstract 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 × 3 × 10 days, the 2nd tetracycline 250 mg × 4 × 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>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.     

Increased respiratory burst activity is associated with normal expression of IgG-Fc-receptors and complement receptors in peripheral neutrophils from patients with juvenile periodontitis

The respiratory burst activity in peripheral neutrophils from nine patients with localized juvenile periodontitis (LJP) and age- and sex-matched healthy controls was studied by measuring the intensity of luminol-enhanced chemiluminescence (CL) induced by unopsonized and three differently opsonized zymosan particles, formyl-methionyl-leucyl-phenylalanine (FMLP) or phorbol myristate acetate (PMA). The neutrophils from LJP patients showed in general more intense CL with all activators than did their controls. Particulary, the CL response induced by unopsonized zymosan particles and FMLP were significantly higher (p < 0.05 and 0.001). When comparisons were made between female LJP patients (n = 6) and matched controls, also serum-opsonized and IgG-opsonized zymosan particles produced CL was significantly increased (p < 0.05). In order to determine whether the elevated CL responses to zymosan particles were due to altered levels of the interacting receptors on neutrophil surface, an immunofluorescence analysis of the expression of IgG-Fc-receptors (FcR) and complement receptors (CR) was performed with flow cytometry. No significant difference in the expression of FcRII, FcRIII, CRl and CR3 was detected in LJP group compared to controls. Since the elevated CL responses can not be explained by changes in receptor numbers it is hypothesized that the increased respiratory burst activity in LJP may be caused by altered post receptor signalling pathway.     

Localized Aggressive Periodontitis Treatment Response in Primary and Permanent Dentitions

Background: The comparative treatment response of children and young adults with localized aggressive periodontitis treatment (LAgP) affecting primary and permanent dentition is unknown. The objective of this study is to evaluate the influence of non‐surgical periodontal therapy with adjunctive systemic antibiotics on the clinical outcome of children and young adults with primary versus permanent dentition affected by LAgP. Methods: A cohort of 97 African American participants aged 5 to 21 years (30 males and 67 females; 22 primary and 75 permanent dentitions affected) diagnosed with LAgP were included. Patients presented with no significant medical history. All patients underwent periodontal therapy, which consisted of full‐mouth mechanical debridement at baseline and the 3‐, 6‐, and 12‐month appointments. Additionally, all patients were prescribed a 1‐week regimen of systemic antibiotics at the initial appointment. Clinical parameters were analyzed, including probing depth, clinical attachment level (CAL), bleeding on probing, and percentage of visible plaque. Results: Overall, periodontal therapy was found to be effective in improving the clinical outcomes of both primary and permanent dentitions. Although baseline CALs were similar between the groups, the reduction in mean CAL at 3, 6, and 12 months and reduction in percentage plaque at 3 months were significantly greater in primary dentition compared with permanent dentition. Conclusions: Non‐surgical therapy with systemic antibiotics is effective for LAgP in both primary and permanent dentitions. A greater reduction in CAL in LAgP of primary dentition may suggest that younger children may carry a greater propensity for positive treatment outcomes and healing potential compared with children/young adults with permanent dentition.     

The description of a unique population with a very high prevelance of localized juvenile periodontitis

Abstract. The reported prevalence of localized juvenile periodontitis (LJP) amongst teenagers and young adults varies greatly. The etiology of LJP has been related to Actnobacillus actinomy cetemcomitans Aa$ and it has also been suggested that there may be a transmission of Aa within families resulting in the familial distribution of the disease. This study describes the high prevalence of LJP in adolescents, 12–20 years of age, from a group of nuclear families living and functioning in a closed, closely knit community. The survey was carried out on a population of teenagers that had attended the same school and their siblings. All students attending that school and their siblings were examined. They were given a periodontal examination and a questionnaire relating to their demographic details and their personal oral hygiene habits. The periodontal examination was limited to the incisors and first molar teeth. Plaque index (PII), gingival index (GI), the presence or absence of bleeding on probing (BOP), probing pocket depth (PPD) and recession ere measured. All patients having at least two of the examined sites with probing pocket depth ≥5 mm or one site ≥6 mm were considered as possible sufferers from LJP and had a full mouth periapieal radiographic survey carried out using a paralleling technique to confirm the diagnosis. At the sites with probing pocket depth ≥5 mm, a Shei ruler was used to measure the $$ of the root coronal to the alveolar bone. A cut off point of ≥20mm was used as a measure of true bone loss confirming the clinical diagnosis of LJP 86 individuals from 30 families comprised the population of interest There were 44 males and 42 females with a mean age of 14.7±2.3. Of the 86 individuals examined, 33 individuals from 15 families were diagnosed as having LJP (38.4%). None of the individuals examined showed any evidence of the generalized form of juvenile periodontitis. The mean age of the LJP patients was 15±23 yrs. with a 1:1.75 male to female ratio. Except for 2 pairs of families with genetic tics, no familial connections could be traced between the different nuclear families affected by LJP despite repeated and intensive questioning. There were no significant differences in the PII and the GI between the groups while the LJP group had significantly higher BOP. PPD and PAL than the non-LJP group. These finding strongly suggest an environmental influence in the etiologu of the disease.     

Detection rate of Actinobacillus actinomycetemcomitans on the permanent 1st molars of primary school children in Taiwan by polymerase chain reaction

BACKGROUND, AIMS: Actinobacillus actinomycetemcomitans (Aa) has been implicated as the putative micro-organism for localized juvenile periodontitis (LJP). The most distinct clinical features of LJP include severe angular bony defects of the mesial sides of permanent first molars and the onset of disease during puberty. Currently, no large-scale studies have been performed which address the change in detection rates of Aa on the mesial sides of permanent 1st molars following eruption and up to puberty. METHOD: In this study, subgingival plaque samples were taken from the mesial pockets of 2 randomly selected permanent 1st molars from 328 primary school children and 50 adult staff, and analyzed by polymerase chain reaction (PCR) to detect Aa. RESULTS: The results showed a 5.5% prevalence rate of Aa which increased after the eruption of 1st molars and peaked near puberty. There were no significant differences in the detection rates of Aa among different groups in terms of gender, plaque index (PII), and gingival index (GI); however, the higher detection rates of Aa were significantly associated with increased probing depths at p<0.05. CONCLUSION: PCR analysis of the subgingival plaques demonstrated a prevalence of Aa which peaked near puberty, suggesting that Aa may be important for LJP in Taiwan.     

Increased adhesion of peripheral blood neutrophils from patients with localized juvenile periodontitis

Adhesion of peripheral blood neutrophils from 5 patients with localized juvenile periodontitis (LJP) and age- and gender-matched healthy controls was measured using a semi-automated 96-well microtiter plate assay method. Both unstimulated and formyl-methionyl-leucyl-phenylalanine (FMLP, 10–1000 nM)-stimulated neutrophils from LJP patients showed in general higher adhesion than did their controls. After 15–60 min incubation with 100 and 1000 nM FMLP the numbers of adherent cells were significantly (p<0.05), 2.1–2.6-fold higher in LJP patients than in controls. Neutrophils from these LJP patients showed also enhanced respiratory burst activity in response to unopsonized zymosan stimulation. To test whether a decrease in intracellular diacylglycerol (DAG) kinase activity could account for the increased neutrophil adhesion of LJP patients normal neutrophils were treated with R59949 (10 μM), a DAG-kinase inhibitor. Both unstimulated and FMLP-stimulated normal neutrophiis showed significantly (p<0.05) enhanced adhesion after R59949-treatment. Taken together, our data indicate that neutrophils from the 5 LJP patients investigated here exhibit 2 parallel hyperactivities, namely increased adhesion and enhanced production of reactive oxygen species. Furthermore, our present and previous (Hurttia et al, J Periodont Res 1997; 32: 401-407) results suggest that the observed neutrophil functional abnormalities in some LJP patients may be associated with decreased cellular DAG-kinase activity. It is proposed that the hyperadherent and -active neutrophils may promote the development of LJP by causing tissue damage in the periodontium.     

Occurrence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in juvenile periodontitis

Abstract The occurrence of Actinobacillus actinomycetemcomitans, Porphyromanas gingivalis and Prevotella intermedia in subgingival plaque in 24 juvenile periodontitis patients was determined using DNA probe. 36 samples of subgingival plaque from 36 pockets having ≥6 mm depth, ≥3 mm of loss of attachment, and Weeding on probing anchor suppuration were taken from 18 patients with localized juvenile periodontitis (LJP, age range 12-24 years); and 12 samples from-6 patients with generalized juvenile periodontitis (GJP, age range 23–26 years). As control, an equal numbers of samples from health sites in the same patients were studied. P. gingivalis was found in 17 of 18 LJP patients, and in 31 of 36 diseased sites in those patients. P. intermedia was found in 15 out of the 18 LJP patients and in 28 of the 36 diseased sites. A, actinomycetemcomitans was present in 7 of the 18 LJP patients, and in 9 of the 36 diseased sites, and was not found in any GJP patients. All GJP patients had P. gingivalis 1 out of 12 diseased sites) and P. intermedia (all of the diseased sites). None of the three bacterial species was detected in healthy sites of GJP patients, and were found in healthy sites in only 2 of 18 LJP patients. The high prevalence and high levels of P. gingivalis and P. intermedia found in the LJP and GJP patients studied, suggest that there are populations affected by juvenile periodontitis in which this type of periodontitis is more associated with these species than with A. actinomycetemcomitans.     

Marginal bone loss in the primary dentition

Abstract. The present study was designed to determine the prevalence of bone loss in the primary dentition of children. Radiographs from children aged 7–9 were collected from 25 out of a total of 26 Public Dental Clinics in the County of Örebro, Sweden. These radiographs, representing 36.0%, 50.3% and 48.7% of all 7-, 8- and 9-year-old children ( n = 8666) living in the districts of the participating clinics, constituted a primary sample. In addition, the 9-year-olds were subjected to a more comprehensive sampling procedure to obtain a more complete sample (sample of 9-year-olds), resulting in a group of 2017 children (71.9%). The radiographs were evaluated with respect to presence of marginal bone loss (CEJ-MBL: distance between the cemento-enamel junction and the marginal bone level >2 mm), proximal calculus and number of decayed and filled proximal surfaces (dfs_p) in the posterior areas of the primary dentition. In the primary sample, the prevalence of bone loss for 1 proximal surfaces of the primary dentition in the 7-, 8- and 9-year-old children was 2.0%, 3.1% and 4.5%, respectively. The corresponding figures for proximal calculus were 2.5%, 3.1% and 4.2%. Mean number of dfs_p amounted to 2.3, 2.5 and 3.0. The prevalences of bone loss and proximal calculus as well as the mean number of dfs_p in the sample of 9-year-olds corresponded to the findings for the 9-year-old children in the primary sample. The analyses of the sample of 9-year-olds showed that most of the children with bone loss had 1 affected surface only. The largest CEJ-MBL distance for each individual with bone loss ranged from 2.5 to 6.0 mm. Children with bone loss displayed calculus more often than children without bone loss. The children with bone loss also showed higher mean dfs_p compared to children without bone loss.     

Increased adhesion of peripheral blood neutrophils from patients with localized juvenile periodontitis

Adhesion of peripheral blood neutrophils from 5 patients with localized juvenile periodontitis (LJP) and age- and gender-matched healthy controls was measured using a semi-automated 96-well microtiter plate assay method. Both unstimulated and formyl-methionyl-leucyl-phenylalanine (FMLP, 10-1000 nM)-stimulated neutrophils from LJP patients showed in general higher adhesion than did their controls. After 15-60 min incubation with 100 and 1000 nM FMLP the numbers of adherent cells were significantly (p<0.05), 2.1-2.6-fold higher in LJP patients than in controls. Neutrophils from these LJP patients showed also enhanced respiratory burst activity in response to unopsonized zymosan stimulation. To test whether a decrease in intracellular diacylglycerol (DAG) kinase activity could account for the increased neutrophil adhesion of LJP patients normal neutrophils were treated with R59949 (10 μm), a DAG-kinase inhibitor. Both unstimulated and FMLP-stimulated normal neutrophils showed significantly (p<0.05) enhanced adhesion after R59949-treatment. Taken together, our data indicate that neutrophils from the 5 LJP patients investigated here exhibit 2 parallel hyperactivities, namely increased adhesion and enhanced production of reactive oxygen species. Furthermore, our present and previous (Hurttia et al., J Periodont Res 1997; 32 : 401-407) results suggest that the observed neutrophil functional abnormalities in some LJP patients may be associated with decreased cellular DAG-kinase activity. It is proposed that the hyperadherent and -active neutrophils may promote the development of LJP by causing tissue damage in the periodontium.     

The presence of phage-infected Actinobacillus actinomycetemcomitans in localized juvenile periodontitis patients

Electron microscopy revealed 2 different types of bacteriophages isolated from Actinobacillus actinomycetemcomitans colonizing exclusively diseased sites in 4 patients with localized juvenile periodontitis (LJP). All sites infected with phage were undergoing periodontal destruction, as judged from consecutive routine radiographs. The phages isolated had a wide host range as assessed from their ability to infect a series of reference strains of A. actinomycetemcomitans. A 5th patient harboured non-infected A. actinomycetemcomitans in a surgically treated site which had undergone no bone destruction during the last 12 months. The present findings suggested that the pathogenic potential of A. actinomycetemcomitans in LJP may increase due to phage infection.     

Simultaneous occurrence of unusual odontodysplasia and oligodontia in the permanent dentition: report of a case

Odontodysplasia is an uncommon clinicopathological condition with a variety of expressions. Although it is generally recognized as a localized disorder of dental tissue, its aetiology has not yet been well explained. In the present case, odontodysplasia with oligodontia in the permanent dentition is reported. The patient was in good health with normal stature and no other physical abnormalities. His parents and siblings were dentally and medically normal. The primary teeth appeared to be normal except for the primary second molars, where the enamel was malformed. However, the permanent incisors that had erupted into the oral cavity showed rough and hypoplastic enamel. An orthopantomogram showed 17 congenitally missing permanent teeth and malformation of the other 11 permanent teeth and tooth-germs. Because these findings were caused by developmental disturbances of both the mesodermal and ectodermal dental components, we diagnosed the present case as odontodysplasia accompanied by oligodontia in the permanent dentition.     

Dental Caries and Tooth Loss in Adolescents With Early-Onset Periodontitis

The aim of this study was to assess the caries experience and tooth loss over 6 years in subjects with early-onset periodontitis as compared to their matched controls, and to describe the characteristics of teeth lost during this period. A multi-stage probability sample representing 8th to 12th grade U.S. schoolchildren were screened during the 1986/1987 school year to identify subjects with early-onset periodontitis (cases). The examination included measuring the clinical attachment level, presence of caries and dental restorations, and tooth loss. A random sample of controls without earlyonset periodontitis were selected for a follow-up examination and were matched to cases on gender, race, age, and geographic location. A total of 266 subjects, with a mean age of 16 years at baseline, were examined during the 1992/1993 school year and were classified into localized (LJP) and generalized juvenile periodontitis (GJP), incidental attachment loss (IAL), and control groups. Whites had more caries experience than Blacks and Hispanics, but there were no significant differences in tooth loss between the ethnic groups. The LJP and the IAL groups, respectively, had higher and lower overall caries experience than the control group. The LJP group had a significantly higher number of missing teeth at follow-up, and exhibited more extensive tooth mortality during 6 years than the control group. The GJP group also showed more tooth loss than the control group, but the difference was not statistically significant. In the LJP, GJP, IAL, and control groups, respectively, 43%, 32%, 26%, and 18% of the subjects lost teeth over 6 years due to disease. The findings showed differences in caries activity between the early-onset periodontitis groups and a variation by race. The findings suggest that loss of periodontal support was the principal cause for tooth loss in the LJP and GJP groups, and that dental caries was the principal cause for tooth extraction in the IAL and the control groups. J Periodontol 1996;67:960–967.     

Occurrence of Actinobacillus actinomycetemcomitans and spirochetes in relation to age in localized juvenile periodontitis

Occurrence of Actinobacillus actinomycetemcomitans (A.a.) and spirochetes was examined in relation to the age of patients suffering from localized juvenile periodontitis (LJP). Twenty LJP patients were divided into three age groups: 14-16, 17-19, and 20-25 years of age. Two sites with radiographic alveolar bone loss and two sites without bone loss were examined in each patient. Probing depth, gingival bleeding after probing, and orthopantomographic alveolar bone loss were recorded. Subgingival bacterial samples were taken from the same four sites for cultivation of A.a., and for dark-field microscopic assessment of spirochetes. A.a. was isolated in the youngest group more frequently than in the two older ones. Spirochetes were detected in the youngest group as well, but were not related to the age of the patients. A.a. occurred as frequently with as without spirochetes, both in pockets exhibiting and not exhibiting bone loss. There was no difference in the spirochete proportions between the A.a.-positive and -negative sites. The occurrence of A.a. was not related to the absence, presence, or proportions of the spirochetes, but, unlike the situation with spirochetes, was related to the age of the LJP patients. Thus the occurrence of A.a. is possibly associated with the activity of the disease.     

A skin window study of neutrophil migration in subjects with localized juvenile periodontitis

Abstract This study investigated the effect of a chemoattractant, N-formylmethionyi-leucyl-phenylalanine (FMLP), upon skin window migration of neutrophils into filters in 5 patients with a history of localized juvenile periodontitis (LJP) and 8 controls. On 2 occasions, each subject had 2 superficial skin abrasions made on the inner aspect of the forearm. Initial periodontal treatment was carried out on the disease group between the visits. On one skin window filters were placed that were soaked in physiological saline, and on the other filters soaked with FMLP. Leading fronts and cell densities were measured in each filter. At visit 1, LJP subjects had significantly lower leading fronts and cell densities. At visit 2, the differences were insignificant. The leading fronts for the LJP group were significantly improved on the second visit. No difference was observed between saline and FMLP. The findings of this study indicate that neutrophil migration is reduced in LJP patients where treatment is not involved, and that FMLP has no effect on neutrophil migration from the skin windows under the conditions of this study.     

Actinobacillus actinomycetemcomitans and clinical periodontal status in Finnish juvenile periodontitis patients

The relationship between the clinical periodontal status and the occurrence of Actinobacillus actinomycetemcomitans (A.a.) in 19 Finnish patients with localized juvenile periodontitis (LJP) was studied. Clinical examination included the Plaque Index, Gingival Index, suppuration, probing depth and bleeding on probing. The subgingival bacterial samples were taken from two diseases periodontal pockets with radiographic bone loss and two periodontal pockets exhibiting no radiographic alveolar bone loss. The results indicate that A.a. was isolated in 17 (89%) patients, in 68% of the diseased and in 32% of the control periodontal sites. Supragingival plaque, marginal gingival inflammation, gingival bleeding on probing, and suppuration were found as frequently in A.a.-positive as in A.a.-negative diseased LJP pockets. It was concluded that A.a. was frequently, but not always, detected in diseased LJP lesions. No association was found between the clinical status and the occurrence of A.a.     

Peroxidases, Iactoferrin and lysozyme in peripheral blood neutrophils, gingival crevicular fluid and whole saliva of patients with localized juvenile periodontitis

OBJECTIVE: The aim of this study was to examine the longitudinal association of selected non-immune antimicrobial host factors (peroxidases, lysozyme and lactoferrin) to the localized juvenile periodontitis (LJP) disease status.
MATERIALS AND METHODS: Peroxidases, lysozyme and lactoferrin were quantitated from seven patients with LJP before and after periodontal therapy. Analyses were performed from simultaneously collected samples of peripheral blood polymorphonuclear leukocytes (PMNs), gingival crevicular fluid (GCF from diseased sites) and paraffin-stimulated whole saliva. Similar assays were done also from seven periodontally healthy controls.
RESULTS During untreated phase of LIP myeloperoxid-ase, lysozyme and lactoferrin concentrations were remarkably elevated in peripheral blood PMNs, also reflected in their high concentrations in GCF. All these values normalised with respect to healthy controls during the periodontal therapy. No similar longitudinal changes were seen in whole saliva but during therapy salivary per-oxidase concentrations declined below the control values, in accordance with our previous observations in parotid saliva samples of LJP patients.
CONCLUSIONS: In LJP the concentrations of lysozyme, lactoferrin and myeloperoxidase are significantly elevated in peripheral blood PMNs, also reflected in GCF. During periodontal therapy these values decline and approach those observed in healthy controls. No similar changes are seen in stimulated whole saliva.     

Immunoglobulin-degrading enzymes in localized juvenile periodontitis

Previous reports have indicated the association of periodontal diseases with elevated levels of serum immunoglobulin G (IgG) antibodies to periodontally relevant bacteria. Recent results from this laboratory suggest that enzymes proteolytic for immunoglobulins are important virulence factors of several periodontal bacteria. Specifically, enzymes from Porphyromonas (Bacteroides) gingivalis culture supernatant fluid (SF) cleaved human IgG (4 subclasses), IgA1 and IgA2, IgM, IgD and IgE. Proteolytic enzymes from Actinobacillus actinomycetemcomitans culture SF cleaved IgG, IgA and IgM. An enriched Ig proteolytic preparation from Capnocytophaga ochracea culture SF was shown to extensively cleave all 4 subclasses of human IgG. Extensive degradation of IgG and IgA in crevicular fluid samples on SDS-PAGE from periodontal disease sites of localized juvenile periodontitis (LJP) patients in comparison to little degradation in healthy sites indicated the potential role the proteolytic enzymes from periodontopathogenic bacteria may play in situ. Treatment of IgG with P. gingivalis, A. actinomycetemcomitans and C. ochracea SF resulted in similar patterns of degradation. LJP patients had significantly higher levels of IgG and IgA proteolytic activity in whole saliva than age-, sex-, and race-matched periodontal disease-free controls. However, not all of the proteolytic activity could be ascribed to bacterial proteases since neutrophils are also present in large numbers at diseased sites. Using similar techniques, lysates of neutrophils from healthy controls cleaved IgG, IgA and IgM. The observation of enhanced Ig cleavage activity in crevicular fluid and saliva in LJP patients suggest a role for Ig proteolytic enzymes in LJP.     

Neutrophil chemotaxis in families with localized juvenile periodontitis

Localized juvenile periodontitis (LJP) is characterized by severe, early onset alveolar bone loss, localized to the first molars and incisors and a high prevalence of infection with Actinobacillus actinomycetemcomitans and associated neutrophil functional abnormalities. Due to the frequent occurrence of this condition in families, it was the purpose of this investigation to determine the association of neutrophil chemotaxis abnormalities and clinical periodontal disease in families with LJP. Twenty-two families were studied in which the proband was selected based upon presentation of LJP. All siblings were examined for the presence of LJP and neutrophil chemotaxis was measured on all subjects. The results indicate that there is a high association of LJP and neutrophil chemotaxis disorders and that this association is consistent along family lines. Specially, in families in which the proband exhibits a neutrophil chemotaxis disorder, all affected siblings (LJP) also exhibit depressed neutrophil chemotaxis, whereas, non-affected siblings beyond the age of puberty have normal neutrophil chemotaxis. On the other hand, in families where the proband (LJP) exhibits normal chemotaxis, both normal and affected siblings exhibit normal chemotaxis. The finding among families with LJP that some exhibit neutrophil chemotactic depression and others exhibit normal neutrophils suggests heterogeneity of LJP. Accordingly, it is proposed that there is a syndrome of familial localized juvenile periodontitis with depressed neutrophil chemotaxis and another form of familial localized juvenile periodontitis with normal neutrophil chemotaxis. The chemotaxis disorder and LJP occur in nearly one-half of the siblings in families with LJP. which is consistent with a dominant trait. however, multigenerational studies are necessary to determine the mode of inheritance. Hence, neutrophil chemotaxis is a disease marker which can be used in genetic studies of familial LJP with depressed neutrophil chemotaxis. Furthermore, prepubertal siblings often exhibit defective neutrophil chemotaxis in the families in which the proband exhibits such a defect. Since the prepubertal siblings are not affected by clinically detectable LJP, the finding of neutrophil chemotactic depression in these children further suggests that the neutrophil chemotactic defect is genetic in origin, precedes and may predispose to localized juvenile periodontitis.