Association between detection of oral Actinobacillus actinomycetemcomitans and radiographic bone loss in teenagers. A 4-year longitudinal study

Early-onset periodontitis

In 1993, the 1st European Workshop on Periodontology explicitly recognized that there was insufficient knowledge to differentiate truly different forms of periodontal disease from differences in the presentation/severity of the same disease. In spite of recent progress in our understanding of periodontal diseases, the issue is far from having been resolved. Classification of periodontal diseases, therefore, remains based upon the definition of specific clinical syndromes. Early-onset periodontitis (EOP) is one such syndrome and comprises a group of pathological conditions leading to loss of periodontal tissues early in life. The notion that classifies periodontitis syndromes as "early-onset" or "adult" is primarily epidemiological in nature and is based on the observation that periodontitis is rather infrequent in children and young adults. Nevertheless, considerable epidemiological evidence indicates that periodontitis does affect children and young adults to a level of severity that may lead to premature exfoliation of primary and/or permanent teeth. Clinical presentation of periodontitis early in the life of an individual is thought to indicate that the etiologic agents have been able to cause considerable tissue damage over a relatively short period of time. It also implies either infection with highly virulent bacteria and/or a highly susceptible subject. The purpose of this review is to discuss the criteria generally utilized to classify EOP, provide the rationale to designate EOP as a distinct disease entity, and to review the evidence justifying a subclassification into particular subgroups of EOP.

Eradication of Actinobacillus actinomycetemcomitans from the oral cavity in adult periodontitis

Eradication of Actinobacillus actinomycetemcomitans from the oral cavity seems to be a prerequisite for successful therapeutic outcome in patients periodontally infected with the organism. In view of the limited number of subgingival samples obtained in recent studies one cannot conclude, however, whether eradication has actually been achieved. In the present study clinical and microbiological parameters were monitored in 10 adult patients with A. actinomycetemcomitans-associated periodontitis during successive non-surgical and adjunctive metronidazole plus amoxicillin (or ciprofloxacin) (AB) therapy. In every patient, 13 extracrevicular samples and subgingival samples from the deepest site of every tooth present were selectively cultivated for A. actinomycetemcomitans. The organism was isolated in 47 +/- 29% subgingival and 64 +/- 31% extracrevicular samples. Six weeks following subgingival scaling, A. actinomycetemcomitans was detected in 37 +/- 30% subgingival and 55 +/- 38% extracrevicular samples (n.s.). Three months after antibiotic therapy, the organism was recovered from only 1 patient. At baseline, 7.5 +/- 4.2% sites had a probing pocket depth (PPD) > or = 7 mm. This proportion dropped to 2.3 +/- 2.4% after scaling (p < 0.05) and to 0.3 +/- 0.4% after AB (p < 0.05). The proportion of sites with clinical attachment loss (CAL) > or = 6 mm dropped from 23.3 +/- 13.3% to 17.7 +/- 13.4% (p < 0.05) and to 16.8 +/- 14.6%. Statistical analysis revealed that the organism was strongly related, at baseline, to PPD > or = 7 mm (odds ratio 9.8, p < 0.001). Six weeks after scaling, the organism was associated with CAL > or = 6 mm (odds ratio 1.8, p = 0.02). After scaling, high counts of A. actinomycetemcomitans in excess of 10(4) CFU/ml significantly interfered with attachment gain of > or = 2 mm (odds ratio 0.24, p = 0.001). Based on the present findings, eradication of A. actinomycetemcomitans seems to be possible with adjunctive antibiotic treatment. Elimination of the organism after scaling was only weakly associated with clinical improvement.

Clinical significance of Actinobacillus actinomycetemcomitans in young individuals during orthodontic treatment. A 3-year longitudinal study

The aim of the present study was: (1) to assess longitudinally the occurrence of Actinobacillus actinomycetemcomitans (Aa) in young subjects wearing fixed orthodontic appliances compared to matched appliance-free controls; (2) to determine whether the presence of the micro-organism at baseline could influence the periodontal status assessed 3 years later. 70 subjects, 27 male and 43 female, aged between 12 and 20 years participated in the study: 35 subjects under orthodontic treatment with fixed appliances for at least 6 months, and 35 appliance-free individuals matched for age and gender. All subjects were free of clinically demonstrable loss of attachment. They all received oral hygiene instructions 2x during the 2 months preceding the first clinical and microbiological examination. No subgingival instrumentation was performed between baseline and the 3-year examination. Clinical parameters included gingival bleeding index (GBI), pocket probing depth (PPD) and measurements of attachment level (AL). Statistically significant differences were reported regarding frequency of detection of Aa between both groups at each examination. The %s of orthodontic subjects infected with Aa at the baseline and at the 3-year examination were 86% and 80%, respectively, while the corresponding figures for control subjects were 16.6% and 26.6%. The frequency distribution of %s of Aa in the total anaerobic subgingival flora among control subjects remained fairly stable, whereas the proportion of orthodontic subjects yielding Aa at a concentration > or = 1.0% dropped significantly from 32% at baseline to 19% at the 3-year visit. Calculations of the relative risk for increasing GBI and PPD in both groups when Aa was present at baseline, revealed that the orthodontic subjects positive for Aa had a negligible relative risk of experiencing worse periodontal conditions compared to orthodontic patients where Aa was not detected at baseline. In contrast, control subjects initially infected with Aa presented with a risk for increased GBI 6.6x higher than that for subjects without Aa. In conclusion, the present study confirmed previous cross-sectional findings reporting that young individual with an integer periodontium wearing fixed orthodontic appliances harbor Aa with a statistically significant greater frequency than appliance-free matched controls. However, although orthodontic patients exhibited more inflammation, their deteriorated clinical conditions could not be accounted for by the sole presence of Aa in their sulci. In contrast, appliance-free young subjects initially infected with Aa had a higher risk of experiencing more gingival inflammation than subjects without the bacterium during a 3-year observation period.

A longitudinal study of Actinobacillus actinomycetemcomitans in army recruits

During recruiting examinations 201 recruits, 18-25 yr old, were examined for subgingival and extracrevicular Actinobacillus actinomycetemcomitans. The organism was isolated in 55 subjects, most often at low levels. Cluster analysis revealed 3 clusters with no (A, n = 86) or minor (B, n = 92) periodontal disease and low DMF-S, as well as established periodontitis, increased D + DF-S and high DMF-S (C, n = 22). When leaving the 12-months' service, 105 recruits were re-examined (54 cluster A, 41 cluster B, 9 cluster C subjects, 1 recruit who was not clustered). An increase of periodontal probing depth (PPD) of > or = 3 mm at 1 or more sites occurred in 33 subjects: 9 (17%) in cluster A, 16 (39%) in cluster B, 7 (78%) in cluster C and in the not-clustered recruit. Considerable variation in frequency distributions of PPD alterations was observed, therefore significant (p < 0.1) mean increase (1-sample t-test) and skew g1 (S-statistic) were additionally considered to define an "active" case. A total of 7 recruits (6.7%) met the criteria. Logistic regression analysis revealed a significant influence of self-reported smoking habits on activity status. Thus, heavy smokers (> 20 cigarettes/d) had a 14-fold higher risk (p = 0.030) for developing or progressing periodontitis compared to non- or light smokers (< 10 cigarettes/d). In particular, cluster B recruits appeared to have a lower risk (p = 0.11) for developing periodontitis than cluster C recruits (established periodontitis, high DMF-S). A. actinomycetemcomitans was isolated in 29 recruits (27.6%) at baseline and 30 recruits (28.6%) after 12 months. Presence of the organism was not a risk factor for periodontitis. However, in active subjects, significantly more samples were only A. actinomycetemcomitans-positive at re-examination compared to inactive recruits. It was concluded that smoking is a significant risk factor for periodontitis. Subjects with established periodontitis tend to deteriorate further. A. actinomycetemcomitans seems not to increase the risk for developing or progressing periodontitis in this age group. Longer studies involving larger populations are needed to confirm these observations.

Natural distribution of oral Actinobacillus actinomycetemcomitans in young men with minimal periodontal disease

A total of 1005 subgingival and extracrevicular samples from 201 male recruits, 18-25 yr old, were selectively cultivated for Actinobacillus actinomycetemcomitans. The organism was isolated in 55 subjects (27%); 9.5% of pooled subgingival plaque samples from first molars, 14% cheek mucosa, 20% dorsum of tongue and 20% saliva samples were culture-positive. In order to divide the study population into distinct clinical categories, cluster analysis was performed, based on previous caries experience, probing pocket depth categories, bleeding scores, visible plaque and calculus. Two clusters (n = 86 and n = 92, respectively) were identified with no or minimal periodontal disease (mean +/- standard deviation % of periodontal probing depth 1-2 mm 78.7 +/- 10.4% and 57.4 +/- 12.6%, respectively; virtually no periodontal probing/depth in excess of 4 mm) and a relatively low DMF-S (22 +/- 13). A third cluster (n = 22) had, in contrast, a high DMF-S (47.7 +/- 17.2) and a relatively high % of periodontal pockets of > or = 5 mm (5.9 +/- 5.2%). Prevalence of A. actinomycetemcomitans in this cluster was 41%, while the organism was found in 23% and 27% in the minimally diseased populations (p < 0.15). Whereas no heterogeneity of associations between subgingival and extracrevicular occurrence of the organism could be ascertained in different clusters, the organism was significantly more often identified in extracrevicular material, especially dorsum of tongue samples, compared with subgingival plaque (McNemar's chi2 = 12.45, p < 0.001). Multiple linear regression analysis revealed the number of A. actinomycetemcomitans positive samples as well as the % of sites bleeding on probing being positively associated with the % of sites with a probing pocket depth of > or = 5 mm (R2 = 0.345, p < 0.0001). The present large-scale investigation points to the wide distribution of this putative periodontopathogen in young individuals with minimal periodontal disease.

Occurrence of Actinobacillus actinomycetemcomitans in patients wearing orthodontic appliances. A cross-sectional study

The aim of the present study was to assess: (1) the occurrence of Actinobacillus actinomycetemcomitans (Aa) in subgingival plaque from young patients undergoing orthodontic treatment with fixed appliances; (2) a possible relationship between the presence of Aa and the clinical conditions; (3) a relation between the duration of orthodontic treatment and the microbiological and clinical parameters; (4) whether differences exist when taking into consideration the different type of appliances, i.e., bands or brackets. 34 subjects aged between 12 and 20 years participated in the study. Of these, 20 subjects had worn orthodontic appliances (test group), while the remaining 14 subjects served as matched control (control group). 4 to 8 sites in each patient were available for clinical and microbiological examination. Clinical parameters consisted of presence/absence of plaque and gingival bleeding index (GBI). Microbiological sampling was performed in the same sites as in the clinical examination. A statistically significant difference was present when comparing %s of GBI positive scores between teeth from the test group (57.5%) and teeth from the control group (25%). Plaque was present in 53% of test sites and 37% of control sites, but this difference was not statistically significant. Aa was detected from at least one site in 85% of test subjects and in 15% of the control subjects (p < 0.001). Among the subjects, 41% harboured Aa at a concentration between 0.1% and 1.0%, whereas another 40% yielded Aa at a concentration greater than 1.0%. Finally, a positive correlation was noted between the % of sites positive for Aa and the % of sites displaying a positive GBI score (r = 0.41; p < 0.005). No relation was found between the duration of orthodontic treatment and the microbiological or clinical parameters; neither were statistically significant differences found when we compared results from sites wearing bands or brackets. In conclusion, the present study showed that young subjects wearing orthodontic appliances harbour Aa with a remarkable frequency of detection, although plaque levels do not significantly differ from those of a matched control group.

Actinobacillus actinomycetemcomitans pneumonia with chest wall and subphrenic abscess

A 14-year-old girl had progressive dyspnea and right lower chest pain for about 1 1/2 months and a weight loss of 3 kg in 2 months. Chest X-ray revealed right pleural effusion and a round infiltration over the right lower chest, initially suspected to be malignant. Image study revealed consolidation in the right middle and lower lobes with abscess-like lesions around the right lower pleura and transdiaphrenic involvement to the subphrenic region. The lesion had also invaded the intercostal muscle. The pleural abscess was obtained by fiberoptic thoracoscopy, and culture of the pus grew typical colonies of Actinobacillus actinomycetemcomitans. After the causative microorganism had been identified, cefoxitin was given for 2 weeks followed by oral amoxicillin (250 mg/6 h) for a total period of 3 months. Follow-up chest X-ray revealed resolution of the lung lesions and the patient recovered gradually without any sequelae.

Clinical and microbiological effects of controlled-release locally delivered minocycline in periodontitis

The clinical efficacy of minocycline in a subgingival local delivery system was evaluated alone (M) or as an adjunct to scaling and root planing (M + SRP), in comparison to scaling and root planing (SRP) or to no subgingival treatment (NoTx) in adult periodontitis. Fifty-one adult patients with > or = 7 mm periodontal pockets demonstrating the presence by culture of Porphyromonas gingivalis (Pg), Prevotella intermedia (P(i)), or Actinobacillus actinomycetemcomitans (Aa) were randomized into one of the above 4 treatment groups. All sites > or = 5 mm in the most diseased quadrant in each patient received the therapy. Other quadrants were not treated. All patients received standardized oral hygiene instructions at the beginning of the study. At 0, 1, 3 and 6 months following therapy the 7 mm experimental sites were evaluated for selected periodontal pathogens by DNA probe analysis. At these same time points, the plaque index, gingival index, and bleeding on probing were evaluated as well as probing depth and relative clinical attachment level which were assessed by means of an automated probe. Probing depth reduction with M + SRP was significantly greater than all other groups at one month and significantly greater than NoTx and SRP at 3 months. There were no differences in probing depth reduction among groups at 6 months. At 6 months the gain in clinical attachment level was significantly greater for SRP than for either the NoTx or M groups. The prevalence of Pg decreased significantly in the M and M + SRP groups at one month.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence of early periodontitis in a group of young individuals during 8 years: associations with selected potential predictors

The aim of the present study was to assess the incidence of early radiographic bone loss in a birth cohort over 8 years and to assess possible associations between incidence of bone loss and reported dental behavior, ethnic background, and previous orthodontic treatment. In a case control study comprising a proportion of the study population, the detection of black pigmented Bacteroides and Actinobacillus actinomycetemcomitans and their association with early radiographic bone loss was assessed. At the beginning of the study in 1984, there were 2,767 subjects. In 1992 sets of bite-wing radiographs were obtained from 215 subjects, who also filled out a questionnaire concerning their present and past dental behavior, ethnic background, and orthodontic treatment. Radiographic alveolar bone loss was recorded if the distance from the cemento-enamel junction to the alveolar crest exceeded 2 mm. Thirteen subjects (6%) showed new sites with bone loss over the 8-year period. Subgingival plaque was sampled from these 13 subjects and from 13 control subjects. None of the independent variables could be associated with the observed incidence of radiographic bone loss in this cohort, with the possible exception of the presence of A. actinomycetemcomitans which was detected in about 50% of the new sites with bone loss.

Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The annual review of selected dental literature this year cites 384 published papers and reports. This year's review contains more editorial comment than reviews of years passed. New data on the biological responses to materials is emphasized in several sections. Observations on new compounds able to prevent plaque formation are presented. Clinically relevant advances in knowledge concerning the etching of different tooth structures are reported along with the effect of etching procedures on the dental pulp. Evaluation of periodontal diseases in all age groups is a topic. Limitations of current diagnostic techniques in periodontal disease, temporomandibular disorders, and implant therapy are included. There are new views on the use of dental amalgam. The future use of dental mercury is predicted. Interest in new ceramic systems is indicated as the demand for esthetics continues. Clinical information is emphasized over scientific information throughout this year's review.