Page, RC, Baab, DA. A New look at the Etiology and Pathogenesis of Early Onset Periodontitis. J. Periodontol. 56:12, 1985

This report is based on a study of a family consisting of a mother and father and their three young sons. All three boys were losing their primary anterior teeth prematurely. Remaining teeth, even though there was significant bone loss, manifested no clinical signs of inflammation. A diagnosis of prepubertal periodontitis of the localized type was formed. Plaque samples demonstrated putative periodontal pathogens and antibodies to suspected periodontal pathogen was found in the serum of two of three boys. Furthermore, abnormally low chemotaxis of peripheral blood monocytes was determined. Other diagnoses were examined. Subsequent exfoliated teeth had no apical root resorption and at times had large amounts of postnatal secondary dentin. Hypophosphotasia was suspected. Clinical laboratory levels of serum alkaline phosphatase and phosphoethanolamine were found to be low. This led to questions concerning the role of cementum composition in various form of periodontal disease and that abnormalities in cementum be an important determinant in susceptibility to periodontitis. Several cases are review which indicate a high degree of likelihood that cemenal deposition may have been faulty that predisposed teeth to early-onset periodontitis. It was concluded that in some cases of EOP, a major determinant of site specificity and susceptibility may be abnormal deposition or maintenance of root cementum, such as those observed in mild cases of hypophospotasia.

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