Zambon, J, Christersson, R, Genco: Diagnosis and Treatment of Localized Juvenile Periodontitis. JADA, 113:295, 1986

Review Article. Proposed treatment modalities directed to reduce subgingival AA
(AA=HA=Haemophilus actinomycetemcomitans).

• Brothers or sisters of an LJP patient have 50% chance of develop the disease.
• Some studies have shown that siblings with and without the disease have neutrophil function defects.
• Factors that may be responsible for familial nature of LJP are:
  1. Putative pathogen, AA, can be transferred among family members.
  2. Susceptibility of certain families to AA as a result of inheritable defects in the immune system. It has been reported that about 70% of pats with LJP have neutrophils impaired chemotactic abilities.

Hypothesis about the pattern of destruction

1. Immune response limit disease process: The first molars and incisors are the first teeth to erupt. AA colonized (transmitted from other family member), and then the immune system produce opsonizing antibodies against AA. Antibodies control the numbers of AA at initial sites of infection and prevent spreading of AA to other periodontal sites.
2. Absence of bacterial antagonism to AA in infected sites. (Presence of inhibitory bacteria can prevent spread of AA to other sites).

VIRULENCE of AA is due to production of: Leukotoxins, chemotaxis inhibiting factor, lipopolysaccharides that can cause bone resorption, collagenase (destroy gingival connective tissue), epitheliotoxins, lymphotoxins.

There is evidence to suggest that AA is the causative agent for LJP and other forms of periodontitis:

• Pats with LJP develop high levels of serum, salivary and crevicular fluid antibodies specifically against AA.
• Invasive properties of AA (bacterial invasion).
• Animal studies: when AA was transplanted in monkeys produced severe periodontal attachment and bone loss.

PROPOSED TX: Mechanical debridement and systemic use of tetracycline. In order to avoid "under" or "over tx", the presence of AA should be monitor by laboratory technique. Immunologic techniques such as immunofluorescent microscopy seems to be better and faster than culture, and could be obtained in a dental office.

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