This is very similar to the material presented by Slots at the AAP meeting in Denver '87. Importance of this study seems to be that it portends the use of microbiology in the diagnosis and management of the various periodontal diseases, in this case the diagnosis and treatment of juvenile periodontitis. Patients (n=8, mean age 15.6 years) with molar/incisor bone loss and pocketing characteristic of juvenile periodontitis were entered into clinical protocol of 3 sequential stages.
Stage I: S/Rp;
Stage II: S/Rp with concurrent tetracycline (TCN) therapy (1 gm/day x 28 days); and
Stage III: Perio surgery with TCN therapy. A decision to advance to the next stage was made solely on clinical findings. (suppuration, BOP, etc.)
Micro sampling was done concurrently with all clinical exams using paper points and looking for percentages of BPB, STB, and A.a.
At baseline exam all sites had A.a. (40% of total cultivable microflora), 1 had STB, and 4 sites had BPB. Deepest pocket depths at baseline averaged 8 mm, all sites had BOP, and 7 out of 8 showed suppuration. S/Rp had no clinical or micro effects on any patient and all went on to Stage II. Five patients went on to Stage III.
Results were that S/Rp with TCN was clinically and microbiologically most effective as sites in which A.a. was predominant. Surgery with TCN was required in all cases in which the sites had high levels of BPB and A.a., and of course, S/Rp had no definitive therapeutic effect.
The findings were consistent with many others (Slots, Zambon, Mandell and Socransky, and Eisenmann) and add further support to the strong association of high levels of A.a. with the pathogenesis of juvenile periodontitis.
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