Periodontal Treatment Outcome and Microbiological Findings in Prepubertal Periodontitis

Objectives: This study describes the periodontal treatment outcome during 4 years of two cases of prepubertal periodontitis, and the subgingival microbial profiles using 16S rRNA-based clonal analyses and a microarray technique.

Methods: A 3-year old female and her 4-year old brother were diagnosed with prepubertal periodontitis at the department of periodontology-Damascus University. During a 4 years period the patients were treated multiple times with nonsurgical periodontal therapy and systemic antibiotics. Subgingival dental plaque was collected before treatment from inflamed periodontal sites with deep probing depths. Comprehensive bacterial profiles were determined by using the Human Oral Microbe Identification Microarray (HOMIM) (http://mim.forsyth.org), and were also subjected to 16S rRNA clonal analysis.

Results: At the initial examination the periodontal tissues showed overt inflammation, gingival bleeding, and increased probing depth of deciduous teeth. Periodontal treatment slightly improved the periodontal status of deciduous teeth and delayed their loss. The deciduous teeth exfoliated prematurely, and in 1 subject the teeth were lost before 6 years of age. The periodontal tissues around the permanent teeth became inflamed soon after eruption, and by age of 7 years the first molars had probing depth of 7-8 mm and bleeding on probing. Forty (40) taxa were detected by HOMIM. Those species/phylotypes detected in medium-high levels were Capnocytophaga granulosa, Haemophilus spp., Parvimonas mica, and Streptococcus spp. Other less frequent organisms included Actinomyces odontolyticus, Aggregatibacter segnis, Campylobacter showae, Capnocytophaga, Gemella haemolysans, Granulicatella adiacens, Neisseria spp.,  and Veillonella spp. None of the red-complex organisms were detected.

Conclusions: Treatment of prepupertal periodontitis is very challenging, and overt inflammation and deep pockets persisted despite the multiple sessions of periodontal treatment and systemic antibiotics. The subgingival microbiota in prepuertal periodontitis appears to be different from that of  chronic periodontitis and is consistent with an opportunistic infection.