Prepubertal Periodontitis. I. Definition of a Clinical Disease Entity,

Abstract

F ive cases are reported of periodontitis affecting the deciduous teeth in young children. The purpose of the report is to define prepubertal periodontitis as a clinical entity, establish diagnostic criteria, demonstrate clinical, radiographic, and historical features, document progression, and explore methods of treatment. The disease occurs in localized and generalized forms. In the localized form, either few teeth or many may be affected. The onset appears to be around the age of 4 years or before. The gingival tissue manifests only minor inflammation, if any, and microbial plaque is minimal. Alveolar bone destruction proceeds more rapidly than in adults or teenagers with periodontitis, but much slower than in individuals with generalized prepubertal periodontitis. In some cases, otitis media and upper respiratory infections are also present, although these are not life‐threatening. The progress of the disease can be halted, so far as is known, by curettage coupled with antibiotic therapy and improved toothbrushing. The hallmarks of generalized prepubertal periodontitis include a fiery red acute inflammation pervading the marginal and attached gingiva around all the teeth, gingival proliferation, cleft formation, and recession. Onset is at the time of tooth eruption. Alveolar bone destruction, sometimes accompanied by destruction of the tooth roots, proceeds at an alarming rate. The affected children have otitis media and recurrent, sometimes life‐threatening infections. Their periodontitis seems to be refractory to antibiotic therapy. In one case, the disease was controlled by extraction of the hopeless teeth combined with meticulous plaque control. Abnormalities in peripheral blood leukocyte chemotaxis have been found in all children with prepubertal periodontitis studied so far. In our children with the generalized form of the disease, both neutrophils and monocytes were profoundly abnormal and the basic defect appeared to be in cell adherence, while in children with localized disease, either neutrophils or monocytes but not both cell types were affected, and the defects were not profound. Prepubertal periodontitis seems to be more common in females than in males. In some families susceptibility appears to have a maternal pattern of inheritance, while in others no pattern of transmission is apparent. Prepubertal periodontitis may be followed by severe periodontitis of the permanent teeth or by a normal permanent dentition.