Juvenile Periodontitis

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Introduction

An uncommon disease characterized by peridontal destruction, often in the absence of overt gingival inflammation

Epidemiology

  • Prevalence 1:1000; male = female
  • Onset at puberty or earlier

Clinical features

  • Affects the first permanent molar and incisors
  • Actinobacillus, Actinomycetes comitans has been isolated from the affected sites
  • Results in drifting and loss of the first permanent molar and incisors

Investigation 

Radiology may reveal marked bone loss interdentally, inter-radicularly and apically

Complications

  • Tooth loss

Malocclusion

  • Temporomandibular Joint (TMJ) dysfunction syndrome

Non-drug Treatment 

  • Control of plaque bacteria by use of antiseptic solution
  • Establishing a healthy gingival and periodontal attachment
  • Oral hygiene instruction and motivation
  • Regular scaling and polishing
  • Root planing
  • Splinting of mobile tooth
  • Periodontal surgery
  • Bone regenerative techniques e.g using polytetrafluoroethylene (PTFE) membranes, Bio-Oss, bio-membrane

Drug Treatment

  • Metronidazole
    • Adult: 200mg orally every 8 hours for 5 days
    • Child
      • 1-3: 50mg orally every 8 hours
      • 3-7 years: 100mg every 12 hours
      • 7-10 years: 100mg every 8 hours
      • 10-18 years: 200mg every 8 hours

Plus

  • Tetracycline
    • Adult: 250mg orally daily for up to 21 days
    • Child under 12 years: metronidazole and amoxicillin (or erythromycin for those sensitive to penicillin) 

Precaution

  • Tetracyclines should not be given to children under 12 years