Buccal flap elevated. Note bone loss on MB root.		Palatal root almost out of bone. Note bone loss in furcation.

Clinical: A 13 year old girl was referred for a consultation shortly after beginning orthodontic treatment. The first premolars had been extracted and labial arches had been placed on her teeth. The problem? The dentist had noted deep pockets around all four first molars. He informed the patients parents that he didnt think the molars could be saved, and that they had to be removed. Losing the maxillary first premolars and molars would compromise any dentition, but losing them at age thirteen presented grave consequences.

The patient was a healthy Caucasian. She took no medication and had no history of any medical problems. Both parents had complete dentitions. No other siblings were examined.

Examination revealed 8-10 mm defects about all four first molars. The teeth were mobile, possibly because she was undergoing orthodontic treatment. Deep osseous defects were noted around these teeth.

Dx: Localized juvenile periodontitis.

1. Remove the orthodontic wires.
2. Prescribe tetracycline 250 mg, q.i.d. x 14 days
3. Flap surgery
4. Bone graft

The same treatment was performed in all four quadrants. The maxillary right, shown here, had the most severe breakdown. Healing was uneventful.

X-ray in 1984, depicting bone loss on tooth # 3.		Seven-year follow-up. New bone has formed.

Discussion: LJP or localized periodontitis is rare, especially in Caucasians. It is often characterized by isolated defects on the mesial of all first molars, and between the maxillary incisors. Though this is a frequent pattern for LJP, it is by no means the only one. LJP can be generalized throughout the mouth or have some other configuration. What is common, however, is that it occurs in young people, usually ages 11-15. Unlike the adult variety of periodontitis, juvenile periodontitis can be treated with a high degree of success.

The first step is to use antibiotics. AA, or Actinomyces Acetocomitans, is usually the culprit organism in this disease. Interestingly, it responds better to tetracycline than penicillin. AA has been found to invade the connective tissues. So the way to get rid of it is to hit it with a therapeutic dose of tetracycline, then perform surgery, which will remove the residual organisms residing in the tissues adjacent to the teeth. In theory, it is not necessary to perform a bone graft or use any other regenerative technique. But its hard not to do so, if for no other reason than the bone graft acts like a biologic bandage as the clot forms and new bone - hopefully - invades the infected area.

In 1984, this patient was thirteen. All four molars were saved. She went on to have orthodontic treatment, without any consequence or recurrence of the acute disease. She was last seen in this office in 1997, when a pocket was beginning to form on the mesial of tooth # 30. At age 27, LJP is behind her, but shes old enough to have garden-variety adult periodontitis.

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