Suppression of the periodontopathic

microflora in localized juvenile

periodontitis by systemic tetracycline
SLOTS & ROSLING, 1983
Methods (Brief)
Aa implicated in development of LJP
Tx include
-subgingival debridement
-topical betadiene solution (Iodine antiseptic)
-Systemic tetracycline
-20 deep pockets, 10 normal sites (no deep pockets), 6 LJP pts,
-3 stages over 24 weeks, results monitored for additional 38 weeks (total 60)
-stage 1: plaque control SRD, at least 6 hrs of debridement/no surgery (0-16 weeks)
-stage 2: Betadiene saturated cotton gauze inserted into periodontal pockets (16-22 weeks)
-stage 3: systemic tetracycline therapy 1g/day for 14 days (22-24 weeks)
-Subgingival microflora determined at frequent intervals by selective culturing of Aa, Capnocytophaga, direct microscope examination
-Clinical effect measured by changes in probing periodontal attachment level, probing periodontal pocket depth, radiographic bone loss,
other clinical parameters
 Results - subgingival bacterial load

T. Denticola

-Deep pockets yielded approximately 10-fold higher numbers of bacteria than shallow pockets – decreased following SRD
-Shallow pockets had greater bacterial populations after SRD
-Topical betadine had no effect on bacterial numbers in deep pockets
-Tetracycline suppressed overall bacterial load, with more pronounced effects on spirochetes compared to motile rods
Results –Aa and Capnocytophaga
-Measured by presence/absence
Aa
-Present in all deep pockets but only 2/10 shallow
pockets
-Reduced by SRD, but still present in significant
numbers (19/20)
-Increased presence in shallow pockets after SRD
(5/10)
-Strongly suppressed by tetracylin, with an almost
immediate effect
Capnocytophaga
-Unlikely Aa, no strong preference to colonize
deeperpockets
-Again, SRD mild effect, with little betadine action
ad tetracycline
 Results – Effect of Tetracyclin on Aa
Aministered at 1g/day

-Significant reductions in both Aa and Capnocytophaga from day 1

-Tetracycline induced a slower response in Aa populations compared to Capnocytophaga
-All sites were cleared of capnocytophaga by day 6
-It took up to 13 days to clear some sites of Aa
-The higher the level of baseline Aa, the longer the treatment was required to suppress Aa to below
detectable levels, and higher the chance of recurrence
 Results – Clinical Parameters

-Pre tx
High plaque levels – 82.5%
61.2% of sites demonstrated bleeding upon probing
Avg Gingival Inflammatory index 1.6
-SRD
Moderate reduction in plaque and inflammation
Did not arrest loss of periodontal attachment – decrease in CAL possibly due to residual bacterial load
-Tetracyclin
Arrest of loss of periodontal attachment – increase in CAL
 Results – Changes in CAL

Post SRD
9 deep and 3 shallow pockets lost 1 – 2mm of attachment
During tetracyclin (22-24)
only 1 deep pocket showed increase in CAL, while the 9 deep periodontal pockets have regained attachment
Post tetracyclin - maintenance (24-36)
some rebound in CAL, possibly due to recurrence of Aa
Other Results
- changes in probing attachment level were a good reflection of changes in radiographic alveolar
bone mass/level
◦ 5/6 pockets showing increases in CAL also exhibited radiographic bone loss
◦ 14/15 pockets with no change in probing attachment exhibited no radiographic bone levels

- Capnocytophaga and spirochetes not found in refractory sites, with increases in CAL at week 36
- Motile rods showed poor correlation with changes in CAL

- Aa levels consistent with CAL change at week 36

- Aa was present in high numbers in all 4 periodontal pockets exhibiting 1-2 mm of attachment loss
- Aa not recovered in pockets that demonstrates an increase of >2.5mm of attachment
Discussion – Tx modalities
-SRD by itself unable to substantially suppress or eradicate Aa or other bacterial populations
◦ Found not only for deep pockets but also shallower pockets
◦ Instrumentation of shallow pockets results in loss of CT attachment and loss of supporting alveolar bone
◦ Ability to persist aftering SRD attribute to postulated ability of Aa and other bacteria to invade pocket
epithelium
◦ Potential for tx which removes soft tissue such as gingivectomy, flap surgery to eradicating these
organisms

-Betadine exhibited little effect on bacterial counts

-14 day systemic tetracyclin administration lowered Aa, Capnocytophaga and spirochetes to below
detectable levels in majority of pockets examined
Recommended that therapy of 1g/day be continued for at least 1 week after obtaining
negative cultures results to prevent recurrence
Discussion
-Subgingival spirochetes and motile rods not good markers of disease presence or progression
◦ Spirochetes detected in only one pocket, which was in remission
◦ No difference in proportion or amount of motile rods in pockets with active disease or pockets in remission

-Results do not support the role of Capnocytophaga in the pathogenesis of LJP

◦ Not discovered in the 4 pockets with continued breakdown post tx
◦ Present in periodontal pockets that demonstrated gain of attachment

‘Although only a selected portion of the microflora was studied, the present results further incriminate Aa in the
etiology of localized juvenile periodontitis.’
◦ Present in all deep pockets prior to treatment
◦ Also present in refractory sites that showed increase CAL despite tetracyclin tx