title: Prevalence of Actinobacillus actinomycetemcomitans and clinical conditions in children and adolescents from rural and urban areas of central Italy.
abstract: BACKGROUND
  The aim of this study was to report on the prevalence of Actinobacillus actinomycetemcomitans (Aa) and the periodontal clinical conditions in children and adolescents from a rural area of central Italy compared with the ones from an urban area of the same region.
  
  
  METHODS
  The study population consisted of 780 systemically healthy children, aged 6-14 years inhabiting the county of Chieti. 505 children attended 3 primary and 2 secondary schools from a rural area whereas 275 individuals attended 1 primary and 1 secondary school from the city of Chieti. The 2 provincial areas present a great difference in socioeconomic level and cultural background. Clinical examination consisted of recording the % of gingival sites positive for the presence of plaque (P1+), bleeding on probing (BOP+), mean probing depth (PD) from each primary or permanent tooth fully erupted in the oral cavity. Loss of periodontal attachment (AL+) was evaluated only in interproximal sites. AL+ subjects were distinguished in juvenile periodontitis (JP) prepubertal periodontis and early periodontitis (EP) patients. 8 gingival sites were microbiologically sampled in each subject and cultured, after pooling, for the presence of Aa.
  
  
  RESULTS
  30.3% of rural subjects, were positive for the presence of Aa, the difference from urban children (16%) being statistically significant (p=0.01) irrespective of gender and age. Aa showed a significantly (p=0.006) higher mean proportion in subgingival plaque samples from rural children (0.13% versus 0.02%). Loss of periodontal attachment in at least one site was found in 18 rural children (3.56%) (3 JP; 15 EP) and 2 urban girls (0.72%)(1 JP; 1 EP). No significant differences for AL were observed within the rural group according to the gender and age differentiation. In the urban group, both AL+ subjects were Aa+, while among children from rural areas all 3 JP and 13 EP subjects were Aa+. Rural subjects evidenced significantly worse clinical parameters with respect to urban children (% PI+ sites: p=0.000; % BOP+ sites: p=0.010; mean PD: p=0.000.) The relative risk for AL+ sites was significantly greater (2.42) in rural subjects harboring Aa in subgingival plaque. Similarly, the presence of Aa in subgingival plaque was related to a greater risk of more than 50% of BOP+ gingival sites in both rural and urban subjects (1.45 and 8.40, respectively).
  
  
  CONCLUSIONS
  Results of this study suggest that Aa colonization in children and adolescents from central Italy is affected by socioeconomic and cultural factors; these factors also affect the periodontal condition of the subjects.
authors.affiliation: Department of Periodontology, School of Dentistry, G. D'Annunzio University, Chieti, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Paolantonio
authors.forename: G
authors.initials: G
authors.lastname: di Bonaventura
authors.forename: G
authors.initials: G
authors.lastname: di Placido
authors.forename: V
authors.initials: V
authors.lastname: Tumini
authors.forename: G
authors.initials: G
authors.lastname: Catamo
authors.forename: A
authors.initials: A
authors.lastname: di Donato
authors.forename: R
authors.initials: R
authors.lastname: Piccolomini
mesh_terms: D000293:Adolescent; D016976:Aggregatibacter actinomycetemcomitans / Q000302:isolation & purification / Q000472:pathogenicity*; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D003773:Dental Plaque / Q000453:epidemiology / Q000382:microbiology*; D003774:Dental Plaque Index; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D017622:Periodontal Attachment Loss / Q000453:epidemiology* / Q000382:microbiology*; D010512:Periodontal Index; D015995:Prevalence; D012423:Rural Health / Q000706:statistics & numerical data*; D014504:Urban Health / Q000706:statistics & numerical data*