Treatment of Papillon-Lefèvre syndrome periodontitis.
OBJECTIVE
Conventional mechanical treatment of Papillon-Lefèvre syndrome periodontitis has a poor prognosis. This report describes an effective antimicrobial treatment of rapidly progressing periodontitis in an 11-year old girl having Papillon-Lefèvre syndrome.


METHODS
Clinical examination included conventional periodontal measurements and radiographic analysis. Occurrence of major suspected periodontopathic bacteria was determined by selective and non-selective culture and by polymerase chain reaction (PCR) identification. Presence of cytomegalovirus and Epstein-Barr type 1 virus was determined by a nested-PCR detection method. Therapy included scaling and root planing, oral hygiene instruction, and systemic amoxicillin-metronidazole therapy (250 mg of each/3 times daily/10 days) which, based on follow-up microbiological testing, was repeated after 4 months. Supportive periodontal therapy took place at 2 visits during a 16-month period.


RESULTS
At baseline, 10 of 22 available teeth demonstrated severe periodontal breakdown. At 16 months, probing and radiographic measurements revealed no teeth with additional attachment loss, and several teeth exhibited significant reduction in gingivitis and pocket depth, increase in radiographic alveolar bone height and clinical attachment level, and radiographic evidence of crestal lamina dura. Baseline subgingival microbiota included Actinobacillus actinomycetemcomitans (3.4% of total isolates), Prevotella nigrescens (16.4%), Fusobacteriumnucleatum (14.3%) and Peptostreptococcus micros (10.6%), as well as cytomegalovirus and Epstein-Barr type 1 virus. At termination of the study, culture and PCR examinations showed absence of A. actinomycetemcomitans, P. micros and herpesviruses, and P. nigrescens and F.nucleatum each comprised less than 0.1 % of subgingival isolates.


CONCLUSIONS
This study suggests that controlling the periodontopathic microbiota by appropriate antibiotic and conventional periodontal therapy can arrest Papillon-Lefèvre syndrome periodontitis.
Pacheco
J J
JJ
Department of Periodontology, School of Dentistry, Instituto Superior de Ciências da Saúde-Norte, Paredes, Portugal.
Coelho
C
C
Salazar
F
F
Contreras
A
A
Slots
J
J
Velazco
C H
CH
D016976:Aggregatibacter actinomycetemcomitans / Q000254:growth & development; D016301:Alveolar Bone Loss / Q000628:therapy; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D003587:Cytomegalovirus / Q000302:isolation & purification; D012534:Dental Scaling; D005260:Female; D005500:Follow-Up Studies; D016967:Fusobacterium nucleatum / Q000254:growth & development; D005891:Gingivitis / Q000628:therapy; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D009910:Oral Hygiene; D010214:Papillon-Lefevre Disease / Q000150:complications*; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D010462:Peptostreptococcus / Q000254:growth & development; D017622:Periodontal Attachment Loss / Q000628:therapy; D010514:Periodontal Pocket / Q000628:therapy; D010518:Periodontitis / Q000382:microbiology / Q000628:therapy* / Q000821:virology; D018720:Prevotella / Q000254:growth & development; D011379:Prognosis; D016745:Root Planing
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D010406:Penicillins; D008795:Metronidazole; D000658:Amoxicillin