Slots J _quot;Predominant cultivable organisms in juvenile by gyvwpsjkko


									                    This Week’s Citation Classic @ %~l’%
              Sets J. hxiormnant cultwabie
                       J. Dent. Res. 84: l-10,
        nent teeth of young
                                     md Dept. Microbiology,
                                                             affects the perma,
                                                                and can MU%
                                                                                          m Juvenile

                                                                                           Royal Dental College, Copenhagen, &m&l
                                                                                          . I

                                                                                                                               A. actinomycetemcomitens
                                                                                                                      the oral cavity in childhood                           and is

        pmnounced           damage          to a dentition.       This study rep.                    poised to initiate periodontal                       destruction             on
        resented       the first comprehensive                description        of the             the first teeth to erupt, viz. the incisors and
       pathogenic          organisms            in the disease.          Deep pen                   first molars; the teeth that are also affected
       odontal       lesions        harbored          a characteristic         Gram.                in localized juvenile                 periodontitis.             The peri-
       negative         microflora.        The key pathogen                 was iss                 odontsl       A. actinomycetemcomitans                                  infec-
      lated,       characterized,                 and later       classified         as             tion gives rise to a strong antibody                           response
      ActhaLwciilusactinomycete~m~ns.                                   Knowledge                  The antibodies             have the potential                   to control
     about the organism’s                   epidemiology,          transmissibil.                 the small number of A. actinomycetemcom-
     ity, and susceptibility              to treatment        has dramatically                     ifanscellsseeding                 tosurfacesof               latererupt-
     changed         the prevention,              treatment,     and prognosis                    ing teeth, thereby                preventing            breakdown               of
     of the disease.            [The SC/e indicates              that this papel
                                                                                                  those teeth. High antibody                        levels eventually
     has been cited in more than 165 publications.]                                               may also neutralize                    the microbial               insult in
                                       WC                                                        the original             lesions,         if the teeth are still
                                                                                                 remaining.            The familial             distribution             of the
                          Long        in   the Tooth                                            disease           stems         from transmission                         of A
                                                                                                scfinomycefemcomifanssmong                                   susceptible
                                  Jergen Slots                                                  family members.                The transmission                   route has
                University         of Southern         California                              been delinested                by microbial             fingerprinting
                   School of Dentistry,               MC0 841                                  including           biotyping,           serotyping,             and, rno;
                   Los Angeles, CA 900894841                                                  recently,           restriction          fragment            length poly-
            Local*edjwenileperiodontitieaffilctsO.l-                                          morphism              patterns.
         1.0 percent of teenagers               in the US and Euro.                                   Treatment         and prognosis                of the localized
         peen populations            and may occur with higher                                juvenile         periodontitis              has dramatically                    in+
        prevalence         in some Third-World                countries                       proved            with        the identification                         of A
        The disease          has a familial            predisposition‘                        actinomycetemcomitans                            as the key path&
        and is particularly          prevalent       among African-                           gen. in addition                 to residing              in deep peri-
        Americans.         Localized       juvenile periodontitis                            odontal pockets, A. actinomycetemcomitsns
        may lead to loss of the upper and lower                                              is capable of invading                    gingival tissue. This is
       incisor and first molar teeth within a period                                         probably          the reason that mechanical                              tooth
       of a few years.                                                                       cleaning fails to eradicate                       the organism                and
           Until the mid-1970s,              nothing       was known                         arrest the disease.                    On the other hand, se.
      about the pathogenic                   microorganisms                in                #ected systemic                antimicrobial              therapies            are
      localized       juvenile        periodontitis.          Some re-                      able to eliminate                  the organisms                  from oral
     searchers          even held the view that the dis-                                    sites and stop disease                           progression.               Sys-
     ease was due to degenerative                         rather than                       temic antimicrobial                   therapy         is now used rou-
     infectious        causes. It often failed to respond                                   tinely as an adjunct                      to conventional                   peri-
    to conventional              periodontal        therapy.                                odontal           therapy            and has significantly
          This article identified a certain Gramnega.                                       enhanced            the prognosis                of the patient.               Lo-
   tlve bacterium,            later classified        by this author                        :alized juvenile                periodontitis              represents              a
   ss Actinobacillus               actinomycetemcomitans,                                  prime example of how a systematic                                  research
  to be the most likely putative                        pathogen         of                approach            has led to a radical change in the
  localized         juvenile       periodontitis.         Many labo-                       understanding,                treatment,           and prognosis                  of
  ratories        in the US, Europe,                and Asia later                         a previously             serious oral disease.
 confirmed            this finding.         Today, localized           ju-                      In research, localized juvenileperiodontitis
 venile periodontiiis                 is the periodontal             dis-                  8 widely usad as a model to delineate                                         the
 eese entity that most convincingly                          has been                      nolecular          events in destructive                      periodontal
 related to a given bacterium.                                                            disease.’          Data from studies of localized                               ju-
         The localized           nature      and other clinical                     I     venile periodontiiis                   have been instrumental
itsns virulence
                   of the disease             are the result of
                        between A. actinomycetemcom-
                             factors and protective                host
                                                                                   I1     in generating
                                                                                          lecular biology
                                                                                                                      new hypotheses
                                                                                                                           of certain
                                                                                                                                                         on the mo-
                                                                                                                                                forms of adult

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