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PERIO - Periodontal Practice Today
PERIO - Periodontal Practice Today 3 (2006), No. 2     15. June 2006
PERIO - Periodontal Practice Today 3 (2006), No. 2  (15.06.2006)

Page 115-122

Association of High Plaque Levels of Prevotella intermedia with Aggressive Periodontitis in a 16-year-old Female
Tipton, David A./Pabst, Michael J./Thomas, Edwin L./Babu, Jegdish P./Stein, Sidney H./Fry, Hiram R.
Background: Aggressive periodontitis (AP) encompasses a group of highly destructive forms of periodontitis. Its pathogenesis may be related to alterations in inflammatory and immune responses and in the oral flora.
Methods: A 16-year-old Black female patient presented with chief complaints of gingival pain and tooth mobility. She received a complete clinical dental examination, full mouth periapical radiographs, and laboratory tests including complete blood count, comprehensive metabolic panel, and microbiological plaque analysis. In vitro studies included salivary analysis and neutrophil and monocyte response to lipopolysaccharide (LPS).
Results: The patient had severe generalised gingival inflammation, type III tooth mobility, 8 to 10+ mm pocket depths, and extreme, generalised alveolar bone loss. Blood analysis revealed chronic non-cyclic neutropaenia, monocytosis, and slightly elevated protein levels. Subgingival plaque contained high levels of Prevotella intermedia/nigrescens (P.i.) (~50%) and Porphyromonas gingivalis (P.g.) (~15%). The patient's neutrophils and monocytes produced superoxide and interleukin-1ß normally in response to N-formylmethionyl-leucyl-phenylalanine and E. coli LPS, and the neutrophils attached and migrated normally. Prevotella LPS had lower neutrophil priming activity than Actinobacillus actinomycetemcomitans or Fusobacterium nucleatum LPS. Salivary protein, and myeloperoxidase and lactoperoxidase activities were elevated.
Conclusions: This report supports others associating P.i. and P.g. with AP. The high levels of P.i. in the plaque are of particular interest, because P.i. LPS had low ability to prime neutrophils. This excessive growth of P.i. and P.g., coupled with low numbers of normally functioning circulating neutrophils, may have contributed to the development of AP.

Keywords: aggressive periodontitis, Prevotella intermedia, neutrophils, lipopolysaccharide (LPS)