LOSS OF DECIDUOUS TEETH AND GERMS OF PERMANENT INCISORS IN A 4-YEAR-OLD CHILD - AN ATYPIC PREPUBERTAL PERIODONTITIS - A CLINICAL, MICROBIOLOGICAL, IMMUNOLOGICAL AND ULTRASTRUCTURAL-STUDY

A 4-year-old child was referred, in April 1988, to Rennes Dental Schoo l (France) for deciduous tooth mobility with premature loss of 4 decid uous teeth and germs of 2, permanent incisors. Microbiological examina tions by culture revealed the presence of the periodontal pathogen Act inobacillus actinomycetemcomitans. Immunofluorescence of plaque sample s revealed the presence of Porphyromonas gingivalis that had not been isolated by culture. Neutrophil functions were within normal ranges. T ransmission electron microscopy of gingiva showed a disorganised epith elium. The connective tissue was infiltrated by inflammatory cells. Th e basement membranes were normal, but the connective tissue-epithelium interface was mainly composed of short rete pegs. Scanning electron m icroscopy of extracted deciduous teeth revealed lack of cementum, lacu nae in the cementum and lack of fibrillar insertion on the middle part of the root. Skin lesions, mainly situated on face, were observed. Tr eatment uas by extraction of mobile deciduous teeth combined with 3-we ek courses of metronidazole. Clinical and microbiological follow-up wa s continued over a 7-year period. No periodontal lesions have been det ected since eruption of the permanent teeth. The present subgingival a nd lingual microflora (December 1995) is composed of bacteria associat ed with periodontal health. However, the future appearance of a hither to undetected systemic disease is still possible.