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Juvenile periodontitis: no laughing matter.

Although relatively rare, this irreversible gum disease gives no warning before claiming the teeth of unsuspecting teenagers.

At age 15, Brenda, an attractive high-school sophomore, thought she had better things to worry about than the growing looseness in her front "They looked fine when I smiled," she says, "and they didn't hurt, so I figured whatever was causing it would eventually just go away."

Instead, the teenager's teeth got looser. Within a few months Brenda's front teeth had become so wobbly that she was afraid they would fall out if she bit into an apple. "At that point," she says, "all I could think about was how ugly I would look without front teeth."

Brenda was diagnosed with juvenile periodontitis, a rapidly progressing gum disease in which the tissue and bone that support the teeth are destroyed. "This disease is generally irreversible in nature, so whatever destruction occurs cannot be reversed," explains Jon Suzuki, a professor of periodontics and microbiology at the University of Maryland. In Brenda's case, the shocked teenager lost six of her eight front teeth. And Brenda is not alone. Dr. Suzuki estimates that 2 to 3 percent of young people aged 12 to 18 have juvenile periodontitis.

The major problem with juvenile periodontitis is that there are usually no warning signs. The gums do not bleed, swell, or discolor. "It's generally a painless disease until the later stages," says a periodontal researcher, Eugene Savitt of Cambridge, Massachusetts. "It's only in the final stages of the disease, when the teeth start to move, that the patient becomes aware there is a problem."

Research suggests that juvenile periodontitis-which progresses at a rate three to five times faster than adult periodontal disease-may be associated with the hormonal changes of puberty. "The general assumption has been that these hormonal changes affect the oral environment, allowing the destructive bacteria that cause this disease to rapidly multiply and cause problems," Dr. Savitt explains.

Juvenile periodontitis occurs three times more frequently in females than in males. As a result, many researchers believe that an inability to fight off destructive oral bacteria is linked to the X chromosome and passed ftom mother to child. "There are strong genetic implications with this disease," Dr. Suzuki says. "That's why it's extremely important for the entire family of a patient who has been diagnosed as having juvenile periodontitis to be checked for the disease."*

Early detection of juvenile periodontitis is the key to successful preventive treatment. "The problem," Dr. Suzuki says, "is that most people avoid going to the dentist except when something hurts. Young people, especially, feel that they are invincible, that they have great healing powers, or that it just won't happen to them. What they don't realize is that without routine dental care and examinations, it's possible to have this disease and end up losing their teeth. And," he adds, "if you lose your adult teeth, you lose them for a lifetime."

Dental experts recommend a complete periodontal examination every three to six months for all children entering puberty. X-rays of teeth should be taken at least once a year to detect early signs of rapid bone loss.

A new DNA probe, DMDx test, provides the most accurate early detection of juvenile periodontitis by measuring the specific levels of bacteria in the mouth. The test, developed by genetic researchers at BioTechnica Diagnostics, a Boston-based laboratory, is 95 percent accurate. However, because the $100 test is an expensive screening tool, Dr. Suzuki recommends it only for patients whose families have a history of tooth loss or juvenile periodontitis.

If caught in time, this aggressive disease can be stopped by a combination of antibiotic therapy, frequent professional cleanings, and meticulous at-home brushing and flossing.

Left unchecked, the disease can progress rapidly. "It's important to remember it's a silent disease," Dr. Suzuki says. "There is no way to see it at home. The teeth look normal until they start to wobble.

"The bottom line," he adds, "is that teenagers don't have to lose their teeth. Teeth are meant to be kept a lifetime, and with good maintenance and preventive care, they can be."

*Editor's note. Dr. David Bixler, chairman and professor at the Department of Oral-Facial Genetics at the Indiana University School of Dentistry, concurs that all family members of a juvenile periodontitis patient should be monitored. There is good evidence now that at least one major form of juvenile periodonitis has a simple genetic pattern, he said. In Finland it hay been reported to be an autosomal-recessive trait, and in this country there may well be an X-linked-dominant genetic type.
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Author:Senz, Laurie S.
Publication:Saturday Evening Post
Date:May 1, 1989
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