Mechanisms and Treatment Response of Aggressive Periodontitis in Children

• Systemic Inflammatory Response [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  The investigators are testing for systemic (plasma levels) and local (gingival crevicular fluid levels) inflammatory responses using milliplex assay analysis.
  
  

• Oral Microbiota [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  The investigators are testing oral subgingival microbiota using Homin microarray analysis to detect ~300 bacterial species in aggressive periodontitis children compared to healthy siblings and unrelated controls.
  
  

Aggressive periodontitis (AgP) is a group of rare, but severe, rapidly progressing form of periodontitis, characterized by an early age of onset and rapid bone destruction that leads to early tooth loss. It appears that this disease result from a combination of bacterial infection and hyperactivity of the immune system. However, given its rare occurrence and difficulties in gathering large populations, knowledge on specific mechanisms and consequently proper treatment of this disease remains based on case reports and a few small clinical trials.

The investigators have identified a cohort of at least fifty African-American children diagnosed within one clinical setting in Tallahassee, Florida, with a very similar pattern of localized AgP (LAgP). This group represents a small underserved population of north Florida. Our preliminary data shows an exacerbated immune response and specific groups of bacteria involved with this disease. With proper diagnostic tools and with the knowledge the investigators have already gained within this population, the investigators believe they are able to gather a larger population to further understand this aggressive disease and the effects conventional treatment has upon its mechanisms.

Therefore, the overall goal of this study is to determine which mechanisms are responsible for the rapid tissue destruction in children with aggressive periodontitis, and how conventional periodontal intervention affects these mechanisms. Our central hypothesis is that AgP is associated with a combination of a hyper-inflammatory innate trait and a specific group of bacteria and that periodontal therapy is able to modulate these parameters responsible for tissue destruction.

In order to test our hypothesis the investigators propose to: 1- To determine if 'traditional' periodontal treatment alters the hyper-responsive trait observed in LAgP by evaluating the systemic regulatory mechanisms of cyto/chemokine expression which contribute to tissue destruction; 2- To determine how local inflammatory mediators and metalloproteinases are modulated through the progression and treatment of periodontal disease in children with LAgP.; and 3- To determine alterations in subgingival microflora associated with LAgP after traditional periodontal treatment.

The investigators hope that the outcomes of this study will provide us with a better understanding of the mechanisms involved with aggressive periodontal tissue destruction in children and how treatment affects these mechanisms. This will enables us to investigate early and improved treatment approaches to prevent early tooth loss and possible future systemic complications.