一名8岁女孩被诊断患有心脏皮肤综合征,出现牙龈疼痛到我们部门,炎症,和出血。她的病史包括call体发育不全,智力残疾,毛营养不良,全球发育迟缓,近视,喉软化症,甲状腺功能减退,和骨质疏松症。诊断为“牙周炎是全身性疾病的直接表现”。在9年的随访中,有自发性牙龈出血的加重发作,牙间乳头溃疡,牙齿活动性,和进行性牙齿脱落。这些恶化发作中的一些通过给予阿莫西林和甲硝唑临床解决。因此,我们提出了抗生素治疗前后的口腔微生物组研究(龈下和唾液样本)。在使用抗生素之前,牙龈下水平上最丰富的属是普雷沃氏菌,链球菌,梭杆菌,Leptotrichia,和Aggregatibacter.在测序的94个属中,57在治疗后状态下的丰度低于基线,特别是某些革兰氏阴性牙周病原体,如卟啉单胞菌,密螺旋体,Aggregatibacter,梭杆菌,和弯曲杆菌.相比之下,与口腔健康有关的其他属,比如嗜血杆菌,肉芽肿,和Abbioprophia,在施用抗生素后显示增加。总之,牙周炎恶化作为全身性疾病的直接表现,偶尔可以用全身性抗生素来控制,无需进行机械牙周治疗。这种临床恢复与口腔微生物组的实质性变化相关,这导致微生物群的优生恢复。
An 8-year-old girl diagnosed with cardiofaciocutaneous syndrome presented to our department with gingival pain, inflammation, and bleeding. Her medical history included hypoplasia of the corpus callosum, intellectual disability, trichothiodystrophy, global developmental delay, myopia, laryngomalacia, hypothyroidism, and osteoporosis. A diagnosis was reached of \"periodontitis as a direct manifestation of systemic diseases\". During 9 years of follow-up, there were exacerbation episodes with spontaneous gum bleeding, ulcers in the interdental papilla, tooth mobility, and progressive tooth loss. Some of these exacerbation episodes resolved clinically with the administration of amoxicillin and metronidazole. We therefore proposed an oral microbiome study (subgingival and saliva samples) before and after antibiotic therapy. The most abundant genera at the subgingival level before administering antibiotics were Prevotella, Streptococcus, Fusobacterium, Leptotrichia, and Aggregatibacter. Of the 94 genera sequenced, 57 were less abundant in the post-treatment state than at baseline, particularly certain Gram-negative periodontal pathogens such as Porphyromonas, Treponema, Aggregatibacter, Fusobacterium, and Campylobacter. In contrast, other genera related to oral health, such as Haemophilus, Granulicatella, and Abiotrophia, showed an increase after administering the antibiotic. In conclusion, periodontitis exacerbations as a direct manifestation of systemic disease can occasionally be controlled exclusively with systemic antibiotics, without the need for performing mechanical periodontal therapy. This clinical recovery is correlated to substantial changes in the oral microbiome, which lead to the recovery of eubiosis of the microbiota.