Local application of tetracycline solution with a microbrush: an alternative treatment for persistent periodontitis

OBJECTIVE

Topical antibiotics may overcome shortcomings of mechanical therapy for localized persistent periodontitis. This double-center, single-blind, randomized controlled study aimed to evaluate the microbiologic profile and clinical parameters of persistent periodontal pockets after treatment with tetracycline solution.

METHOD AND MATERIALS

Thirty-seven patients who had at least 4 non-adjacent sites of persistent periodontal pockets with probing depth of at least 5 mm and bleeding on probing were randomly assigned to test and control groups. In the test group, 2 teeth received 4 applications of tetracycline solution (100 mg/mL) with a microbrush(T), while the other 2 teeth received the same treatment plus 1 session of scaling and root planing(SRP+T). In the control group, 2 teeth received 1 session of scaling and root planing(SRP), and the other 2 teeth received 4 applications of saline with a microbrush plus 1 session of scaling and root planing(SRP+S). Clinical parameters of probing depth, bleeding on probing, visible plaque index, gingival bleeding index, gingival recession, as well as clinical attachment level and subgingival plaque samples (evaluated by polymerase chain reaction) were measured at baseline and 1, 3, and 6 months.

RESULTS

All therapies yielded statistically significant data on clinical measurements with no significant differences among groups. Presence of bacteria decreased in both groups, but only in the test group was a significant decrease of Porphyromonasgingivalis,Tannerellaforsythia, and Actinobacillusactinomycetemcomitans noted up to 6 months.

CONCLUSION

Tetracycline applied with a microbrush may be an alternative treatment for persistent periodontitis that can probably be mediated by reduction of microorganism proliferation

[Species composition of anaerobic microflora in parodontal pocket depending upon disease stage]

With the help of polymerase chain reaction (PCR) the dynamic of species composition of anaerobic microflora in cases of generalized parodontitis was established. It was detected that disease severity increase was followed by the increase of the number of anaerobic microflora species in parodontal pocket; at that it was impossible to connect the presence of some determined type of microorganism with the inflammatory parodontal process intensity. It was shown that proteins fimbrilin and gingipain were not the only parodontitis pathogenic factors although the first one (fimbrilin) could be connected with aggressive disease flow. The suggested PCR scheme could be useful for early disease stage diagnostic and substantiation of antimicrobial therapy method selection.

Prevalence of Actinobacillus actinomycetemcomitans in Chinese chronic periodontitis patients and periodontally healthy adults

OBJECTIVE

Actinobacillusactinomycetemcomitans is a major periodontal pathogen. This research was aimed at investigating the prevalence of A actinomycetemcomitans in Chinese chronic periodontitis patients and periodontally healthy adults.

METHOD AND MATERIALS

A total of 116 chronic periodontitis patients and 111 periodontally healthy adults were included. In each periodontitispatient,subgingival plaque samples were collected from 2 molar sites with the deepest pockets and 1 periodontally healthy site. The samples of periodontally healthy adults were obtained from the mesiobuccal site of 1 maxillary first molar. A actinomycetemcomitans was detected by 16S rRNA polymerase chain action. Pocket depth, clinical attachment loss, and bleeding on probing of the sampled sites were recorded.

RESULTS

A actinomycetemcomitans was detected in only 1 site (0.90%) of periodontally healthy subjects. For chronic periodontitispatients, the prevalence of periodontitis sites (33.62%) was significantly higher than that of healthy sites (0.90%)(P<.05); the occurrence showed a decreasing trend as patient age increased: highest in the 20- to 35-year-old group (44.12%), followed by the 36- to 55-year-old group (36.36%) and 56- to 75-year-old group (22.73%)(P<.05). A actinomycetemcomitans was most frequently detected in sites with pocket depth 7 mm or more and clinical attachment loss 6 mm or more (P<.05) and more often detected in sites that exhibited bleeding on probing (37.07%) than those that did not (7.41%)(P<.05).

CONCLUSIONS

A actinmycetemcomitans was more frequently detected in periodontitis sites than in periodontally healthy sites. For chronic periodontitispatients, a higher prevalence was associated with the severe sites than moderate and mild sites. A actinomycetemcomitans is considered to be a major pathogen in the etiology of chronic periodontitis

[Bacteriological spectrum of periodontal pocket in patients with coronary heart disease and myocardial infarction]

INTRODUCTION

In the last years literature has paid attention to positive correlation between periodontitis and coronary heart disease, acute coronary events, including myocardial infarction. Mechanisms of this relationship are not completely known. One of the research trends for elucidation of these problems are bacteriological studies. The aim of this study was qualitative and quantitative evaluation of bacterial flora of the periodontal pocket in patients with coronary heart disease and myocardial infarction, with co-existing periodontitis.

MATERIAL AND METHODS

The research included 40 patients, hospitalised in 1st Clinic of Cardiology, Medical University in Gdańsk. Group 1 included 20 patients after myocardial infarction, group 2 of 20 patients with diagnosed coronary heart disease, with many years duration without acute events. Control group encompassed 20 patients of Chair and Department of Periodontology and Oral Mucosa Diseases, Medical University in Gdańsk, without cardiovascular diseases. Inclusion criterion for the study was diagnosed chronic periodontitis in all patients. In clinical evaluation indices: API, SBI, PD and CAL were used. The material for bacteriological research was taken in each patient from 4 periodontal pockets, minimum 5 mm depth. The culture and identification were performed with present principles. Based on the litearture data about potential pathogenicity for periodontium and cardiovascular system, species for analyse were chosen.

RESULTS

Statistical analyse proved equality of evaluated groups and control group in gender, age and estimated clinical indices. In periodontal pockets all patients anaerobic flora dominated, however without significiant differences in species range. Among microaerophilia and streptococci statistical analyse showed significiant differences in frequency of isolation of Actinobacillus actinomycetescomitans and Streptococcus sanguis in group 1 in comparision to group 2 and control group. Quantitative analyse showed no significiant differences between groups for all bacteria species.

CONCLUSIONS

Clinical evaluation showed comparable values of periodontal parameters. The bacteria species Porphyromonas gingivalis, Actinobacillus actinomycetescomitans and Streptococcus sanguis were more often isolated from periodontal pockets in persons after myocardial infarction, statistically significant for A.a. and S.s.

Individual architecture of subgingival microflora in chronic periodontitis

BACKGROUND

Nearly 400 species of bacteria have been found in human periodontal pockets, and half of them remain uncultured to date. The diagnosis of individual periodontal microflora using culture-independent detection of species is expected to serve as a tool for 'tailor-made' periodontal treatments. However, the richness and abundance of bacterial species within individual subgingival microflora have not been sufficiently studied to develop more specific diagnostic microbiological tests. The purpose of this study was to determine the ecological architecture of the subgingival microflora among chronic periodontitis patients and their individual differences based on phylotype analyses.

METHODS

Four 16S rRNA gene libraries were constructed from subgingival plaque samples taken from all diseased sites in four chronic periodontitis patients. The 480 clones generated from each of the four libraries were analyzed by phylotyping and subjected to ecological estimation of species richness.

RESULTS

The indices of species richness of the four libraries were 73, 75, 98 or 100 phylotypes. A total of 195 phylotypes were identified in the combined libraries. The majority of phylotypes were assigned to the Bacteroidetes, Fusobacteria, Proteobacteria, Firmicutes and Actinobacteria phyla. The phylotypes assigned to the Bacteroidetes and Fusobacteria phyla were the most predominant in each library (chi2-test, p < 0.05).

CONCLUSIONS

In this study, the molecular ecology of 1920 clones obtained from four patients' subgingival plaque samples was examined. More than half of the detected clones were categorized under either the Bacteroidetes or the Fusobacteria phyla. Each library showed unique richness and abundance of phylotypes.

DNA Checkerboard method for bacterial detection of microbiota from teeth and tongue biofilms. A preliminary study

AIM

The aim of this study was to determine the prevalence of 13 bacterial species in the dorsum tongue biofilm and compare its microbiota to that of subgingival samples in healthy adult subjects using DNA Checkerboard hybridization.

METHODS

A total of 40 samples, from subgingival and tongue biofilm, were enrolled into the study. All the samples were harvested and analyzed by DNA Checkerboard method for their content of 13 species of bacteria. Bacterial scores from each subject and location were averaged and the results of both sites were compared using the Wilcoxon signed ranks test.

RESULTS

All the microorganisms evaluated were detected in both tongue and subgingival samples, without significant differences in their prevalence.

CONCLUSIONS

The dorsum of the tongue was colonized by various microorganisms with similar prevalence as found in the subgingival biofilm of healthy individuals, suggesting that the tongue could be a potential microbial reservoir and may play a role in the recolonization of teeth surfaces.

Locally delivered antimicrobials: clinical evidence and relevance

Periodontitis is a common oral infection and inflammatory condition. Following treatment, residual or persistent periodontal inflammation is associated with disease progression and tooth loss. Cumulative evidence from clinical trials and meta-analyses support a complementary medical-mechanical model that combines locally delivered antimicrobials with scaling and root planing for the treatment of chronic periodontitis. Accordingly, greater pocket depth reductions and/or attachment level gains occur in patients treated with adjunctive locally administered antimicrobials (eg, tetracycline, chlorhexidine, doxycycline, and minocycline). These responses are clinically relevant because they are accompanied by a higher probability of patient maintenance or pocket resolution. Recent trials also indicate that locally administered antimicrobials may enhance the effects of periodontal surgical therapy and may reduce the signs of peri-implantitis. The consistency of these findings supports the use of locally administered antimicrobials for managing dental patients with chronic periodontitis.

[Combined method for testing microflora in oral specimens]

The integrated procedure used in a clinical laboratory to test oral specimens for the microflora, which includes microscopic and rapid cultural studies, enhances the specificity and sensitivity of detection of fungi of the genus Candida as the used chromogenic selective nutrient medium allows C. albicans, C. glabrata, and C. tropocalis to be identified in the primary culture, without increase the time of giving the results of a test. The results of a test for the fungi may be quantitatively presented, which is of importance for the reasonable use of antifungal therapy (only when the diagnostically significant quantity of Candida exceeds) and of value for the control of the results of therapy. Semiquantitative detection of other morphological types (Leptotrichia, Borrelia, Fusobacterium, Protozoon) makes it possible to prescribe etiotropic therapy and to evaluate its efficiency.

Periodontal Disease: Production of volatile sulphur compounds in diseased periodontal pockets is significantly increased in smokers

OBJECTIVE

This study was undertaken in order to test the hypothesis that the consequences of tobacco smoking may include increased synthesis of toxic volatile sulphur compounds in diseased periodontal pockets.

DESIGN

A cross-sectional, parallel study comparing groups of smokers and non-smokers with periodontitis and the level of volatile sulphur compounds in the gingival sulci of these subjects.

PATIENTS AND METHODS

Levels of volatile sulphur compounds were measured in diseased periodontal sites of 12 smokers and 11 non-smokers using a portable sulphide monitor. Anaerobic and aerobic counts of the total cultivable subgingival microflora of both groups were also determined.

RESULTS

The percentage of sites per subject with high levels of sulphides (> or = 10 units) detected in moderate (4-6 mm) and deep (> or = 7 mm) periodontal pockets was found to be significantly higher in smokers, compared to non-smokers (P = 0.040 and P = 0.005, respectively). No significant difference in the microbiological parameters tested were observed between the two groups.

CONCLUSIONS

Increased production of volatile sulphur compounds may represent a further mechanism of increased susceptibility to periodontitis in smokers and also help to explain the reported association between smoking and halitosis.

Subantimicrobial dose doxycycline effects on osteopenic bone loss: microbiologic results

BACKGROUND

Based on microbiologic concerns, the safety of a 24-month regimen of subantimicrobial dose doxycycline (SDD; 20 mg twice a day) was evaluated in postmenopausal osteopenic women with periodontitis in a double-blind, placebo-controlled, randomized clinical trial.

METHODS

Subgingival samples were collected from two sites (probing depth > or = 5 mm) in each of 128 subjects at baseline, with the same sites resampled at the conclusion of the 2-year period. The samples were enumerated on selective and non-selective media and on doxycycline (4 microg/ml) medium. Up to five different colonial morphologies were subcultured from the doxycycline medium, identified to species, and susceptibilities determined to doxycycline and five other antibiotics. Data were analyzed for microbial differences in total colony forming units (CFU), periodontal and opportunistic pathogens, and changes in species and in susceptibilities of isolates recovered on doxycycline medium.

RESULTS

There was no significant evidence that changes in total anaerobic counts over the treatment period (P = 0.96) differed between treatment groups. Likewise, periodontal pathogens, opportunistic pathogens, or normal flora did not differ descriptively between groups. Although there was a significant increase (P <0.001) in the total CFU recovered from the 4 microg/ml doxycycline plates at 24 months for SDD versus placebo, the percentage that was clinically resistant to doxycycline (minimal inhibitory concentration [MIC] > or = 16 microg/ml) decreased over the 24-month period in both groups and did not differ between the treatment groups (SDD: 79% to 76%; placebo: 83% to 70%; P = 0.2). There were no significant differences (P >0.28 for each) in the change in cross-resistance between the groups for doxycycline and the other five antibiotics.

CONCLUSIONS

No antimicrobial effect on the subgingival flora was detected following treatment with SDD for 24 months, relative to baseline or to placebo. The increase in initial resistance (at 4 microg/ml) did not translate into a significant increase in the percent resistant to doxycycline (MIC > or = 16 microg/ml) for patients in the SDD group.

Serum antibody levels against Porphyromonas gingivalis extract and its chromatographic fraction in chronic and aggressive periodontitis

Periodontitis is an inflammatory oral disease caused by multifactorial intrinsic and extrinsic agents, including Gram-negative bacteria such as Porphyromonas gingivalis.

OBJECTIVE

To evaluate if there is difference in the serum levels of IgA, IgG and IgG subclasses reactive to Porphyromonas gingivalis in subjects with different periodontal conditions.

METHODS

The study included 89 patients divided into four groups: 29 subjects with moderate or severe chronic periodontitis (CP), 12 with aggressive periodontitis (AP), 22 with gingivitis or mild periodontitis (GP), and 26 healthy controls (HC). Humoral response was assayed by enzyme-linked immunosorbent assay (ELISA) to verify serum levels of IgG, IgG1, IgG2, IgG3, IgG4 and IgA serum levels reacting to crude P. gingivalis ATCC 33277 sonicate extract and fraction IV, an enrichment of the immunoreactive bands of the crude extract obtained by chromatography.

RESULTS

IgA, IgG (p < 0.01), IgG2, IgG3 and IgG4 serum level reactions to fraction IV were higher in the CP group compared with the healthy control. The CP group had higher levels of IgG and IgG4 to both antigens than the GP group, and higher levels of IgG and IgG4 to sonicate extract than the AP group. There were statistically significant differences in serum levels of IgG to both antigens (p < 0.01), IgG2 to fraction IV (p < 0.01), IgG3 to fraction IV (p < 0.05) and IgG4 to both antigens (p < 0.05) between AP and HC groups. IgG1 titers to sonicate extract were significantly higher (p < 0.05) in the GP group in comparison to the AP group.

CONCLUSIONS

The findings of this study suggest that there are differences in the serum levels of IgA, IgG and IgG subclasses in patients with different periodontal conditions.

Systemic administration of doxycycline versus metronidazole plus amoxicillin in the treatment of localized aggressive periodontitis: a clinical and microbiologic study

OBJECTIVE

The use of antibiotics as an adjunctive therapy in the management of periodontal diseases has always been of interest for dental practitioners. Although studies have demonstrated the importance of different antibiotics as adjunct in the treatment of periodontitis, few studies have reported comparative results of antibiotics in localized aggressive periodontitis (LAP). The aim of the present study was to evaluate the comparative effects of systemic tetracycline derivative doxycycline versus a combination of metronidazole and amoxicillin in the elimination/suppression of Actinobacillus actinomycetemcomitans and their clinical effects during 90 days of follow-up in patients with LAP.

METHOD AND MATERIALS

Thirty patients with untreated LAP participated in the study. Patients were randomly divided into 2 groups and given doxycycline or metronidazole plus amoxicillin, and periodontal clinical parameters were achieved at baseline and 10, 30, 60, and 90 days after microbiologic sampling. Patients were also given mechanical debridement after measurement at baseline.

RESULTS

Both groups of patients demonstrated improvement in clinical parameters, and microbiologic samples did not show any A actinomycetemcomitans at days 30, 60, and 90.

CONCLUSION

Systemic use of doxycycline or metronidazole plus amoxicillin as an adjunct to conventional therapy may be used for the treatment of patients with LAP.

[Anaerobic bacteria of periodontal pockets in course of periodontitis and premature labor]

The aim of the study is was to evaluate anaerobic periodontal mikrobes in 120 postpartum mothers. Group I consisted of mothers with a birth weight of less than 2,500g and gestational age < 37 weeks. Group II included mothers with normal birth weight infants. All women in both of groups were subjected to a full-mouth periodontal examination to determine a periodontal status. The microbial investigation for anaerobic bacteria of deepest periodontal pockets was performed in 35 cases of periodontits. A significantly higher incidence of preterm low birth weight cases in patiens with periodontitis was documented. In addition higher variety of anaerobic bacteria of periodontal pockets in mothers with preterm low birth weight infants comparison to control group was observed.

Detection of Porphyromonas gingivalis and Streptococcus intermedius in chronic periodontitis patients by multiplex PCR

A Multiplex PCR assay for the detection of Porphyromonas gingivalis and Streptococcus intermedius in chronic periodontitis is presented. A total of 180 samples from 65 adults with untreated periodontitis and 17 healthy volunteers were taken and processed in a simple boiling step. Cell lysates were used as DNA source for multiplex PCR assays. Primers were designed from 16S rRNA gene sequences from the GenBank-EMBL database showing specificity for target pathogens. This multiplex PCR system could detect 8.2 P gingivalis and S. intermedius cells. In untreated periodontitis patients, only 78.5% were positive for one or both bacteria; 37% were positive for P gingivalis only, 17% for S. intermedius and 24.5% for both. P. gingivalis was detected in 23.5% of healthy volunteers, while S. intermedius was not detected in the same patients. The distribution of these bacteria was related to the periodontal probing depth, while 95.23% of patients with pockets wih 6 to 7 mm deep were positive for either or both, only 70.45% of of them with 4 to 5 mm pockets were positive.

Detection of Porphyromonas gingivalis in the amniotic fluid in pregnant women with a diagnosis of threatened premature labor

BACKGROUND

Epidemiologic and randomized controlled studies have shown that periodontal diseases may be associated with preterm labor and delivery of infants with low birth weights. The purpose of the present study was to determine the presence of microbial invasion of the amniotic cavity by periodontopathic bacteria in pregnant women with a diagnosis of threatened premature labor.

METHODS

A periodontal examination and collection of amniotic fluid and subgingival plaque samples were performed on women identified as having threatened premature labor (preterm premature rupture of membranes without clinical infection or labor and preterm labor with intact membranes) and a gestational age ranging between 24 and 34 weeks. Samples collected from amniotic fluid and from the four deepest periodontal pockets in each patient were pooled in prereduced transport fluid and cultured. Porphyromonas gingivalis was identified primarily by colony morphology under stereoscopic microscope and rapid biochemical tests. Amniotic fluid or plaque samples were homogenized, DNA was extracted, and polymerase chain reaction (PCR) amplification of 16S rRNA with specific and universal primers was carried out.

RESULTS

Twenty-six women with threatened premature labor were included: eight with preterm premature rupture of membranes and 18 with preterm labor with intact membranes. Eight women presented with gingivitis, 12 with chronic periodontitis, and six without periodontal disease. Microbial invasion of the amniotic cavity as detected by P. gingivalis PCR was 30.8% (eight of 26 patients). In these eight patients, P. gingivalis was present in both the subgingival samples and the respective amniotic fluid sample.

CONCLUSION

The presence of microbial invasion of the amniotic cavity by P. gingivalis could indicate a role for periodontal pathogenic bacteria in pregnant women with a diagnosis of threatened premature labor.

Microbiological evaluation of the effects of hyperbaric oxygen on periodontal disease

The term periodontitis indicates a variety of clinical manifestations of infectious disorders in which the supporting tissues of the teeth are attacked. The initiation and progression of periodontal disease are attributed to the presence of elevated levels of pathogenic bacteria within the gingival crevice. Approaches to periodontal treatment range from surgical to regenerative therapy and anti-infective chemotherapy. Anti-infective drug therapy should be rationally based on the composition of the pathogenic microbiota. It is also important to recognize that the periodontopathic plaque constitutes a bacterial biofilm infection that may render the resident microorganisms more resistant than the same organisms grown planktonically. Hyperbaric oxygen (HBO) has been successfully used in several medical applications. The therapeutic effect is related to elevated partial oxygen pressure in the tissues. The aim of this study was to evaluate the effects of HBO on a selected number of patients suffering from adult chronic periodontitis in comparison with surgical intervention (scaling and root planning, SRP), as well as the effects of a combination of both therapies on the evolution over time of the microflora of the periodontal pockets. Bacteria were detected either by culture or by a molecular method (PCR). Microbiological data indicate that the combination of HBO and SRP substantially reduced (by up to 99.9%) the gram-negative anaerobe loads of the subgingival microflora. The low values of pathogens persisted for at least two months after the therapy. HBO or SRP alone produced a temporarily more limited effect on periodontal anaerobes. Additional experimental confirmation of these results was provided by molecular detection of the main periodontopathogenic bacteria with a significant reduction in the number of dental sites which harboured them. It is also shown that HBO both alone and in combination with SRP reduced the Gingival Index value to zero and gingival health persisted for 3 months at least. Thus, in parallel with the loss of periodontopathogenic bacteria, a substantial improvement in oral health was observed. In conclusion, this study has shown that HBO may represent a useful aid, especially in combination with SRP, as far as non-surgical periodontal therapy is concerned.

Microbiological findings after periodontal therapy using curettes, Er:YAG laser, sonic, and ultrasonic scalers

AIM

To evaluate and compare the microbiological effects of hand instruments, Er:YAG-laser, sonic, and ultrasonic scalers in patients with chronic periodontitis. Patient perception of each treatment was documented.

MATERIAL AND METHODS

From 72 patients, bacterial samples were collected from the deepest pocket in each quadrant (total: 288 sites). A polymerase chain reaction kit estimated the amount of Aggregatibacter (Actinobacillus) actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythensis (Tf), and Treponema denticola (Td) at baseline as well as 3 and 6 months after therapy. One quadrant in each patient was randomly assigned to curettes (H-group), Er:YAG laser (L-group), sonic device (S-group), or ultrasonic device (U-group).

RESULTS

Three months post-operatively, the amounts of Pg, Pi, Tf, and Td were significantly reduced in all groups. Laser and sonic instrumentation failed to reduce Aa. Six months after therapy, significant differences were still detected for Pg (L- and U-group), for Pi and Tf (S-group), and for Td (L-, S- and U-group). Patients rated ultrasonic treatment as more preferable than hand and laser instrumentation.

CONCLUSION

The various treatment methods resulted in a comparable reduction of the evaluated periodontal pathogens, and bacterial increase was only partially different 6 months post-operatively. Ultrasonic instrumentation caused less discomfort.

Detection of Treponema denticola in saliva obtained from patients with various periodontal conditions

The aim of the study was to determine the prevalence of Treponema denticola in saliva of periodontally diseased and healthy patients and its relationship with the periodontal status. A 16S rRNA-based polymerase chain reaction detection method was used to determine the prevalence of T. denticola in whole saliva samples from patients with chronic periodontitis (CP, n = 37), aggressive periodontitis (AgP, n = 24), and healthy subjects (n = 28). The periodontal status of each subject was assessed by criteria based on probing depth, clinical attachment loss, and extent of periodontal breakdown. Risk factors were assessed individually and adjusted for confounding using a binary logistic regression model. The results showed that the prevalence of T. denticola in CP patients was significantly higher than those in healthy and AgP subjects (P < 0.05). Odds ratio analysis revealed a positive association for CP group/T. denticola-positive and smoking/T. denticola-positive subjects. Furthermore, all clinical measurements were significantly greater (P < 0.05) for T. denticola-positive subjects compared to T. denticola-negative subjects. After binary logistic regression analysis, both T. denticola and smoking were independently and strongly associated with development of CP. It was concluded that when used in conjunction with an optimized clinical examination protocol, this assay may offer a rapid, useful, and cost-effective tool for monitoring the presence of T. denticola in noninvasive clinical samples from both healthy and diseased patients and correlating it with the amount and extent of periodontal breakdown.

Microbiologic Analysis of Periodontal Pockets and Carotid Atheromatous Plaques in Advanced Chronic Periodontitis Patients

BACKGROUND

In recent years, many researchers have focused their attention on the ability of periodontal pathogens to colonize atheromatous plaques. Nevertheless, a clear correlation between the detection rates of periodontopathic bacterial DNA in atheromas and in subgingival plaque samples has not been established. The aim of our study was to assess the presence of five periodontal pathogens (Actinobacillus actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia [formerly Tannerella forsythensis]) in periodontal pockets and in carotid atheromas recovered from the same patients.

METHODS

Thirty-three patients with advanced chronic periodontitis scheduled for endarterectomy were enrolled in the study. DNA was extracted from subgingival plaque samples and carotid atheromas. Universal bacteria primers for general detection of bacteria and species-specific primers for detection of periodontal pathogens were used to amplify part of the 16S rRNA gene by polymerase chain reaction.

RESULTS

All subgingival plaque samples were positive for at least one target microorganism. The prevalence of T. forsythia, P. gingivalis, T. denticola, P. intermedia, and A. actinomycetemcomitans were 69.7%, 63.6%, 54.5%, 45.4%, and 33.3%, respectively. Bacterial DNA was detected in 31 out of 33 endarterectomy specimens. However, none of the samples tested positive for DNA from periodontal pathogens.

CONCLUSION

The presence of periodontal bacteria in atheromatous plaques was not confirmed by this investigation; thus, no correlation could be drawn between periodontitis bacteria and microorganisms involved in the atherosclerotic lesions.

Identification of intracellular oral species within human crevicular epithelial cells from subjects with chronic periodontitis by fluorescence in situ hybridization

BACKGROUND AND OBJECTIVE

Interactions between oral bacteria and gingival epithelial cells play an important role in the pathogenesis of periodontal diseases. This study used in situ hybridization with 16 rRNA probes and confocal microscopy to detect the periodontal pathogens Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Tannerella forsythia, and Treponema denticola within epithelial cells from periodontal pockets, gingival crevice, and buccal mucosa collected from subjects with chronic periodontitis (n = 14) and good periodontal health (n = 8).

MATERIAL AND METHODS

Each green fluorescent species-specific and universal probe was hybridized with all 58 epithelial samples from the 22 patients. The samples were observed by confocal microscopy to confirm the intracellular localization of oral species of bacteria. The mean frequency of detection and number of intracellular bacteria per epithelial cell were computed for each sample.

RESULTS

The frequency of cells with internalized bacteria was higher in samples from the gingival crevice than in samples from the oral mucosa. Epithelial cells from all subjects harbored intracellular bacteria; however, patients with periodontitis presented significantly higher counts of bacteria per cell than periodontally healthy individuals (p < 0.05). Periodontal pathogens showed a trend to be detected in higher numbers in epithelial cells from periodontitis patients. In particular, T. forsythia and T. denticola were significantly more prevalent in periodontal pocket cells than healthy sulci and buccal cell samples in the periodontitis group (p < 0.05).

CONCLUSION

Those findings indicate that crevicular and buccal cells present internalized bacteria, regardless of periodontal status. However, higher bacterial loads are detected in cells from subjects with periodontitis.

Minocycline HCl Microspheres Reduce Red-Complex Bacteria in Periodontal Disease Therapy

BACKGROUND

The objective of this trial was to measure the antimicrobial effects of a minocycline HCl microsphere (MM) local drug-delivery system when used as an adjunct to scaling and root planing (SRP). DNA probe analysis for 40 bacteria was used to evaluate the oral bacteria of 127 subjects with moderate to advanced chronic periodontitis.

METHODS

Subjects were randomly assigned to either SRP alone (N = 65) or MM + SRP (N = 62). The primary endpoints of this study were changes in numbers and proportions of the red-complex bacteria (RCB) and the sum of Porphyromonas gingivalis, Tannerella forsythia (formally T. forsythensis), and Treponema denticola relative to 40 oral bacteria at each test site from baseline to day 30. Numbers of RCB from the five test sites were averaged to provide a value for each subject.

RESULTS

MM + SRP reduced the proportion of RCB by 6.49% and the numbers by 9.4 x 10(5). The reduction in RCB proportions and numbers by SRP alone (5.03% and 5.1 x 10(5), respectively) was significantly less. In addition, MM + SRP reduced probing depth by 1.38 mm (compared to 1.01 mm by SRP alone), bleeding on probing was reduced by 25.2% (compared to 13.8% by SRP alone), and a clinical attachment level gain of 1.16 mm (compared to 0.80 mm by SRP alone) was achieved.

CONCLUSION

These observations support the hypothesis that RCBs are responsible for periodontal disease and that local antimicrobial therapy using MM + SRP effectively reduces numbers of RCBs and their proportions to a greater extent than SRP alone.

Rapid detection of Actinobacillus actinomycetemcomitans using a loop-mediated isothermal amplification method

INTRODUCTION

Actinobacillus actinomycetemcomitans has been implicated in the etiology of aggressive periodontitis. In this study, we applied a novel nucleic acid amplification method, called loop-mediated isothermal amplification (LAMP), which amplifies DNA with high specificity, efficiency and rapidity under isothermal conditions, allowing the rapid detection of A. actinomycetemcomitans.

METHODS

We designed the primers for detecting A. actinomycetemcomitans and evaluated the specificity and sensitivity of the assay.

RESULTS

The LAMP primers used in this study successfully amplified serotypes a-e of A. actinomycetemcomitans, while other oral bacteria were not amplified. By measuring the precipitation of magnesium pyrophosphate, we could quantify the chromosomal DNA of A. actinomycetemcomitans. The detection limits using the real-time turbidimetry analysis were 5.8 x 10(2)-5.8 x 10(7) copies of A. actinomycetemcomitans template DNA per reaction tube. In addition, the LAMP assay was used for the rapid detection of A. actinomycetemcomitans in clinical specimens from eight individuals. The results with the LAMP method were similar to those using conventional polymerase chain reaction.

CONCLUSION

Our results suggest that the LAMP-based assay is very useful for the rapid detection of A. actinomycetemcomitans.

Effect of the Diode Laser on Bacteremia Associated with Dental Ultrasonic Scaling: A Clinical and Microbiological Study

OBJECTIVE

The purpose of this study is to evaluate the potential use of diode lasers (DLs) to reduce bacteremia associated with ultrasonic scaling (US). Furthermore, the clinical efficacy of DLs as an adjunct to US in the treatment of gingivitis was investigated.

BACKGROUND DATA

Recently, lasers have found new applications in dental practice. The benefits of the use of DLs as an adjunct to US have not yet been determined.

METHODS

Twenty-two gingivitis patients were treated using a split-mouth study design in which each side was randomly treated by US alone or DL followed by US (DL + US). Blood samples were drawn just before and during US in each treatment step to detect induced bacteremia. Clinical parameters including plaque index, sulcus bleeding index, probing depth, and relative attachment level were recorded at baseline and 4 weeks postoperatively.

RESULTS

Bacteremia was detected in 15 patients (68%) after US alone, and in 8 patients following DL + US (36%). The reduction of the incidence of odontogenic bacteremia during US after the application of DL was statistically significant (p < 0.05). Clinical signs improved eventually, with no significant differences between the two treatment regimens (p > 0.05).

CONCLUSIONS

Application of DL energy can reduce bacteria in gingival crevices which may reduce bacteremia following US. The use of DL did not show additional clinical influence on gingival healing after treatment of gingivitis with US.

Periodontal pathogens in erupting third molars of periodontally healthy subjects

The presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Tannerella forsythensis in bacteriologic samples of 5-7-mm deep mandibular third-molar pericoronal pockets was analysed by polymerase chain reaction, to test the hypothesis that these sites would harbour the bacteria. The patients were periodontally healthy 20-year-old Finnish male conscripts. Sixteen had acute pericoronitis, 28 chronic pericoronitis, and 15 were symptom-free controls. A. actinomycetemcomitans was detected in only 7% of the samples from chronic pericoronitis cases, whereas P. gingivalis was positive in 20% of the symptom-free versus 69% (P = 0.018) of the acute and 57% (P = 0.044) of the chronic cases. The percentages for P. intermedia were 93, 94 and 93%, and for T. forsythensis 47, 63 and 57%, respectively. These results confirm that, apart from A. actinomycetemcomitans, periodontopathogens are common in third-molar sites in periodontally healthy individuals.

Periodontics: 3. Non-Surgical Periodontal Therapy in General Dental Practice

Non-surgical periodontal therapy is an integral part of periodontal treatment and has been defined as plaque removal, plaque control, supra- and subgingival scaling, root surface debridement, and the adjunctive use of chemical agents.

CLINICAL RELEVANCE

Knowledge of the role of non-surgical periodontal therapy is central to good patient care.

Periodontal disease and coronary heart disease: an epidemiological and microbiological study

AIMS

This is an investigation on the association between periodontal disease and an increased risk of coronary heart disease; the main hypothesis is that periodontal infections may increase the systemic inflammatory burden of the host above a threshold that may favour the atherogenic processes.

MATERIALS AND METHODS

Case-control study with 27 cases, cardiologically affected, and 15 healthy controls. Patients underwent a complete periodontal probing. Periodontal conditions were compared between cases and controls to assess the mentioned association and to search for periodontal conditions related to the increased coronary risk. The presence and prevalence of periodontal pathogens was assessed in crevicular fluid samples.

RESULTS

The overall periodontal conditions resulted worse in the test group. In particular periodontal conditions such as the presence of deep pockets (probing depth >6 mm) and the loss of more than 12 teeth might represent indicators of a strongly increased risk of cardiological disease and microbiological investigations confirmed these findings; Prevotella gingivalis was the most common bacteria.

CONCLUSION

This study supports the existence of an epidemiologic association between periodontal disease and coronary heart disease and confirms previous data present in the literature. Two periodontal parameters, deep pockets and number of missing teeth, seem to be important risk factors for cardiovascular diseases.

An in vitro biofilm model of subgingival plaque

INTRODUCTION

Numerous biofilm models have been described for the study of bacteria associated with the supragingival plaque. However, there are fewer models available for the study of subgingival plaque. The purpose of this study was to develop and validate a model that closely mimicked the composition of the subgingival flora.

METHODS

The model was developed as follows: calcium hydroxyapatite disks were coated overnight with 10% sterile saliva, placed in flat-bottomed tissue culture plates containing trypticase-soy broth, directly inoculated with a small aliquot of dispersed subgingival plaque, incubated anaerobically, and transferred to fresh medium at 48-h intervals until climax (steady-state) biofilms were formed ( approximately 10 days).

RESULTS

The model, based on samples from eight periodontitis patients and eight healthy subjects, yielded a multi-species, heterogeneous biofilm, consisting of both gram-positive and gram-negative species, and comprising 15-20 cultivable species associated with the subgingival flora. The species present and their proportions were reflective of the initial cultivable subgingival flora. Comparisons of the initial plaque samples from healthy subjects and the mature biofilms showed 81% similarity in species and 70% similarity in the proportions present. Biofilms formed from samples obtained from periodontally diseased subjects were 69% similar in species and 57% similar in the proportions present.

CONCLUSIONS

The biofilm model described here closely reproduces the composition of the cultivable subgingival plaque both in the species present and in their relative proportions. Differences existed between biofilms grown from diseased and non-diseased sites with the former being characterized by the presence of periodontal pathogens at microbially significant levels.

Clinical and microbiological effects of a combined mechanic-antibiotic therapy in subjects with Actinobacillus actinomycetemcomitans-associated periodontitis

PURPOSE

To evaluate the clinical and microbiological effects of a combined mechanic-antibiotic periodontal therapy in subjects that were tested positive for subgingival Actinobacillus actinomycetemcomitans (A.a.).

METHODS

The postoperative follow-up ranged from 12-115 months (average 39.2 months). This follow-up study analyzed the data of 53 subjects (37 females) aged from 16-59 years, who underwent systemic periodontal therapy with adjunctive systemic antibiotics between 1992-2001 and had their last re-examination including microbiological analysis done in 2003. The antibiotic regime was either amoxicillin/metronidazole or ciprofloxacine/metronidazole. During this study, A.a. was detected with two gene probe tests (IAI PadoTest 4.5 and DMDx/PathoTek) and cultivation on TSBV agar plates. The clinical situation was characterized with the help of pocket probing depths and subsequent categorization into three different groups (< or = 4 mm, 5-6 mm and > or = 7 mm).

RESULTS

After therapy, A.a. was detected with IAI PadoTest 4.5 in a magnitude between 3.0 x 10(3) up to 2.06 x 10(5) counts per specimen in 9 out of 53 subjects. Only two subjects tested positive for A.a. with the DMDx/PathoTek-assays and the agar cultivation. The clinical situation improved significantly in all subjects after systemic periodontal therapy. The treatment results remained stable during the course of the postoperative follow-up. Concerning the clinical data, no differences were found between the subjects that were tested positive and negative for A.a in the postoperative period.

A telescopic crown concept for the restoration of partially edentulous patients with aggressive generalized periodontitis: a 3-year prospective longitudinal study

This prospective longitudinal 3-year study compared clinical parameters and implant success rates of removable superstructures supported by both teeth and implants in patients with treated generalized aggressive periodontitis (GAP) and of cemented, implant-retained fixed superstructures in periodontally healthy patients. A total of 17 partially edentulous patients with 54 implants took part in the study. Nine patients with treated GAP received removable superstructures according to the Marburg double crown system, and eight periodontally healthy patients received fixed superstructures. Teeth were examined 2 to 4 weeks before extraction of the nonretainable teeth (baseline) and 3 weeks after insertion of the definitive abutments. Every 3 months over a 3-year period, clinical parameters were recorded and the composition of the subgingival microflora was determined. Intraoral radiographs were obtained at baseline, just after insertion of the superstructure, and 1 and 3 years later. Both groups showed mean plaque and gingival indices below 0.43 at implants and teeth. Mean probing depths around implants increased by approximately 0.7 mm and remained virtually constant for the teeth. Mean attachment loss at implants was 0.9 mm in GAP patients and 0.5 mm in healthy patients. The morphologic distribution of microorganisms in both groups showed healthy conditions. Moderate bone loss at teeth and implants was registered. Implant success rates were 100% in the healthy patients and 97.6% in the GAP patients. No significant differences were seen in the results between the groups.

Influence of Sampling Strategy on Microbiologic Results Before and After Periodontal Treatment

BACKGROUND

The aim of this study was to test whether different sampling strategies would influence the microbiologic outcomes by assessing the bacterial load and composition of the subgingival microbiota by means of anaerobic culturing before and after periodontal treatment.

METHODS

The first study (1 versus 4 [1vs4]) included 33 patients with generalized chronic periodontitis. Two sampling strategies were compared, sampling one site from the deepest pocket in the mouth (M1) versus a pooled sample of four sites from the deepest pockets in each quadrant (M4). The second study (2 versus 4 [2vs4]) included 20 patients with generalized chronic periodontitis. The strategy M4 was compared to a pooled sample of two non-adjacent sites in the same quadrant (M2). All samples were processed identically by means of anaerobic culturing. In both studies, a pretreatment sampling was taken. However, in the second study (2vs4), subgingival samples were also taken at 1, 3, and 6 months after periodontal therapy. Quantitative data were compared between strategies by means of t test and signed-rank test; qualitative data were compared by means of 2 x 2 contingency tables.

RESULTS

Pretreatment samples showed that total anaerobic counts were significantly higher for M4 compared to M1 (P <0.001) and M2 (P = 0.025). However, there were no significant differences in regard to percentage of microbiota and counts for each pathogen. Most of the qualitative differences between strategies were caused by false negatives in M1 and M2. Post-treatment samples showed a reduction in total counts and a limited impact in the frequency of detection of periodontal pathogens. M2 detected a significant decrease in the frequency of detection of Porphyromonas gingivalis, which was not confirmed by the M4 strategy.

CONCLUSION

The criteria of selection and the number of sites selected when sampling the subgingival biofilm in patients with generalized chronic periodontitis may influence the detection and quantitation of periodontal pathogens when evaluated by culture especially after treatment.

Drug Concentration in Inflamed Periodontal Tissues After Systemically Administered Azithromycin

BACKGROUND

Azithromycin is an azalide antibiotic, effective against a wide range of oral bacteria including periodontopathic bacteria. Azithromycin is taken up by phagocytes and is released into inflamed tissue over time. The concentration of azithromycin in inflamed periodontal tissues over time has not been studied. In this study, we determined the azithromycin concentration in the gingiva and inflammatory connective tissue of the periodontal pocket in periodontal patients who had been administered azithromycin systemically. We also evaluated the clinical and microbiologic effects of azithromycin.

METHODS

Thirty-four patients with periodontitis were prescribed azithromycin 500 mg once daily for 3 days. During the 14-day study, clinical parameters (probing depth, gingival index, bleeding on probing, and gingival crevicular fluid level) were recorded, subgingival plaque was collected for bacteriologic examination, and the azithromycin concentration in the tissues lining the periodontal pocket was measured by agar diffusion bioassay.

RESULTS

Clinical parameters significantly improved after administration of azithromycin. The total number of cultivated bacteria also significantly decreased by day 4 but slightly increased after day 7. Sustained reduction in levels of six periodontopathic bacteria was not apparent until day 14. On day 7, the azithromycin concentration in the tissues lining the periodontal pockets was 50% of that on day 4, and on day 14 only 20%.

CONCLUSION

Azithromycin is detectable in inflamed periodontal tissues >or=14 days after systemic administration; it is associated with clinical and microbiologic improvement.

Comparison of Curet and Paper Point Sampling of Subgingival Bacteria as Analyzed by Real-Time Polymerase Chain Reaction

BACKGROUND

The outcome of microbiological diagnostics may depend on the sampling technique. It was the aim of the present study to compare two widely used sampling techniques for subgingival bacteria using quantitative real-time polymerase chain reaction.

METHODS

Twenty patients with chronic periodontitis were randomized into two groups. In group A, samples were taken first with a paper point and then with a curet at the same site (single-rooted teeth with probing depth >5 mm) before scaling and root planing and after 10 weeks. The sampling sequence was reversed in group B. The analysis enabled the quantification of Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, and Tannerella forsythensis and total bacterial counts (TBCs). Statistical analysis included t test, kappa, and Spearman correlation.

RESULTS

Higher TBC was harvested with curets than by paper points (P = 0.008). The plaque composition with regard to total target pathogens was similar for both sampling techniques. A strong positive correlation was found between curet and paper point samples for TBC and single target bacteria.

CONCLUSIONS

Overall, there was a relatively good agreement for the results of paper point and curet sampling. Thus, both techniques seem to be suitable for microbiological diagnostics.

Multiple displacement amplification as an aid in checkerboard DNA-DNA hybridization

OBJECTIVE

The study aimed to determine if multiple displacement amplification could be used to provide abundant target DNA and DNA probes for checkerboard DNA-DNA hybridization.

METHODS

Multiple displacement amplification was used to amplify 1 and 10 ng DNA from 16 individual bacterial species, DNA from single colonies, from a mixture of 20 bacterial species and oral biofilm samples, such as supragingival plaque, subgingival plaque, buccal swab and root canal samples. Samples in reaction buffer were heat-denatured at 95 degrees C for 3 min and cooled to 4 degrees C. Phi29 DNA polymerase was added and the mixture was incubated at 30 degrees C for 16-18 h. The quantity of the product was evaluated by the Picogreen assay. The amplified material was labeled with digoxigenin. The probes were compared with probes obtained from unamplified DNA using checkerboard DNA-DNA hybridization. Both amplified DNA and unamplified DNA were used as targets on the membrane. Amplified oral biofilm samples were compared to unamplified samples using checkerboard DNA-DNA hybridization.

RESULTS

The DNA yield ranged from 4 to 11 microg. DNA-DNA hybridization showed that the amplified genome of each species used either as target or as probe provided signals equivalent to controls and that amplification of a mixture of species provided signals comparable to those provided by the unamplified source mixture. Amplified oral biofilm samples exhibited comparable proportions of bacterial DNA when compared to the original unamplified samples.

CONCLUSIONS

The multiple displacement amplification technique is a simple and reliable method to uniformly amplify DNA for use in checkerboard DNA-DNA hybridization. It is also a useful tool in the amplification of clinical samples.

Aggregatibacter actinomycetemcomitans as indicator for aggressive periodontitis by two analysing strategies

OBJECTIVE

To compare the subgingival microbiota of aggressive and chronic periodontitis (ChP) using single-site and pooled plaque samples.

METHODS

In 60 patients with aggressive or ChP, subgingival plaque was sampled from the four deepest pockets using two sterile paper points simultaneously. One paper point from each pocket was put in a separate transport vial, the second was pooled with the three other paper points of a respective patient. The content of each vial was analysed for Aggregatibacter actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola.

RESULTS

Pooled plaque samples detected higher numbers for all tested pathogens than single-site samples. Detection frequencies were similar for both strategies. Using single-site samples, A. actinomycetemcomitans detection rate was statistically significantly a higher in aggressive than in ChP (p=0.01). A. actinomycetemcomitans was found in higher numbers, the other pathogens in lower numbers in aggressive than in ChP. Neither presence nor absence of one of the tested bacteria had sufficient positive or negative predictive value for aggressive periodontitis.

CONCLUSION

A. actinomycetemcomitans was detected in higher numbers and frequency in aggressive than in ChP. Its detection may confirm the clinical diagnosis and influence therapy. As a diagnostic test, its sensitivity and predictive value was low.

Periodontal pathogens in periodontal pockets and in carotid atheromatous plaques

AIM

In the last years the relationship between periodontitis and cardiovascular diseases has been a subject of increasing research. The identification of periodontopathic bacteria in atheromas can contribute to our knowledge of such an association. The aim of our study was to assess the concomitant presence of 5 periodontal pathogens (Actinobacillus actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) in periodontal pockets and in carotid atheromas recovered from the same individuals.

METHODS

Twenty-one patients with chronic periodontitis scheduled for endarterectomy for carotid stenosis were enrolled in the study. Subgingival plaque samples and carotid atheromas were examined using the polymerase chain reaction and reverse hybridization techniques by means of specific probes for periodontal bacteria. Human beta-globin amplification was used as internal polymerase chain reaction efficiency control.

RESULTS

Three patients were excluded because the endarterectomy specimens were negative to DNA amplification. All subgingival plaque samples were positive for at least one target micro-organism. The prevalence of Tannerella forsythia, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, and Actinobacillus actinomycetemcomitans was 72.22%, 61.11%, 55.56%, 50%, and 33.33%, respectively. No periodontal bacteria DNA was detected in any endarterectomy specimen.

CONCLUSIONS

The presence of periodontal bacteria in atheromatous plaques was not confirmed by this investigation and, thus, no correlation between periodontitis bacteria and micro-organisms involved in the atherosclerotic lesions could be drawn.

Occurrence of Periodontopathic and Superinfecting Bacteria in Chronic and Aggressive Periodontitis Subjects in a Colombian Population

BACKGROUND

Differences in the composition of subgingival microbiota in periodontitis have been observed in different geographic locations. Some of these microbial differences could have clinical significance. This study describes clinical parameters and the composition of the subgingival microbiota in chronic periodontitis (CP) and aggressive periodontitis (AgP) patients in a Colombian population.

METHODS

Clinical parameters (probing depth, clinical attachment level, bleeding on probing, and plaque index) and plaque samples from 68 CP, 12 AgP, and 30 periodontally healthy subjects were analyzed. Subgingival samples were processed using culture, biochemical tests, and polymerase chain reaction for the detection of periodontal and superinfecting pathogens. The analysis of variance, chi(2), and Kruskal-Wallis tests were used to evaluate differences between groups for clinical parameters and microbiologic composition (P <or=0.05).

RESULTS

Clinical parameters were significantly increased in CP and AgP patients compared to healthy subjects (P <0.001), but no differences were found between periodontitis groups. Porphyromonas gingivalis, Tannerella forsythensis, and Eikenella corrodens showed higher frequencies in AgP compared to CP and healthy subjects (P <0.05). Extension (localized and generalized) of the periodontal destruction had no effect on the composition of the subgingival microbiota. Gram-negative enteric rods were more frequent in AgP patients (P <0.01).

CONCLUSIONS

This study demonstrated a high prevalence of P. gingivalis, T. forsythensis, and E. corrodens in AgP patients. Gram-negative enteric rods were frequent in AgP and CP patients. Differences in the composition of subgingival microbiota in periodontitis patients need to be taken into account when considering the best therapeutic approach for each individual, including the use of antibiotics.

A three-year prospective study of adult subjects with gingivitis II: microbiological parameters

AIM

To investigate whether the clinical benefits obtained with a periodontal prevention programme in subjects with periodontal health or minimal disease were accompanied by beneficial changes in the subgingival microbiota.

MATERIAL AND METHODS

One hundred and twenty-four subjects completed the study. Subjects were clinically and microbiologically monitored at baseline, 1, 2 and 3 years. Subgingival plaque samples were taken from the mesiobuccal aspect of every tooth and were analysed for the levels of 40 bacterial species using checkerboard DNA-DNA hybridization (total samples=13,477). The mean counts of each of the 40 test species were calculated for each subject at each time point. Significance of differences over time was sought using the Friedman test. p values were adjusted for multiple comparisons.

RESULTS

All clinical parameters, at the microbiologically sampled sites, improved over time. The clinical changes were accompanied by statistically significant decreases in the mean counts of 35 of the 40 test species. Major reductions occurred by year 2 for Actinomyces, Capnocytophaga, Campylobacter, Fusobacterium and Prevotella species. At year 3, there was a modest re-growth of the majority of the species.

CONCLUSIONS

The clinical improvements obtained through preventive measures were accompanied by a shift to a more host-compatible subgingival microbiota.

Comparison of subgingival bacterial sampling with oral lavage for detection and quantification of periodontal pathogens by real-time polymerase chain reaction

BACKGROUND

Saliva has been studied for the presence of subgingival pathogens in periodontitis patients. With the anaerobic culture technique, the discrepancy between salivary recovery and subgingival presence has been significant, which makes this approach not suitable for practical use in the microbial diagnosis of periodontitis patients. The real-time polymerase chain reaction (PCR) technique represents a very sensitive technique to detect and quantify bacterial pathogens. The aim of the study was to compare the presence and numbers of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia, and Micromonas micros in subgingival plaque and mouthwash samples by the anaerobic culture and real-time PCR techniques.

METHODS

Pooled subgingival plaque samples and 10-ml mouthwash samples were collected from 21 adult patients with periodontitis and analyzed by quantitative anaerobic culture and real-time PCR for A. actinomycetemcomitans, P. gingivalis, T. forsythensis, P. intermedia, and M. micros.

RESULTS

The detection frequency of A. actinomycetemcomitans, P. gingivalis, and T. forsythensis in subgingival plaque was identical by culture and real-time PCR and was higher for P. intermedia and M. micros by real-time PCR. The highest detection frequencies for the target bacteria were found in mouthwash samples by real-time PCR. The additional value of the real-time PCR to detect target bacteria was 38% for P. gingivalis, 73% for T. forsythensis, 77% for P. intermedia, and 71% for M. micros. The sensitivity to detect target species in mouthwash by real-time PCR was 100% for all test species except for P. intermedia (93.8%).

CONCLUSIONS

Rapid detection and quantification of periodontal pathogens in mouthwash samples are possible by real-time PCR. The procedure is significantly less time-consuming than subgingival sampling with paper points. This approach to detect major periodontal pathogens in mouthwash samples may simplify microbial diagnosis in periodontitis patients and may be used to monitor periodontal treatment.

Effects of Full-Mouth Scaling and Root Planing in Conjunction With Systemically Administered Azithromycin

BACKGROUND

One-stage full-mouth disinfection (FMD), in which full-mouth scaling and root planing (SRP) is performed with adjunctive use of chlorhexidine, was introduced in 1995. There have been several reports on the effectiveness of this treatment protocol. However, FMD was reported to induce pyrexia frequently. We examined the effects of full-mouth SRP in conjunction with azithromycin administered orally before SRP to control the number of bacteria. The purpose of this study was to compare the effects of full-mouth SRP using azithromycin with conventional SRP.

METHODS

Thirty-four subjects (17 in the test group and 17 in the control group) with severe chronic periodontitis were selected. The subjects of the test group had azithromycin 3 days before full-mouth SRP. Clinical parameters (probing depth [PD], gingival index [GI], bleeding on probing [BOP], and gingival crevicular fluid [GCF]), total number of bacteria, and number of black pigment-producing rods (BPRs) were evaluated at baseline and 5, 13, and 25 weeks after baseline.

RESULTS

All clinical parameters improved in the test group more than in the control group. In the bacteriologic examination, the total number of bacteria did not change during the examination. In the test group, BPRs were not detected until 13 weeks. However, BPRs were detected in the control group by 13 weeks.

CONCLUSION

It was shown that full-mouth SRP using systemically administered azithromycin was a clinically and bacteriologically useful basic periodontal treatment for severe chronic periodontitis.

Microbiological effect of the use of an ultrasonic device and iodine irrigation in patients with severe chronic periodontal disease: a randomized controlled clinical study

OBJECTIVE

Instrumentation of the subgingival area is aimed at removing as much as possible of the bacterial biofilm and subgingival calculus. Since mechanical root debridement is a technically demanding procedure, antiseptics and antibiotics delivered either locally or systemically have been used as adjunct to scaling and root-planning procedures in order to control the subgingival biofilm and thereby enhance the treatment outcome. Our aim was to study the microbiological effect of ultrasonic debridement with or without povidone-iodine (PVP-iodine) in the treatment of severe chronic periodontitis.

MATERIAL AND METHODS

Twenty patients were recruited to the study. Each test site and the related quadrant were randomly assigned to one of four different treatment modalities: ultrasonic scaling+subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth, ultrasonic scaling+subgingival irrigation with sterile saline solution for 5 min/tooth, subgingival irrigation with sterile saline solution for 5 min/tooth and subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth. The individuals were followed longitudinally for 6 months.

RESULTS

The present study showed that non-surgical periodontal therapy with the use of an ultrasonic device was effective in reducing the analyzed putative periodontal bacteria. No statistically significant difference between ultrasonic+saline and ultrasonic+PVP-iodine was found.

CONCLUSIONS

Ultrasonic debridement reduced the periodontal markers in patients with severe chronic periodontitis. The reduction was selective. A concentration of 0.5% PVP-iodine did not add any anti-microbiological effect compared to ultrasonic debridement alone.

Periodontal healing after non-surgical therapy with a new ultrasonic device: a randomized controlled clinical trial

AIM

The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using the new Vector ultrasonic system versus scaling and root planing (S/RP) with Gracey curettes.

MATERIAL AND METHODS

The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and the lower jaws each. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was assessed. The Wilcoxon signed rank test (alpha=0.05) was used for statistical analysis.

RESULTS

Both therapies provided statistically significant clinical and microbiological improvements of periodontal conditions after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites, no other clinical and microbiological parameters revealed significant differences between the sites treated with the Vector system or S/RP.

CONCLUSION

Both the Vector system and S/RP provided favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.

Microbiological outcomes of quadrant versus full-mouth root planing as monitored by real-time PCR

OBJECTIVES

To study the short-term microbiological changes following full-mouth compared with quadrant wise scaling and root planing (FMRP and QRP) as well as long-term effects.

METHOD

Twenty patients with chronic periodontitis were randomized into a test group treated in two sessions with subgingival scaling and root planing within 24 h (FMRP) and a control group treated quadrant by quadrant in four sessions at intervals of one week (QRP). Microbiological samples were taken in the two deepest pockets of the maxillary right quadrant immediately before treatment and after 1 day, 1, 2, 4, 8, 12, and 24 weeks. The samples were evaluated by real-time PCR for quantification of Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum ssp., Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, and Tannerella forsythia as well as for total bacterial counts (TBC).

RESULTS

Treatment resulted in a TBC median log reduction of 0.75 (FMRP) and 0.72 (QRP). There were no differences between groups either for the short term (1 day-4 weeks) (analysis of variance: p=0.3150) or for long term (4-24 weeks) (analysis of variance: p=0.9671). Likewise, no differences were detected for selected target bacteria.

CONCLUSION

The results of the present study showed similar microbiological outcomes following both treatment modalities.

Association of common chronic infections with coronary artery disease in patients without any conventional risk factors

BACKGROUND & OBJECTIVES

Report from the west suggest an association of infections and inflammation with atherosclerotic coronary artery disease (CAD). Entire microbial burden from several simultaneous chronic infections could be more important than a single infection in promoting atherosclerosis. No study has been done in Indian population, investigating the association of various chronic infections with CAD. We therefore evaluated the presence of markers of chronic infections in CAD patients having no conventional risk factors and healthy individuals in a tertiary care hospital in north India.

METHODS

Seropositivity to IgG antibodies was investigated for Chlamydia pneumoniae, Mycoplasma pneumoniae, and Helicobacter pylori in 30 CAD patients with no conventional risk factors scheduled for coronary artery bypass surgery and in healthy blood donors. Periodontal pathogens were isolated by aerobic and anaerobic culture.

RESULTS

All patients except one were < 55 yr of age and six were younger than 40 yr. Seropositivity to C. pneumoniae was significantly higher in CAD patients than healthy controls (63.3 vs. 23.3%, P<0.01). Combined seropositivity to both C. pneumoniae and M. pneumoniae was significantly higher in CAD patients with myocardial infarction (MI) than those without MI (61.5 vs. 11.8%, P<0.05). Aerobic and anaerobic cultures for the isolation of periodontal pathogens were positive in seven patients and five healthy blood donors.

INTERPRETATION & CONCLUSION

C. pneumoniae seropositivity was significantly higher (P<0.001) in CAD patients without any of the conventional risk factors for CAD. Combined seropositivity to C. pneumoniae and M. pneumoniae was significantly higher (P<0.05) in CAD patients with MI than in those without MI. Possibly CAD in young is not (or less) governed by conventional risk factors, and infectious agents can be potential risk factors for the development of atherosclerosis and CAD in this subset of patients.

Two Subgingival Plaque-Sampling Strategies Used With RNA Probes

BACKGROUND

The purpose of this study was to compare the results of microbiological RNA-probe analysis after subgingival plaque sampling applying two different strategies.

METHODS

In 220 patients, clinical examinations were obtained prior to commencement of therapy for aggressive or generalized severe chronic periodontitis (n = 113), after combined mechanical and antibiotic anti-infective periodontal therapy (n = 43), or because of periodontal pockets despite adequate therapy (n = 64). Subgingival plaque samples were obtained from the three pockets with the deepest probing depths. Two sterile paper points were inserted simultaneously into the periodontal pockets. One paper point from each pocket was put into a separate transport vial; the second paper point was pooled (multiple site test [MT3]) with paper points from each of the two other sampling sites from the respective patient into a transport vial. The content of each vial was analyzed separately for Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola (Td) with a commercially available RNA-probe test.

RESULTS

For all tested pathogens, log-transformed numbers of bacteria were higher in pooled samples compared to the mean values for the separate samples (P < or =0.01). However, for Td only, statistically significant differences in frequency were seen between the separate samples and MT3. These findings were observed over all samples as well as after evaluation of subgroups separately.

CONCLUSIONS

Pooling of plaque samples increased the bacterial counts per analysis compared to separate samples and thus may increase the probability of detecting existing pathogens. However, this observation only was statistically significant for the frequency of Td.

Distribution of Genotypes of Porphyromonas gingivalis in Type 2 Diabetic Patients with Periodontitis in Mexico

OBJECTIVE

To determine and compare the distribution of Porphyromonas gingivalis fimA genotypes in type 2 diabetes mellitus (T2DM) patients affected by periodontitis, using non-diabetic subjects with and without periodontitis as control groups.

MATERIAL AND METHODS

This study involved 75 subjects divided into three groups of 25 subjects each: Group 1 (non-T2DM without periodontitis), Group 2 (non-T2DM with periodontitis) and Group 3 (T2DM with periodontitis). The outcome variable was periodontitis, and explanatory variables were age, sex, T2DM and specific P. gingivalis fimA genotypes.

RESULTS

In non-T2DM subjects with healthy periodontal tissues, type I fimA was the most frequently detected individually (40%) or in combinations (40%). In non-T2DM subjects with periodontitis, the most frequently detected type was Ib individually (20%) or in combinations (36%). In T2DM patients with periodontitis, the most frequently detected types were types I (20%) and III (20%), but there was no statistical difference (p>0.05) with non-T2DM periodontitis subjects.

CONCLUSIONS

Type I genotype was more frequently detected in periodontally healthy sites from non-T2DM subjects than in periodontitis sites from either subjects with or without T2DM. However, in sites affected by periodontitis from T2DM subjects the predominating types were I and III, which are less virulent strains of P. gingivalis.

Relationship of cariogenic bacteria levels with periodontal status and root surface caries in elderly Japanese

OBJECTIVE

The relationship of the levels of cariogenic bacterial species with periodontal status and decayed root surfaces was investigated in elderly Japanese subjects.

METHODS

Three hundred and sixty-eight individuals (each 75 years old) were examined for periodontal status (pocket depth, attachment loss), root surface caries and salivary levels of mutans streptococci (MS) and lactobacilli (LB).

RESULTS

Values >4 mm of attachment loss (rAL4) and for average attachment loss (aAL) of sites measured were significantly higher in subjects with LB than those without. Multiple regression analysis also showed a correlation between aAL and rAL4 values with the presence of LB (aAL p = 0.003; rAL4 p = 0.002). Further, multiple regression analysis of interacting factors regarding decayed root surfaces showed that LB carriers had a greater incidence of decayed root surface caries (p = 0.003), while MS and LB levels were correlated to the number of decayed root surfaces (LB p = 0.010; MS p = 0.026).

CONCLUSION

Our results indicate that considerable attachment loss elevates the possibility of having LB, thus increasing the risk of root surface caries. It was also found that LB and MS measurements may be useful indicators of decayed root surfaces in elderly individuals with attachment loss.

Use of DNA probes in the diagnosis and treatment of periodontitis --a case series

Aggressive periodontitis is characterized by rapid attachment and bone loss with no underlying systemic disease and is associated with specific bacteria like Actinobacillus actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg). In this case series 25 patients were diagnosed with aggressive periodontitis by the aid of DNA probes for Aa and Pg and other periodontal pathogens. The use of DNA probes for the detection of periodontal pathogens may aid in the diagnosis and treatment of aggressive periodontitis. Clinical experience suggests that lowering periodontal pathogens to undetectable levels could improve the long-term stability of periodontal health.