Enzymatic characterization of oral and non-oral black-pigmented Bacteroides species

CD14 and TLR4 Gene Polymorphisms in Adult Periodontitis

Bacterial deposits, smoking, and host genetic factors play a major role in an individual’s predisposition to periodontitis. Bacterial components are recognized by CD14 and toll-like receptor 4 (TLR4), resulting in a NF-κB-based inflammatory response. We hypothesized that functional CD14 and TLR4 polymorphisms contribute to periodontitis susceptibility. We aimed to investigate the occurrence of CD14-260C>T, TLR4 299Asp>Gly, and 399Thr>Ile gene polymorphisms in adult periodontititis. DNA was collected from 100 patients with severe periodontitis and from 99 periodontally healthy controls. The gene polymorphisms were determined by the PCR technique. The presence of the periodontal pathogens Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, and whether the subjects smoked, was included in the analyses. The CD14-260T/T genotype was found in 34.0% of periodontitis patients and in 20.2% of controls. Logistic regression analysis adjusted for gender, age, smoking, and prevalence of P. gingivalis and A. actinomycetemcomitans showed an association between the CD14-260T/T genotype and periodontitis (P = 0.004, OR 3.0, 95% CI 1.4–6.9). We conclude that the CD14-260T/T genotype contributes to the susceptibility to severe periodontitis in Dutch Caucasians.

Changes in oral microflora after full-mouth tooth extraction: a prospective cohort study

AIM

The aim of the study was to evaluate the effect of full-mouth tooth extraction on the oral microflora, with emphasis on the presence and load of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis.

MATERIAL AND METHODS

Adult patients (n = 30), with moderate to advanced periodontitis and scheduled for full-mouth tooth extraction, were consecutively selected. Prior to and 1 and 3 months after full-mouth tooth extraction saliva, tongue, buccal and gingival mucosa and subgingival plaque/prosthesis samples were obtained. Aerobic and anaerobic culture techniques and quantitative real-time polymerase chain reaction (qPCR) were employed for the detection of oral pathogens.

RESULTS

Full-mouth tooth extraction resulted in reduction below detection level of A. actinomycetemcomitans and P. gingivalis in 15 of 16 and 8 of 16 previously positive patients using culture techniques and qPCR, respectively. Those patients remaining qPCR positive showed a significant reduction in load of these bacteria.

CONCLUSION

Full-mouth tooth extraction significantly changes the oral microflora. These changes include reduction of A. actinomycetemcomitans and P. gingivalis, frequently to levels below detection threshold. In some patients, A. actinomycetemcomitans and P. gingivalis can persist in the edentulous oral cavity up to 3 months after full-mouth tooth extraction.

Feasibility and Influence of the Microgap of Two Implants Placed in a Non-Submerged Procedure: A Five-Year Follow-Up Clinical Trial

BACKGROUND

The aim of this study was to evaluate the feasibility of using a two-piece implant system in a non-submerged procedure and to study the impact of the microgap between the implant and abutment.

METHODS

Sixty edentulous patients (Cawood Class V-VI) participated in this study. After randomization, 20 patients received two two-piece implants placed in a non-submerged procedure, 20 patients received two two-piece implants placed in the traditional submerged procedure, and 20 patients were treated with two one-piece dental implants placed in the traditional non-submerged procedure. The implants were placed in the mandible for overdenture treatment. A standardized clinical evaluation was performed and radiographs were taken immediately after denture insertion and yearly up to 5 years. Peri-implant samples were collected 12, 36, and 60 months after loading with sterile paper points and analyzed for the presence of putative periodontal pathogens using culture techniques.

RESULTS

One two-piece implant of the non-submerged group and one two-piece implant of the submerged group were lost after 6 and 12 months, respectively. After 5 years of functioning, no significant clinical, radiological, or microbiological differences were found between the three groups. No association was found between the level of the microgap and the amount of bone loss.

CONCLUSIONS

The results of this study indicate that dental implants designed for a submerged implantation procedure can also be used in a non-submerged procedure and may be as predictable as when used in a submerged procedure or as one-piece implants. The microgap at the crestal level in two-piece implants does not appear to have an adverse effect on the amount of peri-implant bone loss.

CARD15 gene mutations in periodontitis

OBJECTIVES

The CARD15 gene encodes the Nod2 protein, which is involved in intracellular recognition of bacterial products like peptidoglycan, activates inflammation and regulates apoptosis through nuclear factor-kappa B, a transcription factor that plays a central role in the innate immunity. Two functional mutations, an insertion mutation at nucleotide 3020 (3020insC) and a missense mutation C2104T in the CARD15 gene (originally NOD2 gene) have been reported to be associated with Crohn's disease. Our aim was to investigate the occurrence of CARD15 gene polymorphisms in adult patients with periodontitis taking into account smoking and presence of putative periodontal pathogens as additional variables.

MATERIAL AND METHODS

A case-control study was performed in 104 Dutch Caucasian patients with severe adult periodontitis (54 non-smokers and 50 smokers, mean age 46 years) and in 97 ethnically matched, periodontal healthy controls (73 non-smokers and 24 smokers, mean age 40 years). DNA isolated from a mouthwash was typed with PCR technology. Presence of putative periodontal pathogens was established by culture technique.

RESULTS

Frequencies of the CARD15 3020insC and 2104T mutations were similar in the periodontitis group and in the control group (5.1% and 13.3%; 5.2% and 10.3%, respectively). The highest carrier frequency of CARD15 mutations was found in non-smoking patients without Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans (29.4% versus 17.4% in controls); however it did not reach statistical significance.

CONCLUSION

Our results suggest no role for CARD15 3020insC and C2104T mutations in adult periodontitis.

Effect of smoking and periodontal treatment on the subgingival microflora

BACKGROUND

The effect of smoking on the prevalence of periodontal pathogens after periodontal treatment is still not clear. Some studies found no effect of the smoking status on the prevalence of periodontal pathogens after therapy, whereas others did. The aim of this retrospective study was to investigate the influence of smoking on the treatment of periodontitis and the composition of the subgingival microflora.

METHOD

The study included 59 periodontitis patients (mean age 41.5 years): 30 smokers and 29 nonsmokers. The treatment consisted of initial periodontal therapy and, if necessary, surgery and/or antibiotics. Clinical and microbiological data were obtained before and after treatment at the deepest site in each quadrant. A pooled sample was analysed for the presence of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotalla intermedia (Pi), Bacteroides forsythus (Bf), Fusobacterium nucleatum (Fn) and Peptostreptococcus micros (Pm).

RESULTS

For smokers and nonsmokers a significant improvement of the clinical condition was found after treatment. A decrease could be assessed for bleeding on probing (smokers: 0.46; nonsmokers: 0.52) and probing pocket depth (PPD) (smokers: 1.64 mm; nonsmokers: 2.09 mm). Furthermore, both groups showed gain of attachment (smokers: 0.68 mm; nonsmokers: 1.46 mm). No significant difference in bleeding on probing and PPD reduction was found between smokers and nonsmokers. In contrast, nonsmokers showed significantly more gain of attachment than smokers. The microbiological results revealed no differences in the prevalence of the various bacteria between smokers and nonsmokers before treatment. After treatment in nonsmokers, a significant decrease was found in the prevalence of Aa (11-3), Pg (17-7), Pi (27-11), Bf (27-11), Fn (28-20) and Pm (27-17). In smokers, a significant decrease could be shown only for the prevalence of Pg (15-5).

CONCLUSIONS

Nonsmokers showed more gain of attachment and a greater decrease in the prevalence of periodontal bacteria as compared to smokers. The phenomenon that among smokers, more patients remain culture positive for periodontal pathogens after therapy, may contribute to the often observed unfavourable treatment results in smoker periodontitis patients.

Two-part implants inserted in a one-stage or a two-stage procedure. A prospective comparative study

OBJECTIVE

The aim of this study was to evaluate the feasibility of using a two-part implant system in a one-stage procedure and to monitor the microflora in the peri-implant area in relation to clinical and radiographic outcome.

MATERIAL AND METHODS

After randomisation, 40 edentulous patients (Cawood & Howell class V-VI) received two IMZ implants in the anterior mandible inserted by either a one-stage (n = 20) or a two-stage (n = 20) surgical procedure for overdenture treatment. A standardised clinical and radiographic evaluation was performed after denture insertion as well as 6 and 12 months thereafter. Twelve months after loading, peri-implant samples were collected and analysed for the presence of putative periodontal pathogens using culture technique.

RESULTS

No striking differences were found between the two groups with regard to the clinical parameters during the evaluation period. The mean bone loss in the first year of functioning was 0.6 mm in both groups. With regard to the gingiva score, plaque score, bleeding score or bone loss between T0 and T12, no associations were found with the presence of the cultured microorganisms. An association was present between pockets >or= 4 mm and the presence of Peptostreptococcus micros in the two-stage group.

CONCLUSIONS

The short-term results indicate that two-part implants inserted in a one-stage procedure may be as predictable as inserted in the common two-stage procedure. The peri-implant sulcus can and does harbour potential periodontal pathogens without significant signs of tissue breakdown.

Two-stage IMZ implants and ITI implants inserted in a single-stage procedure. A prospective comparative study

The aim of this study was to evaluate the feasibility of using a two-stage implant system in a single-stage procedure and to study the impact of the microgap at crestal level and to monitor the microflora in the peri-implant area. Forty edentulous patients (Cawood & Howell class V-VI) participated in this study. After randomisation, 20 patients received two IMZ implants inserted in a single-stage procedure and 20 patients received two ITI implants. After 3 months, overdentures were fabricated, supported by a bar and clip attachment. A standardised clinical and radiographic evaluation was performed immediately after denture insertion and 6 and 12 months later. Twelve months after loading, peri-implant samples were collected with sterile paper points and analysed for the presence of putative periodontal pathogens using culture techniques. One IMZ implant was lost due to insufficient osseointegration. With regard to the clinical parameters at the 12 months evaluation, significant differences for plaque score and probing pocket depth (IMZ: mean 3.3 mm, ITI: mean 2.9 mm) were found between the two groups. The mean bone loss in the first year of functioning was 0.6 mm for both groups. Prevotella intermedia was detected more often in the ITI group (12 implants) than in the IMZ group (three implants). Porphyromonas gingivalis was found in three patients. In one of these patients an implant showed bone loss of 1.6 mm between T0 and T12. Some associations were found between clinical parameters and the target microorganisms in the ITI group. These associations were not present in the IMZ group. The short-term results indicate that two-stage implants inserted in a single-stage procedure may be as predictable as one-stage implants. The microgap at crestal level in nonsubmerged IMZ implants seems to have no adverse influence on the peri-implant microbiological colonisation and of crestal bone loss in the first year of functioning. The peri-implant sulcus can and does harbour potential periodontal pathogens without signs of peri-implantitis during the evaluation period of 1 year.

Absence of a specific subgingival microflora in adults with Down's syndrome

BACKGROUND

Periodontal disease in Down's syndrome (DS) is generally characterized by a high degree of bone loss. Bone loss of 5 mm or more is observed in 70% of these subjects. Among DS subjects, considerable differences in disease progression occur. So far, no studies have been conducted in which specific properties of the subgingival microflora have been related to the condition observed.

AIMS

To investigate (1) the subgingival microflora in DS subjects and other mentally retarded (control) individuals which were matched to the utmost and (2) to investigate the subgingival microflora of a "low-risk" and a " high-risk" group formed in DS subjects.

MATERIAL AND METHODS

17 DS subjects and 17 control subjects were matched with respect to age, plaque level and bleeding on probing. In addition, the DS group was divided in a "low-risk" group (0-2 teeth lost due to periodontal disease n=6) and a "high-risk"group (6-13 teeth lost due to periodontal disease n=11). Prevalence and proportions of the putative periodontal pathogens Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Peptostreptococcus micros, Fusobacterium nucleatum and Campylobacter rectus in the subgingival plaque were determined using anaerobic culture techniques. No differences in the prevalence of distinct suspected periodontopathic bacteria and bacterial subgingival composition between the DS group and the control group could be established. Also no differences in the prevalence of the seven investigated microbial species between the "low-risk" and the "high-risk" group were observed.

CONCLUSIONS

Because of the lack of differences in microflora between the DS group and the control group, a specific effect of the microbiological composition in the periodontal status of subjects with DS can be excluded in this population. Host factors constitute the more likely explanation of the differences observed in DS.

Amoxicillin plus metronidazole in the treatment of adult periodontitis patients. A double-blind placebo-controlled study

BACKGROUND, AIMS

The aim of this double-blind, parallel study was to evaluate the adjunctive effects of systemically administered amoxicillin and metronidazole in a group of adult periodontitis patients who also received supra- and subgingival debridement.

METHODS

49 patients with a diagnosis of generalised severe periodontitis participated in the study. Random assignment resulted in 26 patients in the placebo (P) group with a mean age of 40 years and 23 patients in the test (T) group which had a mean age of 45 years. Clinical measurements and microbiological assessments were taken at baseline and 3 months after completion of initial periodontal therapy with additional placebo or antibiotic treatment. Patients received coded study medication of either 375 mg amoxicillin in combination with 250 mg metronidazole or identical placebo tablets, every 8 hours for the following 7 days.

RESULTS

At baseline, no statistically significant differences between groups were found for any of the clinical parameters. Except for the plaque, there was a significantly larger change in the bleeding, probing pocket depth (PPD) and clinical attachment level (CAL) in the T-group as compared to the P-group after therapy. The greatest reduction in PPD was found at sites with initial PPD of > or = 7 mm, 2.5 mm in the P-group and 3.2 mm in the T-group. The improvement in CAL was most pronounced in the PPD category > or = 7 mm and amounted to 1.5 mm and 2.0 mm in the P- and T-groups, respectively. No significant decrease was found in the number of patients positive for any of the test species in the P-group. The number of patients positive for Porphyromonas gingivalis, Bacteroides forsythus and Prevotella intermedia in the T-group showed a significant decrease. After therapy there was a significant difference between the P- and the T- group in the remaining number of patients positive for P. gingivalis, B. forsythus and Peptostreptococcus micros. 4 subgroups were created on the basis of the initial microbiological status for P. gingivalis positive (Pg-pos) and negative patients (Pg-neg) in the P- and the T-groups. The difference in reduction of PPD between Pg-pos and Pg-neg patients was particularly evident with respect to the changes in % of sites with a probing pocket depth > or = 5 mm. This % decreased from 45% at baseline to 23% after treatment in the Pg-pos placebo subgroup and decreased from 46% to 11% in the Pg-pos test subgroup (p < or = 0.005). In contrast, the changes in the proportions of sites with a probing pocket depth > or = 5 mm in the Pg-neg placebo and Pg-neg test subgroup were similar, from 43% at baseline to 18% after treatment versus 40% to 12% respectively.

CONCLUSIONS

This study has shown that systemic usage of metronidazole and amoxicillin, when used in conjunction with initial periodontal treatment in adult periodontitis patients, achieves significantly better clinical and microbiological results than initial periodontal treatment alone. Moreover, this research suggests that especially patients diagnosed with P. gingivalis benefit from antibiotic treatment.

Pre- and post-implantation microbiota of the tongue, teeth, and newly placed implants

OBJECTIVES

This investigation sought intra-oral sources of species colonizing dental implants.

MATERIALS AND METHODS

Plaque samples were taken pre- and post-successful osseointegration from implants, teeth, and from tongues of 10 edentulous and 11 partially dentate subjects. Samples were assayed using whole genomic DNA probes in a checkerboard assay to 42 subgingival species.

RESULTS

Similar prevalences and mean levels (10(3) to 10(4)) of microorganisms colonized implants and teeth. Species levels from tongue samples were higher than those of teeth and implants, although species prevalence was similar, suggesting that larger samples were obtained from the tongue. No significant differences were observed between the microbiota from the tongue of edentulous and partially dentate subjects. Most implant species were detected on tongue pre-implantation. In individual edentulous subjects, there were positive associations between Capnocytophaga ochracea and Campylobacter rectus from tongue and implant samples. In individual partially dentate subjects, there were positive associations between Fusobacterium nucleatum subsp. vincentii from tongue and implant samples, and Treponema denticola from implant and tooth samples taken at the same visit.

CONCLUSION

This study indicated that the tongue, in addition to teeth, can be a source for species colonizing new implants.

Additional clinical and microbiological effects of amoxicillin and metronidazole after initial periodontal therapy

The aims of this study were to evaluate the clinical and microbiological effects of initial periodontal therapy (IT) and to determine the additional effects of systemic amoxicillin (Flemoxin Solutab) 375 mg TID plus metronidazole 250 mg TID therapy, in patients with adult Actinobacillus actinomycetemcomitans (Aa)-associated periodontitis in conjunction with either Porphyromonas gingivalis (Pg), Bacteroides forsythus (Bf) and/or Prevotella intermedia (Pi). In addition the adverse effects of the antimicrobial therapy were also documented. A total of 22 patients were enrolled. The deepest, bleeding pocket in each quadrant was selected and at these 4 experimental sites clinical measurements and microbiological testing was carried out at baseline, after (IT), i.e., 21 weeks after baseline, and after antimicrobial therapy (AM), i.e., 35 weeks after baseline. At baseline, the mean plaque index (PI) amounted 0.5, 0.1 after IT and 0.3 after systemic AM. The mean bleeding index decreased from 1.6 to 1.2 after IT and a further decrease to 0.7 after AM was noted. Suppuration was completely eliminated after AM. The mean change of probing pocket depth (PPD) after IT amounted 1.4 mm and was further reduced with an additional mean change of 1.1 mm after medication. Clinical attachment gain was 1.1 mm after IT and an additional 0.9 mm was observed after AM. One of the 22 Aa positive patients and 4 of 17 Pg positive patients became negative for these species after IT. The number of patients with detectable Pi decreased from 16 to 10 after IT. After AM, in comparison to baseline, suppression below detection level for Aa was achieved in 19 out of 22, for Pg in 9 out of 17, for Bf in 13 out of 14, and for Pi in 11 out of 16 patients. By contrast, higher frequencies of Peptostreptococcus micros and Fusobacterium nucleatum were found after AM. On the basis of the microbiological results the study group was separated into 2 subgroups: group A consisted of subjects who had no detectable levels of Aa, Pg, Bf and <5% of Pi after AM. Group B consisted of those who still showed presence of one of these 3 species and/or > or =5% levels of Pi. After AM, group B had significantly higher PI, BI, PPD and CAL scores then group A. It is concluded that group A showed low plaque scores and no detectable periodontal pathogens. This microbiological condition has been associated with a long-term stable periodontium.

Effects of metronidazole in patients with "refractory" periodontitis associated with Bacteroides forsythus

The aim of the present study was to monitor the microbiological and clinical effects of renewed supra- and subgingival debridement in conjunction with systemic metronidazole therapy (500 mg TID for 7 days) in 27 "refractory" periodontitis patients, culture positive for Bacteroides forsythus and negative for Actinobacillus actinomycetemcomitans. Clinical evaluation included assessment of plaque, bleeding upon probing, probing pocket depth and clinical attachment loss at the deepest, bleeding site in each quadrant. Microbiological evaluation was carried out by anaerobic cultivation of subgingival plaque samples from the same sites. 6 months after renewed debridement and systemic metronidazole (RD+M), a statistically significant improvement of all clinical parameters was observed, except for the plaque index. After RD+M, B. forsythus was suppressed below detection level in 17 of the 27 patients, P. gingivalis in 9 out of 15 patients and P. intermedia in 14 of the 21 patients. Before RD+M, 12 patients harboured simultaneously B. forsythus, P. gingivalis as well as P. intermedia. Out of these, 6 patients were culture negative for the 3 species after therapy and showed the greatest reduction in pocket depth (3.1 mm) and gain of clinical attachment level (2.5 mm). In the treatment of refractory periodontitis, associated with patients culture positive for B. forsythus and negative for A. actinomycetemcomitans, metronidazole can significantly improve the clinical and microbiological parameters.

Rapid characterization of periodontal bacterial isolates by using fluorogenic substrate tests

Eighty-nine species of subgingival bacteria, represented by 121 reference strains and 892 patient isolates, including gram-negative, gram-positive, aerobic, facultatively anaerobic, microaerophilic, and anaerobic species, were characterized with a panel of fluorogenic, 4-methylumbelliferyl-linked substrate tests. Identifications of all patient isolates were confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) of whole-cell proteins relative to reference strains. Characteristic profiles of positive fluorogenic reactions differentiated most of the species, including five Porphyromonas species, six pigmenting and five nonpigmenting Prevotella species, Bacteroides forsythus, three Capnocytophaga species, six Actinomyces species, four Propionibacterium species, and eight Streptococcus species. Two mannoside isomers differentiated Actinomyces israelii and Actinomyces gerencseriae. In addition to Porphyromonas gingivalis, B. forsythus, and Capnocytophaga species, Fusobacterium alocis, Actinomyces odontolyticus, Actinomyces meyeri, and Bifidobacterium dentium were all positive for so-called trypsin-like activity. Fusobacterium nucleatum, Eikenella corrodens, Actinobacillus actinomycetemcomitans, and Campylobacter species were nonreactive with the carbohydrate-based substrates tested. Fluorogenic substrate tests provided a sensitive and simple method for biochemical characterization that could presumptively identify to species level most subgingival isolates within 4 h. The method was ideal for rapidly obtaining presumptive identifications of isolates prior to confirming identifications by definitive methods, such as SDS-PAGE.

Comparative study of four proteases from spent culture media of Porphyromonas gingivalis (FAY-19M-1)

Four gelatin cleaving proteases were partially purified from culture media of Porphyromonas gingivalis (FAY-19M-1) by sequential chromatography on columns of DEAE-Sepharose, Sephadex G-100 and chromatofocusing on PBE-94. The molecular mass of each of these proteases, estimated by relative mobility on gelatin-containing SDS-PAGE, was 50 kDa (Pool D1b), 120 kDa (Pool E1a), approximately 160 kDa (Pool E1b) and > 300 kDa (Pool A1a), respectively. These proteases also differed with respect to charge characteristics, inhibition profile and cleavage specificity. Protease pools A1a and E1a were inhibited by thiol modifying reagents. Protease pool A1a was also inhibited by N-tosyl-L-lysine chloromethyl ketone, and E1a was inhibited by antipain. Protease pool D1b was inhibited by E-64, leupeptin and antipain, and protease E1b was not inhibited by either of these inhibitors. The detailed substrate specificity of these proteases was checked by using chromogenic substrates, synthetic peptides and native proteins. Protease E1b was very active in degrading collagen, fibrinogen, fibronectin, IgG, IgA, third component of complement (C3), serum albumin, transferrin and varies; is directly proportional to 1-acid glycoprotein as substrates. Fibrinogen, fibronectin and complement C3 component were also cleaved by A1a, D1b and E1a. Synthetic peptides insulin B chain, cecropin P-1 and magainin were cleaved by E1b. Based on FAB analysis E1b showed preferential cleavage at hydrophobic or neutral residues. Protease A1a was active towards chromogenic substrates with either lys or arg in P1 position. Protease D1b cleaved chromogenic substrates with arg in P1 position and cleaved synthetic peptides magainin and (KIAGKIA)3-NH2 at lys residues also. Protease E1a showed glycyl-prolyl peptidase activity.

Chemotaxonomy of Bacteroides: a review

The loose definition of Bacteroides, some species of which are important etiologic agents of oral diseases, has enabled isolates with only marginal similarities to be reposited in this genus. Many attempts have been made over the years to improve the taxonomy of this heterogeneous group of bacteria. The present article reviews major chemotaxonomic characters and techniques that have been used for this purpose: pigmentation, metabolites, whole-cell fatty acids, phospholipids, isoprenoid quinones, carbohydrates of lipopolysaccharide, whole-cell proteins, peptidoglycans, enzymes, pyrolysis mass spectrometry, DNA composition, restriction fragment length polymorphisms of DNA and ribosomal (r) RNA, homology of DNA and RNA, DNA-rRNA hybridization, and 16S and 5S rRNA oligonucleotide cataloging and sequencing. Despite improvements in their taxonomy, some bacteroides are still misclassified. Suggestions for further improvements in the taxonomy of bacteroides are made.

Degradation of immunoglobulin G by periodontal bacteria

Several subgingival microorganisms were tested for their ability to utilize human immunoglobulin G (IgG) as a substrate for growth. This was done using a protein-free chemically defined medium, supplemented with IgG. Stimulation of growth was observed for Capnocytophaga ochracea, Porphyromonas asaccharolytica, Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, Prevotella oralis, Lactobacillus catenaforme and Streptococcus intermedius. Immunoelectrophoresis, sodium dodecyl sulfate-polyacrylamide gel electrophoresis and a protein assay demonstrated that P. intermedia and P. endodontalis completely degraded the protein chains of IgG. Partial breakdown of IgG was observed for P. asaccharolytica and C. ochracea, whereas P. oralis cleaved the IgG heavy chain, yielding Fc and Fab fragments. All these bacteria utilized IgG as a substrate for growth. Binding studies using an enzyme-linked immunosorbent assay, revealed complete loss of in vitro antigen-antibody binding capacity after incubation of specific IgG with P. endodontalis and partial loss of binding with P. intermedia, P. gingivalis, C. ochracea or Fusobacterium nucleatum. Degradation or inactivation of IgG by oral bacteria is thought to be important in the causation of polymicrobial infections.

Purification and characterization of lysine- and arginine-specific gingivain proteases from Porphyromonas gingivalis

Four gingivain proteases, active in presence of L-cysteine, were purified from spent culture media of oral pathogen Porphyromonas gingivalis by ion-exchange chromatography on MonoQ and chromatofocusing on MonoP columns. Three of the purified proteases, with molecular masses of 75 kDa, 70 kDa and 55 kDa, respectively, hydrolyzed synthetic chromogenic substrates with arginine in the P1 position. One protease, with a molecular mass of 80 kDa, hydrolyzed substrates with lysine in the P1 position. It is proposed these enzymes be named: arg-gingivain-75, arg-gingivain-70, arg-gingivain-55, and lys-gingivain-80, respectively, based on their molecular mass and specificity for either arginine or lysine in the P1 position.

Microbiological and clinical effects of metronidazole and amoxicillin in Actinobacillus actinomycetemcomitans-associated periodontitis. A 2-year evaluation

In this study, we evaluated the microbiological and clinical effects of mechanical debridement in combination with metronidazole and amoxicillin therapy in 48 patients with Actinobacillus actinomycetemcomitans-associated periodontitis, 3 months and at least 24 months after active treatment. The results of this study showed that 47 out of 48 patients were still negative for A. actinomycetemcomitans subgingivally, at the mucous membranes, the tonsillar area and in the saliva, 2 years after therapy. The clinical results showed that a reduction of probing pocket depth, probing attachment level, bleeding index and plaque index was not only seen in the time between baseline and 3 months after therapy, but further clinical improvement was observed between 3 and 24 months after active treatment. We conclude that combined mechanical debridement and metronidazole plus amoxicillin therapy is very effective in suppressing A. actinomycetemcomitans below cultivable levels over a long period of time, suggesting elimination of this organism, and that recolonization of A. actinomycetemcomitans seems to be a rare event. The elimination of A. actinomycetemcomitans is paralleled by a further improvement of the periodontal status of the patients, even up to 24 months after active treatment.

Effects of N-acetylglucosamine on carbohydrate fermentation by Streptococcus mutans NCTC 10449 and Streptococcus sobrinus SL-1

We have investigated the ability of two species of streptococci isolated from the human oral cavity (Streptococcus mutans NCTC 10449 and Streptococcus sobrinus SL-1) to metabolize N-acetylglucosamine (GlcNAc), a naturally occurring amino sugar present in saliva and human glycoproteins, when provided as the sole fermentable carbohydrate and determined the effects of the presence of GlcNAc on the fermentation of other carbohydrates. S. mutans used GlcNAc at concentrations of up to 10 mM to increase cell numbers, but S. sobrinus was unable to ferment the amino sugar alone and its uptake only occurred in the presence of a fermentable carbohydrate. GlcNAc had a marked inhibitory effect on the ability of S. sobrinus to produce lactic acid from glucose, sucrose, and fructose, at the same time increasing the lag period and doubling time of batch-grown cells. Such patterns of inhibition were found with S. mutans, but the effects were less than those seen in S. sobrinus. In mixed culture studies of the two species, S. sobrinus became the predominant organism when 10 mM glucose was supplied as the sole fermentable carbohydrate, with a concomitant decrease in the numbers of S. mutans cells, but supplementation of the broth with 10 mM glucose and 10 mM GlcNAc resulted in the emergence of S. mutans as the predominant organism. S. mutans and S. sobrinus grown in media containing glucose possessed the ability to transport glucose and GlcNAc, probably via the same glucose-phosphotransferase system at similar rates. However, intracellular levels of N-acetylglucosamine-6-phosphate deacetylase and glucosamine-6-phosphate deaminase were markedly higher in S. mutans grown on glucose and GlcNAc than in S. sobrinus: 34 and 398 and 8 and 17 nmol of NADPH formed per mi per mg of protein for S. mutans and S. sobrinus, respectively. We propose that GlcNAc inhibited growth of S. sobrinus in media containing glucose and GlcNAc by competing with glucose for the glucose phosphotransferase, depleting intracellular levels of phosphoenolpyruvate, and possessing, in contrast to S. mutans, low levels of N-acetyl-glucosamine-6-phosphate deacetylase and glucosamine-6-phosphate deaminase activity. Together, these data suggest that in dental plaque, S. sobrinus when exposed to GlcNAc will have a reduced ability to compete with S. mutans for dietary carbohydrates, contributing to the greater frequency of isolation of S. mutans from human populations.

Porphyromonas (Bacteroides) endodontalis: its role in endodontal infections

Porphyromonas endodontalis (formerly Bacteroides endodontalis) is a black-pigmented anaerobic Gram-negative rod which is associated with endodontal infections. It has been isolated from infected dental root canals and submucous abscesses of endodontal origin. The presence of P. endodontalis in infected dental root canals has been correlated with symptoms of an acute infection. It is occasionally found on oral mucous membranes and periodontal pockets. P. endodontalis has shown relatively low virulence in experimental monoinfections. In anaerobic mixed infections it can play an essential role. Differences in virulence between strains have been related to capsular material. On the basis of different types of capsules, three serotypes have been described. P. endodontalis is sensitive to a wide range of antibiotics, including the penicillins, the tetracyclines, and metronidazole.

Glycosidase activities in gingival crevicular fluid in subjects with adult periodontitis or gingivitis

Specific glycosidase activities were determined in samples of gingival crevicular fluid (GCF) collected from eight predetermined sites in two groups, each of 20 adult patients, with either gingivitis or periodontitis. The total activities (as units of enzyme activity per sample) of alpha-L-fucosidase, sialidase, beta-N-acetylglucosaminidase, beta-galactosidase, beta-glucosidase and alpha-glucosidase were significantly greater in the periodontitis group. In contrast, the total beta-mannosidase and hexosaminidase A activities were significantly greater in the gingivitis group, while there was no significant difference in the total alpha-mannosidase activity between the groups. Only the specific activities (as units of enzyme activity per min per microliter of GCF) of beta-mannosidase and hexosaminidase A were significantly different between the groups being greater in the gingivitis group. When used to predict the clinical status of individual periodontal sites, the total enzyme activities had specificity and sensitivity values of 91.9 and 61.3%, respectively. Measurement of glycosidase activities might thus have a role in monitoring the efficacy of periodontal treatment or in predicting future periodontal disease but this will require further investigation.

Chronic conjunctivitis caused by oral anaerobes and effectively treated with systemic metronidazole plus amoxicillin

In this study, we report on a case of refractory, unilateral anaerobic conjunctivitis. The predominant anaerobic flora consisted of Prevotella intermedia (formerly Bacteroides intermedius) and Peptostreptococcus micros. By using the technique of restriction endonuclease fingerprinting of genomic DNA, it was shown that the P. intermedia likely originated from the oral cavity. Topically applied antibiotics had failed to suppress the infection in the past. Successful treatment was achieved after systemic administration of metronidazole plus amoxicillin.

Occurrence of Bacteroides gingivalis, Bacteroides intermedius and Actinobacillus actinomycetemcomitans in severe periodontitis in relation to age and treatment history

A total of 242 subjects including 138 untreated severe periodontitis patients and 104 patients with refractory periodontal disease, previously treated for severe periodontitis, were examined for the occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius. Pooled subgingival samples of representative periodontal lesions were used for anaerobic cultivation on blood agar and for the enumeration of A. actinomycetemcomitans on selective TSBV medium. 97% of the untreated patients were infected with one or more of the test micro-organisms. In this patient group, the occurrence of A. actinomycetemcomitans, B. gingivalis and B. intermedius was 54%, 48% and 63%, respectively. The prevalence of A. actinomycetemcomitans positive patients appeared to be age related and decreased with increasing age. Likewise, the number of patients solely infected with A. actinomycetemcomitans decreased with increasing age. The prevalence of B. gingivalis infected patients appeared to increase with increasing age. These phenomena were not observed in the refractory periodontitis patients. The occurrence of A. actinomycetemcomitans, B. gingivalis and B. intermedius in the refractory periodontitis group was 55%, 27% and 59%, respectively. A statistical significant difference in the prevalence of B. gingivalis was found between the untreated and the refractory periodontitis patients. In both patient groups, the relative proportion of A. actinomycetemcomitans was significantly higher in subjects with this bacterium as the sole indicator micro-organism than in patients who, besides being infected with A. actinomycetemcomitans, were also infected with black-pigmented Bacteroides species. Furthermore, in comparison with untreated patients, unsuccessfully treated patients solely infected with A. actinomycetemcomitans had on average a lower number but also a higher mean % of this bacterium.(ABSTRACT TRUNCATED AT 250 WORDS)

Improved metabolic control, clinical periodontal status and subgingival microbiology in insulin-dependent diabetes mellitus. A prospective study

The effect of improved metabolic control on the clinical periodontal condition and the subgingival microflora of diseased and healthy periodontal pockets in 6 ambulatory insulin-dependent diabetes mellitus (IDDM) patients was prospectively studied. Duplicate measurements with a time-interval of 3 days were made every 4 moths for assessment of the metabolic status, the clinical periodontal condition and the subgingival microflora. During the study, patients maintained personal oral hygiene measures as they usually did before the study. Neither supplementary dental prophylaxis nor oral hygiene measures were applied during the investigation. Long-term metabolic control (HbAlc) improved significantly with intensive conventional insulin treatment. Gingival redness decreased significantly whereas gingival swelling showed a not significant trend to decrease. It is suggested that microvascular changes associated with improved metabolic control in diabetes mellitus may mediate the observed change in gingival redness. No effect could be demonstrated for probing pocket depth, probing attachment level, bleeding on probing and the plaque index. Statistical analysis of the effect of improved metabolic control on the subgingival microflora revealed that only the % of streptococci increased significantly in diseased periodontal pockets. In general, no significant changes were found in either healthy or diseased pockets with regard to the bacterial flora associated with periodontal disease. The results of the present study indicate that improved metabolic control in IDDM patients may have no potential impetus for an improved clinical periodontal condition nor on the subgingival bacterial flora. It is concluded that the periodontal condition in IDDM patients may only ameliorate when local oral hygiene measures are applied.

Associations between salivary levels of mutans streptococci, lactobacilli, yeasts and black-pigmented Bacteroides spp. and dental variables in elderly dental patients

Multivariate step-wise regression analyses demonstrated that in a population of 146 elderly dental patients (mean age 69.8 yr) the salivary level of mutans streptococci was unrelated to the root DFS score, unlike the levels of lactobacilli and yeasts. Mutans streptococci were related to the wearing of partial dentures and the number of snacks eaten per day, while salivary lactobacillus levels were also related to the number of snacks eaten per day and to denture wearing, and negatively related to saliva buffering. Salivary yeast levels were also related to the wearing of partial dentures and the number of snacks eaten per day, and negatively related to salivary neuraminidase activity. The R2 values ranged from 0.21 to 0.28. Salivary level of black-pigmented Bacteroides spp. were related to maximum CPITN score, mean bleeding index and salivary trypsin-like activity (R2 was 0.08).

Periodontal condition and microbiology of healthy and diseased periodontal pockets in type 1 diabetes mellitus patients

On the basis of glycosylated hemoglobin (HbA1c) values, 22 type 1 (insulin-dependent) diabetic adults were grouped into patients with near normal (HbA1c less than or equal to 7.7%) and poor (HbA1c greater than or equal to 9.9%) metabolic control. A total of 44 subgingival sites were examined for Actinobacillus actinomycetemcomitans, black-pigmented Bacteroides species and Capnocytophaga species. No significant difference could be demonstrated between patients in the 2 test groups with regard to periodontal condition. Neither age of diabetic patients nor duration of diabetes mellitus influenced the periodontal parameters. In both test groups, pocket depth of 4 mm or more (greater than or equal to 4 mm) was found to be significantly associated with increased swelling, bleeding after probing and amount of marginal plaque. Proportionally high %s of cultivable A. actinomycetemcomitans (mean 4.3%; range 2.8-5.8%), Bacteroides gingivalis (33.2% and 34.6%) and Bacteroides intermedius (mean 4.2%; range 0.001-13.5%) were isolated from diseased periodontal pockets. In diabetic patients with poor metabolic control, B. intermedius was isolated from diseased periodontal pockets with a mean % of 7.2%, range 0.3-12.5%. Independent of the degree of metabolic control, low %s of Capnocytophaga species were isolated from diseased and healthy periodontal pockets, mean 0.9% (range 0.003-3.9%) and mean 1.4% (range 0.04-4.9%), respectively. It was concluded from this study that metabolic control seems to have no direct effect on the periodontium. Furthermore, the rôle of Capnocytophaga species in the pathogenesis of infectious periodontal disease in type 1 diabetic patients seems to be overestimated.(ABSTRACT TRUNCATED AT 250 WORDS)

Enzyme profiles of oral spirochetes in RapID-ANA system

Enzyme profiles of oral Treponema species were determined by using RapID-ANA (Innovative Diagnostic System, Atlanta, Ga.), a 4-h test system which detects 18 enzymatic reactions, including aminopeptidases and glycosidases. Seventy-two clinical isolates of Treponema denticola, four reference strains of T. denticola (ATCC 35404, ATCC 35405, ATCC 35520, and ATCC 33521), one strain of T. vincentii (ATCC 35580), and two strains of T. socranskii subspecies (T. socranskii subsp. buccale ATCC 35534 and T. socranskii subsp. socranskii ATCC 35536) were used in this study. All T. denticola strains produced indole and a variety of aminopeptidases and glycosidases. These organisms could be differentiated into two groups on the basis of tetrazolium reductase and serine, phenylalanine, and glycine aminopeptidase activities. T. vincentii produced N-acetylglucosaminidase and arginine aminopeptidase, which facilitated the differentiation of this organism from T. socranskii subspecies and the T. denticola group. T. socranskii subspecies gave positive reactions for alkaline phosphatase only. These findings suggest that the RapID-ANA system is useful for enzymatic characterization and differentiation of oral spirochetes.

Response of a Streptococcus sanguis strain to arginine-containing peptides

For dental plaque organisms such as Streptococcus sanguis, the ecological importance of the ability to utilize arginine as an energy source has been established in previous studies. The present investigation was undertaken to determine the ability of a strain of S. sanguis to process unsubstituted arginine-containing peptides. The organism was grown under glucose-limited conditions in a chemically defined medium, and peptide was added to washed, resting cells in a pH-stat at pH 7.0. Filtrates taken at appropriate time intervals were assayed for peptide, free amino acids, and metabolites. Irrespective of the position of the arginine residue, all peptides tested were attacked, although those that possessed a C-terminal arginine (including a tetrapeptide) were processed at a faster rate than were those in which arginine was N terminal. However, C-terminal arginine was cleaved only slowly from a peptide containing 24 residues. In each case, most of the released arginine was converted to ornithine via the arginine deiminase pathway. Such peptidase activities appeared to occur at or near the cell surface and were probably constitutive. It was found that the organism grew in chemically defined medium containing arginine that was present solely in the form of a tripeptide, and also that a strain of S. mutans possessed only a limited ability to attack arginine-containing peptides and was unable to utilize the released arginine.