Interactions within a collection of eight bacterial strains isolated from a monkey dental root canal

Importance of Virulence Factors for the Persistence of Oral Bacteria in the Inflamed Gingival Crevice and in the Pathogenesis of Periodontal Disease

Periodontitis is a chronic inflammation that develops due to a destructive tissue response to prolonged inflammation and a disturbed homeostasis (dysbiosis) in the interplay between the microorganisms of the dental biofilm and the host. The infectious nature of the microbes associated with periodontitis is unclear, as is the role of specific bacterial species and virulence factors that interfere with the host defense and tissue repair. This review highlights the impact of classical virulence factors, such as exotoxins, endotoxins, fimbriae and capsule, but also aims to emphasize the often-neglected cascade of metabolic products (e.g., those generated by anaerobic and proteolytic metabolism) that are produced by the bacterial phenotypes that survive and thrive in deep, inflamed periodontal pockets. This metabolic activity of the microbes aggravates the inflammatory response from a low-grade physiologic (homeostatic) inflammation (i.e., gingivitis) into more destructive or tissue remodeling processes in periodontitis. That bacteria associated with periodontitis are linked with a number of systemic diseases of importance in clinical medicine is highlighted and exemplified with rheumatoid arthritis, The unclear significance of a number of potential "virulence factors" that contribute to the pathogenicity of specific bacterial species in the complex biofilm-host interaction clinically is discussed in this review.

Caries and Periodontitis: Contesting the Conventional Wisdom on Their Aetiology

We review the literature on the oral microbiome and the role of the microbiota in the development of dental caries and periodontitis. While most research has been focused on identifying one or more specific determinants of these diseases, the results have provided limited predictive value and have not been able to explain the variation in the distribution of these diseases observed in epidemiological or clinical studies. Drawing on existing knowledge about the nature of the oral microbiota, we suggest that a stochastic model based on the Weiner process provides simple and parsimonious explanations for the pathogenesis of both caries and periodontitis, making few assumptions, and providing explanations for phenomena that have hitherto proved difficult, or have required complex arguments, to explain. These diseases occur as the result of the dental hard tissues and periodontal tissues integrating the random "noise" caused by normal metabolic activities of commensal microorganisms in the dental biofilm. The processes that result in the progression and regression of caries and periodontitis may be considered as "natural," rather than pathological, even if, when left unchecked over long periods of time, they can result in the development of pathologies. The likelihood of progression or regression can be influenced by other determinants, but these processes will nevertheless occur in the absence of such influences. The distributional characteristics of the model approximate the findings of epidemiological studies indicating that, for both caries and periodontitis, there will be few sites affected in the early period after the eruption of the permanent dentition, but in those older there is an almost linear relationship with increasing age; furthermore, the longer a site survives without being affected, the less likely that it will be affected. We discuss the clinical and public health importance of these findings.

Influence of residual bacteria on periapical tissue healing after chemomechanical treatment and root filling of experimentally infected monkey teeth

The purpose of this study was twofold: first, to determine the influence on the healing of the periapical tissues when selected bacterial strains and combinations thereof remain after root canal treatment; and, second, the relationship to healing of the quality of the root filling. In eight monkeys, 175 root canals, previously infected with combinations of four or five bacterial strains and with radiographically verified apical periodontitis, were endodontically treated, bacteriologically controlled, and permanently obturated. After 2-2.5 yr, the periapical regions were radiographically and histologically examined. Of these teeth, 48 root canals were also examined for bacteria remaining after removal of the root fillings. When bacteria remained after the endodontic treatment, 79% of the root canals showed non-healed periapical lesions, compared with 28% where no bacteria were found. Combinations of residual bacterial species were more frequently related to non-healed lesions than were single strains. When no bacteria remained, healing occurred independently of the quality of the root filling. In contrast, when bacteria remained, there was a greater correlation with non-healing in poor-quality root fillings than in technically well-performed fillings. In root canals where bacteria were found after removal of the root filling, 97% had not healed, compared with 18% for those root canals with no bacteria detected. The present study demonstrates the importance of obtaining a bacteria-free root canal system before permanent root filling in order to achieve optimal healing conditions for the periapical tissues.

Virulence, phenotype and genotype characteristics of endodontic Enterococcus spp

BACKGROUND/AIMS

Enterococci have been implicated in persistent root canal infections but their role in the infection process remains unclear. This study investigated the virulence, phenotype and genotype of 33 endodontic enterococcal isolates.

METHODS

Phenotypic tests were conducted for antibiotic resistance, clumping response to pheromone, and production of gelatinase, hemolysin and bacteriocin. Genotype analysis involved polymerase chain reaction amplification of virulence determinants encoding aggregation substances asa and asa373, cytolysin activator cylA, gelatinase gelE, gelatinase-negative phenotype ef1841/fsrC, adherence factors esp and ace, and endocarditis antigen efaA. Physical DNA characterization involved pulsed-field gel electrophoresis of genomic DNA, and plasmid analysis.

RESULTS

Potential virulence traits expressed included production of gelatinase by Enterococcus faecalis (n=23), and response to pheromones in E. faecalis culture filtrate (n=16). Fourteen strains produced bacteriocin. Five strains were resistant to tetracycline and one to gentamicin, whereas all were susceptible to ampicillin, benzylpenicillin, chloramphenicol, erythromycin, fusidic acid, kanamycin, rifampin, streptomycin and vancomycin. Polymerase chain reaction products encoding efaA, ace, and asa were detected in all isolates; esp was detected in 20 isolates, cylA in six isolates, but asa373 was never detected. The gelatinase gene (gelE) was detected in all isolates of E. faecalis (n=31) but not in Enterococcus faecium (n=2); a 23.9 kb deletion sequence corresponding to the gelatinase-negative phenotype was detected in six of the eight E. faecalis isolates that did not produce gelatinase. Pulsed-field gel electrophoresis and plasmid analyses revealed genetic polymorphism with clonal types evident. Plasmid DNA was detected in 25 strains, with up to four plasmids per strain and a similar (5.1 kb) plasmid occurring in 16 isolates.

CONCLUSIONS

Phenotypic and genotypic evidence of potential virulence factors were identified in endodontic Enterococcus spp., specifically production of gelatinase and response to pheromones.

Apical periodontitis development and bacterial response to endodontic treatment. Experimental root canal infections in monkeys with selected bacterial strains

In six monkeys, 160 root canals were inoculated with a combination of four bacterial strains belonging to species Streptococcus milleri, Peptostreptococcus anaerobius, Prevotella oralis, and Fusobacterium nucleatum. In two other monkeys, 24 root canals were inoculated with a five-strain combination consisting of these strains and a strain of Enterococcus faecalis. All strains were previously isolated from an infected monkey root canal. After 8-12 months, survival of the strains was recorded bacteriologically, and the reaction in the periapical region was radiographed. From 180 of 184 root canals, one or more of the bacterial strains were reisolated. The two facultative strains were more frequently reisolated than the anaerobic strains. Apical periodontitis was registered in the periapical region of more than 96% of root canals with reisolated bacteria but in none of those without reisolated bacteria. Endodontic treatment was carried out in two sessions with an interval of 14 d without interappointment dressings, and the effect was evaluated bacteriologically before and after each treatment. The chemo-mechanical treatment reduced significantly the number of strains and bacterial cells. The facultative bacteria were more resistant to the treatment than the anaerobic bacteria. The five-strain combination had a higher survival rate than the four-strain combination.

Fusobacterium nucleatum in endodontic flare-ups

OBJECTIVE

The extent to which Fusobacterium nucleatum is recovered from root canals of teeth that present with an interappointment flare-up following endodontic instrumentation was investigated.

STUDY DESIGN

Included in the study were 28 patients that sought emergency treatment after initiation of root canal therapy. Only non-painful teeth that had been treated because of a necrotic pulp and periapical inflammatory lesion were studied. Root canal samples for bacterial analysis were taken, transported to a bacteriological laboratory, and processed for a semiquantitative assessment of bacterial isolates. Bacterial findings were correlated with self-assessed pain intensity as recorded by means of a Visual Analogue Scale. Clinical presentation of swelling and presence of exudate in the treated root canals were also linked.

RESULTS

Bacteria were recovered from all teeth examined. Gram-negative anaerobic coccoid rods (Prevotella species and Porphyromonas species) were frequent isolates. All teeth in patients who were reported to be in severe pain (Visual Analogue Scale > or = 6) displayed F nucleatum. Nine out of 10 of these teeth also had swelling and exudate in the root canals. Samples from the remaining patients that had teeth with less pain score showed a variable bacterial recovery. None of these teeth displayed F nucleatum.

CONCLUSION

F nucleatum appears to be associated with the development of the most severe forms of interappointment endodontic flare-ups.

Periapical inflammatory responses and their modulation

Periapical inflammatory responses occur as a consequence of bacterial infection of the dental pulp, as a result of caries, trauma, or iatrogenic insult. Periapical inflammation stimulates the formation of granulomas and cysts, with the destruction of bone. These inflammatory responses are complex and consist of diverse elements. Immediate-type responses--including vasodilatation, increased vascular permeability, and leukocyte extravasation--are mediated by endogenous mediators, including prostanoids, kinins, and neuropeptides. Non-specific immune responses--including polymorphonuclear leukocyte and monocyte migration and activation, and cytokine production--are elicited in response to bacteria and their products. Interleukin-1 and prostaglandins in particular have been implicated as central mediators of periapical bone resorption. Chronic periapical inflammation further involves specific T- and B-cell-mediated anti-bacterial responses, and activates a network of regulatory cytokines which are produced by Th1- and Th2-type T-lymphocytes. Various naturally occurring and genetically engineered models of immunodeficiency are beginning to help elucidate those components of the immune system which protect the pulpal/periapical complex. Both specific and non-specific responses interface with and are regulated by the neural system. The modulation of these responses by immune response modifies, cytokine antagonists, and other novel therapeutic agents is discussed. As an experimental model, periapical inflammation has many advantages which permit it to be used in studies of microbial ecology and pathogenesis, host response, neuroimmunology, and bone resorption and regeneration.

Characterization of Bacteroides forsythus isolates

Fifteen Bacteroides forsythus strains freshly isolated from patients with periodontitis were used together with three collection strains and one type strain for characterization of growth on various media; determination of enzymatic profiles, antibiotic susceptibility profiles, 16S rRNA ribotypes, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) outer membrane protein profiles, and pathogenicity; and gas chromatography analysis by using a wound chamber model in rabbits. All strains were stimulated by N-acetylmuramic acid, while one strain needed a further supplement such as yeast extract for optimal growth. All strains showed trypsin-like activity. While 10 different ribotypes were found, the SDS-PAGE profiles revealed similar patterns for all strains. All strains were sensitive to penicillin G (MICs, <0.5 microg/ml), ampicillin (MICs, <1.0 microg/ml), amoxicillin (MICs, <0.38 microg/ml), metronidazole (MICs, <0.005 microg/ml), tetracycline (MICs, <0.19 microg/ml), doxycycline (MICs, 0.05 microg/ml), erythromycin (MICs, <0.4 microg/ml), and clindamycin (MICs, <0.016 microg/ml), while they were less sensitive to ciprofloxacin (MICs, <4 microg/ml). B. forsythus did not cause abscess formation by monoinoculation. B. forsythus coinoculated with Fusobacterium nucleatum ATCC 10953 caused abscess formation in 75% of rabbits, while it caused abscess formation in 100% of rabbits when it was coinoculated with Porphyromonas gingivalis FDC 381. In the case of the latter combination, four of six rabbits died of sepsis after 6 to 7 days, and P. gingivalis and B. forsythus were recovered from the heart blood at a proportion of 10:1. B. forsythus strains were highly virulent and invasive in combination with P. gingivalis.

Pathogenicity of Prevotella intermedia and Prevotella nigrescens isolates in a wound chamber model in rabbits

The pathogenicity of 14 isolates identified as Prevotella intermedia or Prevotella nigrescens by serogrouping using monoclonal antibodies was compared in a tissue cage model in rabbits. Seven strains from periodontal abscesses, 5 strains from deep periodontal pockets and 2 strains from gingivitis were tested in the animal model comprising 6 Teflon tissue cages implanted on the back each of 34 rabbits. A total of 10(5)-10(8) cells of P. intermedia or P. nigrescens strains were inoculated alone or together with either Actinobacillus actinomycetemcomitans or Streptococcus mitis. Five strains of Porphyromonas gingivalis were used as a reference. The infectivity was recorded as pus formation and log viable count in aspirated material for 3, 7 and 14 days. None of the Prevotella strains inoculated in monoculture survived more than 3 days, and they had no capacity to produce abscess. P. intermedia or P. nigrescens strains in combination with A. actinomycetemcomitans produced abscesses in 33-100% and with S. mitis in 42-100%. No difference in abscess formation or log viable count in samples after 14 days was recorded between serogroup I (P. intermedia) and serogroup II and III (P. nigrescens). The infectivity of P. intermedia or P. nigresceas strains did not differ whether they were isolated from periodontal abscess, periodontal pocket or gingivitis. P. intermedia and P. nigrescens strains produced abscesses in combination with a facultative anaerobic strain and appears to have a similar pathogenicity in the wound chamber model in rabbits.

Pathogenicity of bacteria using a simulated root canal system

The purpose of this study was to investigate the reliability of an implantation test using Teflon-simulated root canals for evaluating the pathogenicity of root canal bacteria. Models including suspensions of lyophilized strains (Actinomyces israelii, Streptococcus faecalis, and Porphyromonas asaccharolyticus) were implanted in rat subcutaneous tissue for 1 wk, and histological changes were observed. Severe inflammation occurred around the models. Among them, P. asaccharolyticus induced the severest inflammatory response. Further study using P. asaccharolyticus was conducted to compare the implantation test's ability to evaluate pathogenicity with that of an injection test at 1, 2, or 4 wk. Tissue injected with a bacterial suspension showed no clear response through the experimental periods, whereas tissue around implantation sites showed a severe response at 1 wk. However, the inflammatory response subsided at later stages. Consequently, further improvement is needed to investigate pathogenicity for long periods.

Microbial associations in periodontitis sites before and after treatment

Duplicate samples from 110 periodontal sites of 6 mm or more pocket depth in 16 patients were analyzed for the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Capnocytophaga spp., Campylobacter rectus, Eikenella corrodens and Fusobacterium nucleatum. The sites were sampled before and after nonsurgical periodontal treatment. No statistically significant associations were found before treatment between any of the analyzed species. After treatment, statistically significant associations were found between E. corrodens and all the other species, F. nucleatum and P. intermedia; Capnocytophaga spp. and C. rectus; P. intermedia vs Capnocytophaga spp. and P. gingivalis; and C. rectus vs Capnocytophaga spp. and A. actinomycetemcomitans. Some of these associations could be explained either by patient-related factors or site-related characteristics such as the pocket depth. The proportion of P. gingivalis seemed to be unrelated to the proportion of P. intermedia in the samples. If one of the analyzed microbes was found in one of the sampled pockets in a patient, the probability of finding that microbe in all the sampled sites in the same patient before treatment was more than 50%. This probability was reduced after treatment for many species, especially P. gingivalis, which showed a probability of zero. The probability of detecting a bacterial species on at least one additional site if it was present on one in the same individual was nearly 100%, both before and after treatment, for all species studied. This study has shown several potential microbial associations in the subgingival plaque flora of deep periodontal pockets.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of suspected periodontopathogens in microbiological monitoring of periodontitis

Periodontal disease is the clinical result of a complex interaction between the host and plaque bacteria. Although a specificity to some degree is found for Actinobacillus actinomycetemcomitans in localized juvenile periodontitis (LJP), it has been difficult to obtain evidence for a specific etiological role of the bacteria associated with periodontal disease in adults. What we see is the net result of host-parasite interactions which in an unpredictable moment accumulate and exceed the threshold of tissue integrity. This hypothesis is concomitant with the view of periodontal disease as a polymicrobial infection, predominantly anaerobic, which occurs commonly in the oral cavity or elsewhere in the body. Some micro-organisms (risk markers) occur more frequently than others and may significantly determine the outcome of this host-parasite interaction. Microbiological sampling and analysis seem to be of limited value in risk assessment; however, they can be used as tools in diagnosis in LJP patients and acute infections, and in treatment decision and therapy control in "refractory" patients. Suspected pathogens (risk markers) are Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and some species of spirochetes, while the roles of Prevotella intermedia, Bacteroidesforsythus, Fusobacterium nucleatum, Campylobacter rectus, and Peptostreptococcus micros are more uncertain. The presence of periodontopathogens as well as enterics, Staphylococcus aureus and Candida especially, should be considered in patients with systemic individual disorders--e.g., diabetes mellitus, neutropenia, agranulocytosis, and AIDS--or with implants.

Microbiological evaluation of periapical infections in Egypt

This study identifies and correlates proportions of bacteria in periapically involved anterior teeth of 85 adult Egyptian patients. Affected sites were free from caries and periodontal disease but had a history of trauma. The mean number of component bacterial species per specimen was 3.1. Anaerobic bacteria were the dominant flora present in specimen cultures, comprising 73% (190/259) of cultivable bacteria. The most frequently isolated organisms were Eubacterium species (68%), black-pigmented Bacteroides (56%), Streptococcus morbillorum (47%) and non-pigmented Bacteroides (37%). These organisms also showed the highest proportional values relative to total cultivable bacteria. The mean percentages of total viable counts of these isolates were 19.0%, 14.1%, 18.0% and 15.5%, respectively. Statistical analysis of data revealed a significant negative correlation between S. morbillorum and Bacteroides species.

In vitro survival of Bacteroides intermedius in five transport media, alone or in the presence of Streptococcus sanguis

The survival rate of Bacteroides intermedius was first tested in monoculture, and Streptococcus sanguis was then added in 5 different transport media; 2 nonnutritious media, the viability-preserving medium of the University of Göteborg No. IV (VMG IV), reduced transport fluid (RTF), and 3 nutritious media, thioglycolate medium (TG), peptone yeast extract medium (PY) and PY medium with 1% glucose (PYG). All manipulations were carried out in an anaerobic chamber. After a given transport time (6 or 24 h) aliquots were spread on plates containing solid PY medium by means of an automated spiral system device, thus permitting counts after incubation. The slight variations in the counts of B. intermedius in monoculture, not exceeding 0.5 log10 in the 5 media tested, indicated its good survival capability, i.e. at least 24 h. By contrast, when S. sanguis was added, it was only possible to use nutritious media such as PY or TG for 6 h. In the glocose-containing media (PYG, TG), the multiplication of rapidly glucose-fermenting microorganisms such as streptococci influenced the B. intermedius survival rate. Therefore, the transport time for oral microbiological samples needs to be reduced as much as possible. The use of excessively rich media (particularly media containing a high level of glucose) should be avoided.

Capacity of anaerobic bacteria enclosed in a simulated root canal to induce inflammation

In an effort to simulate the infected dental root canal, bacteria were enclosed in polyethylene tubes that were subcutaneously implanted into rats. Four different bacterial combinations, selected from nine oral species, were tested. The contents of 144 inoculated and implanted 'root canals' were analysed after 2 and 4 weeks of implantation. Bacteroides, Streptococcus, Actinomyces and Fusobacterium were inoculated in low numbers but dominated the mixed flora at the end of the experiment. The bacteria-filled tubes induced inflammation of the rat tissue at the implant opening ('foramen'). It is confirmed that mixed bacterial populations survive, show succession and develop within an enclosed environment. Such florae cause significant inflammation at the interface with the host tissues.

Experimental infections by Bacteroides gingivalis in non-immunized and immunized rabbits

The interactions between Bacteroides gingivalis and systemic antibodies were studied in tissue cages implanted in the backs of New Zealand white rabbits. Infectivity was evaluated according to clinical signs and to leukocyte and bacterial counts in material aspirated from the tissue cages. Pre- and post-inoculation antibody levels to sonicated whole bacterial cells were determined by enzyme-linked immunosorbent and agar immunodiffusion assays. Rabbits immunized against B. gingivalis and then challenged with pure cultures of B. gingivalis revealed complete elimination or markedly lower postinoculation bacterial counts and considerably weaker tissue reactions than non-immunized animals. B. gingivalis co-inoculated with Actinobacillus actinomycetemcomitans caused significantly more severe infections than observed in monoinfected animals. The present results suggest that the immune system acting through systemic antibodies and/or cellular mechanisms may modulate the pathogenic potential of infecting periodontal pathogens.