1
|
Grant MM, Scott AE, Matthews JB, Griffiths HR, Chapple ILC. Pre-conditioning of gingival epithelial cells with sub-apoptotic concentrations of curcumin prevents pro-inflammatory cytokine release. J Periodontal Res 2023; 58:634-645. [PMID: 36919895 DOI: 10.1111/jre.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/19/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Plaque-induced gingival inflammation (gingivitis) is ubiquitous in humans. The epithelial barrier reacts to the presence of oral bacteria and induces inflammatory cascades. The objective of this study was to investigate the mechanism by which the small molecule micronutrient curcumin could decrease inflammatory response in vitro to oral bacterium heat-killed Fusobacterium nucleatum as curcumin could be a useful compound for combatting gingivitis already consumed by humans. METHODS H400 oral epithelial cell line was pre-conditioned with curcumin and the production of cytokines was measured by enzyme-linked immunosorbent assay (ELISA) and translocation of transcription factors was used to monitor inflammatory responses. Haem oxygenase (HO-1) expression and molecules that HO-1 releases were evaluated for their potential to reduce the quantity of cytokine production. Immunofluorescence microscopy and Western blotting were used to evaluate changes in transcription factor and enzyme location. RESULTS Pre-conditioning of H400 cells with a sub-apoptotic concentration of curcumin (20 μM) attenuated secretion of Granulocyte-Macrophage - Colony-Stimulating Factor (GM-CSF) and reduced NFkB nuclear translocation. This pre-conditioning caused an increase in nuclear Nrf2; an initial drop (at 8 h) followed by an adaptive increase (at 24 h) in glutathione; and an increase in haem oxygenase (HO-1) expression. Inhibition of HO-1 by SnPPIX prevented the curcumin-induced attenuation of GM-CSF production. HO-1 catalyses the breakdown of haem to carbon monoxide, free iron and biliverdin: the HO-1/CO anti-inflammatory pathway. Elevations in carbon monoxide, achieved using carbon monoxide releasing molecule-2 (CORM2) treatment alone abrogated F. nucleatum-induced cytokine production. Biliverdin is converted to bilirubin by biliverdin reductase (BVR). This pleiotropic protein was found to increase in cell membrane expression upon curcumin treatment. CONCLUSION Curcumin decreased inflammatory cytokine production induced by Fusobacterium nucleatum in H400 oral epithelial cells. The mechanism of action appears to be driven by the increase of haem oxygenase and the production of carbon monoxide.
Collapse
Affiliation(s)
- Melissa M Grant
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences and National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and Birmingham Dental Hospital, Birmingham, UK
| | | | - John B Matthews
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences and National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and Birmingham Dental Hospital, Birmingham, UK
| | | | - Iain L C Chapple
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences and National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and Birmingham Dental Hospital, Birmingham, UK
| |
Collapse
|
2
|
Klomp T, Jahr H, Abdelbary MMH, Conrads G. Evaluation of hydrocortisone as a strain-dependent growth-regulator of Porphyromonasgingivalis. Anaerobe 2023; 80:102698. [PMID: 36681234 DOI: 10.1016/j.anaerobe.2023.102698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Porphyromonas gingivalis is an oral key pathogen and known to be very diverse in geno- and phenotypes. It is a fastidious bacterium with low O2-tolerance and 3-7 days of incubation are necessary. With growing interest in the field of microbial endocrinology we explored the potential growth-stimulating effect of hydrocortisone (HC, synonym cortisol) on P. gingivalis cultures. MATERIAL AND METHODS Six different P. gingivalis strains were pre-incubated in supplemented Brain-Heart-Infusion broth under appropriate conditions for 24 h, diluted and transferred into microplates. A newly developed and semi-automated spectrophotometric measurement in triplicate, applying a SpectraMax i3x microplate reader at an optical density of 600 nm, was conducted to test growth differences between test group (exposed to a supplement of either 1.25, 2.5, 5, 10, or 20 μg/ml of hydrocortisone) and control group over 48 h of anaerobic incubation (O2 ≤ 1%). Furthermore, strains were also incubated on HC-supplemented blood agar to test for a possible growth-stimulating effect on solid media. RESULTS HC significantly stimulated the lag-phase growth of four out of six P. gingivalis strains. Our data suggest a concentration-dependent growth stimulatory effect of HC between 2.5 and 5 μg/ml, while below 1.25 μg/ml and above 10 μg/ml HC either did not stimulate or inhibited growth. CONCLUSIONS HC could reduce the incubation time when isolating P. gingivalis from clinical samples and could boost low biomass cultivations especially during their lag-phase. The growth-modulating effect might be via modulation of virulence factors/quorum sensing gene expression or by reactive oxygen species(ROS)-capturing during early stages of bacterial growth. Further experiments are necessary to explain the mechanism behind our observations.
Collapse
Affiliation(s)
- Tim Klomp
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany; Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany
| | - Holger Jahr
- Department of Anatomy and Cell Biology, Uniklinik RWTH Aachen and Institute of Structural Mechanics and Lightweight Design, RWTH Aachen University, Aachen, Germany
| | - Mohamed M H Abdelbary
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany
| | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany.
| |
Collapse
|
3
|
Moraes RM, Garcia MT, Stossi F, de Barros PP, Junqueira JC, Anbinder AL. Effects of α and β-adrenergic signaling on innate immunity and Porphyromonas gingivalis virulence in an invertebrate model. Virulence 2022; 13:1614-1630. [PMID: 36121102 PMCID: PMC9487758 DOI: 10.1080/21505594.2022.2123302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
To investigate the role of adrenergic signalling (AS) in the host immune response and Porphyromonas gingivalis virulence, we compared norepinephrine (NE) and isoproterenol (ISO) responses in Galleria mellonella. P. gingivalis infection was evaluated by survival; humoral immune responses (i.e. melanization and cecropin and gloverin mRNA expression); cellular immune responses (i.e. haemocyte count, nodulation by histology); and P. gingivalis recovery (CFU/mL). P. gingivalis was cultivated in the presence of ISO (PgISO) or NE and injected into the larvae for survival evaluation. Finally, we co-injected ISO and PgISO to evaluate the concomitant effects on the immune response and bacterial virulence. None of the ligands were toxic to the larvae; ISO increased haemocyte number, even after P. gingivalis infection, by mobilizing sessile haemocytes in a β-adrenergic-specific manner, while NE showed the opposite effect. ISO treatment reduced larval mortality and the number of recovered bacteria, while NE increased mortality and showed no effect on bacterial recovery. ISO and NE had similar effects on melanization and decreased the expression of cecropin. Although co-cultivation with NE and ISO increased the gene expression of bacterial virulence factors in vitro, only the injection of PgISO increased larval death, which was partially reversed by circulating ISO. Therefore, α- and β-adrenergic signalling had opposite effects after P. gingivalis infection. Ultimately, the catecholamine influence on the immune response overcame the effect of more virulent strains. The effect of AS directly on the pathogen found in vitro did not translate to the in vivo setting.
Collapse
Affiliation(s)
- Renata Mendonça Moraes
- Institute of Science and Technology, Biosciences and Diagnosis Department, São Paulo State University (Unesp), São José dos Campos, SP, Brazil
| | - Maíra Terra Garcia
- Institute of Science and Technology, Biosciences and Diagnosis Department, São Paulo State University (Unesp), São José dos Campos, SP, Brazil
| | - Fabio Stossi
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA.,GCC Center for Advanced Microscopy and Image Informatics, Houston, Texas, USA
| | - Patrícia Pimentel de Barros
- Institute of Science and Technology, Biosciences and Diagnosis Department, São Paulo State University (Unesp), São José dos Campos, SP, Brazil.,Multicampi School of Medical Sciences, Federal University of Rio Grande do Norte (UFRN), Caicó, RN, Brazil
| | - Juliana Campos Junqueira
- Institute of Science and Technology, Biosciences and Diagnosis Department, São Paulo State University (Unesp), São José dos Campos, SP, Brazil
| | - Ana Lia Anbinder
- Institute of Science and Technology, Biosciences and Diagnosis Department, São Paulo State University (Unesp), São José dos Campos, SP, Brazil
| |
Collapse
|
4
|
Zhu L, Zhou C, Chen S, Huang D, Jiang Y, Lan Y, Zou S, Li Y. Osteoporosis and Alveolar Bone Health in Periodontitis Niche: A Predisposing Factors-Centered Review. Cells 2022; 11:3380. [PMID: 36359775 PMCID: PMC9657655 DOI: 10.3390/cells11213380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/26/2023] Open
Abstract
Periodontitis is a periodontal inflammatory condition that results from disrupted periodontal host-microbe homeostasis, manifested by the destruction of tooth-supporting structures, especially inflammatory alveolar bone loss. Osteoporosis is characterized by systemic deterioration of bone mass and microarchitecture. The roles of many systemic factors have been identified in the pathogenesis of osteoporosis, including endocrine change, metabolic disorders, health-impaired behaviors and mental stress. The prevalence rate of osteoporotic fracture is in sustained elevation in the past decades. Recent studies suggest that individuals with concomitant osteoporosis are more vulnerable to periodontal impairment. Current reviews of worse periodontal status in the context of osteoporosis are limited, mainly centering on the impacts of menopausal and diabetic osteoporosis on periodontitis. Herein, this review article makes an effort to provide a comprehensive view of the relationship between osteoporosis and periodontitis, with a focus on clarifying how those risk factors in osteoporotic populations modify the alveolar bone homeostasis in the periodontitis niche.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Yuyu Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| |
Collapse
|
5
|
Abstract
Mental health disorders, particularly depression and anxiety, affect a significant number of the global population. Several pathophysiological pathways for these disorders have been identified, including the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and the immune system. In addition, life events, environmental factors, and lifestyle affect the onset, progression, and recurrence of mental health disorders. These may all overlap with periodontal and/or peri-implant disease. Mental health disorders are associated with more severe periodontal disease and, in some cases, poorer healing outcomes to nonsurgical periodontal therapy. They can result in behavior modification, such as poor oral hygiene practices, tobacco smoking, and alcohol abuse, which are also risk factors for periodontal disease and, therefore, may have a contributory effect. Stress has immunomodulatory effects regulating immune cell numbers and function, as well as proinflammatory cytokine production. Stress markers such as cortisol and catecholamines may modulate periodontal bacterial growth and the expression of virulence factors. Stress and some mental health disorders are accompanied by a low-grade chronic inflammation that may be involved in their relationship with periodontal disease and vice versa. Although the gut microbiome interacting with the central nervous system (gut-brain axis) is thought to play a significant role in mental illness, less is understood about the role of the oral microbiome. The evidence for mental health disorders on implant outcomes is lacking, but may mainly be through behaviourial changes. Through lack of compliance withoral hygiene and maintenance visits, peri-implant health can be affected. Increased smoking and risk of periodontal disease may also affect implant outcomes. Selective serotonin reuptake inhibitors have been linked with higher implant failure. They have an anabolic effect on bone, reducing turnover, which could account for the increased loss.
Collapse
Affiliation(s)
- Jake Ball
- Centre for Rural Dentistry and Oral HealthCharles Sturt UniversityOrangeNew South WalesAustralia
| | - Ivan Darby
- Periodontics, Melbourne Dental SchoolThe University of MelbourneMelbourneVictoriaAustralia
| |
Collapse
|
6
|
Cortês IT, Rosalen PL, Berto LA, Castro ML, Pedrini DL, Porto AN, Cogo-Müller K, Nobre Franco GC. Effect of adrenaline and noradrenaline on biofilm formation and virulence factors of Streptococcus mutans UA159. Arch Oral Biol 2021; 125:105091. [PMID: 33652302 DOI: 10.1016/j.archoralbio.2021.105091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate in vitro the effects of adrenaline and noradrenaline on the biofilm formation on orthodontic brackets, acid production and expression of virulence genes of Streptococcus mutans UA159 (S. mutans). DESIGN S. mutans UA159 biofilm was formed on orthodontic brackets under exposure to adrenaline (100 μM), noradrenaline (50 μM) or PBS solution (control group) in triptone-yeast extract with 1 % sucrose. After 24 h, biofilm formation was quantified through Colony Forming Units / mL (CFU/mL) and RNA was extracted to perform gene expression analysis through real-time reverse transcriptase-PCR (RT-qPCR). Evaluation of acid production was carried out on planktonic cultures for 6 h. One-way ANOVA followed by Tukey's test was carried to determine statistical difference. The level of significance was set at 5 %. RESULTS Catecholamines stimulated biofilm formation of S. mutans in orthodontic brackets (p < 0,05) but did not interfere with acid production (pH reduction) or the expression of the tested genes related to biofilm formation (gtfB, gtfC, gbpA, gbpB, gbpC, gbpD and brpA), aciduric (relA) and acidogenic properties (ldh). CONCLUSIONS The present study was the first to demonstrate that catecholamines can stimulate S. mutans UA159 biofilm formation. These findings can contribute to clarify the role of stress on bacterial metabolism and contribute to the understanding of a possible role on caries development, mainly in orthodontic patients.
Collapse
Affiliation(s)
- Iago Torres Cortês
- State University of Campinas, School of Dentistry of Piracicaba, Piracicaba, SP, Brazil.
| | - Pedro Luiz Rosalen
- State University of Campinas, School of Dentistry of Piracicaba, Piracicaba, SP, Brazil; Graduate Program in Biological Sciences, Federal University of Alfenas, Alfenas, MG, Brazil.
| | - Luciana Aranha Berto
- State University of Campinas, School of Dentistry of Piracicaba, Piracicaba, SP, Brazil.
| | | | | | | | - Karina Cogo-Müller
- State University of Campinas, School of Dentistry of Piracicaba, Piracicaba, SP, Brazil; State University of Campinas, Faculty of Pharmaceutical Sciences, Campinas, SP, Brazil.
| | | |
Collapse
|
7
|
Abstract
Periodontal diseases are chronic inflammatory, multifactorial diseases where the major triggering factors for disease onset are bacteria and their toxins, but the major part of tissue destruction occurs as a result of host response towards the periodontal microbiome. Periodontal microbiome consists of a wide range of microorganisms including obligate and facultative anaerobes. In health, there is a dynamic balance between the host, environment, and the microbiome. Environmental factors, mainly tobacco smoking and psychological stress, disrupt the symbiotic relationship. Tobacco smoke and its components alter the bacterial surface and functions such as growth. Psychological stressors and stress hormones may affect the outcome of an infection by changing the virulence factors and/or host response. This review aims to provide currently available data on the effects of the major environmental factors on the periodontal microbiome.
Collapse
Affiliation(s)
- Nurcan Buduneli
- Department of Periodontology, Faculty of Dentistry, Ege University, İzmir, Turkey
| |
Collapse
|
8
|
Dubar M, Clerc-Urmès I, Baumann C, Clément C, Alauzet C, Bisson C. Relations of Psychosocial Factors and Cortisol with Periodontal and Bacterial Parameters: A Prospective Clinical Study in 30 Patients with Periodontitis Before and After Non-Surgical Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207651. [PMID: 33092182 PMCID: PMC7588876 DOI: 10.3390/ijerph17207651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/18/2022]
Abstract
(1) Background: The progression of periodontitis, induced by polymicrobial dysbiosis, can be modified by systemic or environmental factors such as stress or anxiety affecting host response. The purpose of this study is to evaluate the potential associations between psychosocial factors scores or salivary cortisol levels with clinical periodontal parameters and bacterial environment in patients with periodontitis; (2) Methods: Subgingival microbiota was collected in two pathological and one healthy sites from thirty diseased patients (before/after scaling and root planing (SRP)) and from one healthy site from thirty control patients. Usual clinical periodontal parameters were recorded, and a saliva sample was harvested. Patients completed stress and anxiety self-assessment questionnaires. Cortisol concentrations were determined by ELISA and bacteria were identified by PCR; (3) Results: No correlation between salivary cortisol and the stress-anxiety self-declared was found (p > 0.05), but high concentrations of this molecule were associated positively and linearly with periodontal pocket depth (p = 0.04). It appeared that certain psychosocial stressors are associated with a modulation of the bacterial colonization of pockets of diseased group (before/after SRP), notably concerning Tannerella forsythia (p = 0.02), Porphyromonas gingivalis (p = 0.03), Fusobacterium nucleatum (p = 0.049) and Campylobacter rectus (p = 0.01). (4) Conclusion: This study reveals associations between bacteria colonization and psychosocial parameters in periodontitis that needs to be further investigated.
Collapse
Affiliation(s)
- Marie Dubar
- Department of Periodontology, School of Dentistry, Lille University Hospital, 59000 Lille, France
- Stress Immunity Pathogens Unit (SIMPA), EA 7300, University of Lorraine, F-54000 Nancy, France; (C.A.); (C.B.)
- Correspondence:
| | - Isabelle Clerc-Urmès
- Department of Methodology, Promotion and Investigation, UMDS, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (I.C.-U.); (C.B.)
| | - Cédric Baumann
- Department of Methodology, Promotion and Investigation, UMDS, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (I.C.-U.); (C.B.)
| | - Céline Clément
- CHRU Nancy, Department of Public Health Dentistry, University Hospital, 54000 Nancy, France;
- “Interpsy” Laboratory, University of Lorraine, EA 4432, CEDEX 54015 Nancy, France
- «Health Systemic Process» Laboratory, University Lyon 1, EA 4129, 69008 Lyon, France
| | - Corentine Alauzet
- Stress Immunity Pathogens Unit (SIMPA), EA 7300, University of Lorraine, F-54000 Nancy, France; (C.A.); (C.B.)
- CHRU Nancy, Microbiology Department, University Hospital, F-54000 Nancy, France
| | - Catherine Bisson
- Stress Immunity Pathogens Unit (SIMPA), EA 7300, University of Lorraine, F-54000 Nancy, France; (C.A.); (C.B.)
- Department of Periodontology, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-lès-Nancy, France
| |
Collapse
|
9
|
Inbaraj S, Sejian V, Ramasamy S. Role of environmental stressor-host immune system–pathogen interactions in development of infectious disease in farm animals. BIOL RHYTHM RES 2019. [DOI: 10.1080/09291016.2019.1695084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Sophia Inbaraj
- Division of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute, Bareilly, India
| | - Veerasamy Sejian
- Animal Physiology Division, ICAR-National Institute Animal Nutrition and Physiology, Bengaluru, India
| | - Santhamani Ramasamy
- Department of microbiology and immunology, Post-doctoral research fellow, Albert Einstein College of Medicine, New York, NY, USA
| |
Collapse
|
10
|
Identification of Bacteria Associated with a Periodontal Disease in Thai Patients Based on Next-Generation Sequencing. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.13646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
|
11
|
Stress hormone epinephrine (adrenaline) and norepinephrine (noradrenaline) effects on the anaerobic bacteria. Anaerobe 2017; 44:13-19. [DOI: 10.1016/j.anaerobe.2017.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/26/2022]
|
12
|
Sampaio-Maia B, Caldas IM, Pereira ML, Pérez-Mongiovi D, Araujo R. The Oral Microbiome in Health and Its Implication in Oral and Systemic Diseases. ADVANCES IN APPLIED MICROBIOLOGY 2016; 97:171-210. [PMID: 27926431 DOI: 10.1016/bs.aambs.2016.08.002] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The oral microbiome can alter the balance between health and disease, locally and systemically. Within the oral cavity, bacteria, archaea, fungi, protozoa, and viruses may all be found, each having a particular role, but strongly interacting with each other and with the host, in sickness or in health. A description on how colonization occurs and how the oral microbiome dynamically evolves throughout the host's life is given. In this chapter the authors also address oral and nonoral conditions in which oral microorganisms may play a role in the etiology and progression, presenting the up-to-date knowledge on oral dysbiosis as well as the known underlying pathophysiologic mechanisms involving oral microorganisms in each condition. In oral pathology, oral microorganisms are associated with several diseases, namely dental caries, periodontal diseases, endodontic infections, and also oral cancer. In systemic diseases, nonoral infections, adverse pregnancy outcomes, cardiovascular diseases, and diabetes are among the most prevalent pathologies linked with oral cavity microorganisms. The knowledge on how colonization occurs, how oral microbiome coevolves with the host, and how oral microorganisms interact with each other may be a key factor to understand diseases etiology and progression.
Collapse
Affiliation(s)
| | - I M Caldas
- Universidade do Porto, Portugal; Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal; Universidade de Coimbra, Portugal
| | | | - D Pérez-Mongiovi
- Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, Gandra, Portugal
| | - R Araujo
- Universidade do Porto, Portugal; Flinders University, Adelaide, SA, Australia
| |
Collapse
|
13
|
Sandrini S, Aldriwesh M, Alruways M, Freestone P. Microbial endocrinology: host-bacteria communication within the gut microbiome. J Endocrinol 2015; 225:R21-34. [PMID: 25792117 DOI: 10.1530/joe-14-0615] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/28/2022]
Abstract
The human body is home to trillions of micro-organisms, which are increasingly being shown to have significant effects on a variety of disease states. Evidence exists that a bidirectional communication is taking place between us and our microbiome co-habitants, and that this dialogue is capable of influencing our health in a variety of ways. This review considers how host hormonal signals shape the microbiome, and what in return the microbiome residents may be signalling to their hosts.
Collapse
Affiliation(s)
- Sara Sandrini
- Department of Infection Immunity and Inflammation, University of Leicester, Maurice Shock Medical Sciences Building, University Road, Leicester LE1 9HN, UK
| | - Marwh Aldriwesh
- Department of Infection Immunity and Inflammation, University of Leicester, Maurice Shock Medical Sciences Building, University Road, Leicester LE1 9HN, UK
| | - Mashael Alruways
- Department of Infection Immunity and Inflammation, University of Leicester, Maurice Shock Medical Sciences Building, University Road, Leicester LE1 9HN, UK
| | - Primrose Freestone
- Department of Infection Immunity and Inflammation, University of Leicester, Maurice Shock Medical Sciences Building, University Road, Leicester LE1 9HN, UK
| |
Collapse
|
14
|
Nobbs AH, Jenkinson HF. Interkingdom networking within the oral microbiome. Microbes Infect 2015; 17:484-92. [PMID: 25805401 DOI: 10.1016/j.micinf.2015.03.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/10/2015] [Accepted: 03/13/2015] [Indexed: 02/07/2023]
Abstract
Different sites within the oropharynx harbour unique microbial communities. Co-evolution of microbes and host has resulted in complex interkingdom circuitries. Metabolic signalling is crucial to these processes, and novel microbial communication factors are progressively being discovered. Resolving interkingdom networks will lead to better understanding of oral health or disease aetiology.
Collapse
Affiliation(s)
- Angela H Nobbs
- School of Oral and Dental Sciences, University of Bristol, Bristol BS1 2LY, United Kingdom
| | - Howard F Jenkinson
- School of Oral and Dental Sciences, University of Bristol, Bristol BS1 2LY, United Kingdom.
| |
Collapse
|
15
|
Calil CM, Oliveira GM, Cogo K, Pereira AC, Marcondes FK, Groppo FC. Effects of stress hormones on the production of volatile sulfur compounds by periodontopathogenic bacteria. Braz Oral Res 2014; 28:S1806-83242014000100228. [DOI: 10.1590/1807-3107bor-2014.vol28.0008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 02/06/2014] [Indexed: 05/28/2023] Open
|
16
|
Akcalı A, Huck O, Buduneli N, Davideau JL, Köse T, Tenenbaum H. Exposure of Porphyromonas gingivalis to cortisol increases bacterial growth. Arch Oral Biol 2014; 59:30-4. [DOI: 10.1016/j.archoralbio.2013.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 09/08/2013] [Accepted: 09/12/2013] [Indexed: 01/29/2023]
|
17
|
Graziano TS, Closs P, Poppi T, Franco GC, Cortelli JR, Groppo FC, Cogo K. Catecholamines promote the expression of virulence and oxidative stress genes in Porphyromonas gingivalis. J Periodontal Res 2013; 49:660-9. [DOI: 10.1111/jre.12148] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2013] [Indexed: 01/04/2023]
Affiliation(s)
- T. S. Graziano
- Department of Physiological Sciences; Area of Pharmacology, Anesthesiology and Therapeutics; Piracicaba Dental School; University of Campinas; Piracicaba SP Brazil
| | - P. Closs
- Department of Periodontology; Dentistry School University of Taubaté; Taubaté SP Brazil
| | - T. Poppi
- Department of Periodontology; Dentistry School University of Taubaté; Taubaté SP Brazil
| | - G. C. Franco
- Laboratory of Physiology and Pathophysiology; Department of General Biology; State University of Ponta Grossa; Ponta Grossa PR Brazil
| | - J. R. Cortelli
- Department of Periodontology; Dentistry School University of Taubaté; Taubaté SP Brazil
| | - F. C. Groppo
- Department of Physiological Sciences; Area of Pharmacology, Anesthesiology and Therapeutics; Piracicaba Dental School; University of Campinas; Piracicaba SP Brazil
| | - K. Cogo
- Department of Dentistry; Implantology Area; University of Santo Amaro; São Paulo SP Brazil
| |
Collapse
|
18
|
The effects of stress hormones on growth of selected periodontitis related bacteria. Anaerobe 2013; 24:49-54. [PMID: 24036419 DOI: 10.1016/j.anaerobe.2013.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/20/2013] [Accepted: 09/02/2013] [Indexed: 11/22/2022]
Abstract
The focus of this study was to examine in vitro the effects of stress hormones (catecholamines: epinephrine, norepinephrine, dopamine and hydrocortisone: cortisol) on the growth of four anaerobic species of periodontitis-related bacteria (Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia and Tannerella forsythia) and one facultative anaerobic species (Eikenella corrodens). Bacterial growth was determined by two different methods: fluorescence in situ hybridization (FISH), and the viable count by culture method. To simulate stress, each single strain was grown in a special growth medium with three different concentrations of each hormone, using an anaerobic chamber at 37 °C. Growth of F. nucleatum increased in the presence of all stress hormones. Growth of P. gingivalis was not significantly influenced by any hormone. Growth of P. intermedia and E. corrodens was inhibited by almost all stress hormones tested. Both methods of analysis revealed that the highest concentrations of norepinephrine and cortisol increased the growth of T. forsythia. Different hormones have a different effect on the growth of periodontitis-related bacteria in vitro. It appears that bacterial viability is more strongly influenced than is bacterial metabolic activity. The growth of F. nucleatum particularly and partially of T. forsythia is increased by several stress hormones and may have an additional negative impact on periodontal disease.
Collapse
|
19
|
Freestone P. Communication between Bacteria and Their Hosts. SCIENTIFICA 2013; 2013:361073. [PMID: 24381789 PMCID: PMC3871906 DOI: 10.1155/2013/361073] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/11/2013] [Indexed: 05/17/2023]
Abstract
It is clear that a dialogue is occurring between microbes and their hosts and that chemical signals are the language of this interkingdom communication. Microbial endocrinology shows that, through their long coexistence with animals and plants, microorganisms have evolved sensors for detecting eukaryotic hormones, which the microbe uses to determine that they are within proximity of a suitable host and to optimally time the expression of genes needed for host colonisation. It has also been shown that some prokaryotic chemical communication signals are recognized by eukaryotes. Deciphering what is being said during the cross-talk between microbe and host is therefore important, as it could lead to new strategies for preventing or treating bacterial infections.
Collapse
Affiliation(s)
- Primrose Freestone
- Department of Infection, Immunity and Inflammation, University of Leicester, Maurice Shock Medical Sciences Building, University Road, Leicester LE1 9HN, UK
- *Primrose Freestone:
| |
Collapse
|
20
|
Abstract
To help investigate the relationship between inflammatory and other diseases and the composition of the gut microbiota, we propose that a positive-feedback loop exists between the preferences of the host for a particular dietary regimen, the composition of the gut microbiota that depends on this regimen, and the preferences of the host as influenced by the gut microbiota. We cite evidence in support of this hypothesis and make testable predictions.
Collapse
|
21
|
Abstract
The feed efficiency of ruminant meat and dairy livestock can be significantly influenced by factors within their living environments. In particular, events perceived by the animals as stressful (such as parturition, transport or handling) have been found to affect susceptibility to infection. It has been well documented that even minor stress such as weighing can result in an increase in colonisation and faecal shedding of enteric pathogens such as Salmonella enterica and Escherichia coli O157:H7. Such infections affect both ruminant overall health and therefore performance, and are a particular problem for the meat production industries. Prior explanations for stress enhancing the likelihood of infection is that activation of the sympathetic nervous system under stress leads to the release of neuroendocrine mediators such as the catecholamine stress hormones noradrenaline and adrenaline, which may impair innate and adaptive immunity. More recently, however, another equally compelling explanation, viewed through the lens of the newly recognised microbiological discipline of microbial endocrinology is that the myriad of bacteria within the ruminant digestive tract are as responsive to the hormonal output of stress as the cells of their host. Work from our laboratories has shown that enteric pathogens have evolved systems for directly sensing stress hormones. We have demonstrated that even brief exposure of enteric pathogens to physiological concentrations of stress hormones can result in massive increases in growth and marked changes in expression of virulence factors such as adhesins and toxins. Happy, less stressed ruminants may therefore be better-nourished animals and safer sources of meat. This article reviews evidence that stress, as well as affecting nutrition, in ruminants is correlated with increased risk of enteric bacterial infections, and examines the molecular mechanisms that may be at work in both processes.
Collapse
|
22
|
Akcali A, Huck O, Tenenbaum H, Davideau JL, Buduneli N. Periodontal diseases and stress: a brief review. J Oral Rehabil 2012; 40:60-8. [DOI: 10.1111/j.1365-2842.2012.02341.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2012] [Indexed: 12/19/2022]
Affiliation(s)
- A. Akcali
- Department of Periodontology; School of Dentistry; Ege University; Izmir; Turkey
| | - O. Huck
- Department of Periodontology; Dental Faculty; University of Strasbourg; Strasbourg; France
| | - H. Tenenbaum
- Department of Periodontology; Dental Faculty; University of Strasbourg; Strasbourg; France
| | - J. L. Davideau
- Department of Periodontology; Dental Faculty; University of Strasbourg; Strasbourg; France
| | - N. Buduneli
- Department of Periodontology; School of Dentistry; Ege University; Izmir; Turkey
| |
Collapse
|
23
|
Global effects of catecholamines on Actinobacillus pleuropneumoniae gene expression. PLoS One 2012; 7:e31121. [PMID: 22347439 PMCID: PMC3275570 DOI: 10.1371/journal.pone.0031121] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 01/03/2012] [Indexed: 11/26/2022] Open
Abstract
Bacteria can use mammalian hormones to modulate pathogenic processes that play essential roles in disease development. Actinobacillus pleuropneumoniae is an important porcine respiratory pathogen causing great economic losses in the pig industry globally. Stress is known to contribute to the outcome of A. pleuropneumoniae infection. To test whether A. pleuropneumoniae could respond to stress hormone catecholamines, gene expression profiles after epinephrine (Epi) and norepinephrine (NE) treatment were compared with those from untreated bacteria. The microarray results showed that 158 and 105 genes were differentially expressed in the presence of Epi and NE, respectively. These genes were assigned to various functional categories including many virulence factors. Only 18 genes were regulated by both hormones. These genes included apxIA (the ApxI toxin structural gene), pgaB (involved in biofilm formation), APL_0443 (an autotransporter adhesin) and genes encoding potential hormone receptors such as tyrP2, the ygiY-ygiX (qseC-qseB) operon and narQ-narP (involved in nitrate metabolism). Further investigations demonstrated that cytotoxic activity was enhanced by Epi but repressed by NE in accordance with apxIA gene expression changes. Biofilm formation was not affected by either of the two hormones despite pgaB expression being affected. Adhesion to host cells was induced by NE but not by Epi, suggesting that the hormones affect other putative adhesins in addition to APL_0443. This study revealed that A. pleuropneumoniae gene expression, including those encoding virulence factors, was altered in response to both catecholamines. The differential regulation of A. pleuropneumoniae gene expression by the two hormones suggests that this pathogen may have multiple responsive systems for the two catecholamines.
Collapse
|
24
|
Abstract
AbstractMicrobial Endocrinology is a new microbiology research discipline that represents the intersection of microbiology and endocrinology with neurophysiology. It has as its main tenet that through their long co-existence with animals and plants, micro-organisms have evolved sensory systems for detecting host-associated hormones. These sensing systems allow the microbe to determine that they are within proximity of a suitable host, and that is time to initiate expression of genes involved in host colonisation. Microbial Endocrinology therefore provides a new paradigm with which to examine and understand the interactions of micro-organisms with their host under conditions present in both health and disease. This article will focus on microbial interactions with the fight and flight family of catecholamine stress hormones.
Collapse
|
25
|
Saito T, Inagaki S, Sakurai K, Okuda K, Ishihara K. Exposure of P. gingivalis to noradrenaline reduces bacterial growth and elevates ArgX protease activity. Arch Oral Biol 2011; 56:244-50. [DOI: 10.1016/j.archoralbio.2010.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 09/16/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
|
26
|
Grant MM, Kolamunne RT, Lock FE, Matthews JB, Chapple ILC, Griffiths HR. Oxygen tension modulates the cytokine response of oral epithelium to periodontal bacteria. J Clin Periodontol 2010; 37:1039-48. [PMID: 20955352 DOI: 10.1111/j.1600-051x.2010.01622.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is an inverse relationship between pocket depth and pocket oxygen tension with deep pockets being associated with anaerobic bacteria. However, little is known about how the host tissues respond to bacteria under differing oxygen tensions within the periodontal pocket. AIM To investigate the effect of different oxygen tensions upon nuclear factor-kappa B (NF-κB) activation and the inflammatory cytokine response of oral epithelial cells when exposed to nine species of oral bacteria. MATERIALS AND METHODS H400 oral epithelial cells were equilibrated at 2%, 10% or 21% oxygen. Cells were stimulated with heat-killed oral bacteria at multiplicity of infection 10:1, Escherichia coli lipopolysaccharide (15 μg/ml) or vehicle control. Interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF-α) levels were measured by enzyme-linked immunosorbent assay and NF-κB activation was measured by reporter vector or by immunohistochemical analysis. RESULTS Tannerella forsythensis, Porphyromonas gingivalis and Prevotella intermedia elicited the greatest epithelial NF-κB activation and cytokine responses. An oxygen-tension-dependent trend in cytokine production was observed with the highest IL-8 and TNF-α production observed at 2% oxygen and lowest at 21% oxygen. CONCLUSIONS These data demonstrate a greater pro-inflammatory host response and cell signalling response to bacteria present in more anaerobic conditions, and hypersensitivity of epithelial cells to pro-inflammatory stimuli at 2% oxygen, which may have implications for disease pathogenesis and/or therapy.
Collapse
Affiliation(s)
- Melissa M Grant
- Periodontal Research Group, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | | | | | | | | | | |
Collapse
|
27
|
Screening for subgingival occurrence of gram-negative enteric rods in periodontally diseased and healthy subjects. Arch Oral Biol 2010; 55:728-36. [DOI: 10.1016/j.archoralbio.2010.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 06/12/2010] [Accepted: 07/27/2010] [Indexed: 11/23/2022]
|
28
|
Freestone PPE, Lyte M. Microbial endocrinology: experimental design issues in the study of interkingdom signalling in infectious disease. ADVANCES IN APPLIED MICROBIOLOGY 2008; 64:75-105. [PMID: 18485281 DOI: 10.1016/s0065-2164(08)00402-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Primrose P E Freestone
- Department of Infection, Immunity and Inflammation, University of Leicester School of Medicine, Leicester, United Kingdom
| | | |
Collapse
|
29
|
Unsal H, Balkaya M, Unsal C, Biyik H, Başbülbül G, Poyrazoğlu E. The short-term effects of different doses of dexamethasone on the numbers of some bacteria in the ileum. Dig Dis Sci 2008; 53:1842-5. [PMID: 18049898 DOI: 10.1007/s10620-007-0089-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 10/27/2007] [Indexed: 12/09/2022]
Abstract
Glucocorticoids are known to affect intestinal biota both directly or indirectly. The aim of the study reported here was to determine the short-term effects of different doses of dexamethasone on the numbers of various ileal bacteria populations. Rats were randomly put into groups, and each group was administered a single-dose injection of dexamethasone at either 0.1, 0.5, 1, 2.5, 5, or 10 mg/kg body weight. At 48-h post-injection, the numbers of total aerobe, anaerobe, lactobacilli and coliform bacteria in the ileum were determined. The numbers of total aerobes and lactobacilli were higher in the groups receiving 5 and 10 mg/kg dexamethasone than in the control and other dose groups (P < 0.01 and P < 0.001, respectively). The number of ileal anaerobic bacteria was higher in group receiving 5 mg/kg than in the other groups (P < 0.01). There were more coliform bacteria in the group receiving 0.1 mg/kg than in the groups receiving 0.5, 1 and 10 mg/kg (P < 0.05). In light of these results, the effects of dose-dependent increases in the number of different bacterial groups affecting gut functions have still to be determined in future studies.
Collapse
Affiliation(s)
- Hümeyra Unsal
- Department of Physiology, Faculty of Veterinary Medicine, Adnan Menderes University, Isikli, Aydin 09016, Turkey.
| | | | | | | | | | | |
Collapse
|
30
|
Freestone PPE, Sandrini SM, Haigh RD, Lyte M. Microbial endocrinology: how stress influences susceptibility to infection. Trends Microbiol 2008; 16:55-64. [PMID: 18191570 DOI: 10.1016/j.tim.2007.11.005] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 11/29/2007] [Accepted: 11/29/2007] [Indexed: 11/24/2022]
Abstract
A holistic approach to understanding the mechanisms by which stress influences the pathogenesis of infectious disease has resulted in the development of the field of microbial endocrinology. This transdisciplinary field represents the intersection of microbiology with mammalian endocrinology and neurophysiology, and is based on the tenet that microorganisms have evolved systems for using neurohormones, which are widely distributed throughout nature, as environmental cues to initiate growth and pathogenic processes. This review reveals that responsiveness to human stress hormones is widespread in the microbial world and documents recent advances in microbial endocrinology.
Collapse
Affiliation(s)
- Primrose P E Freestone
- Department of Infection, Immunity and Inflammation, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | | | | | | |
Collapse
|
31
|
|
32
|
Nakajima K, Hamada N, Takahashi Y, Sasaguri K, Tsukinoki K, Umemoto T, Sato S. Restraint stress enhances alveolar bone loss in an experimental rat model. J Periodontal Res 2007; 41:527-34. [PMID: 17076777 DOI: 10.1111/j.1600-0765.2006.00901.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The purpose of the present study was to examine the effects of restraint stress on periodontal breakdown resulting from Porphyromonas gingivalis-challenged periodontitis in rats. MATERIAL AND METHODS To examine the influence of restraint stress on periodontal breakdown, rats were orally challenged with the periodontal pathogen P. gingivalis. Twenty male, specific pathogen-free (SPF) 3-wk-old, Sprague-Dawley rats were divided into four groups: group A (controls), group B (exposed to restraint stress for 12 h/d for 22 d), group C (orally challenged with P. gingivalis), and group D (exposed to restraint stress for 12 h/d for 22 d and orally challenged with P. gingivalis). After 22 d, all animals were killed. The distance from the alveolar bone crest to the cemento-enamel junction was determined, concentrations of adrenocorticotropic hormone were measured as stress markers, and atrophy of the thymus and spleen were assessed. In addition, the furcation area of the maxillary molars was examined histologically, while gingival cytokine gene expression was assessed by mRNA using reverse transcription-polymerase chain reaction (RT-PCR). RESULTS In the restrained group, all stress markers were elevated, and the thymus and spleen were atrophied. Combined restraint stress and oral challenge with P. gingivalis resulted in significantly higher bone loss, and osteoclasts were observed. RT-PCR analysis revealed low cytokine gene expression in the restrained groups. CONCLUSION These results suggest that the presence of restraint stress significantly enhances the progression of P. gingivalis-challenged periodontitis in rats.
Collapse
Affiliation(s)
- K Nakajima
- Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics, Kanagawa Dental College, Yokosuka, Japan
| | | | | | | | | | | | | |
Collapse
|