In vitro evaluation of the effect of nicotine, cotinine, and caffeine on oral microorganisms

Reduction of nicotine content in tobacco through microbial degradation: research progress and potential applications

Originally native to South America, tobacco and is now distributed worldwide as a major cash crop. Nicotine is the main harmful component of tobacco leaves, cigarette smoke and tobacco waste, which severely affects not only the flavor of the tobacco leaf, but also causes great damage to human health. As the anti-smoking movement continued to grow since the 1950s, and consumers become more aware of their health and environmental protection, the world tobacco industry has been committed to research, develop and produce low nicotine cigarette products with relatively low risk to human health. Among various approaches, the use of microorganisms to reduce nicotine content and improve tobacco quality has become one of the most promising methods. Due to increasing interest in nicotine-degrading microorganisms (NDMs), this article reviews recent reports on NDMs, nicotine-degrading enzymes, regulation of nicotine-degrading bacterial consortia and optimization of fermentation conditions, aiming to provide updated references for the in-depth research and application of microorganisms for the degradation of nicotine.

Tobacco-enhanced biofilm formation by Porphyromonas gingivalis and other oral microbes

Microbial biofilms promote pathogenesis by disguising antigens, facilitating immune evasion, providing protection against antibiotics and other antimicrobials and, generally, fostering survival and persistence. Environmental fluxes are known to influence biofilm formation and composition, with recent data suggesting that tobacco and tobacco-derived stimuli are particularly important mediators of biofilm initiation and development in vitro and determinants of polymicrobial communities in vivo. The evidence for tobacco-augmented biofilm formation by oral bacteria, tobacco-induced oral dysbiosis, tobacco-resistance strategies, and bacterial physiology is summarized herein. A general overview is provided alongside specific insights gained through studies of the model and archetypal, anaerobic, Gram-negative oral pathobiont, Porphyromonas gingivalis.

Nicotine promotes pathogenic bacterial growth and biofilm formation in peri-implant

Introduction. Peri-implantitis is a plaque-associated disease that leads to implant loss and arises from bacterial biofilms on the surface of the implant. Smoking is a risk factor for peri-implantitis and impedes treatment effectiveness. Additionally, aryl hydrocarbon receptor (AHR), IL-6, and IL-22 levels are related to peri-implantitis.Aim. We aimed to investigate the effects of nicotine on inflammatory response, bacterial growth and biofilm formation.Hypothesis/Gap Statement. We hypothesized that nicotine promoted pathogenic bacterial growth and biofilm formation, thereby aggravating inflammation.Methodology. The expression of AHR, IL-6 and IL-22 was measured in peri-implant sulci fluid using quantitative PCR and Western blot analyses. The cementum was incubated with bacterial suspension including Porphyromonas gingivalis, Streptococcus sanguinis and Fusobacterium nucleatum and treated with 100, 200, 250 and 300 µg ml-1 nicotine, and then, the absorbance and number of colony-forming units were detected. Biofilm formation was evaluated using the tissue culture plate method and safranin O staining. Carbohydrates and proteins were measured by the phenol-sulfuric acid method and the bicinchoninic acid method, respectively.Results. The results indicated that smoking increased the levels of AHR, IL-6 and IL-22. Functionally, nicotine promoted the growth of P. gingivalis, S. sanguinis and F. nucleatum. Additionally, it promoted the biofilm formation of these bacteria and increased the contents of carbohydrates and proteins.Conclusion. Nicotine promoted bacterial growth and biofilm build-up, suggesting that smoking may aggravate the progression of peri-implantitis.

Mechanical and antibacterial properties of an experimental flowable composite containing Nb2O5 and NF_TiO2 nanoparticles

This study developed an experimental flowable composite incorporated with niobium pentoxide (Nb2O5) combined or not with titanium dioxide co-doped with fluorine and nitrogen (NF_TiO2) and evaluated the mechanical and antibacterial properties. The experimental flowable composite (TEGDMA + BisGMA 1:1 + 60%wt - inorganic filler - borosilicate 0.7 μm) was formulated according to the type and concentration of Nb2O5 and NF_TiO2 (0.5, 1, 1.5 and 2 wt%) or NF_TiO2 + Nb2O5 (0.25, 0.5, 0.75 and 1 wt% - 1:1). The control groups were formed by the experimental composite without the incorporation of Nb2O5 and/or NF_TiO2 (GC-E) and by a commercial flowable composite (GC). The characterization of the surface of the composite and its particles was carried out using scanning electron microscopy (SEM) and energy dispersive x-rays (EDX). Specimens were manufactured and subjected to mechanical tests of flexural strength (FS) (n = 12), flexural modulus (FM) (n = 12), roughness (Ra) (n = 10), microhardness (n = 10), and contact angle (n = 10); and, to evaluate the antibacterial activity, they were submitted to tests of biofilm formation against S. mutans (CFU/mL) (n = 5), biofilm biomass by dry weight (n = 5) and confocal laser microscopy (%LIVE/DEAD) (n = 5). Data were submitted to one-way ANOVA and Tukey's post-hoc and, those that were not homoscedastic, but with normality, were submitted to Welch's ANOVA and Games-Howell's post-hoc. Dunnet's test was used to compare the controls with the other experimental groups (α = 5). The Nb2O5 particles had an average size of 32.4 μm and the nanoparticles (NPs) of NF_TiO2, 10 nm. EDX analysis identified isolated peaks of N, F, Ti, and Nb confirming the presence of these particles in the resin matrix. The 1.5% NF_TiO2 group had a higher FS and FM than the controls (p < 0.05). GC showed higher microhardness between groups (p < 0.05). There was no difference between the experimental groups regarding contact angle and roughness (p > 0.05), except for GC, which had the highest Ra values and the lowest contact angle between groups (p < 0.05). Composites containing 0.5%, 1%, 1.5%, and 2% Nb2O5, 1%, 1.5%, and 2% NF_TiO2 and 2% Nb2O5 + NF_TiO2 showed lower biofilm formation (p < 0.05), lower total biofilm biomass (p < 0.05), and a higher percentage of dead cells (44%, 52%, 52%, 79%, 42% 43%, 62%, 65%, respectively) than GC and GC-E (5% and 1%, respectively). It is concluded that the incorporation of 1.5% NF_TiO2 promoted a greater FS and FM among the experimental composites and that the addition of Nb2O5 particles (0.5%, 1%, 1.5%, and 2%), NF_TiO2 (1%, 1.5% and 2%) and the combination Nb2O5 + NF_TiO2 (2%) showed significant antibacterial effects.

Non-antimicrobial pharmaceuticals can affect the development of antibiotic resistance in hospital wastewater

Within this study, we were interested in the effects of wastewater on the development of antimicrobial resistance. Microorganisms can relatively promptly adapt to evolutionary pressures of the environment, including antibiotics. Therefore, we tested how the adaptability of the model microorganism Salmonella enterica is affected by wastewater full of pharmaceuticals, illicit drugs, and other micropollutants. Wastewater samples had been taken from effluent of hospitals and from wastewater treatment plant (WWTP) Petržalka influent and effluent. In these samples, presence of 38 substances was monitored. The highest concentration was observed in case of tramadol, citalopram, venlafaxine, cotinine, atenolol, valsartan, carbamazepine, azithromycin, and ciprofloxacin. According to this data, we focused also on individual pharmaceutical compounds presented in wastewater samples in elevated concentrations. Effect on resistance development of two pain relief medications (carbamazepine, tramadol), hypotensive medications (atenolol, valsartan), and the nicotine metabolite (cotinine) was also investigated. For this study, we employed concentrations presented in wastewater as well as in urine of patients and/or users. To determine the frequency of mutations leading to ciprofloxacin resistance, we applied the modified Ames test employing the strain Salmonella Typhimurium. Resistance index increased in the case of all wastewater samples from conventional hospitals where we observed a 1.22-1.69-fold increase of mutations leading to ciprofloxacin resistance. Tested compounds caused rise of resistance index in lower concentrations found in wastewater. The most significant increase of resistance index was detected after carbamazepine treatment.

The Impact of Smoking on Subgingival Microflora: From Periodontal Health to Disease

Periodontal disease is one of the most common diseases of the oral cavity affecting up to 90% of the worldwide population. Smoking has been identified as a major risk factor in the development and progression of periodontal disease. It is essential to assess the influence of smoking on subgingival microflora that is the principal etiological factor of the disease to clarify the contribution of smoking to periodontal disease. Therefore, this article reviews the current research findings regarding the impact of smoking on subgingival microflora and discusses several potential mechanisms. Cultivation-based and targeted molecular approaches yield controversial results in determining the presence or absence of smoking-induced differences in the prevalence or levels of certain periodontal pathogens, such as the “red complex.” However, substantial changes in the subgingival microflora of smokers, regardless of their periodontal condition (clinical health, gingivitis, or periodontitis), have been demonstrated in recent microbiome studies. Available literature suggests that smoking facilitates early acquisition and colonization of periodontal pathogens, resulting in an “at-risk-for-harm” subgingival microbial community in the healthy periodontium. In periodontal diseases, the subgingival microflora in smokers is characterized by a pathogen-enriched community with lower resilience compared to that in non-smokers, which increases the difficulty of treatment. Biological changes in key pathogens, such as Porphyromonas gingivalis, together with the ineffective host immune response for clearance, might contribute to alterations in the subgingival microflora in smokers. Nonetheless, further studies are necessary to provide solid evidence for the underlying mechanisms.

Effect of tobacco on periodontal disease and oral cancer

INTRODUCTION

Periodontal disease and oral cancer are common health hazards. Epidemiological investigations show that smoking, periodontal disease and oral cancer are closely related. Tobacco is one of the major risk factors for periodontitis and oral cancer.

METHODS

A systematic literature review was performed. To identify relevant studies, the following online databases were searched using specific keywords: PubMed, Web of Science and CNKI.

RESULTS

Tobacco not only possesses an addictive effect, but it aggravates periodontal disease by promoting the invasion of pathogenic bacteria, inhibiting autoimmune defense, aggravating the inflammatory reaction, and aggravating the loss of alveolar bone. According to current evidence, tobacco significantly aggravates the development and progression of periodontal disease and oral cancer, and periodontal disease may be related to the prevalence of oral cancer.

CONCLUSIONS

Clinicians should strongly recommend that smokers undertake a strategy to stop smoking to avoid the exacerbation of nicotine-related periodontal disease and to reduce the incidence of oral cancer.

Antibacterial resin-based composite containing chlorhexidine for dental applications

OBJETICVE

The aim of this study was to develop a composite material with antibacterial activity using MMT loaded with clorhexidine (CHX). For that it was used a BisGMA/TEGDMA matrix and added low concentration of MMT/CHX. The aim was to evaluate the drug release capacity of MMT, and not to provide reinforcement.

METHODS

Six experimental composites were made with organic matrix of BisGMA/TEGDMA in equal proportions by weight. The composites received organophlizated montmorillonite with or without CHX. The concentrations were 2,5; 5 or 10% by weight. Degree of conversion (DC) was evaluated using FTIR (peak 6165 cm-1; n=5). Specimens for flexural properties (10×2×1mm) were immediate tested (24h). Elastic modulus(E) and flexural strength (FS) was measured using the three point bending test (n=10). Inibition halo was used to test the antibacterial activity against Staphylococcus aureus, Streptococcus mutans, and Porphyromonas gingivalis (n=5 for each bacteria). The inhibition of biofilm formation (BF) was evaluated by inserting polymerized disc of composite in to a culture media colonized with Streptococcus mutans (n=10). The release of CHX was measured using ultraviolet (255nm) for 10 days (n=5). The data of degree of conversion was analysed using Kruskal-Wallis/ Mann-Whitney, and the other variables using two-way ANOVA/Tukey, always considering a global level of significance of 5%.

RESULTS

DC ranged from 71% to 74%. E ranged from 5.7 to 8.1GPa. FS ranged from 61.4 to 74.7MPa. There were no statistical differences among the groups for all the variables. For the three bacteria tested the composites with CHX loaded presented inhibition of growth for all concentration, except for 2,5% that did not inihibited the growth of P. gingivalis. BF was lower for the groups with 10% MMT/CHX, all groups presented BF, even those without CHX loaded. All concentrations presented release off CHX during all the 28 days analyzed.

CONCLUSIONS

Within the limitation of this study it can be concluded that: all concentrations tested presented release of CHX and reduced BF. All concentration presented antibacterial activity for the three bacteria tested, except for 2,5% that did not inhibit the growth of P. gingivalis. The presence of MMT with CHX loaded did not interfere in the properties evaluated.

Tobacco-induced suppression of the vascular response to dental plaque

Cigarette smoking presents oral health professionals with a clinical and research conundrum: reduced periodontal vascular responsiveness to the oral biofilm accompanied by increased susceptibility to destructive periodontal diseases. This presents a significant problem, hampering diagnosis and complicating treatment planning. The aim of this review is to summarize contemporary hypotheses that help to explain mechanistically the phenomenon of a suppressed bleeding response to dysbiotic plaque in the periodontia of smokers. The influence of smoke exposure on angiogenesis, innate cell function, the production of inflammatory mediators including cytokines and proteases, tobacco-bacteria interactions, and potential genetic predisposition are discussed.

Analysis of oral microorganism diversity in healthy individuals before and after chewing areca nuts using PCR-denatured gradient gel electrophoresis

To analyze oral microbial diversity in the saliva of 8 healthy individuals before and after chewing areca nuts. Saliva samples were collected before chewing areca nuts, after chewing areca nuts for 5 min and after chewing areca nuts for 30 min. DNA was extracted, and microbial diversity was examined using PCR-denaturing gradient gel electrophoresis (PCR-DGGE). When examining DGGE profiles collectively, the bands associated with Streptococcus and Veillonella were the most intense, making them the most prevalent bacteria. Furthermore, the band intensities did not decrease after chewing areca nuts for 5 or 30 min; thus, these bacteria were unaffected. However, when examining some individuals, the band intensities for Streptococcus and Veillonella became more intense after 5 min of chewing and then returned to the pre-chewing level. This difference may be attributed to the mechanical movements of the oral cavity or individual differences. Other bacteria, such as Neisseria, Actinomycetes, and Rothia dentocariosa, were also found to have an increased or decreased prevalence following areca nut-chewing. Since the predominant species that are present following areca nut-chewing include Streptococcus and Veillonella, it would seem likely that these bacteria play an important role in the periodontal diseases associated with areca chewing.

Nicotine Impairs Macrophage Control of Mycobacterium tuberculosis

Pure nicotine impairs macrophage killing of Mycobacterium tuberculosis (MTB), but it is not known whether the nicotine component in cigarette smoke (CS) plays a role. Moreover, the mechanisms by which nicotine impairs macrophage immunity against MTB have not been explored. To neutralize the effects of nicotine in CS extract, we used a competitive inhibitor to the nicotinic acetylcholine receptor (nAChR)-mecamylamine-as well as macrophages derived from mice with genetic disruption of specific subunits of nAChR. We also determined whether nicotine impaired macrophage autophagy and whether nicotine-exposed T regulatory cells (Tregs) could subvert macrophage anti-MTB immunity. Mecamylamine reduced the CS extract increase in MTB burden by 43%. CS extract increase in MTB was also significantly attenuated in macrophages from mice with genetic disruption of either the α7, β2, or β4 subunit of nAChR. Nicotine inhibited autophagosome formation in MTB-infected THP-1 cells and primary murine alveolar macrophages, as well as increased the intracellular MTB burden. Nicotine increased migration of THP-1 cells, consistent with the increased number of macrophages found in the lungs of smokers. Nicotine induced Tregs to produce transforming growth factor-β. Naive mouse macrophages co-cultured with nicotine-exposed Tregs had significantly greater numbers of viable MTB recovered with increased IL-10 production and urea production, but no difference in secreted nitric oxide as compared with macrophages cocultured with unexposed Tregs. We conclude that nicotine in CS plays an important role in subverting macrophage control of MTB infection.

Scratching the surface - tobacco-induced bacterial biofilms

Individual environmental factors, such as iron, temperature and oxygen, are known to have a profound effect on bacterial phenotype. Therefore, it is surprising so little known is about the influence of chemically complex cigarette smoke on bacterial physiology. Recent evidence has demonstrated that tobacco smoke and components alter the bacterial surface and promote biofilm formation in several important human pathogens, including Staphylococcus aureus, Streptococcus mutans, Klebsiella pneumonia, Porphyromonas gingivalis and Pseudomonas aeruginosa. The mechanisms underlying this phenomenon and the relevance to increased susceptibility to infectious disease in smokers and to treatment are reviewed.

Nicotine: Its Stimulating and Inhibitory Effects on Oral Microorganisms

Tobacco users are much more susceptible to dental caries and periodontal diseases than non-tobacco users. Research suggests that this increased susceptibility may be due in part to nicotine, a primary active component of tobacco. Five bacterial species and one yeast species commonly found in the human oral cavity, Lactobacillus casei, Actinomyces viscosus, Actinomyces naeslundii, Rothia dentocariosa, Enterococcus faecalis, and Candida albicans respectively, were utilized to investigate if any correlation existed between exposure to various concentrations of nicotine ranging from 0 to 32 mg/ml and the growth of each microorganism. The minimum inhibitory concentration (MIC), minimum biofilm inhibitory concentration (MBIC), and planktonic growth were measured. The MIC was determined to be 16 mg/ml for all organisms except E. faecalis, which had an MIC of 32 mg/ml. Nicotine had a varying effect on planktonic growth across the different species. A distinct upward trend in biofilm formation was found in A. viscosus, L. casei, E. faecalis, and C. albicans through 8 mg/ml. Nicotine also enhanced R. dentocariosa biofilm formation in all concentrations through 8 mg/ml but was most enhanced at 1 mg/ml. Alternatively, A. naeslundii exhibited a complete downward trend through 32 mg/ml. The MBIC was found to be 16 mg/ml in all organisms studied. These findings further support research suggesting that the increased susceptibility to oral health diseases experienced by tobacco users may be caused in part by an upregulation in biofilm formation of these oral pathogens.

Anti cariogenic effect of terminalia chebula

BACKGROUND

Terminalia chebula is one of the traditional medicines used in the treatment of many diseases and possesses a wide variety of therapeutic activities. The aim of this study was to determine the antimicrobial properties of Terminalia chebula against oral pathogens related to caries.

MATERIALS AND METHODS

In this study, Antimicrobial activity was tested using Kirby bouer method by streaking. Total phenol and total flavonoid content were analysed. Twenty high caries risk patients were subjected to rinse aqueous extract of Terminalia chebula. Salivary samples were collected for pH and microbial screening. Oral pathogens were identified by qualitative biochemical analysis.

RESULTS

The total phenol content of extract was found to be 21.33 ±1.633 (mean ± SD) and total flavonoids was found to be 23.17 ± 2.317 (mean ± SD). There was a gradual increase in pH till 45mts post-rinse when compared to pre-rinse was observed. Antimicrobial effect of Terminalia Chebula aganist microbes showed that there was a significant reduction between the pre-rinse and post-rinse samples.

CONCLUSION

These promising findings suggested the presence of antimicrobial activity of Terminalia Chebula against oral pathogens and proven to be an effective alternate antimicrobial agent.

Current status on biochemistry and molecular biology of microbial degradation of nicotine

Bioremediation is one of the most promising methods to clean up polluted environments using highly efficient potent microbes. Microbes with specific enzymes and biochemical pathways are capable of degrading the tobacco alkaloids including highly toxic heterocyclic compound, nicotine. After the metabolic conversion, these nicotinophilic microbes use nicotine as the sole carbon, nitrogen, and energy source for their growth. Various nicotine degradation pathways such as demethylation pathway in fungi, pyridine pathway in Gram-positive bacteria, pyrrolidine pathway, and variant of pyridine and pyrrolidine pathways in Gram-negative bacteria have been reported. In this review, we discussed the nicotine-degrading pathways of microbes and their enzymes and biotechnological applications of nicotine intermediate metabolites.

Tobacco smoke augments Porphyromonas gingivalis-Streptococcus gordonii biofilm formation

Smoking is responsible for the majority of periodontitis cases in the US and smokers are more susceptible than non-smokers to infection by the periodontal pathogen Porphyromonas gingivalis. P. gingivalis colonization of the oral cavity is dependent upon its interaction with other plaque bacteria, including Streptococcus gordonii. Microarray analysis suggested that exposure of P. gingivalis to cigarette smoke extract (CSE) increased the expression of the major fimbrial antigen (FimA), but not the minor fimbrial antigen (Mfa1). Therefore, we hypothesized that CSE promotes P. gingivalis-S. gordonii biofilm formation in a FimA-dependent manner. FimA total protein and cell surface expression were increased upon exposure to CSE whereas Mfa1 was unaffected. CSE exposure did not induce P. gingivalis auto-aggregation but did promote dual species biofilm formation, monitored by microcolony numbers and depth (both, p<0.05). Interestingly, P. gingivalis biofilms grown in the presence of CSE exhibited a lower pro-inflammatory capacity (TNF-α, IL-6) than control biofilms (both, p<0.01). CSE-exposed P. gingivalis bound more strongly to immobilized rGAPDH, the cognate FimA ligand on S. gordonii, than control biofilms (p<0.001) and did so in a dose-dependent manner. Nevertheless, a peptide representing the Mfa1 binding site on S. gordonii, SspB, completely inhibited dual species biofilm formation. Thus, CSE likely augments P. gingivalis biofilm formation by increasing FimA avidity which, in turn, supports initial interspecies interactions and promotes subsequent high affinity Mfa1-SspB interactions driving biofilm growth. CSE induction of P. gingivalis biofilms of limited pro-inflammatory potential may explain the increased persistence of this pathogen in smokers. These findings may also be relevant to other biofilm-induced infectious diseases and conditions.

Potential activity of the purine compounds caffeine and aminophylline on bacteria

BACKGROUND

Purine compounds are special types of alkaloids. Caffeine and aminophylline are considered the most important members of purines due to their wide use in therapeutics.

AIMS

To detect any potential antibacterial effects on pathogenic bacteria of the widely prescribed members of purines caffeine and aminophylline.

MATERIALS AND METHODS

Two species of gram-positive bacteria and five species of gram-negative bacteria were exposed to these purine agents. Antibacterial effects of the tested purines were determined using the spectrophotometer method to assess the minimum inhibition concentrations (MIC).

RESULTS

Among the strains of bacteria tested, Bacillus subtilis showed the most susceptibility to purine agents. Staphylococcus aureus and Bacillus subtilis were found to be more susceptible to caffeine than the other strains. Aminophylline showed inhibitory action on many isolates, especially at the concentration of 10mg/ml. Paracoccus yeei demonstrated resistance to all tested purine compounds up to a concentration of 10.5mg/ml.

CONCLUSIONS

Caffeine and aminophylline had the ability to inhibit many strains of pathogenic bacteria.

Influence of cigarette smoke condensate on cariogenic and candidal biofilm formation on orthodontic materials

INTRODUCTION

An experimental analysis was made to quantify the adherence rates and the biofilm formation capacity of Streptococcus mutans ATCC25175 and Candida albicans SC5314 on orthodontic material surfaces in the presence of cigarette smoke condensate (CSC).

METHODS

Metal brackets, bands, acrylic resin, and polyurethane elastic rings were coated with stimulated saliva and submitted to adhesion and biofilm formation tests with and without CSC in a dynamic system.

RESULTS

The CSC increased the adhesion of S mutans ATCC25175 to the acquired pellicle (P <0.05) for bands (4.08 times), acrylic resin (2.89 times), and brackets (3.37 times) and reduced it in polyurethane elastic (2.66 times; P <0.05). S mutans ATCC25175 biofilm biomass was increased by CSC only on brackets (1.60 times; P <0.05). In the presence of CSC, the adhesion of C albicans SC5314 increased (P <0.05) on bands (1.81 times), brackets (9.61 times), elastics (29,133 times), and acrylic resin (177 times). Greater formation of C albicans SC5314 biofilm caused by CSC (P <0.05) was observed on acrylic resin (2.13 times) and brackets (2.32 times).

CONCLUSIONS

The results indicated that cigarette tobacco smoke can interfere with the adhesion and biofilm formation of these microorganisms to various orthodontic materials.

Tobacco-induced alterations to Porphyromonas gingivalis-host interactions

Smokers are more susceptible than non-smokers to persistent infection by Porphyromonas gingivalis, a causative agent of periodontitis. Patients who smoke exhibit increased susceptibility to periodontitis and are more likely to display severe disease and be refractory to treatment. Paradoxically, smokers demonstrate reduced clinical inflammation. We show that P. gingivalis cells exposed to cigarette smoke extract (CSE) induce a lower proinflammatory response (tumour necrosis factor-alpha, interleukin-6, interleukin-12 p40) from monocytes and peripheral blood mononuclear cells than do unexposed bacteria. This effect is reversed when CSE-exposed bacteria are subcultured in fresh medium without CSE. Using microarrays representative of the P. gingivalis genome, CSE-exposure resulted in differential regulation of 6.8% of P. gingivalis genes, including detoxification and oxidative stress-related genes; DNA repair genes; and multiple genes related to P. gingivalis virulence, including genes in the major fimbrial and capsular operons. Exposure to CSE also altered the expression of outer membrane proteins, most notably by inducing the virulence factors RagA and RagB, and a putative lipoprotein cotranscribed with the minor fimbrial antigen. Therefore, CSE represents an environmental stress to which P. gingivalis adapts by altering gene expression and outer membrane proteins. These changes may explain, in part, the altered virulence and host-pathogen interactions that have been documented in vivo in smokers with periodontal disease.