The role of immunology in periodontal disease

The impact of smoking on periodontitis patients' GCF/serum cytokine profile both before and after periodontal therapy: a meta-analysis

BACKGROUND

Smoking is an established modifying factor for the host immune response of periodontitis patients. However, its exact influence remains unclear. We aimed to compare the cytokine profile of periodontitis patients with and without smoking habits both before and after periodontal therapy to preliminarily explore its influence on the host immune response to periodontitis.

METHODS

The protocol of the present meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the code CRD42021255656. Meta-analysis was performed for each cytokine if at least three studies were included. We synthesized the evidence to compare the cytokine profile of periodontitis with and without smoking both in gingival cervical fluid (GCF) and serum to explore the impact of smoking on periodontitis both locally and systemically. Moreover, we also compared the cytokine profile of the two groups of patients after periodontal therapy to explore the effect of smoking on the outcome of periodontal therapy.

RESULTS

Fifteen studies were included in this meta-analysis. We found that there was no significant difference between the two groups of patients in the baseline cytokine profile. However, after periodontal therapy, smoking periodontitis patients showed significantly higher IL-1β levels in their GCF than nonsmoking patients.

DISCUSSION

There was no significant difference between smoking and nonsmoking periodontitis patients in the baseline cytokine profile. However, after periodontal therapy, smoking periodontitis patients showed significantly higher IL-1β levels in their GCF than nonsmoking patients, which indicates that smoking may impair the response of periodontitis to periodontal treatment.

Waistline to the gumline: Relationship between obesity and periodontal disease-biological and management considerations

Obesity is a pandemic and periodontitis is the sixth most prevalent disease in the world. These two noncommunicable diseases share several risk determinants. Epidemiologic evidence from the last 2 decades has established an increase in periodontitis prevalence in obese and overweight individuals. Biologic mechanisms potentially linking obesity and periodontal disease are adiposity-associated hyperinflammation, microbial dysbiosis, altered immune response, specific genetic polymorphisms, and increased stress. However, because of the lack of longitudinal interventional studies and randomized clinical trials, there is insufficient evidence to determine the cause-effect relationship between these two diseases. Despite this, the negative impact of obesity on oral health is well established. Several logistic and physiologic complications are associated with treating obese patients in a dental setting, and it requires an interprofessional team approach. Oral health care professionals need to be aware of the specific management considerations while rendering for this cohort, including modified practice facility and equipment, tailored supportive periodontal therapy, and heightened precaution during conscious sedation and surgical procedures.

Association between asthma and periodontal disease: A systematic review and meta-analysis

BACKGROUND

The aim of this systematic review (SR) is to evaluate the association between asthma and periodontal disease.

METHODS

An electronic search without date or language restrictions was carried out in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and LILACS until May 2016. In addition, manual searches and searches of the gray literature were conducted. The search process, data analysis, and quality assessment were performed by two independent reviewing authors. Eligibility criteria included prospective and retrospective cohort studies, case-controls, and randomized clinical trials.

RESULTS

The search and selection process yielded 21 studies, published between 1979 and 2017. The meta-analysis showed a statistically significant difference for the parameters of gingival bleeding, plaque index, and gingival index for participants with asthma (P < 0.001).

CONCLUSION

Data from this SR strongly suggest the association of asthma with periodontal disease.

WITHDRAWN: Interrelation of periodontal parameters between asthmatics and nonasthmatics subjects: a systematic review and meta-analysis

The Publisher regrets that this article is a duplication of an article that has already been published in the Journal of Periodontology, 89 (2018) 440-455, doi:10.1902/jop.2017.170363. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Sub-Micrometric Liposomes as Drug Delivery Systems in the Treatment and Periodontitis

Periodontitis is a complex disease and bacterial infection is one of the most common factors involved in this disease. Current strategies for the local delivery of antibiotics do not allow a complete clearance of bacteria filling dentinal tubules and this limits their therapeutic efficacy. Therefore, there is a strong need for the development of new delivery strategies aimed at improving the efficacy of antibiotic therapy for periodontitis with special reference to their ability to penetrate into the tubules. The aim of the present study is to develop liposome-based delivery systems of sub-micron dimension, able to diffuse into the dentinal tubules. A further aim of the research is to develop a protocol for enhanced diffusion based on the use of magnetic liposomes and magnetic fields. Liposomes were produced by hydration of a pre-liposomal formulation. The vesicles were stabilised with PEG and their re-sizing was achieved by extrusion. Magnetite nanoparticles were synthesized inside the vesicles, i.e., the chemical reaction involving FeCl2, FeCl3 and NH3 occurred within the core of the newly formed liposomes. Dynamic Light Scattering analysis was performed for size characterization. A mathematical model was implemented to predict the diffusion of the liposomes in dentinal tubules. Ex-vivo validation was performed on extracted human teeth. We produced PEG-ylated liposomes (average size 204.3 nm) and PEG-ylated magnetic liposomes (average size 286 nm) and an iron content of 4.2μg/ml. Through mathematical modelling, we deduced that sub-micrometer vesicles are able to penetrate into dentinal tubules. This penetration is considerably more effective when the vesicles are magnetized and subjected to an external magnetic field which accelerates their movement within the tubules. The liposome-based delivery systems developed by the present study are able to penetrate deeply into the tubules, sometimes reaching their terminal ends.

Autoimmune responses in periodontal diseases

Periodontal diseases are characterized by localized infections and inflammatory conditions and directly affect teeth supporting structures which are the major cause of tooth loss. Several studies have demonstrated the involvement of autoimmune responses in periodontal disease. Evidences of involvement of immunopathology have been reported in periodontal disease. Bacteria in the dental plaque induce antibody formation. Lymphocytes, cytokines and complement system are reported to have an important role in the progression of periodontal disease. The present review describes the involvement of autoimmune responses in periodontal diseases. The mechanisms underlying these responses are also discussed.

Role of periodontal pathogenic bacteria in RANKL-mediated bone destruction in periodontal disease

Accumulated lines of evidence suggest that hyperimmune responses to periodontal bacteria result in the destruction of periodontal connective tissue and alveolar bone. The etiological roles of periodontal bacteria in the onset and progression of periodontal disease (PD) are well documented. However, the mechanism underlying the engagement of periodontal bacteria in RANKL-mediated alveolar bone resorption remains unclear. Therefore, this review article addresses three critical subjects. First, we discuss earlier studies of immune intervention, ultimately leading to the identification of bacteria-reactive lymphocytes as the cellular source of osteoclast-induction factor lymphokine (now called RANKL) in the context of periodontal bone resorption. Next, we consider (1) the effects of periodontal bacteria on RANKL production from a variety of adaptive immune effector cells, as well as fibroblasts, in inflamed periodontal tissue and (2) the bifunctional roles (upregulation vs. downregulation) of LPS produced from periodontal bacteria in a RANKL-induced osteoclast-signal pathway. Future studies in these two areas could lead to new therapeutic approaches for the management of PD by down-modulating RANKL production and/or RANKL-mediated osteoclastogenesis in the context of host immune responses against periodontal pathogenic bacteria.

The relationship between marginal bone loss and serum zinc levels

Serum was analyzed for zinc in 51 patients of varying age and with varying degrees of alveolar bone loss as recorded on roentgenograms. There was a reversed correlation between marginal alveolar bone loss and serum zinc levels. The observations are discussed in relation to the physiological functions of zinc.

Mapping the pathogenesis of periodontitis: a new look

Chronic adult periodontitis is a bacterially induced chronic inflammatory disease that destroys the connective tissue and bone that support teeth. Concepts of the specific mechanisms involved in the disease have evolved with new technologies and knowledge. Histopathologic observations of diseased human tissues were used previously to speculate on the causes of periodontitis and to describe models of pathogenesis. Experimental evidence later emerged to implicate bacterial plaque deposits as the primary factor initiating periodontitis. At the same time, specific bacteria and immunoinflammatory mechanisms were differentially implicated in the disease. In the mid-1990s, early insights about complex diseases, such as periodontitis, led to new conceptual models of the pathogenesis of periodontitis. Those models included the bacterial activation of immunoinflammatory mechanisms, some of which targeted control of the bacterial challenge and others that had adverse effects on bone and connective tissue remodeling. Such models also acknowledged that different environmental and genetic factors modified the clinical phenotype of periodontal disease. However, the models did not capture the dynamic nature of the biochemical processes, i.e., that innate differences among individuals and changes in environmental factors may accelerate biochemical changes or dampen that shift. With emerging genomic, proteomic, and metabolomic data and systems biology tools for interpreting data, it is now possible to begin describing the basic elements of a new model of pathogenesis. Such a model incorporates gene, protein, and metabolite data into dynamic biologic networks that include disease-initiating and -resolving mechanisms. This type of model has a multilevel framework in which the biochemical networks that are regulated by innate and environmental factors can be described and the interrelatedness of networks can be captured. New models in the next few years will be merely frameworks for integrating key knowledge as it becomes available from the "-omics" technologies. However, it is possible to describe some of the key elements of the new models and discuss distinctions between the new and older models. It is hoped that improved conceptual models of pathogenesis will assist in focusing new research and speed the translation of new data into practical applications.

The effect of age on prostaglandin-synthesizing enzymes in the development of gingivitis

BACKGROUND AND OBJECTIVE

The aim of this study was to identify the expression of cyclooxygenase-1, cyclooxygenase-2, cyclooxygenase-3, and microsomal prostaglandin E synthase-1 in young and elderly subjects.

MATERIAL AND METHODS

Periodontally healthy subjects were divided into young (18-30 years, n = 7) and elderly (46-77 years, n = 7). A gingival biopsy was taken at baseline. After experimental gingivitis, clinical examination was repeated and a second biopsy was taken. The expression of cyclooxygenase-1, cyclooxygenase-2, cyclooxygenase-3, and microsomal prostaglandin E synthase-1 was analyzed by means of immunohistochemistry.

RESULTS

In both healthy age groups, cyclooxygenase-1 and microsomal prostaglandin E synthase-1 were expressed in epithelial cells, endothelial cells and fibroblast-like connective tissue cells. Cyclooxygenase-1 was found in Langerhans' cells of the epithelium. Cyclooxygenase-2 expression was observed in cells exhibiting the morphology of epithelial mitosis cells, and the expression of cyclooxygenase-2 in periodontally healthy elderly subjects was significantly lower (p < or = 0.05). Following experimental gingivitis, cyclooxygenase-1 and microsomal prostaglandin E synthase-1 expression did not change. However, the expression of cyclooxygenase-2 was significantly increased in both age groups (p < or = 0.05). Cyclooxygenase-3 was not detected in any group investigated.

CONCLUSION

Cyclooxygenase-1 and microsomal prostaglandin E synthase-1 were expressed constitutively in gingival tissue, and expression was unaffected by age or inflammation states. In contrast, the expression of cyclooxygenase-2 was weaker in elderly subjects. In the course of experimental gingivitis, cyclooxygenase-2 was induced in both age groups.

Antigen activation of THP-1 human monocytic cells after stimulation with lipopolysaccharide from oral microorganisms and granulocyte-macrophage colony-stimulating factor

A human THP-1 monocyte cell line culture system has been utilized to evaluate the morphological changes in THP-1 cells and to measure expression of activation antigens (CD-11b, CD-11c, CD-14, CD-35, CD-68, CD-71 and HLA-DR) as evidence of maturation of THP-1 cells in response to stimulation by lipopolysaccharide (LPS) from the oral microorganisms, Fusobacterium nucleatum and Porphyromonas gingivalis, and granulocyte-macrophage colony-stimulating factor. THP-1 cells were stimulated with LPS (1 microgram/ml) of P. gingivalis or F. nucleatum for different time periods (1, 2, 4 and 7 d). Detection of different activation antigens on THP-1 cells was performed by indirect immunohistochemical staining followed by light microscopy. Confirmational studies were performed in parallel using indirect immunofluorescence and immunogold electron microscopy for detection of the corresponding activation antigens. Expression of different activation antigens by resting THP-1 cells revealed HLA-DR to be on 3% of the cells; CD-11b, 9%; CD-11c, 8%; CD-14, 22%; CD-35, 9% and CD-68, 7%. The CD-71 activation antigen was not expressed in untreated THP-1 cells. LPS stimulation increased expression of all activation antigens. A significant (p < 0.05) increase in expression of CD-11b, CD-11c, CD-14, CD-35, CD-68 and CD-71 was observed when GM-CSF (50 IU/ml) was supplemented during the treatment of THP-1 cells with LPS of F. nucleatum or P. gingivalis. Activation and differentiation of THP-1 cells by LPS from oral microorganisms in the presence of GM-CSF supports a role for human macrophages in acute and chronic periodontal diseases and may explain the clinically observable periodontal exacerbations in some patients after GM-CSF therapy.

Interleukin-6 production by human monocytes treated with granulocyte-macrophage colony-stimulating factor in the presence of lipopolysaccharide of oral microorganisms

This study focused on the effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) and lipopolysaccharide of the putative periodontal pathogens Porphyromonas gingivalis or Fusobacterium nucleatum on IL-6 production by THP-1 cells (a human monocytic cell line). Resting THP-1 cells were alternatively treated with GM-CSF (50 IU/ml) and lipopolysaccharide of P. gingivalis or F. nucleatum, in varying concentrations for varying time periods. IL-6 production in supernatant fluids of treated cells was evaluated by an enzyme-linked immunosorbent assay (ELISA) and a reverse transcription polymerase chain reaction (RT-PCR) was used to evaluate gene expression. Untreated THP-1 cells did not produce IL-6 as determined by ELISA. RT-PCR also failed to detect IL-6 mRNA in untreated THP-1 cells, indicating that IL-6 was not constitutively produced. After stimulation of THP-1 cells with lipopolysaccharide of F. nucleatum or P. gingivalis, IL-6 was produced, peaking at 4 h (200-300 pg/ml) and thereafter sharply declining by 8 h. When GM-CSF was added together with lipopolysaccharide of P. gingivalis or F. nucleatum, there was a synergistic quantitative increase in production of IL-6 as measured by ELISA as compared with lipopolysaccharide alone. IL-6 mRNA was detected by RT-PCR, 15 min after stimulation with lipopolysaccharide of either P. gingivalis or F. nucleatum. GM-CSF supplementation with lipopolysaccharide of P. gingivalis shortened the transcription of IL-6 mRNA to 5 min, a shift which was not observed with lipopolysaccharide of F. nucleatum, possibly indicating a different mechanism of initiation of transcription. Production of IL-6 by GM-CSF-treated THP-1 cells in the presence of lipopolysaccharide of oral microorganisms may provide a model for studying the role of macrophages in acute and chronic periodontal diseases, including the clinical periodontal exacerbation as observed in chemotherapy patients receiving GM-CSF for bone marrow recovery.

Granulocyte-macrophage colony-stimulating factor amplification of interleukin-1beta and tumor necrosis factor alpha production in THP-1 human monocytic cells stimulated with lipopolysaccharide of oral microorganisms

Cytokines, including granulocyte-macrophage colony-stimulating factor (GM-CSF), are used to assist in bone marrow recovery during cancer chemotherapy. Interleukin-1beta (IL-1beta) and tumor necrosis factor alpha (TNF-alpha) play important roles in inflammatory processes, including exacerbation of periodontal diseases, one of the most common complications in patients who undergo this therapy. A human monocyte cell line (THP-1) was utilized to investigate IL-1beta and TNF-alpha production following GM-CSF supplementation with lipopolysaccharide (LPS) from two oral microorganisms, Porphyromonas gingivalis and Fusobacterium nucleatum. LPS of P. gingivalis or F. nucleatum was prepared by a phenol-water extraction method and characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and determination of total protein and endotoxin contents. Resting THP-1 cells were treated with LPS of P. gingivalis or F. nucleatum and/or GM-CSF (50 IU/ml) by using different concentrations for various time periods. Production of IL-1beta and TNF-alpha in THP-1 cells was measured by solid-phase enzyme-linked immunosorbent assay. Reverse transcription (RT)-PCR was used to evaluate the gene expression of resting and treated THP-1 cells. IL-1beta was not detected in untreated THP-1 cells. IL-1beta production was, however, stimulated sharply at 4 h. GM-CSF amplified IL-1beta production in THP-1 cells treated with LPS from both oral anaerobes. No IL-1beta-specific mRNA transcript was detected in untreated THP-1 cells. However, IL-1beta mRNA was detected by RT-PCR 2 h after stimulation of THP-1 cells with LPS from both organisms. GM-CSF did not shorten the IL-1beta transcriptional activation time. GM-CSF plus F. nucleatum or P. gingivalis LPS activated THP-1 cells to produce a 1.6-fold increase in TNF-alpha production at 4 h over LPS stimulation alone. These investigations with the in vitro THP-1 model indicate that there may be an increase in the cellular immune response to oral endotoxin following GM-CSF therapy, as evidenced by production of the tissue-reactive cytokines IL-1beta and TNF-alpha.

Comparison of the oral health status and salivary flow rate of asthmatic patients with those of nonasthmatic adults--results of a pilot study

The oral health status and stimulated salivary flow rate of 33 adult asthmatic outpatients were compared with those of 33 nonasthmatic controls. The groups were matched by age and sex, and an adjustment for education was made in the statistical analysis. In the oral examination, a small difference in the prevalence of caries was observed when the sums of decayed, missing, and filled teeth (DMFT) were compared. The mean (SD) crude DMFT score was 20.1 (5.8) in the asthma group and 18.4 (7.6) in the control group. A statistically significant difference was seen in the amount of periodontal inflammation and in the stimulated salivary flow rate between the groups. The mean (SD) crude periodontal status index (PSI) was 52.7% (23.8%) in the asthmatics and 37.1% (20.4%) in the controls. The 95% confidence interval (95% CI) for the difference in adjusted means of PSI ranged from 0.1% to 21.9% (P = 0.05). In the stimulated salivary flow rate, crude mean values were 1.0 (0.5) ml/min and 1.3 (0.5) ml/min, respectively, and the 95% CI for the difference was from 0.05 ml/min to 0.57 ml/min (P = 0.01). Mucosal lesions in the oral cavity were found in 15 asthmatics (45%) and in eight controls (24%). In conclusion, the results of this study support the hypothesis that adult asthmatics have a higher risk of oral diseases than nonasthmatic subjects.

Children, adolescents and periodontal diseases

OBJECTIVES

This manuscript attempts to critically review current literature regarding the natural history, aetiology and pathogenesis of the common periodontal diseases to affect children and adolescents. The logic behind the emergence of a new classification in the early 1990s is explained and potential problems with the interpretation of such systems outlined.

DATA SOURCES

The manuscript focuses upon recent developments, reported in the international periodontal literature, aimed at unraveling the molecular basis for this group of diseases. The concept of one disease type progressing with time to another disease within the same individual is discussed, and early data presented that indicate the possibility of microbial transmission from deciduous to permanent dentition's within a subject.

CONCLUSIONS

It is concluded that differing classification systems for adolescent and childhood periodontal diseases may lead to confusion within the dental profession, unless the clinical and molecular basis for such diseases is fully understood. Further advances in basic research using molecular biology tools should assist in our understanding of the aetiopathology at a molecular level and hopefully lead to the development of new treatment strategies.

Predominant cultivable microflora of supragingival dental plaque in Chinese individuals

The aim of this study was to determine the predominant supragingival cultivable bacterial flora in Chinese individuals, using the experimental gingivitis model. A total of 11 healthy dental students, mean age 22.5 years (range 20-25) were recruited. All were provided with once-a-week dental prophylaxis and oral hygiene reinforcement for 3 weeks to ensure gingival health. In the fourth week, after prophylaxis, the participants entered a 14-day period without any plaque control. A plaque sample was collected at days 1, 3, 7 and 14 from the buccal surface of the upper right canine, second premolar, first premolar and first molar, respectively. Each sample was then dispensed in tryptic soy-broth transport medium and grown anaerobically to obtain pure cultures, which were subsequently identified. Results showed that Gram-positive cocci and rods were the predominant cultivatable species (51-61%) in the samples throughout the 14-day period; with time there was a decreasing percentage of cocci and an increasing percentage of rods. Gram-negative cocci and rods increased in proportion with the plaque age (11-37%). Streptococcus spp. were the predominant Gram-positive cocci while Actinomyces were the predominant Gram-positive rods isolated. Fusobacterium and Capnocytophaga spp. were the two most frequent Gram-negative anaerobic rods cultured. The results compared with those from other analogous studies from the West suggest the possibility of interracial differences in supragingival plaque flora.

Prostaglandin E2 regulates gingival mononuclear cell immunoglobulin production

Histological studies have revealed elevated levels of T and B lymphocytes in inflamed gingival tissue. Functional analysis of these B cells has determined that they are spontaneously secreting large amounts of immunoglobulin. Several components of bacterial plaque which accumulate during the onset of periodontal disease induce polyclonal B cell activation, and are most likely responsible for the "hyperactive" state of these gingival B lymphocytes. In addition to this exaggerated humoral response, increased levels of inflammatory mediators, such as prostaglandin (PG) E2, have been implicated in the pathogenesis of disease. Therefore, the purpose of this study was to determine if PGE2 could regulate immunoglobulin production within inflamed gingival tissue. Specimens were harvested during routine surgery of patients with chronic adult periodontitis. Utilizing an ELISA, elevated levels of IgG were detected in the supernatant of cultured gingival mononuclear cells. Inclusion of indomethacin, which inhibits arachidonic acid metabolites such as PGE2, caused a decrease in IgG levels. PGE2 exerted a biphasic effect upon IgG production, with high doses diminishing and low doses increasing IgG levels. From a clinical perspective, these results suggest that elevated levels of PGE2 associated with inflammation will attenuate an IgG response and, as PGE2 production wanes, the local humoral response will rebound. Interestingly, the combination of low dose PGE2 and IL-4 induced a synergistic rise in IgG production. These findings support the theory that local PGE2 levels can regulate immunoglobulin production and potentiate cytokine induced class switching within gingival tissue.

Collagenase, gelatinase and elastase activities in sulcular fluid of osseointegrated implants and natural teeth

Proteinases play a key rôle in the physiological degradation and remodelling of the periodontal tissues. The rôle of these enzymes in tissue remodelling remodelling in connection with the insertion of dental endosseous implants has not been elucidated. Therefore, the aim of the present study was to identify the eventual presence of collagenase, gelatinase and elastase activities in periimplant sulcus fluid (PISF) of osseointegrated implants. Gelatinolytic activity in the samples was studied with gelatin-zymograms. Collagenase activity and its susceptibility to tetracycline-inhibition were monitored with SDS-polyacrylamide gel electrophoresis and laser densitometry, and elastase activity with synthetic substrate. Low activities of elastase and collagenase were detected in both PISF of osseointegrated implant patients and gingival crevicular fluid (GCF) of the control patients whereas significantly higher activities were detected in GCF of adult periodontitis patients. Also the profiles of gelatinases were similar in PISF of osseointegrated implant patients and GCF of the controls, but differed from the profile of active gelatinases present in GCF of adult periodontitis patients. The similar activities/characteristics of these proteinases in both periimplant sulcus fluid of healthy dental implants and GCF of healthy natural teeth suggest that they comprise the major proteinases for both periodontal and periimplant tissue remodelling or destruction.

The effect of systemic ibuprofen on gingival inflammation in humans

This clinical trial investigated the influence of short-term ibuprofen therapy on the early phase of the treatment of adult chronic periodontitis. The subjects were 17 patients in good general health referred for specialist periodontal treatment, having moderate chronic adult periodontitis. A series of assessments were made every 2 weeks over an 8-week period, including evaluations of oral hygiene, gingival inflammation and probing pocket depths. All participants received oral hygiene instruction, and following baseline examinations, had half the dentition, chosen at random, treated by scaling and root planing. The patients were randomly distributed into 2 groups, a test group receiving a 14-day course of 800 mg ibuprofen daily, in 4 divided doses, and a control group who did not receive any drug regime. At the 2-week assessment following the drug regime, significantly greater reduction in gingival bleeding, colour and pocketing was detected in the test compared with the control group. The beneficial effects were less evident thereafter. Although clinical application of the regime used in this study would not be justified by these results, further research into anti-inflammatory agents as an adjunct in the treatment of periodontal diseases could be considered, in the light of the beneficial effect on gingivitis in the early phase of periodontal treatment reported.

Serum antibody responses in human periodontitis to cellular components of Capnocytophaga

Serum levels of IgM, IgG and IgG-antibody subclasses directed against cell envelopes, lipopolysaccharides and cytoplasmic fractions from Capnocytophaga sputigena, C. gingivalis and C. ochracea were examined in age-, race- and sex-matched periodontally healthy (n = 25) subjects and subjects with adult periodontitis (n = 25). The envelopes and cytoplasmic fractions were obtained by ballistic disintegration of the cells and ultracentrifugation. Cell envelopes were treated with DNase, RNase and lysozyme. Lipopolysaccharides were obtained by hot phenol-water extraction and treated with DNase and RNase. The relative levels of the antibodies in response to the cell fractions were measured by the streptavidinbiotin micro enzyme-linked immunosorbent assay. Both groups showed IgM and IgG antibodies to each fraction of the three Capnocytophaga species, but the frequency of positive IgG subclass responses varied. The IgG4 responses were lower than the other subclasses. There were no significant differences between the IgM antibody levels of the two groups. However, the adult periodontitis group had significantly lower IgG antibody titres to the cell envelopes and cytoplasmic fractions of C. gingivalis and C. ochracea, and lipopolysaccharide of C. gingivalis. These results were reflected in the depressed levels of IgG1 and/or IgG2 to these cellular fractions from the same bacterial species. The adult periodontitis group also showed a lower level of IgG1 to the cytoplasmic fractions of C. sputigena without any depression in the total IgG antibody level. There were no significant differences between the groups in IgG3 and IgG4 antibody levels to any of the cellular fractions.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunologic mechanisms of pathogenesis in periodontal diseases: an assessment

Principal lines of evidence that immune reactions are central to the pathogenesis of periodontitis are reviewed. Necessary components of immunologic reactions are present in gingiva in the periodontal diseases. Differences between healthy and periodontitis patients with respect to some measures of immune function further indicate that immune reactions do occur in the gingiva during periodontitis. They are probably responsible for at least some of the destruction of connective tissue and bone that occurs. Classical antibody-mediated hypersensitivity reactions probably do not provide the reasons. Mechanisms are more likely to be found in the pro-inflammatory and tissue-degrading effects of cytokines released in host-protective, antigen-specific and polyclonal responses to oral bacterial constituents or products. Some evidence suggests that limitation of clinical destruction in localized early onset periodontitis (JP) may in part be a function of a protective antibody response which develops after an initial rapidly progressive infection. A relatively deficient immune responsiveness may allow progression to more severe and generalized disease (RPP). Suggestions are made for studies needed to confirm suspected pathogenetic mechanisms, approach resultant targeted therapies, and test hypotheses for contrasting roles of immune reactions in different clinical expressions of periodontitis.

Diagnosing periodontal diseases

At present, the diagnosis of periodontal disease requires a clinical evaluation of the patient including visual findings, the use of the periodontal probe, and radiographs. No test is available to evaluate disease activity. In specific cases, adjunctive procedures may also be useful. The identification of pathogenic microorganisms may aid in evaluating the periodontal status of special patients. However, these are not required for an adequate diagnosis of the common adult form of chronic periodontitis.

Periodontal alterations in patients with pemphigus vulgaris taking steroids. A biannual assessment

Periodontal health parameters and salivary cortisol were studied in 19 adult pemphigus vulgaris patients on chronic steroid therapy. The patient population was divided into non-medicated and medicated subjects at intake into the study. A significant difference between the 2 examinations, performed at an interval of 8.73 months +/- 4.35, was found in bleeding index (p less than 0.000 and p less than 0.04, respectively) and gingival recession (p less than 0.000 and p less than 0.009) in both groups. No changes occurred in alveolar bone height. Steroid therapy altered the bleeding index (R = 0.60 and R = 0.80) and gingival recession (R = 0.87 and 0.91) in a dose-related manner, and induced low salivary cortisol. The findings of this study would suggest suppression of the host inflammatory reaction, resulting in an alleged healthy clinical appearance of the periodontium.

Gingival fluid, beta 2-microglobulin and protein levels as indicators of periodontal disease

beta 2-microglobulin (beta 2-m), lysozyme and protein concentrations in gingival fluid were analyzed in 19 patients with severe periodontitis and in 19 controls devoid of any clinical signs of inflammation. A significant increase of the total protein and beta 2-m levels was found in periodontal subjects. In contrast, lysozyme concentration did not reflect the inflammatory status of the periodontium. Statistical analyses showed significant correlations between beta 2-m and protein concentrations in both groups. Furthermore, the values obtained by Periotron 600 closely correlated with the protein and beta 2-m contents, indicating that this method is a reliable aid in assessment of the quantity and quality of crevicular exudate and thus the severity of periodontal disease.

Increased interleukin-1 beta (IL-1 beta) concentration in gingival tissue from periodontitis patients

Human gingival tissues from periodontitis patients were found to contain from 126 fg/mg to 2161 fg/mg interleukin-1 beta as determined by a sensitive enzyme linked immunoassay. No IL-1 beta could be found in normal gingival tissue. This finding may have important consequences relevant to connective tissue destruction and episodes of alveolar bone resorption characteristic of chronic periodontitis.

Rapidly progressive periodontal disease associated with HIV infection: report of case

A case of rapidly progressive periodontal disease associated with human immunodeficiency virus (HIV) infection is presented. Rapid horizontal bone loss, with only moderate inflammation, occurred during a 13-month period. Pocket depth was significantly less than anticipated, given the degree of bone loss. The patient had no signs or symptoms of acquired immune deficiency syndrome (AIDS). The cause, features, diagnosis, and management are discussed.

Effects of immunization with B. macacae on induced periodontitis--preliminary findings

This preliminary study examined the effects of immunization with Bacteroides macacae, the monkey equivalent of the human species of B. gingivalis on ligature-induced periodontitis. During a 12 week immunization period, 8 out of the 12 Macacae fasicularis monkeys were immunized weekly with B. macacae washed cells and 4 were sham-immunized with saline. At the same time, all were scaled and pumiced weekly to establish gingival health. Following this period, the mandibular first molars were ligated in 8 out of the 12 monkeys to induce periodontitis. The immunized, ligated experimental group, the ligated, sham-immunized control group, and the immunized, non-ligated control group were then followed for a 6 months ligation period while plaque was allowed to accumulate. Gingival indices, attachment levels, pocket depths, plaque indices, radiographs, serum and crevicular fluid antibodies and subgingival bacteria were assessed. Immunization led to elevated antibody levels to B. macacae while ligation increased plaque, gingival inflammation, and bone loss. Following the 6 month ligation period, B. macacae comprised 1.7% of the cultivable flora in the immunized, non-ligated monkeys, 2.1% in the immunized, ligated monkeys, and 5.6% in the sham-immunized, ligated monkeys. Similar differences between the immunized, ligated and and the sham-immunized, ligated groups were not seen for B. intermedius, nor B. melaninogenicus. These results suggest a heightened humoral response to B. gingivalis reduces subgingival re-colonization by this organism and modulates the course of ligature-induced periodontitis.

Effect of plaque removal on patients with acute leukemia

The aim of the present investigation was to study the effect of daily plaque removal on gingival inflammation and the occurrence of oral mucosal ulcers in granulocytopenic patients with acute myeloid leukemia. Eleven patients were analyzed prospectively and consecutively during a period of 28 days, in which the patients were treated with antineoplastic drugs. The patients had their teeth scaled, and plaque was removed daily. On Day 1 all had gingival inflammation, and two had profound periodontitis with pocket depths and loss of attachment greater than 5 mm. During the treatment period plaque scores were reduced in all patients and a corresponding decrease in gingival inflammation was seen. It was possible to obtain healthy gingiva during treatment with cytotoxic drugs. In addition, the development of oral mucosal lesions was low compared with other studies. This study demonstrates that daily plaque removal from the teeth resolves gingival inflammation also in severely granulocytopenic patients.

Radiographic quantification of alveolar bone level changes. Predictors of longitudinal bone loss

The purpose of the present study was to determine the relative importance of a set of predictors for the radiographic change in alveolar bone level over 2 years in a group of 180 subjects and to assess the fit of the applied multivariate model. The included predictors were age, sex, initial bone level, type of initial lesion, tooth type, proximal tooth surface, calculus, and the presence of metal crowns or proximal fillings. The multivariate method of choice was multiple classification analysis. The results indicated that in descending order tooth type, initial bone level, and age were the most important predictors. Sex, calculus, and crown and filling margins also showed significant direct effects (beta) on longitudinal bone loss (p less than 0.05). However, their relative importance was far less than that of tooth type, initial bone level, and age. Proximal side showed no significant direct effect. Using seven predictors, the applied multivariate model explained 20% of the variance in longitudinal bone loss.

Bacteria-phagocyte interactions: Fusobacterium-induced secretion of a neutrophil self-regulatory factor

Direct interaction between Fusobacterium nucleatum and human neutrophils resulted in the secretion of a neutrophil self-regulatory factor(s). The secretion of this factor was bacteria specific, and depended on the integrity of the bacteria cell surface. Factor secretion occurred within 15 min of bacteria--neutrophil interaction. Pre-treatment of neutrophils with cytochalasin B but not sodium fluoride inhibited factor secretion. The factor was sensitive to trypsin and heat treatment. Ultrafiltration experiments showed that it has a molecular weight between 10,000 and 30,000 daltons. Its biologic role may be that of a molecular mediator for the recruitment of resting neutrophils so as to amplify the immunological and inflammatory response.

Bacterial penetration of pocket soft tissues in chronic adult and juvenile periodontitis cases. An ultrastructural study

This study investigates bacterial invasion of the soft tissue walls of deep pockets from cases with adult (AP) and juvenile periodontitis (JP). Transmission electron microscopy was used to examine pocket soft tissue walls removed from extracted teeth from 5 patients with AP and 2 patients with JP. Bacteria were sparse throughout the epithelium and connective tissue, regardless of the level of tissue breakdown. However many inflammatory cells were seen, and these did appear to be located in regions of marked collagen loss. Accumulations of large numbers of bacteria were extremely rare and found only on the epithelial surface or in artefactual spaces within the deeper tissues. The findings indicate that the tissue destruction associated with periodontitis is not directly related to bacterial invasion. The sparse organisms within the pocket tissues probably result from passive entry rather than an invasive action. Under these circumstances, it would seem reasonable to suggest that bacterial metabolic products rather than the micro-organisms themselves penetrate the tissues in periodontitis.

Salivary IgA, lysozyme and beta 2-microglobulin in periodontal disease

The concentrations of IgA, lysozyme and beta 2-microglobulin (beta 2-m) were quantitated in wax-stimulated mixed saliva from 28 patients with severe periodontitis and from 28 healthy controls. The mutual correlations between IgA, lysozyme and beta 2-m were determined. In patients with periodontitis decreased lysozyme concentrations were detected when compared with controls (P less than 0.05). The correlation between IgA and beta 2-m concentrations was highly significant in both groups studied (P less than 0.0001, and P less than 0.002), whereas beta 2-m and lysozyme concentrations were positively correlated in patients but not in controls. In addition, a significant correlation between IgA and lysozyme was found only in periodontal patients (P less than 0.001).

Prevalence of incipient juvenile periodontitis at age 16 years in Switzerland

The present radiographic and clinical survey was performed to study the prevalence of "incipient juvenile periodontitis" in a population of 16-year old adolescents in Switzerland. The subjects to be screened were selected on the basis of the population distribution in the year 1980 in the territory of Switzerland. 7% of all 16-year old adolescents proportionally distributed into the different ethnic groups of Switzerland were incorporated in the study. From the school dental systems, a total of 7604 pairs of bite-wing radiographs were obtained and evaluated for fillings and iatrogenic factors, gross amounts of calculus, resorption of alveolar bone. A diagnosis of "incipient juveline periodontitis" was given if the clinical criteria of this disorder proposed by Baer were met. In 7142 pairs of bite-wing radiographs, such a diagnosis was attributed to 7 female and 12 male patients. Subsequently, they were asked if they would be examined at the University of Berne School of Dental Medicine. On the basis of history, a complete periodontal chart and full mouth radiographs, the diagnosis was confirmed or refuted. 8 patients (4 female and 4 male) were definitely diagnosed as "incipient juvenile periodontitis". This resulted in a prevalence of 0.1% with a ratio of female to male of 1:1 in the country of Switzerland at age 16. As in other industrialized countries, this prevalence seems not to be a major public health problem.

Fluctuations in crevicular and salivary anti-A. viscosus antibody levels in response to treatment of gingivitis

Experimental gingivitis studies support a pathogenic rôle for Actinomyces viscosus because of its numerical predominance in disease-associated plaques. The aims of the present investigation were to quantify specific crevicular IgG against A. viscosus before and after conventional gingivitis treatment and to determine whether salivary IgA and IgG against A. viscosus and A. naeslundii would be affected concomitantly. 6 subjects with generalized gingivitis were selected. Examinations were made before and after treatment and included collection of unstimulated saliva, paraffin-stimulated saliva and crevicular material as well as measurements of clinical parameters. The immunoglobulins were estimated by an ELISA assay using whole bacterial cells as antigen. Crevicular IgG against A. viscosus WVU 627 was demonstrated in pre- and post-treatment samples with a tendency towards increased values in the post-treatment samples. Salivary IgA and IgG against A. viscosus were also demonstrated in pre- and post-treatment samples. There were tendencies towards increased IgA values for paraffin-stimulated saliva and increased IgG values for unstimulated saliva in the post-treatment samples. Salivary IgA and IgG values against A. naeslundii ATCC 12104 were either not detected or barely detectable in both pre- and post-treatment samples. A. naeslundii B 74 IgG values were also rather low. As for A. viscosus WVU 627, anti-B 74 IgA values demonstrated a post-treatment increase for most subjects, especially for unstimulated saliva for which all post-treatment values were elevated. It is interesting to note that saliva samples showed changes similar to crevicular material, considering that salivary IgA is most likely derived from a different source. Together, elevated crevicular and salivary antibody concentrations might account for some of the beneficial effects of periodontal therapy by scaling.

Infectious oral necrosis (cancrum oris) in Nigerian children: a review

The devastating orofacial gangrenous disease known as cancrum oris (noma) is still commonly seen in underprivileged Nigerian children. These children are usually victims of such stressors as chronic malnutrition, numerous endemic communicable diseases and severe adverse physical conditions which may lead to depletion of their adaptive resources or produce physiological maladaptation to additional stressors. Measles is the most common infection preceding the development of noma in Nigerian children. Acquired immunodeficiency as well as the impaired endocrine balance of the chronically malnourished permits, for example, widespread infection with the measles virus. Anergy resulting from the combination of malnutrition and measles virus infection promotes selective overgrowth and invasion by an infective consortium consisting of anaerobic organisms and other species capable of elaborating necessary growth factors for the former. Because of the pre-existing depletion of adaptive physiologic resources in the malnourished child, the infection is not readily contained locally as necrotizing ulcerative gingivitis but instead spreads rapidly to the next naturally occurring anatomical barriers. This is then followed by continuing necrosis and possible sequestration as exemplified by noma.

Inflammatory cells and their subsets in lesions of juvenile periodontitis. A family study

The inflammatory cells in the gingival biopsy samples from a total of 9 patients with juvenile periodontitis (JP) and from 10 of their family members (JPrelat) belonging to 5 different families were subjected to phenotypic characterization. Plasma cells and their immunoglobulins were stained with immunoperoxidase kits for IgA, IgG, and IgM. B, T, and MPS (cells of the mononuclear phagocyte system) cells were demonstrated by the alpha-naphthyl acetate esterase (ANAE) technique in cryostat sections. The subsets (T helper/inducer and T suppressor/cytotoxic cells) of T cells were detected with monoclonal antibodies OKT4 and OKT8, respectively, using indirect immunofluorescence. Similar studies were completed for 19 age- and sex-matched periodontally healthy subjects. IgG plasma cells for outnumbered the IgA and IgM cells in all three series and were most pronounced in JPrelat series. Most of the inflammatory cells were ANAE-negative (B cells) in all series (78-87%). The highest proportions of T and MPS cells were found in the JP series (10% for both). A statistically significantly higher ratio for TH/Ts (OKT4+/OKT8+) was found in both the JP and JPrelat series as compared with that of the healthy controls. The findings suggest that imbalance (either inherited or acquired) in the immune regulation may play role in the development of JP.

Dextran-induced inflammation and its effect on keratinized gingival epithelium in monkeys

The cell population present during dextran-induced inflammation and its effect upon induced keratinization of the sulcular epithelium was investigated in two young adult male Rhesus monkeys. Keratinization of the sulcus epithelium was induced by a combined regimen of scaling, an intravenous injection of achromycin and daily rubber cup prophylaxes. After keratinization was confirmed by means of biopsies, inflammation was induced either by injecting 200 microliters of a 5% dextran saline solution or by applying the solution topically on the marginal gingiva for 2 weeks. Clinical grade dextran, molecular weight 70,000, was used. Physiologic saline solution, either injected or topical, was also used. At the same time, the daily prophylaxes were continued. After the 2 weeks, gingival biopsies were taken from each tooth treated with the different regimens. One-half of each biopsy was routinely processed and stained with hematoxylin and eosin or Rhodamine B, while the other half was processed for and stained with alcoholic and aqueous PAS to detect dextran in tissues. Histologic evaluation was carried out in three areas: a crestal zone, a cervical zone and an oral gingival zone. An Inflammatory Index (II) was determined and the width and length of keratin were measured. Dextran, either topical or injected, produced mainly a chronic inflammatory response characterized by lymphocytes (30-35%), monocytes-macrophages (5-10%), plasma cells (10%), polymorphonuclear leukocytes (PMNs) (15%) and unidentified cells (35%). Conversely, the physiologic saline-induced inflammation showed PMNs (75%), lymphocytes (5%) and unidentified cells (20%). The II for injected areas was significantly higher than for those topically treated or for nontreated controls. However, the increased II did not affect the degree of keratinization achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

Cellular effects of human leukocyte hydrolases III: inflammatory exudate and synovial fibroblasts

Experiments were undertaken to determine whether lysosomal enzymes obtained from human polymorphonuclear leukocytes (PMN) might adversely affect the viability of human synovial fibroblasts. The effects of the PMN granule enzymes were additionally determined in the presence of an inflammatory exudate. These in vitro results indicated that as a result of these experimental conditions, the lysosomal enzymes, although present in relatively high concentration, were incapable of cell destruction and could only release cells from their growth surfaces; as could other proteases. However, even this effect was not expressed in the presence of naturally occurring inhibitors widely distributed in body fluids, such as serum; and most importantly which are also present in inflammatory exudates. This was in spite of the relatively high dilution of serum and inflammatory exudate used. So that, in effect, the relatively dilute inhibitors present in both serum and inflammatory exudates prevented the relatively concentrated lysosomal enzymes from exerting any discernible effects on either the cells, or the intercellular substance under these experimental conditions. This possibly suggests that the role of PMN granule enzymes as mediators of the cellular destruction observed in many inflammatory diseases, needs further elucidation.

The rests of Malassez and chronic marginal periodontitis

The structure of the rests of Malassez and the relationship which they bear to the junctional epithelium in the marginal region of pigs' molars was investigated. A 3-dimensional picture of the marginal rests and their relationship to the junctional epithelium was built up by means of standardized photomicrographs made from serial sections. In teeth involved in chronic marginal inflammation, the rests in this region appeared to form a continuous network and we confirmed the original suggestion of Grant & Bernick that, at frequent intervals, the junctional epithelium"... seemed to be continuous with the epithelial rests in the upper third of the root...". If the anatomical relationship of the rests in man resembles that seen in the pig and they form a continuous network communicating at intervals with the junctional epithelium, this relationship must inevitably lead to speculation about the effects of any potential for reactive proliferative equivalent to that which is frequently seen in the apical region. It is possible that the rests might be acting as the "thin end of the wedge", augmenting and facilitating apical migration of the junctional epithelium during the pathogenesis of the periodontal pocket.

In vitro sorption of albumin, immunoglobulin G, and lysozyme to enamel and cementum from human teeth

Sorption of three 125I-labeled human proteins (albumin, immunoglobulin G, and lysozyme) to enamel and cementum was investigated. All three proteins sorped most when suspended in 0.0005 M solution of phosphate or calcium chloride where the least competition between solute ions and label occurred. The addition of human serum to labeled proteins caused a decrease in their sorption which could be partially reversed by increasing the concentration of label. Kinetic experiments demonstrated that sorption was dependent on protein concentration and incubation time and that most of the sorption occurred within the first minute of the reaction. In conclusion, the binding of the three labeled proteins was affected by the charge of the solute ions and was dependent on ion concentration and reaction time. Sorption correlated for the most part with the pK values of the proteins and thus lysozyme, the most basic protein, sorped more than immunoglobulin G, which sorped more than albumin. In all cases, cementum bound more basic protein than did enamel. Increased levels of albumin sorption to enamel occurred when the protein was suspended in the CaCl2 solution rather than in phosphate. In addition, based on Scatchard analysis, approximately twice as many potential protein binding sites were found for cementum versus enamel.

Juvenile periodontitis: healing following autogenous iliac marrow graft, long-term evaluation

A case of juvenile periodontitis treated by autogenous bone grafting is reported. The patient, an 18-year-old female, presented with periodontal lesions around the incisors and the first lower left molar. The first molar was severely affected with bone defects at the mesial aspect and in the furcation region and, for this reason, was selected for grafting. Minced fragments of bone with its marrow, obtained from the patient's iliac crest, were implanted into the diseased periodontium. 1 year after treatment, clinical and radiological inspection revealed the presence of bone. This bone completely filled the furcation area of the tooth but only partially the mesial aspect. There was, also, significant bone fill in the supracrestal region.

Gingival IgE and histamine concentrations in patients with asthma and in patients with periodontitis

In the present study the concentrations of IgE and histamine were determined in gingival tissue of patients with asthma (N = 15), patients with periodontitis (N = 21) and healthy controls (N = 18). Gingival IgE concentrations in the asthma group were markedly elevated confirming the results obtained in previous studies on salivary IgE concentrations. An increase of IgE was also observed in the periodontitis group. Histamine concentrations in the asthma group did not differ from the healthy controls, while in the periodontitis group a significant decrease in gingival histamine concentrations was found.

Role of the polymorphonuclear leukocyte in periodontal health and disease

This review presents evidence for lysosomal enzymes being at least partly responsible for the tissue destruction seen in periodontal disease. However, many other inflammatory and immunologic mechanisms have been identified that can contribute to tissue destruction (Nisengard 1977). The relationship of PMN to the periodontal tissues is equivalent to the proverbial double-edged sword. The localized tissue destruction that may be due to the extracellular release of PMN enzymes in individuals with normal cell function must be weighed against the role of PMN in containment of gingival bacteria and their products. The consequences of qualitative and/or quantitative abnormalities of neutrophils are far more undesirable for the periodontium. It therefore seems logical to propose that the role of polymorphonuclear leukocytes in the gingival tissues is primarily a defensive one. The presence of neutrophils in the gingival crevice has been shown to reflect the inflammatory condition of the tissues. Due to their availability, it may prove beneficial to use gingival crevicular PMN activity as a reliable clinical index of disease activity. The development of appropriate tests to measure PMN may eventually lead to better diagnostic criteria, including the definition of active versus inactive disease.