Salivary infectious agents and periodontal disease status

BACKGROUND AND OBJECTIVES

The potential of salivary microorganisms to diagnose periodontal disease and to guide periodontal treatment is a research topic of current interest. This study aimed to determine whether the salivary counts of periodontopathic microbes correlated with the periodontal pocket counts of the same infectious agents, and whether the salivary counts of the test infectious agents could distinguish among individuals with periodontal health and various types of periodontal disease.

MATERIAL AND METHODS

The study included 150 systemically healthy adults, of whom 37 were periodontally healthy, 31 had gingivitis, 46 had chronic periodontitis and 36 had aggressive periodontitis. Each study subject contributed microbial samples from the two deepest periodontal pockets of the dentition and from whole saliva. Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Epstein-Barr virus were identified using the TaqMan real-time PCR methodology. Statistical analysis was performed using the Mann-Whitney U-test and the receiver operating characteristic statistics.

RESULTS

C. rectus, F. nucleatum, P. gingivalis, P. intermedia and T. forsythia occurred with significantly higher copy-counts in salivary samples from patients with gingivitis, chronic periodontitis and aggressive periodontitis than from periodontally healthy individuals. A. actinomycetemcomitans only showed higher salivary copy-counts in subjects with aggressive periodontitis compared with subjects with healthy periodontium, and the salivary copy-counts of Epstein-Barr virus did not reveal any significant difference among the four subject groups studied. The diagnostic sensitivity for periodontitis was 89.19 for P. gingivalis and for T. forsythia and 86.49 for P. intermedia, with specificities ranging from 83.78 to 94.59. The optimal copy-counts per mL saliva for identifying periodontitis were 40,000 for P. gingivalis, 700,000 for T. forsythia and 910,000 for P. intermedia.

CONCLUSION

Salivary copy-counts of P. gingivalis, T. forsythia and P. intermedia appear to have the potential to identify the presence of periodontitis, whereas the salivary level of the other test infectious agents may possess little or no diagnostic utility. Longitudinal studies are warranted to determine the ability of salivary copy-counts of major periodontopathic bacteria to predict future periodontal breakdown.

Periodontitis lesions are the main source of salivary cytomegalovirus

BACKGROUND

Herpesviruses play causal or cooperative roles in childhood infections, tumorigenesis, ulcerogenesis, and periodontitis. Saliva is a common vehicle of herpesvirus horizontal transmission, but the source of salivary herpesviruses remains obscure. To evaluate the significance of periodontal disease in shedding of oral herpesviruses, this study determined the genome-copy counts of human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) in whole saliva of subjects with periodontitis, gingivitis, or no natural teeth.

METHODS

Whole saliva was collected from 14 periodontitis patients, 15 gingivitis patients and 13 complete denture wearers. The study subjects were systemically healthy and had not received periodontal treatment in the past 3 months. Real-time TaqMan polymerase chain reaction was used to determine the salivary load of HCMV and EBV.

RESULTS

Salivary HCMV was detected in seven (50%) periodontitis patients, but not in any gingivitis or edentulous subjects (P < 0.001). Salivary EBV was detected in 11 (79%) periodontitis patients, in five (33%) gingivitis patients, and in seven (54%) edentulous subjects (P = 0.076). Salivary samples showed copy counts of HCMV in the range of 3.3 x 10(3)-4.2 x 10(4)/ml and of EBV in the range of 3.6 x 10(2)-1.6 x 10(9)/ml.

CONCLUSIONS

HCMV and EBV are commonly present in the saliva of periodontitis patients. Periodontitis lesions of systemically healthy subjects seem to constitute the main origin of salivary HCMV, but do not comprise the sole source of salivary EBV.

Relationship between human cytomegalovirus transcription and symptomatic apical periodontitis in Iran

BACKGROUND/AIMS

Apical periodontitis of endodontic origin may develop as a result of cooperative interactions among herpesviruses, specific pathogenic bacteria and tissue-destructive inflammatory mediators. This study sought to identify the presence of Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) transcripts in symptomatic and asymptomatic periapical lesions of individuals living in Iran.

MATERIAL AND METHODS

Fifty endodontic patients (28 with symptomatic periapical lesions and 22 with asymptomatic periapical lesions) were included in the study. In each study subject, a microbiological periapical sample was collected using a curette in conjunction with periapical surgery. A reverse transcription-polymerase chain reaction assay was used to identify transcripts of EBV and HCMV.

RESULTS

Human cytomegalovirus transcript was detected in 15 of the 28 (53.6%) symptomatic and in six of the 22 (27.3%) asymptomatic periapical study lesions (significant difference between symptomatic and asymptomatic lesions; P = 0.03, chi-square test). Epstein-Barr virus transcript was identified in one symptomatic and in two asymptomatic periapical lesions.

CONCLUSION

This study establishes that HCMV transcription is common in apical periodontitis and is most frequent in symptomatic lesions. The high frequency of active herpesvirus infections in severe apical periodontitis changes the pathogenic paradigm of the disease and may also have preventive and therapeutic implications.

Epstein-Barr virus in oral diseases

Epstein-Barr virus (EBV), a B-lymphotropic gamma-herpesvirus, causes infectious mononucleosis and oral hairy leukoplakia, and is associated with various types of lymphoid and epithelial malignancies. Saliva is the main vehicle for EBV transmission from individual to individual. Recent studies have also implicated EBV in the pathogenesis of advanced types of periodontal disease. EBV DNA is detected in 60-80% of aggressive periodontitis lesions and in 15-20% of gingivitis lesions or normal periodontal sites. The periodontal presence of EBV is associated with an elevated occurrence of periodontopathic anaerobic bacteria. Moreover, EBV active infection occurs in approximately 70% of symptomatic and large-size periapical lesions. EBV and cytomegalovirus often co-exist in marginal and apical periodontitis. Periodontal therapy can markedly suppress the EBV load in periodontal pockets as well as in saliva, which has the potential to reduce the risk of viral transmission between close individuals. EBV proteins up-regulate cytokines and growth factors, which seem to play a central role in the proliferative response of tongue epithelial cells in oral hairy leukoplakia and in the cell-transformation process of EBV-associated malignancies. Further research is needed to identify the full range of EBV-related diseases in the human oral cavity.

Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis subgingival presence, species-specific serum immunoglobulin G antibody levels, and periodontitis disease recurrence

BACKGROUND AND OBJECTIVE

The biological and clinical effects of antibody against periodontal pathogenic bacteria are incompletely understood. This study evaluated the inter-relationships among periodontal levels of cultivable Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis, species-specific serum immunoglobulin G (IgG) antibody levels, and periodontitis disease activity.

MATERIAL AND METHODS

Forty-three adults who had previously been treated for periodontitis and who also harbored cultivable A. actinomycetemcomitans or P. gingivalis were evaluated semiannually for clinical disease recurrence over a 36-month period. Each patient provided subgingival microbial samples, for the recovery of A. actinomycetemcomitans and P. gingivalis, from the two deepest pockets in each dentition sextant. A. actinomycetemcomitans and P. gingivalis serum IgG antibody levels were assessed using enzyme-linked immunosorbent assay (ELISA), together with whole-cell sonicate extracts from A. actinomycetemcomitans serotypes a-c and P. gingivalis ATCC 33277. Data were analyzed using the Mantel-Haenszel chi-square and Fisher exact two-tailed tests.

RESULTS

Eighteen (60.0%) of 30 A. actinomycetemcomitans-positive subjects, and 10 (76.9%) of 13 P. gingivalis-positive subjects, exhibited recurrent periodontal breakdown within 36 months of periodontal therapy. Nineteen (67.9%) of the 28 patients with active periodontitis had A. actinomycetemcomitans or P. gingivalis serum antibody levels below designated threshold values. In comparison, 10 (66.7%) of 15 culture-positive clinically stable subjects showed A. actinomycetemcomitans or P. gingivalis serum antibody levels above threshold values. The difference between specific antibody levels in periodontitis-active and periodontitis-stable patients was statistically significant (p = 0.032).

CONCLUSIONS

Serum levels of IgG antibodies against A. actinomycetemcomitans or P. gingivalis in periodontitis-stable patients were higher than those in patients with active periodontitis. The results suggest that elevated levels of IgG antibody against A. actinomycetemcomitans and P. gingivalis have a detectable protective effect against periodontal infections with these microorganisms.

Human cytomegalovirus, Epstein-Barr virus and bone resorption-inducing cytokines in periapical lesions of deciduous teeth

BACKGROUND

A connection of herpesvirus periapical infection with symptomatic and large-size periapical lesions has been recognized in adult patients, but no data exist about a possible involvement of herpesviruses in severe periapical pathosis in children. Herpesviruses have the potential to elicit potent bone resorption-inducing cytokines in mammalian cells.

AIM

This study aimed to determine the occurrence of human cytomegalovirus and Epstein-Barr virus DNA, and mRNA transcripts of receptor activator of nuclear kappa B ligand (RANKL), osteoprotegerin, core binding factor alpha-1, colony stimulating factor-1, transforming growth factor-beta, and monocyte chemoattractant protein-1 in periapical symptomatic pathosis of deciduous teeth.

MATERIAL AND METHODS

Twelve deciduous molar teeth from patients aged 2-8 years were extracted due to severe periapical infection, and granulomatous tissue adherent to the root tip of the extracted teeth was collected using a surgical knife. Non-diseased pulpal tissue, obtained from 12 teeth extracted for orthodontic reasons, served as negative control. Polymerase chain reaction assays were employed to identify herpesvirus DNA and cytokine gene expression, using established polymerase chain reaction primers and procedures.

RESULTS

Seven (58%) of the periapical lesions yielded human cytomegalovirus and eight (67%) Epstein-Barr virus. Only one (8%) periapical lesion showed neither human cytomegalovirus nor Epstein-Barr virus. In healthy pulpal tissue, one (8%) specimen demonstrated human cytomegalovirus and another (8%) specimen revealed Epstein-Barr virus. Of the cytokines examined, RANKL expression showed significantly higher occurrence in periapical pathosis than in healthy pulpal tissue (P < 0.040). No relationship was identified between the type of herpesvirus and cytokine expression in the periapical lesions studied.

CONCLUSIONS

The present findings provide evidence of a putative role of human cytomegalovirus and Epstein-Barr virus in the pathogenesis of symptomatic periapical pathosis in deciduous teeth. Increased RANKL expression in periapical lesions may be of pathogenetic significance.

Severe periodontitis in a 5-year-old girl with hyperimmunoglobulin E syndrome

The hyperimmunoglobulin E syndrome (HIES) is a multisystem disorder that affects the: (1) dentition; (2) skeleton; (3) connective tissues; and (4) immune system. Little is known about periodontal manifestations of the syndrome. The purpose of this report was to describe a 5-year-old girl with suspected autosomal-recessive HIES syndrome who revealed profusely bleeding and painful gingiva and generalized aggressive periodontitis. A polymerase chain reaction (PCR)-based microbiological examination detected Porphyromonas gingivalis, Tannerella forsythia, Prevotella nigrescens, Treponema denticola, Eikenella corrodens, and Campylobacter rectus in the deep periodontitis lesions. The extraction of all deciduous teeth due to a poor prognosis and risk of systemic infection led to resolution of the oral inflammation. Long-term follow-up is required to determine the periodontal prognosis of the erupting permanent teeth.

Initial antimicrobial effect of controlled-release doxycycline in subgingival sites

OBJECTIVES

To determine the ability of a 10% doxycycline hyclate controlled-release polymer (Atridox) to suppress periodontopathic bacteria when placed subgingivally following scaling and root planing (Sc/Rp).

METHODS

Eight males and seven females, mean age 48 years, with moderate to advanced periodontitis participated in the study. In each patient, bilateral periodontal pockets probing 6-7 mm were randomly assigned to treatment by Sc/Rp + doxycycline polymer or by Sc/Rp alone. Subgingival placement of doxycycline polymer was carried out according to the manufacturer's instructions. Sc/Rp was performed with hand instruments for at least 10 min in each study tooth. Subgingival samples were collected by paper-points at baseline, at 2 weeks and at 4 weeks post-treatment. Culture methodology was used to isolate and identify putative periodontal pathogens, including Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Dialister pneumosintes, Tannerella forsythia, Prevotella intermedia/Prevotella nigrescens, Campylobacter species, Eubacterium species, Fusobacterium species, Peptostreptococcus micros, Eikenella corrodens, Staphylococcus species, enteric gram-negative rods, beta-hemolytic streptococci and yeasts. The microbiologic examination was carried out blindly. Microbiological data were analyzed using a General Linear Model Analysis of Variance for within and between group effects.

RESULTS

Sites receiving Sc/Rp + doxycycline polymer and sites receiving Sc/Rp alone exhibited similar levels of periodontal pathogens at baseline and did not differ significantly in total viable counts and proportional recovery of periodontopathic bacteria post-treatment.

CONCLUSIONS

Controlled-release doxycycline placed in moderate to deep periodontal pockets caused no significant additional reduction in the subgingival pathogenic microbiota compared to thorough Sc/Rp alone. Since controlled-release doxycycline may not significantly suppress several subgingival pathogenic microorganisms and seems to possess no distinct advantage over broad-spectra, safe and inexpensive antiseptics, the rationale for its employment in periodontal therapy remains unclear.

Update on human cytomegalovirus in destructive periodontal disease

AIM

Human cytomegalovirus (HCMV), a herpesvirus, is discussed in this review as it relates to destructive periodontal disease in humans.

RESULTS

HCMV genomic sequences, detected by polymerase chain reaction identification, occur with elevated frequency in severe adult periodontitis, localized and generalized aggressive (juvenile) periodontitis, Papillon-Lefèvre syndrome periodontitis, acute necrotizing ulcerative gingivitis, and periodontal abscesses.

DISCUSSION

Herpesviruses establish lifelong persistent infections. HCMV infection involves an asymptomatic latent phase interrupted by periods of recrudescence where viral replication and possibly clinical disease become manifest. HCMV reactivation is triggered by a number of immunosuppressive factors, some of which have been shown also to be risk factors/indicators of periodontitis. HCMV periodontal infection may cause release of tissue-destructive cytokines, overgrowth of pathogenic periodontal bacteria, and initiation of cytotoxic or immunopathologic events.

CONCLUSIONS

A growing body of data supports the concept that HCMV contributes to severe types of periodontal disease. HCMV infection of the periodontium may alter the immune control of resident microorganisms and be important in a multistage pathogenesis of periodontitis involving viral activation, periodontopathic bacteria, and host immune responses. Understanding the significance of HCMV and other herpesviruses in the development of periodontal disease may have important therapeutic implications. Vaccines against HCMV, which are in various stages of development, need to be evaluated for their ability to decrease the incidence of destructive periodontal disease.

Cytomegalovirus infection in symptomatic periapical pathosis

AIM

To compare the presence of human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) infections in samples from 25 symptomatic and 19 asymptomatic periapical lesions.

METHODOLOGY

Periapical samples were collected by sterile curettes in conjunction with apicectomy. cDNA-based HCMV and EBV identification was performed on total mRNAs extracted from peripapical tissues, using primers for genes transcribed during the productive phase of the herpesvirus infection. Statistical analysis was performed using chi-squared test.

RESULTS

HCMV was detected in 100% of the symptomatic and in 37% of the asymptomatic study lesions. EBV was identified only in HCMV-infected periapical lesions. The difference in occurrence of HCMV and EBV between symptomatic and asymptomatic periapical lesions was statistically significant (P < 0.0001).

CONCLUSIONS

The noteworthy finding of this study was the ubiquitous occurrence of HCMV active infection in symptomatic periapical pathosis. EBV may contribute to periapical pathogenesis in a subset of symptomatic lesions. HCMV and EBV infections may cause periapical pathosis by inducing cytokine and chemokine release from inflammatory or connective tissue cells, or by impairing local host defences resulting in heightened virulence of resident bacterial pathogens. Knowledge about the role of herpesviruses in periapical pathosis seems important to fully delineate the pathogenesis of endodontic infectious diseases. HCMV and probably EBV should be added to the list of putative pathogenic agents in symptomatic periapical disease.

Human cytomegalovirus and Epstein-Barr virus type 1 in periodontal abscesses

OBJECTIVES

Recent studies have linked herpesviruses to severe types of periodontal disease, but no information exists on their relationship to periodontal abscesses. The present study determined the presence of human cytomegalovirus (HCMV) and Epstein-Barr virus type 1 (EBV-1) in periodontal abscesses and the effect of treatment on the subgingival occurrence of these viruses.

MATERIAL AND METHODS

Eighteen adults with periodontal abscesses participated in the study. Subgingival samples were collected from each patient with sterile curettes from an abscess-affected site and a healthy control site. HCMV and EBV-1 were identified by polymerase chain reaction at the time of the abscess and at 4 months after surgical and systemic doxycycline therapy.

RESULTS

HCMV was detected in 66.7% of periodontal abscess sites and in 5.6% of healthy sites (P=0.002). EBV-1 occurred in 72.2% of abscess sites but not in any healthy site (P<0.001). HCMV and EBV-1 co-infection was identified in 55.6% of the abscess sites. Posttreatment, HCMV and EBV-1 were not found in any study site.

CONCLUSIONS

HCMV and EBV-1 genomes are commonly found in periodontal abscesses. These data favor a model in which a herpesvirus infection of the periodontium impairs the host defense and serves as a platform for the entrance of bacterial pathogens into gingival tissue with subsequent risk of abscess development.

Cytomegalovirus and Epstein-Barr virus are associated with symptomatic periapical pathosis

BACKGROUND

Recent studies have identified human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) in symptomatic periapical lesions. Little information exists on HCMV and EBV in asymptomatic periapical lesions.

AIM

To compare the presence of late transcripts of HCMV, EBV and herpes simplex virus (HSV) in symptomatic and asymptomatic periapical lesions.

METHODS

Periapical samples were collected from seven symptomatic and seven asymptomatic periapical lesions at the time of apicoectomy. HCMV, EBV and HSV late mRNAs were identified by reverse transcription polymerase chain reaction.

RESULTS

HCMV mRNA was detected in all seven symptomatic periapical lesions and in one asymptomatic lesion (Chi-squared test, Yates'P-value = 0.007). EBV mRNA was detected in six symptomatic lesions and in one asymptomatic lesion (P = 0.04). One asymptomatic lesion yielded HSV mRNA.

CONCLUSIONS

HCMV and EBV active infections are associated with acute exacerbation of apical periodontitis. HSV seems to be unimportant in periapical pathosis.

Povidone-iodine as a periodontal pocket disinfectant

OBJECTIVES AND BACKGROUND

Povidone-iodine [polyvinylpyrrolidone-iodine complex (PVP-iodine)] might constitute a valuable adjunct to current periodontal therapy because of its broad-spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and low financial cost. This investigation employed a randomized, split-mouth study design to determine the microbiological and clinical effects of 10% PVP-iodine subgingival irrigation in periodontitis lesions showing radiographic evidence of subgingival calculus.

METHODS

Sixteen adults having at least one periodontal pocket of 6 mm or more in each quadrant of the dentition and harboring one or more periodontopathic bacteria participated in the study. In each subject, a study site in each quadrant was randomly chosen to receive either subgingival irrigation with 10% PVP-iodine together with scaling and root planing, scaling and root planing alone, subgingival irrigation with 10% PVP-iodine, or subgingival irrigation with sterile saline. Prior to therapy and at 5 weeks post-treatment, microbiological culture was carried out without knowledge of the clinical status or the type of treatment rendered. A blinded clinical examiner determined presence of dental plaque, probing pocket depth, and gingival bleeding on probing. Microbiological and clinical data were analyzed using a repeated measures analysis of variance and Kruskal-Wallis rank test with the Tukey and Mann-Whitney post hoc tests.

RESULTS

At 5 weeks post-treatment, subgingival irrigation with PVP-iodine together with scaling and root planing caused a 95% or greater reduction in total pathogen counts in 44% of pockets having >/= 6 mm depth whereas scaling and root planing alone, povidone-iodine irrigation alone and water irrigation alone caused 95% reduction of total pathogens only in 6-13% of similar study sites (P = 0.02). Reduction in mean pocket depth was 1.8 mm for the PVP-iodine/scaling and root planing group, 1.6 mm for the scaling and root planing group, and 0.9 mm for the PVP-iodine and the saline monotherapy groups, with statistical significance reached for the scaling and root planing group vs. the PVP-iodine group (P = 0.04) and for the scaling and root planing group vs. the saline group (P = 0.02). Reduction in visible dental plaque, which ranged from 38% to 62%, showed no significant differences among treatment groups.

CONCLUSIONS

The addition of subgingival PVP-iodine irrigation to conventional mechanical therapy may be a cost-effective means of reducing total counts of periodontal pathogens and helping control periodontal disease. However, subgingival irrigation with PVP-iodine without concomitant mechanical debridement might not improve microbiological and clinical variables in comparison with saline irrigation, at least not in sites with radiographic evidence of subgingival calculus.

The herpesvirus-Porphyromonas gingivalis-periodontitis axis

OBJECTIVES AND BACKGROUND

Members of the herpesvirus family have accumulated considerable support for a role in severe types of periodontitis. This study aimed to examine whether human cytomegalovirus (HCMV), Epstein-Barr virus type 1 (EBV-1) or herpes simplex virus (HSV) together with the major periodontopathic bacterium Porphyromonas gingivalis might interact in the pathogenesis of periodontal breakdown.

METHODS

Sixteen subjects each contributed paper point samples from two progressing and two stable periodontitis lesions, as determined by ongoing loss of probing attachment. Polymerase chain reaction methodology was used to identify subgingival herpesviruses, P. gingivalis and other bacterial pathogens. Chi-squared tests and multivariate logistic regression were employed to identify statistical associations between herpesviruses, periodontopathic bacteria and clinical variables.

RESULTS

HCMV and HSV were both significant predictors of the presence of subgingival P. gingivalis. In turn, P. gingivalis was positively associated with periodontitis active disease, probing attachment level, probing pocket depth, gingival bleeding upon probing and patient age. EBV-1 was not linked to P. gingivalis, although the virus was predictive of periodontitis active disease. The periodontitis disease risk associated with herpesvirus-P. gingivalis combinations depended on both site-specific and subject-specific factors.

CONCLUSION

The present data of aggressive periodontitis implicate HCMV, HSV and P. gingivalis as either cofactors in its etiology or triggers of relapses. Further studies are needed to determine the spectrum of periodontopathogenicity of herpesviruses and effective management of these viruses in periodontal sites.

Cytomegalovirus and Epstein-Barr virus active infection in periapical lesions of teeth with intact crowns

Herpesviruses seem to play an important role in the pathogenesis of aggressive periodontitis and may also contribute to periapical pathosis. This study determined the presence of human cytomegalovirus, Epstein-Barr virus, and herpes simplex virus productive infection in five symptomatic periapical lesions of teeth having intact crowns and calcified necrotic pulps. Periapical samples were collected in conjunction with periapical surgery and kept frozen until virological examination. Reverse transcription-polymerase chain reaction was used in herpesviral identification. RNA was isolated from periapical tissue by a guanidinium isothiocyanate-acid phenol procedure. cDNAs were generated from highly conserved regions of the test viruses using a preamplification kit. Sensitivity and validity of the PCR-primers were determined according to established methods. Amplification products were identified using gel electrophoresis. Human cytomegalovirus and Epstein-Barr virus dual transcription was detected in all five periapical lesions studied. Herpes simplex virus transcript was not identified in any lesion. The present data suggest that human cytomegalovirus or Epstein-Barr virus activation participate in the pathogenesis of symptomatic periapical lesions. We hypothesize that periapical active herpesvirus infection impairs local defenses, thereby inducing overgrowth of endodontopathic bacteria and the clinical flare-up of inflammation.

Cytomegalovirus and Epstein-Barr virus DNA transcription in endodontic symptomatic lesions

OBJECTIVES

Productive Herpesviridae infections are implicated in the etio-pathogenesis of aggressive periodontitis. However, virtually nothing is known about a possible role of herpesviruses in pulpal and periapical pathosis. This study employed a cDNA analysis to determine transcription of human cytomegalovirus (HCMV), Epstein-Barr virus (EBV) and herpes simplex virus (HSV) in 14 recalcitrant periapical lesions and in 2 periapical healthy control sites.

METHODS

Periapical samples were collected in conjunction with periapical surgery and kept frozen until virologic examination. RNA was isolated from periapical tissue by using a guanidinium isothiocyanate-acid phenol procedure (TRIZOL LS Reagent, GIBCO BRL, Rockville, MD). cDNAs were amplified by means of oligonucleotides targeting highly conserved regions of the test viruses and the RT-PCR-100 amplification kit (Sigma-Aldrich, St Louis, MO). Standardization of PCR primer sensitivity and validation was carried out according to established methods. Amplification products were identified by agarose gel electrophoresis.

RESULTS

HCMV transcript was detected in 12 of 13 symptomatic and in 1 asymptomatic periapical lesion. EBV transcript was demonstrated in 8 of the 13 symptomatic lesions but not in the asymptomatic periapical lesion. HCMV and EBV dual transcription occurred at higher frequency in periapical lesions showing radiographic bone destruction of 5 mm x 7 mm or larger than in smaller size lesions (P = 0.03; Chi-squared test). No HCMV or EBV transcription was identified in the 2 healthy control sites. HSV transcript was not detected in any study site.

CONCLUSION

The present data suggest that HCMV or EBV infections participate in the pathogenesis of periapical symptomatic lesions. Herpesviruses may produce periapical pathosis as a direct result of viral infection and replication, or as a consequence of virally induced impairment of the host defense and subsequent increased virulence of resident bacterial pathogens.

Cytomegalovirus periodontal presence is associated with subgingival Dialister pneumosintes and alveolar bone loss

Destructive periodontal disease is associated with human cytomegalovirus (HCMV), Epstein-Barr type 1 virus (EBV-1) and other members of the Herpesviridae family as well as with various gram-negative anaerobic bacteria, including the Dialister pneumosintes species. This study aimed to determine possible interrelationships between periodontal HCMV, EBV-1, herpes simplex virus and D. pneumosintes, and relate the microbiological findings to periodontitis clinical status. Sixteen subjects each contributed paper point samples from two progressing and two stable periodontitis lesions, as determined by ongoing loss of probing attachment. Polymerase chain reaction methodology was used to identify the study herpesviruses and D. pneumosintes. Chi-squared tests, Fisher exact tests and multivariate logistic regression were employed to identify statistical associations among herpesviruses, bacteria and clinical variables. HCMV, and no other virus or combination of viruses, was positively associated with the presence of D. pneumosintes, and the relationship was specific for individual periodontitis sites with no detectable subject effect. D. pneumosintes was in turn positively associated with periodontal pocket depth and disease-active periodontitis. When the average percentage of alveolar bone loss in all teeth was treated as a response, HCMV remained significant even after D. pneumosintes was included in the model, suggesting that both HCMV and D. pneumosintes affected bone loss or, alternatively, HCMV affected factors not studied that themselves can induce bone loss. We hypothesize that periodontal HCMV sets the stage for subgingival proliferation of D. pneumosintes and subsequent periodontal disease progression. Studies on herpesviral-bacterial interactions may hold great promise for delineating important etio-pathogenic aspects of destructive periodontal disease.

Treatment of Papillon-Lefèvre syndrome periodontitis

BACKGROUND, AIMS

Conventional mechanical treatment of Papillon-Lefèvre syndrome periodontitis has a poor prognosis. This report describes an effective antimicrobial treatment of rapidly progressing periodontitis in an 11-year old girl having Papillon-Lefèvre syndrome.

METHOD

Clinical examination included conventional periodontal measurements and radiographic analysis. Occurrence of major suspected periodontopathic bacteria was determined by selective and non-selective culture and by polymerase chain reaction (PCR) identification. Presence of cytomegalovirus and Epstein-Barr type 1 virus was determined by a nested-PCR detection method. Therapy included scaling and root planing, oral hygiene instruction, and systemic amoxicillin-metronidazole therapy (250 mg of each/3 times daily/10 days) which, based on follow-up microbiological testing, was repeated after 4 months. Supportive periodontal therapy took place at 2 visits during a 16-month period.

RESULTS

At baseline, 10 of 22 available teeth demonstrated severe periodontal breakdown. At 16 months, probing and radiographic measurements revealed no teeth with additional attachment loss, and several teeth exhibited significant reduction in gingivitis and pocket depth, increase in radiographic alveolar bone height and clinical attachment level, and radiographic evidence of crestal lamina dura. Baseline subgingival microbiota included Actinobacillus actinomycetemcomitans (3.4% of total isolates), Prevotella nigrescens (16.4%), Fusobacteriumnucleatum (14.3%) and Peptostreptococcus micros (10.6%), as well as cytomegalovirus and Epstein-Barr type 1 virus. At termination of the study, culture and PCR examinations showed absence of A. actinomycetemcomitans, P. micros and herpesviruses, and P. nigrescens and F.nucleatum each comprised less than 0.1 % of subgingival isolates.

CONCLUSION

This study suggests that controlling the periodontopathic microbiota by appropriate antibiotic and conventional periodontal therapy can arrest Papillon-Lefèvre syndrome periodontitis.

Antimicrobials in periodontal maintenance

Mechanical and chemical antimicrobial intervention is the mainstay of preventive periodontal therapy. Successful periodontal maintenance care depends upon the ability of oral health care professionals to combat periodontal infections, and patient compliance with prescribed follow-up care. Since tooth brushing, flossing, and oral rinsing do not reach pathogens present in furcations and at the depths of deep periodontal pockets, adequate oral hygiene should include subgingival treatment with home irrigators or other appropriate self-care remedies in patients with these conditions. Povidone-iodine for professional use and diluted bleach for self-care are inexpensive and valuable antimicrobial agents in periodontal maintenance. The present article outlines the prudent use of antimicrobial therapy in periodontal maintenance.

General health risk of periodontal disease

The possibility that periodontal disease might influence the morbidity and mortality of systemic diseases constitutes a research topic of great current interest. Human periodontal disease is associated with a complex microbiota containing approximately 500 microbial taxa and various human viruses, many of which possess significant virulence potential. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and other periodontopathic bacteria that are unique to the oral cavity and may disseminate to other body sites comprise the best-documented form of dental focal infection. However, systemically healthy individuals seem to be at low risk of acquiring acute non-oral diseases from direct infections by periodontal pathogens. Research data from various laboratories point to periodontal infections as a risk factor for chronic medical disorders, including cardiovascular disease, cerebrovascular accidents and low-birth-weight infants. However, recent epidemiological studies have failed to show a significant relationship between periodontal disease and cardiovascular disease. This review paper evaluates the current status of knowledge on dental focal infection and suggests avenues for further research into the topic of general health risks of periodontal disease.

Aggressive periodontitis associated with Fanconi's anemia. A case report

BACKGROUND

Fanconi's anemia is an autosomal recessive disease associated with chromosomal breakage as well as pancytopenia, skin pigmentation, renal hypoplasia, cardiac defects, microcephaly, congenital malformations of the skeleton, hypogonadism, and increased risk of leukemia. The present report describes the periodontal clinical and microbiological status of an 11-year old male having Fanconi's anemia.

METHODS

Polymerase chain reaction analysis to detect human cytomegalovirus (HCMV), Epstein-Barr type 1 virus, and herpes simplex virus (HSV) was performed on paper-point samples pooled from either 3 periodontal sites with advanced attachment loss or 3 gingivitis sites with no clinical attachment loss. Anaerobic bacterial culture examination was performed on the pooled periodontitis sample.

RESULTS

The patient suffered from pancytopenia, allergy, asthma, hearing impairment, and mental retardation. Dentition consisted of 7 primary teeth, 11 erupted permanent teeth, and 14 unerupted permanent teeth. Most erupted teeth showed severe gingival inflammation with some gingival overgrowth and various degrees of periodontal attachment loss. Genomes of HCMV and HSV were detected in the pooled periodontitis sample and HCMV in the pooled gingivitis sample. The periodontitis sample but not the gingivitis sample revealed HCMV mRNA of major capsid protein, suggestive of active viral infection. The periodontitis sample also yielded Actinobacillus actinomycetemcomitans (1.1% of total isolates), FusobActerium species (7.9%), Campylobacter species (2.2%), Peptostreptococcus micros (3.4%), and Candida albicans (0.3%).

CONCLUSIONS

Oral features of Fanconi's anemia may include increased susceptibility to periodontitis. It is likely that underlying host defense impairment coupled with periodontal infection by HCMV and A. actinomycetemcomitans contribute to the severe type of periodontitis associated with Fanconi's anemia.

Herpes viruses and periodontopathic bacteria in early-onset periodontitis

OBJECTIVES

This study examined the occurrence of human herpes viruses and suspected periodontopathic bacteria in early-onset periodontitis patients who experienced progressive disease in at least 2 periodontal sites during the maintenance phase of therapy.

MATERIAL AND METHODS

In each of 16 individuals (9 male and 7 female; mean age 33.1+/-2.6 years), subgingival plaque samples were collected from 2 deteriorating and 2 stable periodontitis sites. A nested polymerase chain reaction method determined the presence of human cytomegalovirus (HCMV), Epstein-Barr virus type 1 (EBV-1) and herpes simplex virus (HSV). A 16s rRNA polymerase chain reaction method identified Porphyromonas gingivalis, Dialister pneumosintes, Bacteroides forsythus and Actinobacillus actinomycetemcomitans.

RESULTS

HCMV was detected in 59.4% of active and in 12.5% of stable sites (p<0.001), EBV-1 in 43.8% of active and in 12.5 % of stable sites (p=0.01), HSV in 34.5% of active and in 9.4% of stable sites (p=0.03), and co-infection with any of the 3 test herpesviruses in 43.8% of active and in 3.1% of stable sites (p<0.001). P. gingivalis was detected in 71.9% of active and in 37.5% of stable sites (p=0.01), D. pneumosintes in 62.5% of active and in 18.8% of stable sites (p=0.04), co-infection with P. gingivalis and D. pneumosintes in 50% of active and in 0% of stable sites (p<0.001), and co-infection with any 3 or 4 of the test bacteria in 40.6% of active and in 0% of stable sites (p=0.001). All periodontitis sites showing herpesvirus co-infection and all but one site showing P. gingivalis and D. pneumosintes co-infection revealed bleeding upon probing.

CONCLUSIONS

HCMV, EBV-1, HSV and herpesvirus co-infection, as well as P. gingivalis, D. pneumosintes and P. gingivalis-D. pneumosintes co-infection were statistically associated with active periodontitis. Herpesviruses are immunosuppressive and may set the stage for overgrowth of subgingival P. gingivalis, D. pneumosintes and other periodontopathic bacteria. Understanding the significance of herpesviruses in human periodontitis may allow for improved diagnosis, more specific therapy and, ultimately, disease prevention.

Subgingival strains of Candida albicans in relation to geographical origin and occurrence of periodontal pathogenic bacteria

Clonal diversity of subgingival yeast strains was determined in relation to geographical location and coexistence of selected periodontal pathogenic bacteria. A total of 60 dental patients from Finland, the United States and Turkey each contributed five Candida albicans isolates. C. albicans isolates were serotyped using slide agglutination and genotyped using polymerase chain reaction (PCR) amplification and a random sequence primer. In general, each study subject yielded C. albicans isolates belonging to the same serotype and genotype. C. albicans serotype A occurred more frequently in subjects from Finland and Turkey than in subjects from the United States. A total of 27 PCR-based C. albicans genotypes were identified. One C. albicans genotype occurred with particularly high frequency in subjects from Turkey and another genotype in subjects from the United States. Relationships were identified between C. albicans serotypes and genotypes. Further studies are needed to determine environmental factors of importance for subgingival colonization and persistence of C. albicans.

Typing of herpes simplex virus from human periodontium

Herpes simplex virus (HSV) is frequently detected in gingival crevicular fluid and in gingival biopsies of periodontal lesions; however, the relative occurrence of HSV type 1 and 2 in periodontal specimens has not been established. This investigation used type-specific polymerase chain reaction (PCR) to detect the presence of HSV-1 and HSV-2 in periodontal pocket samples from 26 patients who had previously been revealed to have periodontal HSV by PCR amplification of a gene shared by HSV-1 and HSV-2. HSV-1 was detected in all 26 periodontal pocket specimens and HSV-2 was not detected. Apparently, HSV-2 is a rare inhabitant of periodontal sites.

Herpesviruses in HIV-periodontitis

BACKGROUND/AIMS

Human herpesvirus-associated diseases exhibit elevated morbidity and mortality in patients infected with human immunodeficiency virus (HIV). This study aimed to investigate the occurrence of herpesviruses in HIV-periodontitis.

METHOD

Gingival biopsies from periodontitis lesions of 21 HIV-patients and 14 non HIV-patients were studied. Nested-polymerase chain reaction methods were employed to detect human cytomegalovirus, Epstein-Barr virus type 1 and 2 (EBV-1, EBV-2), herpes simplex virus, human herpes virus (HHV)-6, HHV-7 and HHV-8.

RESULTS

Gingival biopsies from HIV-periodontitis lesions showed on average 4.0 herpesvirus species and gingival biopsies from HIV periodontitis lesions of non-HIV patients revealed an average of 1.9 herpesvirus species (p<0.001). Occurrence of 4 to 6 different herpesviruses was more common in HIV- than in non HIV-gingival biopsies (71% vs. 7%) (p<0.001). EVB-2 was detected in 12 (57%) biopsies from HIV-periodontitis but was absent in non HIV-periodontitis biopsies (p= 0.002). HHV-6 also occurred in significantly higher frequency in HIV-periodontitis (71%) than in non HIV-periodontitis (21%) (p=0.01). HHV-8 was detected only in biopsies from HIV-periodontitis lesions..

CONCLUSION

HIV-periodontitis seems to be associated with elevated occurrence of EBV-2, HHV-6 and herpesvirus co-infections compared to periodontitis in non-HIV-patients. The periodontopathic significance of herpesviruses in HIV-periodontitis constitutes a research topic of considerable interest.

Herpesviruses: a unifying causative factor in periodontitis?

Human cytomegalovirus and Epstein-Barr virus type 1 are discussed in this review as they relate to destructive periodontal disease in humans. Genomes of the two herpesviruses occur frequently in severe adult periodontitis, localized and generalized juvenile periodontitis, Papillon-Lefèvre syndrome periodontitis, Down's syndrome periodontitis, HIV-associated periodontitis and acute necrotizing ulcerative gingivitis. Herpesvirus infections generally involve a mild or asymptomatic primary phase followed by an asymptomatic latent phase interrupted sporadically by periods of activation, where viral replication and possibly clinical disease become manifest. Herpesvirus reactivation is triggered by a number of immunosuppressing factors, some of which have also been shown to be risk indicators of periodontal disease. Available evidence argues for the involvement of active cytomegalovirus infection in the initiation and progression of localized juvenile periodontitis and possibly other types of periodontal disease. In periodontal disease, herpesviruses may cause release of tissue-destructive cytokines, overgrowth of pathogenic periodontal bacteria, and initiation of cytotoxic or immunopathogenic events. Understanding the significance of herpesviruses in the causation and pathogenesis of destructive periodontal diseases may have important implications in future prevention and treatment of the diseases.

Frequency of 530-bp deletion in Actinobacillus actinomycetemcomitans leukotoxin promoter region

Actinobacillus actinomycetemcomitans strains showing a 530-bp deletion in the promoter region of the leukotoxin gene operon elaborate high amounts of leukotoxin that may play a role in the pathogenesis of periodontal disease. This study used polymerase chain reaction detection to determine the occurrence of the 530-bp deletion in 94 A. actinomycetemcomitans strains from individuals of various ethnic backgrounds. Eleven blacks and one Hispanic subject but no Caucasian or Asian subjects showed the 530-bp deletion in the leukotoxin promoter region, suggesting that the deletion is mainly a characteristic of individuals of African descent. A. actinomycetemcomitans strains exhibiting a deletion in the leukotoxin promoter region occurred both in individuals having severe periodontitis and in adolescents revealing no evidence of destructive periodontal disease.

Herpesviruses 6, 7 and 8 in HIV- and non-HIV-associated periodontitis

Human herpesviruses, especially cytomegalovirus and Epstein Barr virus type-1, occur with higher frequency in subgingival specimens from periodontitis lesions than from healthy/gingivitis sites. Little or no information is available on the relationship between herpesvirus 6 (HHV-6), herpesvirus 7 (HHV-7) and herpesvirus 8 (HHV-8) and periodontal disease. This study determined the periodontal occurrence of HHV-6, HHV-7 and HHV-8 in 21 HIV-seropositive and 14 HIV-negative adults affected by periodontitis. Gingival biopsy specimens and paper-point samples of subgingival plaque were collected from sites showing 5 mm or more in probing depth. Nested polymerase chain reaction methodology was employed in herpesvirus identification. In the HIV-seropositive periodontitis group, 90% of gingival biopsies and 62% of subgingival plaque samples revealed at least one of the test viruses. HHV-6 occurred in 71%, HHV-7 in 67% and HHV-8 in 24% of gingival biopsies. In the HIV-negative adult periodontitis group, 43% of gingival biopsies showed at least 1 of the test viruses, with HHV-6 present in 21% and H HV-7 in 29% of gingival biopsies and with no detection of HHV-8. The combined occurrence of the 3 test herpesviruses was significantly higher in HIV-seropositive than in HIV-negative adult periodontitis patients (p = 0.008). The human periodontium might constitute a site of infection or reservoir for HHV-6, -7, -8.

Clinical and microbiologic study of periodontal surgery by means of apically positioned flaps with and without osseous recontouring

In periodontitis lesions with interproximal craters, periodontal flap surgery with osseous recontouring allows more apical positioning of the soft periodontal tissue than flap surgery without osseous recontouring. The present study determined the clinical and microbiologic responses to periodontal surgery with and without osseous recontouring in adult periodontitis lesions with interproximal craters. In 7 osseous surgery patients, osteoplasty and ostectomy were performed from the lingual/palatal aspect to eliminate interproximal osseous defects and to partly mimic the original alveolar bony transition to neighboring teeth. In 7 nonosseous surgery patients, the surgical flap was adapted to the preexisting osseous level. Clinical monitoring included periodontal probing depth, Plaque Index, gingival bleeding index, and radiographic examination. Samples of the subgingival microbiota were examined. In sites treated with osseous surgery, mean pocket depth was 5.5 mm at baseline, 1.9 mm at 1 month, 2.0 mm at 3 months, and 2.1 mm at 6 months. In sites not receiving osseous recontouring surgery, the corresponding pocket depths were 5.9 mm, 3.1 mm, 3.8 mm, and 4.1 mm. At baseline in the osseous surgery group, Actinobacillus actinomycetemcomitans was recovered from one patient and Porphyromonas gingivalis from 5 patients; posttreatment, these microbiota were not detected in any patient. In the nonosseous surgery group, the presence of A actinomycetemcomitans increased posttreatment, and levels of P gingivalis remained essentially unchanged after therapy. This study suggests that in patients not receiving adjunctive antibiotic therapy, apically positioned flap surgery with osseous recontouring is more effective than apically positioned flap surgery without osseous recontouring in reducing periodontal pocket depth and levels of major periodontal pathogens.

Efficient antimicrobial treatment in periodontal maintenance care

BACKGROUND

The goal of follow-up care after periodontal therapy is to preserve the function of individual teeth and the dentition, ameliorate symptoms and simplify future surgery or make it unnecessary. Effective follow-up periodontal care depends on early diagnosis and treatment, as well as patient education.

RESULTS

The main determinants of successful periodontal maintenance therapy are dental professionals' ability to combat periodontal infections and patients' compliance with prescribed follow-up care. Mechanical and chemical antimicrobial intervention is the mainstay of preventive periodontal therapy. Chemotherapeutics alone are unlikely to be effective in the presence of subgingival calculus, underscoring the importance of subgingival mechanical débridement. Also, because toothbrushing and rinsing alone do not reach pathogens residing in periodontal pockets of increased depths, oral hygiene procedures should include subgingival treatment with home irrigators or other appropriate self-care remedies.

CLINICAL IMPLICATIONS

When considering possible preventive therapies, dental professionals must weigh the risk of patients' acquiring destructive periodontal disease against potentially adverse effects, financial costs and inconvenience of the preventive treatment. The authors discuss theoretical and practical aspects of follow-up care for patients with periodontal disease. In addition, because it can be both difficult and expensive to control periodontal disease via conventional preventive measures alone, they present a new, simple and more cost-effective antimicrobial protocol for supportive periodontal therapy.

Molecular identification of Dialister pneumosintes in subgingival plaque of humans

Dialister pneumosintes is a nonfermentative, anaerobic, gram-negative rod that grows with small, circular, transparent, shiny, smooth colonies on blood agar. Even though D. pneumosintes has been recovered from deep periodontal pockets, little is known about the relationship between the organism and destructive periodontal disease. This study describes a rapid PCR method to identify D. pneumosintes in periodontal samples. The PCR identification method detected as little as 10 pg of D. pneumosintes DNA or about 1 to 10 cells without nonspecific amplification of various periodontopathic bacteria. Twelve of 22 subgingival samples from adult periodontitis lesions yielded D. pneumosintes either by culture or by PCR identification. In culture-positive samples, D. pneumosintes averaged 3.9% (0.001 to 10.8%) of total isolates. Studies are needed to delineate virulence factors of D. pneumosintes pertinent to periodontal disease.

Importance of Dialister pneumosintes in human periodontitis

Anaerobic bacteria play important roles in the pathogenesis of human periodontitis. This study examined the relationship between a potentially new periodontopathic bacterium Dialister pneumosintes and periodontal disease. A total of 73 women and 62 men aged 18 to 86 years participated in the study. Using a 16S rRNA polymerase chain reaction identification method, the presence of D. pneumosintes was determined in paper-point samples from periodontal pockets of 105 periodontitis and 30 gingivitis patients. D. pneumosintes was detected in 83% of patients having severe periodontitis and in 19% of patients having slight periodontitis. We suggest adding D. pneumosintes to the group of suspected periodontal pathogens.

Human herpesviruses and Porphyromonas gingivalis are associated with juvenile periodontitis

BACKGROUND

Although herpesviruses have been associated with adult periodontitis, their relationship with juvenile periodontitis (JP) has not been established. This case-control study examined possible associations between JP and pathogenic bacteria, the human cytomegalovirus (HCMV), and the Epstein-Barr type 1 virus (EBV-1).

METHODS

Subjects were participants in a larger survey of schoolchildren in North-Central Jamaica. Subgingival plaque samples from 15 subjects with JP, 20 with incipient periodontitis (IP), and 65 randomly-selected healthy controls were assayed for Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans using a 16S rRNA polymerase chain reaction (PCR) identification method, and for HCMV and EBV-1 using nested PCR identification.

RESULTS

Strong bivariate associations were found between JP and P. gingivalis (odds ratio [OR] = 12.7; 95% CI = 2.6, 61.4), HCMV (OR = 10.0; 95% CI = 2.7, 36.3), and A. actinomycetemcomitans (OR = 8.0; 95% CI = 2.3, 27.5), but not EBV-1. In multivariate analyses, P. gingivalis remained a significant explanatory variable (OR = 7.8; 95% CI = 1.5, 40.9); however, the associations were marginal for HCMV (OR = 4.6; 95% CI = 0.9, 22.7), and non-significant for A. actinomycetemcomitans (OR = 2.0; 95% CI = 0.4, 9.7). The associations with JP and the extent of attachment loss were even stronger when both P. gingivalis and HCMV were detected together. P. gingivalis (OR = 3.9; 95% CI = 1.3, 12.0) and EBV-1 (OR = 3.3; 95% CI = 1.0, 10.3) were the only significant explanatory variables in the multivariate analysis of IP.

CONCLUSIONS

P. gingivalis is the strongest and most stable indicator of periodontitis in Jamaican adolescents. Co-infection with P. gingivalis and HCMV appears to be particularly deleterious to periodontal health.

Primer for antimicrobial periodontal therapy

Successful prevention and treatment of periodontitis is contingent upon effective control of the periodontopathic microbiota. Periodontal pathogens reside in subgingival sites but also colonize supragingival plaque, tongue dorsum and other oral sites. Controlling destructive periodontal disease warrants a comprehensive antimicrobial approach that targets periodontal pathogens in various ecological niches of the oral cavity. Also, to effectively combat periodontal pathogens, the various elements of antimicrobial periodontal therapy should be engaged within a short period of time. Scaling and root planing, with or without periodontal surgery, along with proper oral hygiene, constitute the primary approach to controlling periodontopathogens. Antimicrobial agents administered systemically or locally can help suppress periodontal pathogens in periodontal sites and in the entire mouth. Microbiological testing aids the clinician in selecting the most effective antimicrobial agent or combination of agents, and in monitoring the effectiveness of periodontal treatment. The present paper considers theoretical and practical aspects of effective antimicrobial treatment of destructive periodontal disease.

Herpesviruses and periodontopathic bacteria in Trisomy 21 periodontitis

BACKGROUND

Little is known about the etiology and pathogenesis of periodontal disease in Trisomy 21 patients. This study determined the occurrence of herpesviruses and putative periodontopathic bacteria in Trisomy 21 periodontitis.

METHODS

Nineteen Trisomy 21 patients (17 to 37 years of age) contributed subgingival samples from molar and bicuspid teeth presenting interproximal periodontitis lesions (probing depths, 5 to 8 mm) and from shallow periodontal sites (probing depths, 1 to 3 mm). Samples were obtained at baseline, and at 1 and 4 weeks after subgingival debridement by means of hand instruments and ultrasonic scalers. Epstein-Barr virus type 1 and 2 (EBV-1 and EBV-2), human cytomegalovirus (HCMV), and herpes simplex virus (HSV) were identified by sensitive and specific nested polymerase chain reaction. Putative periodontopathic bacteria were identified by means of non-selective and selective culture.

RESULTS

Of 19 Trisomy 21 periodontitis lesions, 6 (32%) were positive for EBV-1, 5 (26%) were positive for HCMV, 3 (16%) were positive for HSV, and 2 (11%) showed viral co-infection. Of 19 shallow periodontal sites, only one revealed HCMV. Prevotella intermedia, Bacteroides forsythus, and Capnocytophaga species were detected in higher proportions in deep than in shallow periodontal pockets (P = 0.02). Subgingival debridement did not reduce genomic herpesvirus presence but caused a decrease in proportions of Porphyromonas gingivalis and Capnocytophaga species.

CONCLUSIONS

Periodontal herpesvirus-bacteria coinfections may play important roles in the pathogenesis of destructive periodontal disease in Trisomy 21 patients. Herpesviruses may reduce the periodontal defense and promote growth of subgingival bacteria capable of causing periodontal breakdown.

Oral microorganisms and cardiovascular disease

The list of etiological factors for cardiovascular disease is long, complicated, intertwined, and yet to be completed. This paper will evaluate the current evidence for the pathogenic role of certain microorganisms, including those of the oral cavity, in the etiology of cardiovascular disease.

Responsible use of antimicrobials in periodontics

New products and treatment modalities for the management of periodontal disease continue to offer the clinician a large number of choices, many of which involve antimicrobials. Specific pathogenic bacteria play a central role in the etiology and pathogenesis of destructive periodontal disease. Under suitable conditions, periodontal pathogens colonize the subgingival environment and are incorporated into a tenacious biofilm. Successful prevention and treatment of periodontitis is contingent upon effective control of the periodontopathic bacteria. This is accomplished by professional treatment of diseased periodontal sites and patient-performed plaque control. Attention to community factors, such as water contamination and bacterial transmission among family members, facilitates preventive measures and early treatment for the entire family. Subgingival mechanical debridement, with or without surgery, constitutes the basic means of disrupting the subgingival biofilm and controlling pathogens. Appropriate antimicrobial agents that can be administered systemically (antibiotics) or via local delivery (povidone-iodine) may enhance eradication or marked suppression of subgingival pathogens. Microbiological testing may aid the clinician in the selection of the most effective antimicrobial agent or combination of agents. Understanding the benefits and limitations of antibiotics and antiseptics will optimize their usefulness in combating periodontal infections.

Herpesvirus in localized juvenile periodontitis

Herpesvirus genomic sequences can be detected in gingival crevicular fluid of adult periodontitis lesions. Herpesviruses are immunosuppressive and may facilitate establishment of subgingival pathogens. Electron microscopic studies have identified nuclear and cytoplasmic virus-like inclusions in gingival inflammatory cells from localized juvenile periodontitis (LJP). The present study aimed to determine if herpesviruses occur in LJP lesions and if human cytomegalovirus (HCMV) activation is associated with elevated levels of subgingival Actinobacillus actinomycetemcomitans, the putative bacterial pathogen of LJP. Eleven systemically healthy patients exhibiting LJP (10-23 yr) were studied. In each patient, subgingival samples were pooled from 3 periodontitis lesions around first molar and incisor teeth (5-11 mm periodontal pocket depth) and from 3 gingivitis/healthy sites around canines (2-3 mm periodontal pocket depth). Polymerase chain reaction (PCR) was used to detect herpesvirus DNA and HCMV cDNA of major capsid protein transcripts, indicative of viral activation. Selective culture and 16S rRNA PCR were used to identify A. actinomycetemcomitans. Of 11 deep periodontal samples, 8 showed HCMV, 7 showed Epstein-Barr virus type 1 (EBV-1), 1 showed EBV type 2, 6 showed herpes simplex virus (HSV) and 8 showed viral co-infection. Of 11 shallow periodontal samples, 2 showed HCMV, 2 showed EBV-1, 1 showed HSV and 2 showed viral co-infection. The difference in occurrence of HCMV and viral co-infection between deep and shallow periodontal sites was statistically significant (p =0.031). HCMV activation was detected in deep pockets of all 5 virally positive patients with early LJP (aged 10-14 years) but only in 1 of 3 virally positive LJP patients older than 14 years, and not in any shallow pocket tested. HCMV activation appeared related to absence of radiographic crestal alveolar lamina dura, a possible indication of periodontal disease progression. A. actinomycetemcomitans tended to be more prevalent in samples showing active than latent HCMV infection. The present findings are consistent with the notion that periodontal herpesvirus infection and possibly HCMV activation constitute important features of the etiopathogenesis of LJP.

Herpesviruses in human periodontal disease

Recent studies have identified various herpesviruses in human periodontal disease. Epstein-Barr virus type 1 (EBV-1) infects periodontal B-lymphocytes and human cytomegalovirus (HCMV) infects periodontal monocytes/ macrophages and T-lymphocytes. EBV-1, HCMV and other herpesviruses are present more frequently in periodontitis lesions and acute necrotizing ulcerative gingivitis-lesions than in gingivitis or periodontally healthy sites. Reactivation of HCMV in periodontitis lesions tends to be associated with progressing periodontal disease. Herpesvirus-associated periodontitis lesions harbor elevated levels of periodontopathic bacteria, including Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Bacteriodes forsythus, Prevotella intermedia, Prevotella nigrescens and Treponema denticola. It may be that active periodontal herpesvirus infection impairs periodontal defenses, thereby permitting subgingival overgrowth of periodontopathic bacteria. Alteration between latent and active herpesvirus infection in the periodontium might lead to transient local immunosuppression and explain in part the episodic progressive nature of human periodontitis. Tissue tropism of herpesvirus infections might help explain the localized pattern of tissue destruction in periodontitis. Absence of herpesvirus infection or viral reactivation might explain why some individuals carry periodontopathic bacteria while still maintaining periodontal health. Further studies are warranted to delineate whether the proposed herpesvirus-periodontopathic bacteria model might account for some of the pathogenic features of human periodontal disease.

Herpesviruses in periodontal pocket and gingival tissue specimens

Human cytomegalovirus (HCMV) and Epstein-Barr virus type 1 (EBV-1) are frequently detected in crevicular fluid of deep periodontal pockets, but little or no information is available on occurrence of herpesviruses in gingival tissue. This investigation studied the presence of herpesviruses in periodontal pockets and the corresponding gingival tissues from 11 periodontally healthy and 14 periodontitis sites. A nested-polymerase chain reaction was employed to identify the presence of HCMV, EBV-1, EBV-2, herpes simplex virus, human herpesvirus (HHV)-6, HHV-7 and HHV-8 in each test sample. In healthy periodontal sites, HCMV was detected in 1 (9%) and EBV-1 in 2 (18%) pocket samples, and HCMV was detected in 2 (18%) and EBV-1 in 3 (27%) gingival tissue samples. In periodontitis lesions, HCMV was detected in 9 (64%) pocket samples and in 12 (86%) gingival tissue samples, and EBV-1 was detected in 6 (43%) pocket samples and in 11 (79%) gingival tissue samples. HHV-6 and HHV-8 were detected exclusively in gingival tissue samples. The present findings confirm the frequent presence of HCMV and EBV-1 in periodontitis lesions and suggest using gingival tissue specimens for detecting periodontal HHV-6, HHV-7 and HHV-8.

Practical antimicrobial periodontal therapy

Specific pathogenic bacteria play a central role in the etiology and pathogenesis of destructive periodontal disease. Under suitable conditions, periodontal pathogens colonize the subgingival environment and are incorporated into a tenacious biofilm. Successful prevention and treatment of periodontitis is contingent on effective control of the periodontopathic bacteria, which is accomplished with professional treatment of diseased periodontal sites and patient performed plaque control. Subgingival mechanical debridement, with or without surgery, constitutes the basic means of disrupting the subgingival biofilm and controlling pathogens. Appropriate antimicrobial agents that can be administered systemically or via local delivery may enhance eradication or suppression of subgingival pathogens. Microbiological testing may aid the clinician in the selection of the most effective antimicrobial agent or combination of agents. Understanding the benefits and limitations of antibiotics and antiseptics will optimize their usefulness in combating periodontal infections.

Effects of treatment with clindamycin hydrochloride on progression of canine periodontal disease after ultrasonic scaling

This study was conducted to determine the benefit, if any, of combining antibiotic therapy with ultrasonic scaling, root planing, and polishing (USRP) over USRP alone as determined by improvements in plaque index, gingival index, and pocket depth measurements. Thirty dogs with signs of periodontal disease were randomly assigned to the USRP-only treatment group or to the USRP-antibiotic treatment group. USRP was performed on all dogs on study day 0. In addition, dogs in the USRP-antibiotic treatment group received clindamycin hydrochloride (Antirobe, Pharmacia & Upjohn, Kalamazoo, MI) dosed at 2.5 mg/lb body weight (BW) twice a day beginning on day 0 and continuing 8 days. Followup visits occurred 2, 6, 13, and 25 weeks after the start of the study. Treatment differences were compared using a mixed model analysis for repeated measures. This analysis indicated that the clindamycin regimen, after USRP, had a significant effect on plaque and pocket depth measures of periodontal disease but not on gingivitis. For plaque, average index scores for the treatment group were lower at all follow-up visits with significant differences at 2 and 6 weeks after cleaning. The antibiotic treatment group also maintained a significantly smaller average pocket depth, representing a 15% postcleaning reduction for the clindamycin group versus a 3% reduction in the control group.

Update on Actinobacillus Actinomycetemcomitans and Porphyromonas gingivalis in human periodontal disease

Actinobacillus actinomycetemcomitans is an important pathogen of periodontitis in young individuals. Porphyromonas gingivalis is a major pathogen of severe adult periodontitis. A. actinomycetemcomitans and P. gingivalis can be transmitted from family member to family member and may cause periodontitis in the recipient individual. In the USA, A. actinomycetemcomitans occurs more frequently in Hispanics and Asians than in Caucasians. P. gingivalis is more common in Hispanics, Asians and Blacks than in Caucasians. A. actinomycetemcomitans and P. gingivalis strains differ in genotype, serotype, toxin and enzyme production, and cellular invasiveness. Variation in virulence may help explain differing clinical outcomes of periodontal A. actinomycetemcomitans and P. gingivalis infections. A. actinomycetemcomitans and P. gingivalis cannot be eradicated from the great majority of deep periodontal pockets by mechanical debridement alone. A. actinomycetemcomitans may be removed from subgingival sites by adjunctive systemic amoxicillin-metronidazole or other appropriate antibiotic therapies. Subgingival eradication of P. gingivalis may require periodontal surgery as well as antibiotic therapy.

Microbiological features of Papillon-Lefèvre syndrome periodontitis

Papillon-Lefevre syndrome patients exhibit hyperkeratosis palmo-plantaris and severe periodontitis. The syndrome is an autosomal recessive trait, but the mechanism of periodontal destruction is not known. This report presents the clinical and microbiological features of an 11-year old girl with Papillon-Lefèvre syndrome. Clinical examination included conventional periodontal measurements and radiographic analysis. In samples from 3 deep periodontal lesions, the occurrence of major suspected periodontopathic bacteria was determined by selective and non-selective culture and polymerase chain reaction (PCR) identification, and the presence of cytomegalovirus and Epstein-Barr type 1 virus by a nested-PCR detection method. 10 of 22 available teeth demonstrated severe periodontal breakdown. Major cultivable bacteria included Actinobacillus actinomycetemcomitans (3.4% of total isolates), Prevotella nigrescens (16.4%), Fusobacterium nucleatum (14.3%) and Peptostreptococcus micros (10.6%). A. actinomycetemcomitans, P. nigrescens, Porphyromonas gingivalis and Eikenella corrodens were identified by PCR analysis. The patient's non-affected parents and older brother revealed several periodontal pathogens but not A. actinomycetemcomitans. The viral examination demonstrated cytomegalovirus and Epstein-Barr type 1 virus in the subgingival sample of the Papillon-Lefèvre syndrome patient. The father and brother yielded subgingival cytomegalovirus but not Epstein-Barr type 1 virus. We hypothesize that human herpesviruses in concert with A. actinomycetemcomitans play important rôles in the development of Papillon-Lefèvre syndrome periodontitis.

Tetracycline-coated polytetrafluoroethylene barrier membranes in the treatment of intraosseous periodontal lesions

BACKGROUND

Periodontal pathogens are detrimental to periodontal healing in barrier membrane-assisted periodontal therapy. Tetracycline-coating of barrier membranes may reduce levels of infecting pathogens. This study evaluated the clinical and microbiological effects of tetracycline-coated expanded polytetrafluoroethylene (T-ePTFE) barrier membranes in the treatment of 2- to 3-wall intraosseous periodontal lesions around mandibular molars.

METHODS

Eleven patients received non-coated barrier membranes (ePTFE) and 11 patients received T-ePTFE barrier membranes. Tetracycline coating was performed by placing ePTFE membranes first in a 5% tridodecylmethylammonium chloride solution and then in a basic 3% tetracycline solution. Microbiological examination included conventional culture and DNA probe analyses. Barrier membranes were removed 6 weeks after insertion.

RESULTS

At baseline, the periodontal lesion depth averaged 8.0 mm in the ePTFE treated group and 7.4 mm in the T-ePTFE group. At 1 year post-treatment, the mean gain of probing attachment was 1.9 mm in the ePTFE group and 3.3 mm in the T-ePTFE group (P = 0.02). At 3 minutes after membrane placement, suspected periodontal pathogens were detected in several ePTFE membranes but only in one T-ePTFE membrane. At 6 weeks, all membranes showed periodontal pathogens, including Porphyromonas gingivalis, Fusobacterium species, Peptostreptococcus micros, Bacteroides forsythus, and motile rods.

CONCLUSIONS

This study suggests that the use of tetracycline-coated ePTFE barrier membranes can result in additional gain of clinical periodontal attachment, most likely due to the antimicrobial properties of tetracycline during initial healing.