Demonstration of probes in human periodontal pockets

Twenty-two anterior and bicuspid teeth that previously had been designated for extraction, were removed from 11 male patients. Two teeth were extracted from each patient and each tooth had a periodontal pocket of at least 4 mm and a Gingival Index of 2 or 3. One tooth in each patient was subjected to scaling, root planing, and plaque control in an effort to reduce gingival inflammation. By means of an orthodontic tube and composite resin bonding material a periodontal probe under 15 to 20 gm of pressure was fixed in the periodontal pocket of each tooth. The specimens were removed en bloc and histologic specimens prepared. The conclusions were that when the gingiva is inflamed, the tip of the periodontal probe tends to extend to the apical base of the junctional epithelium or slightly beyond but there is great variation in this position. Further, it was concluded that the position of the probe tip during probing is not affected by the depth of the sulcus or periodontal pocket.     

Predominant obligate anaerobes in human periodontal pockets

This study was carried out to investigate the predominant anaerobic bacteria of periodontal pockets in patients with advanced periodontitis, who had no previous treatment other than supragingival scaling, no history of recent or chronic systemic illness, nor any intake of antibiotics within 6 weeks prior to bacteriological sampling. Care was taken not to ignore tiny-colony-forming anaerobes, by means of a stereoscope and an anaerobic glove box system. Out of 422 (100%) isolates, 380 (90%) were obligate anaerobes, suggesting that the environment in periodontal pockets was anaerobic and favors the growth of obligate anaerobes. Among the 380 obligate anaerobes isolated, strains belonging to Eubacterium (54%) were predominant, and many of them occurred in tiny colonies. The other obligate anaerobes isolated were assigned to Wolinella (9%), unidentified motile rods which resemble Wolinella (7%), Peptostreptococcus (6%), Fusobacterium (5%), Bacteroides (2%; including those reclassified to Prevotella and Porphyromonas) and Selenomonas (0.5%). Among the isolates, 67% were Gram-positive bacteria, including 59% of rods (mostly asaccharolytic Eubacterium), suggesting that these bacteria, particularly strains of the Eubacterium species, may play an important role in etiology of adult periodontitis.     

Sulfate-reducing bacteria in periodontal pockets and in healthy oral sites

The aim of this study was to monitor the presence of sulfate-reducing bacteria (SRB) at different sites in the mouths of both healthy individuals and periodontitis patients. In 20 healthy subjects and 21 periodontitis patients, samples were taken from the palate, vestibulum, dorsum of the tongue, supragingival plaque, and periodontal pockets. In order to demonstrate growth of SRB, samples were incubated in an anoxic chamber in a reduced growth-medium for SRB, with an iron-indicator for sulfide production. The SRB were detected throughout the oral cavity. They were found on the mucosa in 10% of both healthy subjects and periodontitis patients. On the tongue and in supragingival plaque, the frequency of detection was slightly higher (22% of the subjects). In contrast, 86% of the periodontitis patients harbored SRB in one or more pockets. In 1/3 of the patients, SRB were present in all 3 pockets that were sampled. The data indicated that SRB belong to the normal oral microbiota, and have a preference for periodontal pockets.     

The effect of supragingival plaque removal on anaerobic bacteria deep periodontal pockets

A study was made to determine if the numbers of subgingival anaerobes in deep periodontal pockets can be controlled by removal of only supragingival plaque. The study was based on the premises that the subgingival flora is dependent on the supragingival plaque for its source of organisms as well as for its perpetuation. Daily professional removal of only supragingival plaque produced a statistically significant reduction per sample in subgingival facultative and obligatory anaerobes.     

The temperature of the periodontal pockets

Abstract The temperature of 104 periodontal pockets of various depths was measured before institution of any preventive or curative therapy. A tendency to a rise in pocket temperature due to increased pocket depth was noted. However, statistically no linear correlation was observed between the temperature and the depth of the periodontal pockets. The possibility of using temperature measurements as a diagnostic and prognostic aid in periodontal disease has been discussed.     

Yeasts in periodontal pockets

OBJECTIVES: The presence of yeasts in periodontal pockets has been described in a few studies. The association between yeasts and putative periodontal pathogens is not well described. This study aims at assessing the prevalence of yeasts in periodontal pockets and possible associations with the clinical conditions of the sampled sites and other micro-organisms present. MATERIAL AND METHODS: 2 subject groups form the basis for this study. The 1st comprises results from microbiological samples from periodontal pockets of 128 subjects. The 2nd originates from 126 periodontal patients with untreated pockets. Microbiological identification was performed after cultivation on blood and Sabouraud agar plates, and "checkerboard" DNA-DNA hybridisation. RESULTS: The prevalence of subjects with yeasts in the pockets was 15.6% and 17.5% in the 2 groups respectively and was inconsistent according to gender. No correlation was found between age and the presence of yeasts. Eubacterium saburreum was weakly correlated with presence of yeasts (r=0.194 p=0.03). Yeasts were rarely found in both samples from the same individual. CONCLUSIONS: Our results indicate that yeasts can be expected to be present in periodontal pockets in one out of 6 periodontal patients independent of gender and age. Eubacterium saburreum seems to occur frequently together with yeasts.     

Configuration of periodontal pockets

138 males and 231 females between the ages of 20 and 49 years received periodontal examinations in the Periodontia Clinic of New York University College of Dentistry and were grouped according to age and sex. Periodontal pockets depths were recorded around each individual tooth present. The computation analysis of the measurement at 33.204 periodontal pockets was calculated by establishing the significance of "t" and F's values for the variations in periodontal pocket depths. It was noted that the depth of the periodontal pockets at interproximal areas was significantly different from the depth of the periodontal pockets at buccal and/or lingual areas. Comparisons further indicated the direction of significant difference to be toward deeper interproximal pockets at maxillary and mandibular teeth.     

Characterization of oral treponemes isolated from human periodontal pockets

A total of 90 clinical strains of oral treponemes was isolated from subgingival plaque in patients with periodontal disease. They were characterized by biochemical means as well as cell enzyme, protein analysis using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and DNA dot blot hybridization. Sixty strains were isolated on Medium 10 (M10), which was fundamentally serum-free. The remainder were isolated on serum-containing media. Isolates were divided into 6 groups according to their biochemical characteristics. Three of the 6 groups were asaccharolytic, and 2 of these 3 groups were Treponema denticola and " Treponema vincenti ". The other 3 groups were saccharolytic and further divided into 9 subgroups. The analyses of cell enzyme, cell protein and dot blot hybridization with the DNA probe of Treponema socranskii indicated that all the saccharolytic groups were T. socranskii or closely related species. This study indicated that the newly characterized saccharolytic oral treponemes could be identified using M10 from the human periodontal pocket.     

Temperature gradients in periodontal pockets

This study was undertaken to determine whether there is any correlation of temperature within periodontal pockets with their depths. Pocket temperatures were measured with a thermocouple at 1 mm intervals of depth in 247 pockets, in 20 patients with periodontitis, mesiobucally and mesiopalatally/mesiolingually in relation to 6 standard teeth. Pocket temperatures increased consistently with pocket depth. Maxillary pockets were cooler than mandibular pockets, but in both jaws the differences between buccal and palatal/lingual pockets were not statistically significant. The findings are in keeping with knowledge about the increased temperature of inflamed tissues and the study appears to have relevance to the diagnosis of disease activity in pockets, but further studies are necessary to establish reference levels of pocket temperature.     

Localization of Porphyromonas gingivalis-carrying fimbriae in situ in human periodontal pockets

Fimbriae, which are involved in adherence, constitute an important pathogenic factor of Porphyromonas gingivalis. In vivo, however, the distribution of P. gingivalis-carrying fimbriae is unknown. The localization of P. gingivalis-carrying fimbriae was examined in situ. From 19 patients with severe periodontitis and P. gingivalis, we obtained 20 teeth with periodontal tissue attached, with and without immunolocalized fimbriae. Eleven teeth were subjected to light microscopy, 9 to electron microscopy. In 6 of the 11 samples examined, we detected positive reactions with an anti-P. gingivalis-fimbriae serum, located in the cementum-attached plaque area in the deep pocket zones. In the so-called 'plaque-free zones', P. gingivalis-carrying fimbriae were immunocytochemically observed to reside in contact with the dental cuticle in 6 of the 9 samples examined. These findings suggest that P. gingivalis-carrying fimbriae are strongly related to adherence to the root surface at the bottoms of human periodontal pockets.     

Detection of human viruses in periodontal pockets using polymerase chain reaction

Even though viruses have been implicated in the etiology of several medical and dental disorders, little or no data are available on the possible involvement of human viruses in the pathogenesis of human periodontal disease. This study investigated the presence of human cytomegalovirus, Epstein-Barr virus, herpes simplex virus, human papillomavirus and human immunodeficiency virus (HIV) in crevicular fluid samples from 30 patients with advanced periodontitis and 26 subjects with gingivitis. Viral identification was performed on direct subgingival samples from 3 diseased sites in each patient using the polymerase chain reaction technique. Seventy-eight percent of advanced periodontitis patients were positive for at least one of the five test viruses. Cytomegalovirus was detected in 60% of the periodontitis patients, Epstein-Barr virus in 30%, herpes simplex virus in 20%, human papillomavirus in 17% and HIV in 7%. Forty percent of the periodontitis patients revealed coinfection by 2 to 5 viruses. Only 31 % of the gingivitis subjects showed a positive viral identification in crevicular fluid, and infected individuals only revealed human cytomegalovirus. This study demonstrated that human viruses may occur in periodontitis lesions with relatively high prevalence. The pathogenetic significance of human viruses in destructive periodontal disease needs to be determined.     

An immunohistochemical study on the localization of Porphyromonas gingivalis, Campylobacter rectus and Actinomyces viscosus in human periodontal pockets

The localization and distribution of Porphyromonas gingivalis, Campylobacter rectus and Actinomyces viscosus were studied in human periodontal pockets. After obtaining voluntary consent from 9 patients, 12 teeth and their surrounding periodontal tissue with advanced adult periodontitis were extracted carefully so as not to change the structure of the periodontal pockets. The specimens were processed into serial sections. One of the sections was stained with Brown & Brenn-modified Gram stain to observe the distribution of bacteria. The others were stained immunohistochemically by the Labelled Streptavidin Biotin method (LSAB method) using specific rabbit antibodies against selected bacteria. Some bacteria could be found within epithelial cells. P. gingivalis was found in 9/12 of the samples examined. Small aggregates of P. gingivalis were scattered in all parts of the periodontal pockets, and some of these aggregates could be seen in close contact with the epithelium. Conversely, C. rectus was observed in 5/12 of the samples examined and was predominantly located in the middle and deep pocket zones. C. rectus tended to form large clumps in both the tooth-attached and epithelium-associated plaque area. A. viscosus was observed in 7/12 of the samples examined and was localized predominantly in the tooth-attached plaque area, especially in the shallow and middle pocket zones. Although unexpected spills of unattached plaque from periodontal pockets was possible, immunohistochemical staining with species-specific antibodies was extremely sensitive and revealed the localization and the distribution of periodontal disease-associated bacteria in human periodontal pockets.     

Oxygen tension (pO2) in untreated human periodontal pockets

The purpose of this study was to assess the oxygen tension in untreated human periodontal pockets and test the hypothesis that the subgingival environmental is anaerobic in nature. Twenty-six patients with advanced chronic inflammatory periodontal disease participated. A total of 111 untreated pockets, 5 to 10 mm in depth, were selected for the pO2 measurements. Pocket depths, Plaque-Index and Gingival-Index were recorded. The pO2 at the base of the 111 pockets ranged from 5 to 27 mm Hg, with an average of 13.3 mm Hg (1.8% O2). Mean pocket depth was 6.9 mm. Moderately deep pockets (5-6 mm) had a mean pO2 of 15.0 mm Hg, whereas deep pockets (7-10 mm) showed a significantly lower pO2 of 11.6 mm Hg. No correlation was found between the pO2 and the Plaque-Index. Higher Gingival-Index scores tended to be associated with higher pO2 values. The pO2 in untreated periodontal pockets was low. However, it does not represent a completely anaerobic environment. Deep pockets contained less oxygen than moderately deep sites.     

Characterization of treponemes isolated from human and non-human primate periodontal pockets

Treponemes were isolated from ligature induced periodontal pockets of non-human primates, and from humans with periodontitis. Approximately 39% of the microscopic count were spirochetes from humans, while 65% of the microscopic microbiota was accounted for by spirochetes from non-human primates. Metabolically, the human treponemal isolates grew on trypticase-yeast extract based media while the non-human primate isolates grew only on pectin, glucuronic or galacturonic acids. The end-products of glucose fermentation by the human treponemes were acetate and propionate, while acetate was produced by the non-human primate treponemes from pectin. All of the human isolates were indole positive, hemolyzed blood, required serum for growth, but did not require thiamine pyrophosphate (TPP). The non-human primate treponemes were indole negative, were inhibited in their growth by blood, grew in the absence of serum, and required TPP for growth. PAGE analysis of whole cell proteins revealed three categories of treponemal isolates: (i) human isolates similar to Treponema denticola ; (ii) human isolates of small size; and (iii) non-human primate isolates similar to the pectinolytic treponemes. Serologically, the human treponemal isolates were similar to T. denticola , while the non-human primate isolates were similar to the pectinolytic treponemes. Four human, 4 non-human primate, and 4 reference treponemes exhibited a Mol% G + C of their DNA of 40.0-43.1. The metabolic differences between the human and non-human primate treponemal isolates may be a reflection of ecological differences in the periodontium of the pathological entities which exist in human and non-human primates.