Untreated periodontal disease in Indonesian adolescents. Longitudinal clinical data and prospective clinical and microbiological risk assessment

BACKGROUND, AIMS: In order to investigate the r le of various putative clinical and microbiological risk markers, a longitudinal study was initiated in a young population deprived of regular dental care. In 1987 all inhabitants in the age range 15-25 years living in a village with approximately 2,000 inhabitants at a tea estate on Western Java, Indonesia, were examined clinically and microbiologically. In total, 167 subjects of the original group of 255 adolescents were re-examined in 1994. The material presented in this paper describes the clinical periodontal condition at baseline (1987) and at follow-up (1994), 7 years later. Furthermore, the relationship between progression of the disease and baseline clinical and microbiological data was assessed. METHODS: Plaque index (PI), bleeding on probing (BOP), pocket depth (PD), and attachment loss (AL) were scored at the approximal surfaces of the vestibular aspects of all teeth. The number of approximal surfaces of the Ramfjord teeth showing subgingival calculus was recorded. At baseline, the dorsum of the tongue, the buccal gingiva in the upper jaw, the saliva and the deepest bleeding pocket without clinical loss of attachment were sampled for microbiological examination with phase contrast microscopy and indirect immunofluorescence. RESULTS: Mean values at baseline and at follow-up were PI: 1.01 and 1.15, BOP: 0.80 and 1.16, PD 3.26 mm and 3.32 mm, AL: 0.33 mm and 0.73 mm, respectively. All parameters except PD showed a statistically significant increase over the 7-year period. The prevalence of the studied bacteria irrespective of the sample site was: A. actinomycetemcomitans 53%, P. gingivalis 88%, P. intermedia 100%, spirochetes 89% and motile micro-organisms 100%. At the full mouth level, logistic regression showed significant odds ratios for progressive disease with age (1.15), subgingival calculus (1.20) and subgingival presence of A. actinomycetemcomitans (4.61). Presence of any of the selected micro-organisms on the mucous membranes was not related with progressive disease. In order to study local factors to explain local disease activity, each subject was characterized using the sampled pocket, which was the deepest bleeding pocket without LA at baseline, as a single response site per patient. In this constrained design, the main statistical factors associated with progressive disease were presence of motile micro-organisms and the plaque score. CONCLUSIONS: This study identified 3 main risk markers for disease progression at the full mouth level: age, amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans.     

Clinical and microbiological associations in chronic periodontitis

Chronic Periodontitis is the most prevalent form of periodontal disease. The subgingival microflora has been associated with the onset and progression of the disease. The aim of this work was to establish associations and correlations between clinical indicators and subgingival plaque microbiological data in patients diagnosed with moderate or severe Periodontitis. One hundred sites with a probing depth of > or = 5 mm were selected. Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BP), Probing Depth (PD) and Clinical Attachment Level (CAL) were measured. The subgingival plaque microbiological assay comprised cultures in selective and non-selective media and identification tests for Porphyromonas gingivalis (Pg), Prevotella intermedia/nigrescens (Pi/n), Actinobacillus actinomycetemcomitans (Aa), Fusobacterium (F) and Peptostreptococcus micros (Pm). Dark field microscopy was used to analyze the relative proportions of Treponema to the total microbial morphotypes. Small Treponeina (ST), Medium Treponema (MT), Large Treponema (LT) and Total Treponema (TT) were determined. Our results showed associations and a correlation between PD and AL, r = 0.62 (p<.0001); PD and Pg X2 = 15.22, r = 0.39 (p<.001); AL and Pg X2 = 10.72, r = 0.32 (p<.001). A negative correlation was observed between Pg and Pi/n X2 = 12.65, r = -0.35 (p<.001); BP and F X2 = 8.93; GI and F X2 = 8.92. The present results reveal associations and correlations between some clinical indicators and subgingival plaque microorganisms in patients diagnosed with Chronic Periodontitis.     

Effect of supragingival plaque control on subgingival microflora and gingivo-periodontal tissues

The aim of this study was to carry out a short term evaluation of the effect of supragingival plaque control on the subgingival microflora and gingivoperiodontal tissues in patients with moderate and severe periodontitis. A total of 92 sites from 23 patients were studied; patients ranged between 35 and 60 years of age (x 46.4 +/- 1.71). Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BP), Probing Depth (PD), and Attachment Level (AL) were measured. Subgingival microflora of the same sites was studied by dark field microscopy, and cultures in non-selective and selective media for Actinobacillus actinomycetemcomitans (Aa), Prevotella intermedia/nigrescens (Pi/n), Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn). The patients were included in a supragingival plaque control program which included oral hygiene training and assessment, and professional control of supragingival plaque and calculus. After 28 days, measurement of clinical parameters and the microbiological study were repeated. The sites were divided according to baseline PD values into: Group 1 (5 mm), Group 2 (6 mm) and Group 3 (> or = 7 mm). Results revealed a significant reduction in PI scores, GI scores, PB and PD in groups 2 and 3. No significant difference in AL was observed in any of the three groups. PI scores were found to decrease significantly in group 1, and GI scores, BP and PD tended to decrease. A significant increase in coccoid cells and a significant decrease in motile rods and spirochetes, both small and total, was observed in groups 2 and 3. Group 1 showed a significant decrease in medium and total spirochetes. At the end of the study, a significant decrease in Pi/n was found in all three groups. Significant decreases were found in Pg and Fn in Groups 3 and 2 respectively. Although it holds true that supragingival plaque control reduced a potentially pathogenic subgingival microbiota, this effect was not sufficient to be compatible with healthy gingivoperiodontal tissues.     

Changes of periodontal status in patients with Down syndrome during a 7-year period

The development of periodontal disease in Down syndrome adolescents (n = 34) was studied clinically and on intraoral radiographs during a 7-yr period. The occurrence of gingival inflammation (GBI), pathological periodontal pockets (>4 mm), sub- and supragingival calculus, alveolar bone height, alveolar bone loss, and the occurrence of the periodontal pathogens Actinobacillus actinomycetemcomitans, Capnocytophaga, and Porphyromonas gingivalis in subgingival plaque were determined. Of the subjects, 41% had one or more pathological periodontal pockets at baseline compared to 65% at follow-up. At the baseline examination, 35% of the individuals exhibited alveolar bone loss compared to 74% at the follow-up. The median value of sites with alveolar bone loss increased from 0 to 1, the new lesions mainly being located in the incisor region. The estimated annual reduction of alveolar bone height in each subject was 0.04 mm on average. The occurrence of the periodontal pathogens A. actinomycetemcomitans, Capnocytophaga, and P. gingivalis in subgingival plaque did not differ between baseline and follow-up. The results of the present study indicate that the frequency of periodontitis, mainly located on the lower incisors, markedly increased during a 7-yr period in Down syndrome individuals, although the severity and progression was limited compared to what has previously been described.     

Java project on periodontal diseases. The natural development of periodontitis: risk factors, risk predictors and risk determinants

OBJECTIVE: To identify risk factors, risk predictors and risk determinants for onset and progression of periodontitis. MATERIAL AND METHODS: For this longitudinal, prospective study all subjects in the age range 15-25 years living in a village of approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were selected. Baseline examination was carried out in 1987 and follow-up examinations in 1994 and 2002. In 2002, 128 subjects could be retrieved from the original group of 255. Baseline examination included evaluation of plaque, bleeding on probing, calculus, pocket depth, attachment loss and presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, spirochetes and motile microorganisms. RESULTS: The mean attachment loss increased from 0.33 mm in 1987 to 0.72 mm in 1994 and 1.97 mm in 2002. Analysis identified the amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans as risk factors, and age as a risk determinant, for the onset of disease. Regarding disease progression, the number of sites with a probing depth > or = 5 mm and the number of sites with recession were identified as risk predictors and male gender as a risk determinant. CONCLUSION: Screening of these parameters early in life could be helpful in the prevention of onset and progression of periodontal diseases.     

Prevalence of Actinobacillus actinomycetemcomitans and clinical conditions in children and adolescents from rural and urban areas of central Italy

BACKGROUND: The aim of this study was to report on the prevalence of Actinobacillus actinomycetemcomitans (Aa) and the periodontal clinical conditions in children and adolescents from a rural area of central Italy compared with the ones from an urban area of the same region. METHOD: The study population consisted of 780 systemically healthy children, aged 6-14 years inhabiting the county of Chieti. 505 children attended 3 primary and 2 secondary schools from a rural area whereas 275 individuals attended 1 primary and 1 secondary school from the city of Chieti. The 2 provincial areas present a great difference in socioeconomic level and cultural background. Clinical examination consisted of recording the % of gingival sites positive for the presence of plaque (P1+), bleeding on probing (BOP+), mean probing depth (PD) from each primary or permanent tooth fully erupted in the oral cavity. Loss of periodontal attachment (AL+) was evaluated only in interproximal sites. AL+ subjects were distinguished in juvenile periodontitis (JP) prepubertal periodontis and early periodontitis (EP) patients. 8 gingival sites were microbiologically sampled in each subject and cultured, after pooling, for the presence of Aa. RESULTS: 30.3% of rural subjects, were positive for the presence of Aa, the difference from urban children (16%) being statistically significant (p=0.01) irrespective of gender and age. Aa showed a significantly (p=0.006) higher mean proportion in subgingival plaque samples from rural children (0.13% versus 0.02%). Loss of periodontal attachment in at least one site was found in 18 rural children (3.56%) (3 JP; 15 EP) and 2 urban girls (0.72%)(1 JP; 1 EP). No significant differences for AL were observed within the rural group according to the gender and age differentiation. In the urban group, both AL+ subjects were Aa+, while among children from rural areas all 3 JP and 13 EP subjects were Aa+. Rural subjects evidenced significantly worse clinical parameters with respect to urban children (% PI+ sites: p=0.000; % BOP+ sites: p=0.010; mean PD: p=0.000.) The relative risk for AL+ sites was significantly greater (2.42) in rural subjects harboring Aa in subgingival plaque. Similarly, the presence of Aa in subgingival plaque was related to a greater risk of more than 50% of BOP+ gingival sites in both rural and urban subjects (1.45 and 8.40, respectively). CONCLUSIONS: Results of this study suggest that Aa colonization in children and adolescents from central Italy is affected by socioeconomic and cultural factors; these factors also affect the periodontal condition of the subjects.     

The effects of subgingival calculus on the clinical outcomes of locally-delivered controlled-release doxycycline compared to scaling and root planing

BACKGROUND, AIM: The effect of subgingival calculus on the clinical outcomes of the local delivery of antimicrobials is unknown. This study examines the clinical outcomes of treatment with locally delivered controlled-release doxycycline (DH) or scaling and root planing (SRP) in subsets of adult periodontitis patients with known baseline levels of subgingival calculus. METHODS: The data examined were obtained from 393 patients who participated in 2 multi-center trials. All patients had baseline subgingival calculus levels assessed and were then treated at baseline and month 4 with either DH or SRP. Clinical attachment levels (CAL), pocket depth (PD) and bleeding on probing (BOP) were assessed at baseline and months 1, 2, 4, 5, 6, 8 and 9. RESULTS: Treatment with either DH or SRP resulted in significant statistical and clinical improvements in CAL, PD and BOP. These clinical outcomes were equivalent regardless of the extent of subgingival calculus present at baseline. CONCLUSIONS: The results indicate that the primary clinical effects of these therapies are the result of a disruption and reduction of the subgingival plaque and not the effect of the removal of subgingival calculus and contaminated cementum.     

Repeated local metronidazole-therapy as adjunct to scaling and root planing in maintenance patients

The purpose of this investigation was to evaluate the effect of local antibiotic therapy with metronidazole adjunctively to scaling and root planing (SRP) versus mechanical treatment alone. 30 maintenance-patients were included in this single-blind study. The subjects had to comply with the following criteria: 2 non-adjacent sites with a probing depth > or =6 mm with bleeding on probing in separate quadrants, no periodontal therapy within the last 3 months, and no antibiotic therapy within the last 6 months. After randomization, the study sites were assigned to one of the following 2 treatments: SRP plus subgingival application of metronidazole 25% dental gel (Elyzol) 5x during 10 days (test site) or SRP alone (control site). Subgingival microbiological samples were taken prior to, and 21 days and 3 months after scaling. The samples were analyzed with a commercial chair-side ELISA (Evalusite) for Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans. Probing pocket depth (PPD), attachment level (AL) and bleeding on probing (BOP) were recorded at baseline and 3 months later. PPD reduction and AL-gain were statistically significant (p<0.001) after both treatments. However, there were no statistically significant differences between them. The same observation was made for BOP. P. gingivalis was reduced significantly after both treatments without statistically significant differences. P. intermedia was reduced significantly only after SRP. A. actinomycetemcomitans was not reduced significantly after either treatment. In conclusion, the repeated local application of metronidazole as an adjunct to SRP and the mechanical treatment alone showed similar clinical and microbiological effects without statistically significant differences with the exception of P. intermedia.     

Clinical responses to mechanical periodontal treatment in Chinese chronic periodontitis patients with and without Actinobacillus actinomycetemcomitans

BACKGROUND: The purpose of this study was to compare 12-month clinical responses to mechanical periodontal treatment in Chinese chronic periodontitis patients at sites with and without Actinobacillus actinomycetemcomitans at baseline, and to investigate the ability of mechanical periodontal treatment to eliminate A. actinomycetemcomitans. METHODS: Nineteen patients and a total of 76 selected sites with a mean probing depth (PD) of > or = 7 mm were studied. Whole mouth presence or absence of supragingival plaque (PI%), bleeding on probing (BOP%), probing depth (PD), and probing attachment level (PAL) were recorded at six sites per tooth at baseline and after 3, 9, and 12 months. Baseline subgingival plaque samples were taken from the deepest PD site in each quadrant using sterile paper points and were cultured on TSBV plates for 5 days in a 5% CO2-air incubator. All sites received mechanical periodontal treatment, which included oral hygiene instructions and supragingival and subgingival instrumentation with or without surgical access, with maintenance care being provided once every 3 months thereafter. RESULTS: At baseline, A. actinomycetemcomitans was isolated in 13 of the 19 subjects (68%) and in 29 out of the 76 sampled sites (38%). At the end of 12 months, in three of the initially A. actinomycetemcomitans-positive subjects, A. actinomycetemcomitans was not detected in the sampled sites, while one subject, in whom A. actinomycetemcomitans was not initially found at the sampled sites was A. actinomycetemcomitans-positive at 12 months. Multi-level variance component models showed there was no statistically significant difference in all clinical parameters between A. actinomycetemcomitans-positive and -negative subjects (P > 0.05). In the sampled sites of the initially A. actinomycetemcomitans-positive subjects, the mean PD was reduced from 7.6 +/- 1.6 mm to 3.2 +/- 1.8 mm, the mean PAL gain was 1.4 +/- 2.0 mm, and the mean recession was 3.0 +/- 2.3 mm. The corresponding figures in the sampled sites of the initially A. actinomycetemcomitans-negative subjects were 7.5 +/- 1.6 mm to 2.7 +/- 1.0 mm, 2.3 +/- 2.6 mm and 2.4 +/- 2.2 mm for mean PD changes, PAL gain, and mean recession, respectively. CONCLUSIONS: Favorable clinical responses to mechanical periodontal therapy may occur in Chinese chronic periodontitis patients at sites infected with A. actinomycetemcomitans. The mere detection of subgignival A. actinomycetemcomitans does not necessarily imply poorer treatment outcomes in the control of chronic periodontitis.     

Adjunctive antimicrobial therapy of periodontitis: long-term effects on disease progression and oral colonization

BACKGROUND: This study assessed the long-term effects of adjunctive antimicrobial therapy on periodontal disease progression and oral colonization. METHODS: Patients with previously untreated chronic periodontitis and subgingival Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis were randomly assigned to subgingival scaling without (control group) or with systemic amoxicillin plus metronidazole and CHX irrigation (test group). Relative attachment levels were determined and subgingival and mucosal plaque samples were taken at baseline, at 10 days (plaque only) and at 3, 6, 9, 12, 18, and 24 months following initial therapy. During maintenance therapy, patients received supragingival debridement only. RESULTS: After 24 months, the 18 test group patients showed at sites with initial probing depths (PD) > or =7 mm a significantly (P <0.05) higher frequency of 2 mm or more attachment gain (37.3% +/- 4.6%) and lower frequency of attachment loss (7.2% +/- 3.1%) compared to the 17 controls (8.2% +/- 3.9% and 19.1% +/- 13.1%, respectively). Compared to controls, the intraoral prevalence of A. actinomycetemcomitans (up to 18 months) and P. gingivalis (up to 3 months) decreased and that of Eikenella corrodens (at 10 days) increased in test patients (P <0.05). In both treatment groups, the detection frequency of Tannerella forsythensis decreased transiently, while an overall increase was recorded for Treponema ssp. CONCLUSIONS: Over the 24-month period, a single course of the administered adjunctive antimicrobial therapy led to a relative risk reduction of 62% for attachment loss at deep sites. However, with the exception of A. actinomycetemcomitans, it failed to induce long-term changes in the prevalence profiles of oral colonization.     

Determination of eight selected periodontal pathogens in the subgingival plaque of maxillary first molars in Japanese school children aged 8-11 years

To prevent the onset or progression of periodontitis, we must understand when periodontal pathogens are first harbored and how they develop the biofilm that causes periodontal disease. The purpose of this study was to determine the relationship between clinical status and selected periodontal pathogens in subgingival plaque in school children. This study was conducted with 95 school children, 8-11 years old. The presence and distribution of eight selected periodontal pathogens sampled from the maxillary right first molar were determined by an indirect immunofluorescent technique and compared with clinical parameters. Of the 95 sites sampled, only one site had all eight pathogens and five sites did not have any of the eight pathogens. The mean number of positive pathogens per site was 3.5 +/- 1.8 and mean percentage of positive pathogens was 3.82 +/- 4.22%. The number and total percentage of positive pathogens were strongly correlated with the Plaque Index (PI). In addition, the number of positive pathogens was correlated to the presence of subgingival calculus. The most frequently found pathogens were Campylobacter rectus (84.2%) and Eikenella corrodens (83.2%), and the least, Actinobacillus actinomycetemcomitans serotype c (7.4%). Of the eight pathogens, the frequency and distribution of Porphyromonas gingivalis were significantly correlated with PI and the presence of calculus. In addition, seven sites with both P. gingivalis and Bacteroides forsythus showed a correlation with gingival inflammation. In conclusion, the presence of P. gingivalis or P. gingivalis and B. forsythus may be a risk marker to be sought in screening for the onset of periodontal disease.     

Gingival crevicular fluid levels of interleukin-1beta and glycemic control in patients with chronic periodontitis and type 2 diabetes

BACKGROUND: Patients with diabetes have increased incidence and severity of periodontal disease not accounted for by differences in the subgingival microbial infection. Poor glycemic control has been consistently associated with periodontal disease severity. Also, recent evidence suggests that hyperglycemia may induce inflammatory cytokine production. Few studies, however, have examined local biochemical measures of periodontal inflammation in patients with type 2 diabetes. The aim of this study was to determine whether glycemic control was related to gingival crevicular fluid (GCF) levels of interleukin-1beta (IL-1beta). METHODs: GCF samples were collected from 45 patients with type 2 diabetes and untreated chronic periodontitis. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and attachment level (AL) were recorded at six sites per tooth. IL-1beta levels were determined from individual GCF samples by enzyme-linked immunoabsorbent assay (ELISA). Individual site and mean patient values were calculated. Glycated hemoglobin (HbA1c) levels were measured from anticoagulated whole blood using an automated affinity chromatography system. Serum glucose was also determined. RESULTS: Clinical periodontal measures (PD, AL, BOP) and measures of glycemic control (HbA1c, random glucose) were significantly correlated with GCF IL-1beta. Patients with greater than 8% HbA1c had significantly higher mean GCF IL-1beta levels than patients with less than 8% HbA1c. In a multivariate model adjusting for age, gender, PD, AL, BOP, and PI, HbA1c and random glucose were independent predictors of high GCF IL-1beta. CONCLUSIONS: Poor glycemic control is associated with elevated GCF IL-1beta. These data are consistent with the hypothesis that hyperglycemia contributes to an heightened inflammatory response, and suggests a mechanism to account for the association between poor glycemic control and periodontal destruction.     

Actinobacillus actinomycetemcomitans, Capnocytophaga and Porphyromonas gingivalis in subgingival plaque of adolescents with Down''s syndrome

Levels of Actinobacillus actinomycetemcomitans, Capnocytophaga and Porphyromonas gingivalis were determined in subgingival plaque samples from 37 adolescents with Down's syndrome and 37 healthy controls matched with respect to age and sex. Gingival inflammation, supra- and subgingival calculus, periodontal pockets ( > 4 mm) and alveolar bone loss were registered. Alveolar bone loss was more frequent in Down's syndrome subjects (32%) than in the controls (3%). A. actinomycetemcomitans was detected in the subgingival plaque in 35% of the Down's syndrome adolescents and in 5% of the controls. On site level, A. actinomycetemcomitans and Capnocytophaga were more frequent in the subgingival plaque samples of Down's syndrome children than in those of controls. Comparing Down's syndrome subjects positive or negative for A. actinomycetemcomitans and Capnocytophaga, no significant differences were found in terms of gingival inflammation, periodontal pockets ( > 4 mm) or number of sites with alveolar bone loss. The results indicate an altered microbial composition of the subgingival plaque of Down's syndrome subjects compared with healthy controls, with higher frequency of A. actinomycetemcomitans.     

Early-onset periodontitis in Hispanic-American adolescents associated with A. actinomycetemcomitans

Abstract – This study examines the frequency of oral disease in an adolescent population, and assesses the relationship to Actinobacillus actinomycetemcomitans. A total of 470 eighth grade students from San Antonio, Texas, were examined clinically for number of teeth, frequency of gingival inflammation, frequency of sites with BOP. and frequency of sites with 3-5 mm pockets, and pockets >5 mm. The population ranged in age from 12 to 17 yr and was 93% Hispanic. Heavy accumulations of plaque and calculus were frequently observed and were associated with gingival inflammation, as 95.6% of the students exhibited bleeding on probing, and 99.6%. of the students presented with at least on quadrant of inflammation upon visual examination. Significantly, 25.7% of the students exhibited early-onset periodontitis (HOP) with 1.7% diagnosed as LJP. Many students exhibited substantial levels of plaque and calculus, but no clinical evidence of loss of attachment. Subjects with periodontitis (EOP or LJP) presented with elevated systemic IgG antibody to actinomycetemcomitans serotype b and subgingival plaque samples positive for the microorganism. These results describe the prevalence of EOP/LJP in an adolescent Hispanic population from South Texas. The findings support that actinomycetemcomitans may represent a pathogen in periodontitis and while oral health care may be poor, contact with the microorganism appears to be required to initiate disease in this population.     

Site-specific development of periodontal disease is associated with increased levels of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia in subgingival plaque

BACKGROUND: Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia (previously T. forsythensis), which are regarded as the principal periodontopathogenic bacteria, exist as a consortium in subgingival biofilms. We aimed to examine quantitative relationships between P. gingivalis, T. denticola, and T. forsythia in subgingival biofilms and the relationship between the quantity and prevalence of these three bacteria and site-specific periodontal health. METHODS: This study was cross-sectional. The study population consisted of 35 adult subjects who visited the Kyushu Dental College Hospital. Plaque samples were collected from 105 periodontal pocket sites. Quantitative analyses of each of the three periodontopathogenic bacteria were performed using real-time polymerase chain reaction with species-specific primers and hybridization probes. RESULTS: The plaque samples were divided into four groups based on the presence or absence of a periodontal pocket (probing depth [PD] > or =4 mm) and bleeding on probing (BOP), regardless of attachment loss. The proportions of all three target bacteria detected in samples from sites of periodontal disease (with PD and BOP) were markedly higher than those in the other sample groups. Cell numbers of P. gingivalis, T. denticola, and T. forsythia in the subgingival plaque of each sampling site were significantly mutually correlated and were increased in the plaque of sites of periodontal disease with PD > or =4 mm and BOP. CONCLUSION: The symbiotic effects of P. gingivalis, T. denticola, and T. forsythia, which coaggregate and exist concomitantly in subgingival biofilms, may be associated with the local development of periodontitis.     

Possible periodontal pathogens associated with clinical symptoms of periodontal disease in Japanese high school students

BACKGROUND: The purpose of this study is to investigate how the components of biofilm and clinical oral status change in adolescents and to identify specific periodontal pathogens as risk markers for the onset of periodontitis. METHODS: One hundred seven high school students (72 boys and 35 girls, all 15 years old) were recruited. The mesio-lingual site of the left lower first molar was selected as the examined site. Probing depth (PD), bleeding on probing (BOP), the presence of subgingival calculus, and Community Periodontal Index (CPI) were determined by examination with a WHO probe. The prevalence and proportion of seven selected periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia, Campylobacter rectus, Eikenella corrodens, and Actinobacillus actinomycetemcomitans serotypes b and c) were determined by indirect immunofluorescent technique, and the prevalence and proportion of spirochetes were determined by their morphology under dark-field microscopy. The relationship between the periodontal status and the bacterial condition was statistically analyzed. RESULTS: The mean proportion of T. forsythensis was significantly higher in BOP (+) sites compared with BOP (-) sites (3.47% +/- 5.35% versus 0.83% +/- 1.95%) and in CPI 3 sites compared with CPI 0 sites (3.29% +/- 5.28% versus 0.68% +/- 1.37%). The mean proportion of C. rectus was significantly increased in BOP (+) compared with BOP (-) (2.01% +/- 2.48% versus 0.79% +/- 0.91%) and in CPI 3 sites compared with CPI 0 sites (2.04% +/- 2.64% versus 0.80% +/- 0.79%). CONCLUSION: The results indicated that T. forsythensis and C. rectus might be able to be used as risk markers for the onset of periodontitis.     

Effect of subgingival scaling during supportive therapy

Background, aims: This prospective study was designed to investigate the rôle of root débridement at 3 month intervals for patients with periodontitis whose disease had persisted following the completion of conventional periodontal treatment. Methods: 39 maintenance patients with at least 4 pockets at least 4 mm deep were assigned to coronal scaling (CS) and subgingival scaling (SS) groups. Probing depths (PD), bleeding on probing (BOP) and relative attachment levels (RAL) were recorded at all eligible sites at baseline and 3, 6, 9 and 12 months later. Plaque index scores were recorded at the 12‐month visit. At every visit, following data collection, both groups received a coronal scaling and the SS group, in addition, received a thorough subgingival débridement. In the CS group, subgingival débridement was performed only for ‘loser’ sites which enhibited loss of attachment 2 mm relative to baseline values. Due to low compliance, only 31 patients completed the study. Thus, data analyses were carried out for 130 sites in 17 CS group patients and 146 sites in 14 SS group patients. Results: During the course of the study, 21 loser sites were identified in each group, but the difference in proportion of loser sites between groups was not significant. Furthermore, although there was a trend toward PD reduction in both groups throughout the study, mean PD, RAL and BOP values were not significantly different from baseline values at any time point, and there were no significant differences between groups with respect to these variables. Mean plaque scores measured at the 12‐month visit revealed no significant differences between groups. Conclusion: These findings call into question the value of performing repeated subgingival scaling at 3‐month intervals for patients with persistent disease.     

Actinobacillus actinomycetemcomitans in destructive periodontal disease. Three-year follow-up results

BACKGROUND: Convincing data exist that A. actinomycetemcomitans is an etiologic agent of periodontal disease. The purpose of this longitudinal study was to evaluate A. actinomycetemcomitans as a diagnostic indicator for periodontal disease in treated and periodontally maintained patients. METHODS: Following comprehensive mechanical/surgical and supportive amoxicillin plus metronidazole therapy in 13 subjects with A. actinomycetemcomitans-associated destructive periodontal disease, we monitored subgingival A. actinomycetemcomitans at 4 individual sites in each patient up to 3 years post-therapy. The periodontal status was determined, and A. actinomycetemcomitans levels were quantitatively enumerated on TSBV agar in CFU/ml. Six patients with a persistence of subgingival A. actinomycetemcomitans at each reexamination within 3 years post-therapy were selected to be at risk for minor periodontal treatment outcomes and further recurrence of periodontal disease (test group). Seven subjects with a complete suppression of A. actinomycetemcomitans at each post-therapy visit served as controls. RESULTS: The periodontal parameters decreased from overall values of 6.39 mm (probing depth, PD) and 7.64 mm (clinical attachment level, CAL) at the outset to 3.81 mm (PD) and 5.62 mm (CAL) 2 years post-therapy (Friedman, P< or =0.05). At the 3-year reexamination, the PD/CAL scores increased to 4.03/5.78 mm. Among the 6 individuals (46%) with persistence of subgingival A. actinomycetemcomitans at the final 3-year visit (test group), periodontal status yielded increased levels of 4.45 mm (PD) and 6.60 mm (CAL). The control subjects (n = 7) revealed lower values of 3.67 mm (PD) and 5.09 mm (CAL). However, on a patient level, during the 3-year observational trial, the periodontal status of the 13 individuals was not statistically affected by subgingival infection with A. actinomycetemcomitans. CONCLUSIONS: Although in advanced periodontal disease, comprehensive mechanical and antimicrobial treatment is an appropriate regimen for sustained improvement of periodontal health, long-term control of subgingival infection with A. actinomycetemcomitans could not be achieved. In the maintenance care of destructive periodontitis, the persistence of A. actinomycetemcomitans is not a diagnostic parameter for periodontal disease.     

The highly leukotoxic JP2 clone of Actinobacillus actinomycetemcomitans and progression of periodontal attachment loss

The JP2 clone of Actinobacillus actinomycetemcomitans has been implicated in the etiology of periodontitis in adolescents. The aim of this two-year longitudinal study was to describe clinical attachment loss (CAL) progression and to assess its association with baseline occurrence of the JP2 and non-JP2 types of A. actinomycetemcomitans. Clinical re-examination of 121 adolescents in Morocco was performed. Progression of CAL > or = 1 mm, > or = 2 mm, > or = 3 mm, and > or = 4 mm on at least one site was found in 58%, 48%, 22%, and 6% of the subjects, respectively. Subjects who, at baseline, harbored the JP2 clone had a significantly higher progression of CAL than did subjects harboring non-JP2 types of A. actinomycetemcomitans. Subjects harboring non-JP2 types displayed a marginally higher CAL progression than did subjects who were culture-negative for A. actinomycetemcomitans.