Serum IgG antibodies reactive with lipoteichoic acid in adult patients with periodontitis

IgG antibody levels to lipoteichoic acid (LTA), prepared from Streptococcus mutans cells, were determined by enzyme-linked immunosorbent assay in serum samples from 149 subjects. An extract from Bacteroides gingivalis and lipopolysaccharide from Escherichia coli 055:B5 served as control antigens. The reference group comprised 28 systemically and periodontally healthy adults. The main test groups were: 52 persons with gingivitis only, and 69 patients with periodontitis. Within those groups, 37 patients had insulin-dependent diabetes mellitus, another 20 patients were prospective or renal transplant recipients. The periodontitis patient group showed significantly (p less than 0.05) higher mean antibody value and higher frequency of extreme antibody responses to both LTA and B. gingivalis than the gingivitis group. LPS did not discriminate between the groups. Multiple regression analysis with gingivitis scores as the dependent variable selected plaque scores, anti-LTA antibody values and general health status as significant (p less than 0.05) regressors. The variance in radiographical alveolar bone loss was significantly (p less than 0.05) explained by age and by antibody values to B. gingivalis and to LTA. The patients with extreme immunological responsiveness to LTA or to B. gingivalis had about twice as much alveolar bone loss as those with normal serological reactivity. The results support the contention that LTA modulates the progression of periodontitis in humans.     

Penicillin-degrading enzymes in sites associated with adult periodontitis

The incidence and enzymatic activity of penicillin-degrading enzymes (beta-lactamases) in gingival crevicular fluid were determined for 406 sites in 52 patients with adult periodonititis. Beta-lactamase activity was detected in 64% of the patients and in 24% of the sites sampled. The enzyme was present in 13% of 206 sites and 36% of 200 sites having probing depths of ≤3 mm and >3 mm, respectively. The incidence of the enzyme was positively correlated with increases in pocket depth up to 8 mm. However, there was no correlation between probing depths and the enzyme activity present. The range of activity detected was equivalent to 0.001 to 0.569 enzyme units per ml of gingival fluid. Approximately 60% of the sites in which beta-lactamase was detected, or 19% of all sites sampled with probing depth > 3 mm, contained enzymatic activity sufficent to inactivate penicillins at the concentrations available in gingival fluid.     

Serum antibodies reacting with subgingival species in refractory periodontitis subjects

Abstract. The purpose of this investigation was to compare the levels of serum IgG antibody to 85 subgitigival species in 32 refractory periodontitis, 56 successfully treated, and 33 periodontally healthy subjects. Refractory subjects showed mean full mouth attachment loss and/or >3 sites showing attachment loss >2.5 mm within I year after 2 treatment modalities, scaling and root planing and surgery plus systemically administered tetracycline. Successfully-treated subjects showed mean attachment level gain and no sites with attachment loss >2.5 mm, 1 year post-therapy. Periodontally healthy subjects exhibited no pocket or attachment level >3 mm. and no evidence of progressing attachment loss during 1 year of monitoring. Baseline serum was obtained from each subject and tested against 85 subgingival species, including reference strains and strains isolated from refractory subjects, using checkerboard immunoblotting. Significance of differences in levels of serum antibody among groups were sought using the Kruskal-Wallis test. Refractory subjects constituted a heterogeneous group based on their serum antibody response to subgingival species. Some individuals had antibody reactions to many subgingival species, while other subjects showed fewer or low numbers of responses. On average, refractory subjects exhibited higher numbers and levels of serum antibody reactions to a wide range of subgingival species than successfully treated or periodontally healthy subjects. Differences in serum antibody among clinical groups were more striking at higher threshold levels of antibody (>50 μg/ml and >100 μg/ml. The data showed that a subject was 10.1 × more likely to be refractory if the subject exhibited antibody reactions with >9 subgingival species at >50 μg/ml (p <0.001, after adjusting for multiple comparisons). Serum antibody to a subset of the test species differed among the clinical groups. Porphyromonas gingivalis, Bacteroides forsythus, and some strains isolated from refractory subjects (a novel Neisseria sp., Enterococcus faecalis, Prevotella loescheii and Prevotella oulora) elicited high serum antibody in the successfully treated and refractory subjects. High levels of serum antibody to a Microbacterium lacticum-like organism, Streptococcus oralis, Streptococcus constellatus, Actinobacillus aetinomyeetemeomitans serotype c and Haemophilus aphrophilus significantly increased the likelihood of a subject being refractory to conventional periodontal therapy.     

Obesity in young women is positively associated with periodontitis

Clinical Oral Investigations - This cross-sectional study was performed to investigate the association between excess body weight and periodontitis in adults, stratified by sex and age, and using...     

IL-1 genotypes associated with adult severe periodontitis are not associated with generalized early onset periodontitis

J Evid Base Dent Pract 2002;2:60-61     

Severe periodontitis in young adults is associated with sub-clinical atherosclerosis

Aim: The aim of this study was to evaluate the association between severe periodontitis and sub‐clinical atherosclerosis in young (40 years) systemically healthy individuals. Material and Methods: Ninety systemically healthy subjects, 45 affected by severe periodontitis (mean age 36.35±3.65 years) and 45 controls without a history of periodontal disease (mean age 33.78±3.28 years), were enrolled in this study. Patients and controls were paired for age, gender, body mass index and smoking habits. Carotid intima‐media thickness (IMT) was bilaterally assessed by ultrasonography at the level of common carotid artery. Traditional cardiovascular risk factors for atherosclerosis were also evaluated. Results: The overall mean carotid IMT was 0.82±0.13 mm in the test group and 0.72±0.07 mm in the control group ( p<0.0001). Stepwise regression analysis showed that periodontitis ( p<0.0001) and regular physical activity ( p=0.0009) were predictor variables of overall mean carotid IMT. When considering an IMT0.82 mm as the critical index of increased cardiovascular risk, periodontal patients overcame this threshold compared with healthy patients by an odds ratio=8.55 [confidence interval 95%: 2.38; 39.81]. No investigated haemostatic variable was associated with increased carotid IMT. Conclusion: Severe periodontitis is associated with sub‐clinical atherosclerosis in young systemically healthy patients.     

Serum IgA and IgG antibodies to Treponema vincentii and Treponema denticola in adult periodontitis, juvenile periodontitis and periodontally healthy subjects

13 patients with untreated adult periodontitis (AP) were compared to 8 subjects free of periodontal disease (H) with respect to plaque index (PlI), gingival index (GI), probing depth (PD) and differential counts of subgingival bacterial morphotypes from a pooled sample of 6 surfaces with the greatest probing depth. Serum antibody levels to T. vincentii and T. denticola strains were also determined in these subjects as well as in the sera from 5 subjects with localized juvenile periodontitis (LJP). Subjects with AP had significantly elevated proportions of spirochetes and motile rods and lower proportions of coccoid cells than H subjects. They also exhibited significantly higher PlI and GI scores and greater probing depths. Antibody levels were normalized against a standard serum and expressed as ELISA units (EU). IgA and IgG antibody levels to all tested spirochete strains were significantly elevated in AP subjects as compared to subjects in group H or subjects with LJP. No significant differences in antibody titers were detectable between the H and LJP groups with respect to any of the tested strains. No significant correlation could be demonstrated between serum antibody titers to any of the oral spirochete strains tested and the proportions of oral spirochetes determined microscopically.     

Measurement of relative avidity of antibodies reactive with Porphyromonas (Bacteroides) gingivalis in the sera of subjects having adult periodontitis

Relative avidities of antibodies to Porphyromonas (Bacteroides) gingivalis in the sera of 15 patients having adult periodontitis and 15 healthy subjects were evaluated using an ammonium thiocyanate-dissociated ELISA. Graded concentrations of ammonium thiocyanate were added to a single dilution of serum in order to dissociate low avidity antibody binding to P. gingivalis . The concentration of thiocyanate resulting in 50% reduction in binding (absorbance) was termed the ID₅₀ for that serum. When IgG-class antibodies were examined, the ID₅₀ of anti- P. gingivalis antibodies in the sera of patients was significantly elevated (0.96M vs 0.71M; p<0.01, Student's t-test). In contrast, when IgM-class antibodies were examined no significant differences in ID₅₀ between patients and controls were found for P. gingivalis (0.54M vs 0.53M). While the ID₅₀ values of patient antibodies were found to be elevated relative to those of healthy controls, comparison with antibodies from rabbits immunized with P. gingivalis and with ID₅₀ values from other human studies suggests that adult humans, in general, produce very low-avidity antibodies to P. gingivalis . It is suggested that the presence of low-avidity antibodies contributes to the pathology associated with periodontal disease.     

Factors associated with adult periodontitis in a dental teaching clinic population

Abstract– Exposure to a number of environmental, behavioral and sociodemographic variables has been associated with increased prevalence and severity of adult periodontitis. However, it is not possible easily to identify the individuals most susceptible to this chronic disease. A case control study was conducted among a population of adults to determine what factors were associated with increased prevalence of moderate to advanced periodontitis. Clinical and radio-graphic data were obtained from dental charts and structured interviews were conducted by telephone to collect sociodemographic and behavioral data. Statistical modeling was completed for the total study population (35–87-year-olds) and for two age-stratified subpopulations. Significant crude disease associations were observed between periodontitis and numerous explanatory variables. However, after adjustment for age and gender, few variables remained significant. Age stratification indicated that young adults (35–54 years) were affected differently from older adults (≧55 years) by exposures to certain variables. Young moderate smokers had a 3.15 times increased risk of periodontitis and young heavy smokers had a 7.33 times increased risk compared to never-smokers. Older single adults had a 3.07 times increased risk compared to those with partners.     

The microbial morphotypes associated with periodontitis health and adult periodontitis: composition and distribution

Subgingival plaque samples were obtained from 162 sites in 27 adult periodontitis patients and 162 sites in 27 healthy patients using a standardized lavage technique. The distribution of 10 different microbial morphotypes was determined by darkfield microscopy. The lavage technique selectively samples the loosely adherent plaque at the base of the periodontal pocket and not the tooth-associated, adherent plaque. This standardized technique permits quantitative comparisons of numerical density of morphotype composition at different sites, in addition to qualitative comparisons or relative proportions. There was a significant positive association between the numerical density of each morphotype within the non-adherent plaque and the number of sites at which the organism was detected in both healthy and diseased subjects. A previously undescribed darkfield morphotype, has been detected with this method. This morphotype, a small motile coccobacillus (S-MO-CB) has been found to be the numerically dominant species in both health and disease. This morphotype has been recovered in pure culture following passage through a 0.4 mu filter and includes organisms of the Wollinella and Campylobacter genus. Non-motile organisms comprised less than 1-2% of the sample from healthy and diseased sites. Motile forms, such as spirochetes, had a high frequency of detection in healthy individuals. Analysis of pooled plaque samples revealed that the prevalence of cocci and fusiforms was significantly elevated in patients with healthy periodontium, as compared to patients with adult periodontitis. In adult periodontitis patients, the frequency of occurrence of medium spirochetes, filaments and small nonmotile rods was significantly elevated in pooled plaque. Analysis of individual sites indicated that the proportion and numerical density of most morphotypes within the non-adherent plaque were not significantly different in disease as compared to health. Disease is characterized by an increased % of small spirochetes and fusiforms at each site. At diseased sites which harbor small spirochetes, the numerical density is elevated four-fold, as compared to healthy sites which have small spirochetes. The numerical density of other morphotypes is not significantly different comparing healthy sites to diseased sites. Thus, the increase in the % of small spirochetes in disease in due to a site-localized four-fold increase in numerical density within the non-adherent plaque.     

Gingival blood flow and temperature changes in young humans with a history of periodontitis

Whether such individuals have different gingival blood flow and temperature responses to local cooling than age- and sex-matched healthy controls was tested. Ten patients with a history of localized juvenile periodontitis or rapidly progressive periodontitis were selected from a periodontal clinic and matched with healthy controls. Gingival blood flow and temperature were monitored continuously before and after cooling via a twin probe placed in the gingival sulcus on the buccal of tooth No. 26. Blood flow was assessed by laser Doppler flowmetry and temperature by a small metal thermistor. Resting values were first recorded for 5 min, followed by 3 min of cooling to 19 degrees C by a gentle stream of cool air, then 12 min of rewarming was allowed. This protocol was repeated twice. Blood flow changes were analysed as the slope of the line formed between the last 2 min of cooling and the last 2 min of rewarming; temperature curves were analysed by a least-squares curve fit of a bi-exponential function. Patients with localized juvenile periodontitis and rapidly progressive periodontitis had similar rewarming temperature curves, but significantly faster blood flow recovery curves than controls (p less than 0.03). Thus, gingival blood flow in young periodontitis patients recovered more rapidly after local cooling than in healthy controls.     

Serum antibodies against the trypsin-like protease of Bacteroides gingivalis in periodontitis

Antibody levels of IgG, IgA and IgM reactive to the trypsin-like enzyme of B. gingivalis were measured by enzyme-linked immunosorbent assay in serum samples from control subjects with clinically healthy gingiva, patients with adult periodontitis (AP) and patients with rapidly progressive periodontitis (RPP). Both AP and RPP patients had significantly higher levels of specific IgG and IgA antibodies than control subjects with healthy gingiva (p<0.001 in both cases). No significant difference was observed between the specific IgM antibody activity in the AP group compared to the control group. However, a significant difference was seen (p<0.01) for IgM activity in the RPP group compared to controls. The results indicate that the trypsin-like enzyme of B. gingivalis is produced in vivo in sufficient amounts to be immunogenic to the host and particularly in patients with AP or RPP.     

Serum antibodies to Bacteroides ginglvalis in periodontitis: A longitudinal study

The level of systemic antibodies to B. gingivalis was assessed longitudinally in a group of 11 adult patients with chronic periodontitis and in 9 periodontally healthy subjects. Immunoglobulin G (IgG), IgA and IgM-specific antibodies were measured by an enzyme-linked immunosorbent assay in serum samples obtained during the natural course of the disease and following scaling and root planing. A serological dichotomy was observed throughout the study in the chronic periodontitis patients. A first subgroup was characterized by a virtual absence of IgA antibody and by IgG and IgM levels similar to those of healthy individuals, suggesting a low level of colonization by B. gingivalis . The patients of the second subgroup had detectable IgA and a significantly higher IgG antibody level that probably reflected the presence of a B. gingivalis infection. There was no statistical difference between the two subgroups for Plaque Index, Gingival Index, probeable pocket depth and age. No cyclic pattern of the antibody levels was observed over the monitoring interval. No peak level of antibody was observed in the immediate posttreatment period, suggesting that scaling and root planing may not provoke active immunization with B. gingivalis . Antibody titres reduced by half 1 year following scaling and root planing were observed in patients presumably infected with B. gingivalis , suggesting that the procedure effectively reduced the immune challenge.     

Treatment planning and sequence for implant therapy in a young adult with generalized aggressive periodontitis

Treatment planning for full-mouth rehabilitation in patients with generalized aggressive periodontitis often requires a staged approach. Few articles have addressed treatment planning and sequencing issues in this patient population. This report describes the multidisciplinary management of a young adult by a combination of periodontal and implant therapy and rehabilitation with fixed prostheses. At a 2-year follow-up, the patient's periodontal health and peri-implant conditions were stable. Prosthodontic rationale and treatment planning concepts in a patient with multiple challenges are discussed.     

IL-1 genotype and adult periodontitis among young New Zealanders.

Several recent studies have investigated the association between interleukin-1 genotype and periodontitis in clinical samples, where generalizability is an issue. The aim of this study was to investigate the association between adult periodontitis and IL-1 genotype in a population-based sample of 26-year-olds. Based on probing depth (PD) measurements, participants were divided into three disease groups: "Severe" (1+ teeth with 5+mm PD; N = 25), "Moderate" (2+ teeth with 4+mm PD; N = 36), and "Controls" (the remainder; N = 800). The "periodontitis-associated genotype" (PAG; Kornman et al., 1997) was present in 20.0% of the "Severe" group and in 34.8% of "Controls", whereas the IL-1A(+4845) [1,1]/IL-1B(+3953) [2,2] genotype was present in 12.0% and 0.9%, respectively. After controlling for sex, smoking status, and plaque levels, we found that those with IL-1B(+3953) [1,1]/IL-1A(+4845) [2,2] had 12.3 times the odds of being in the "Severe" group. Analysis of these data suggests that the IL-1A(+4845) [1,1]/IL-1B(+3953) [2,2] genotype is associated with periodontal disease in this young population. Future periodontal data collections as this cohort ages are required to confirm the predictive value of that genotype.